Cholangitis

Cholangitis

Cholangitis is an inflammation of the bile ducts that occurs as a result of obstruction of the biliary tract and infection of the bile. Most often, with cholangitis, E. coli is sown from bile.

Frequency

• • Cholelithiasis, cholecystitis, cholangitis – 186.2 (registered cases with a diagnosis established for the first time in life), 1425.8 (registered cases) per 100,000 adults 18 years and older
  • Cholelithiasis, cholecystitis, cholangitis – 226.2 (registered cases with a diagnosis established for the first time in life), 1063.9 (registered cases) per 100,000 adolescents aged 15-17
  • Cholelithiasis, cholecystitis, cholangitis – 151.7 (registered cases with a diagnosis established for the first time in life), 548.6 (registered cases) per 100,000 children under 14 years old. The predominant age is 55-70 years. The predominant gender is female. The reasons
  • Obstruction of the bile ducts
  • Stone for choledocholithiasis
  • Tumor (pancreatic, common bile duct, duodenal ampulla, metastatic)
  • With benign postoperative strictures of the bile ducts
  • Parasites (for example, roundworms)
  • blood clots
  • In violation of the patency of the drainage of the bile ducts
  • Reflux of bacteria from the small intestine
  • Choledochoenterostomy
  • Adductor loop syndrome
  • Other reasons
  • Cholecystitis
  • Complications of surgery
  • X-ray examination using contrast agents
  • bacteremia
  • Abramy syndrome is an ascending coli infection of the liver with symptoms of chronic cholangitis.

Clinical picture

• • In 70% of patients with cholangitis, the Sharkd triad is observed – fever (chills), jaundice and pain in the right upper quadrant of the abdomen.
  • Less commonly, cholangitis is asymptomatic (or one of the symptoms is present).

Laboratory research

• • General blood test – leukocytosis with a shift of the leukocyte formula to the left
  • Biochemical blood test
  • Hyperbilirubinemia (in 90% of cases)
  • An increase in the content of alkaline phosphatase (in 90% of cases)
  • Blood test for sterility. Special studies are aimed at identifying any likely pathology of the biliary tract
  • Cholangiography is the diagnostic method of choice
  • Percutaneous transhepatic cholangiography or endoscopic retrograde cholangiopancreatography
  • Ultrasound is used to detect gallstones and determine the size of the common bile duct, but stones in the common bile duct can be diagnosed in less than 15% of cases. Differential Diagnosis
  • Acute cholecystitis
  • liver abscess
  • Hepatitis
  • Acute pancreatitis
  • Acute appendicitis
  • Renal colic
  • Cholangiocarcinoma (especially after 60 years).

Treatment: Management Tactics

• • Parenteral nutrition until resolution of the acute stage; diets number 5, 5a.
  • Antimicrobial agents active against gram-negative aerobic bacteria, enterococci and anaerobic bacteria. Effective combination
  • Ampicillin  – 1 g every 4-6 hours IV or IM (or ciprofloxacin)
  • Tobramycin or amikacin (amikacin sulfate)
  • Metronidazole 500 mg every 8 hours IV.
  • Infusion, detoxification therapy. Surgery
  • If drug therapy is ineffective, emergency decompression of the bile ducts is indicated, performed using traditional surgical intervention, endoscopically and with transhepatic cholangiography
  • In case of obstruction of the bile duct system by a stone, the method of choice is endoscopic papillotomy with stone extraction.

Complications

• • Bacterial liver abscess
  • Sepsis
  • Secondary sclerosing cholangitis. Concomitant pathology
  • Choledocholithiasis
  • Benign biliary strictures
  • Gastrointestinal anastomoses
  • Worm infestation
  • malignant tumor
  • Common bile duct cyst
  • parafatherial diverticulum. The course and prognosis depend on the cause of biliary tract obstruction
  • In acute cholangitis due to cholelithiasis, the prognosis is the most favorable.
  • With tumors – depends on the underlying disease.

Prevention. Control cholangiography during cholecystectomy with removal of preserved common bile duct stones. See also acute appendicitis, cholelithiasis disease, urolithiasis disease. Acute viral hepatitis, Pancreatitis, Acute peritonitis, Primary sclerosing cholangitis, Acute cholecystitis ICD. K83.0 Cholangitis

Notes

• • The afferent loop syndrome is a syndrome that occurs due to the stricture of the afferent loop within the gastrojejunal anastomosis, while the duodenal contents (bile, pancreatic and intestinal juices) accumulate and stagnate in the afferent loop. As a result, intraduodenal pressure increases, which leads to reflux into the common bile and virzung ducts with subsequent development of cholangitis and pancreatitis.
  • Cholangiocarcinoma is a liver cancer that develops from bile duct epithelial cells and accounts for 5 to 30% of all primary malignant liver tumors. Most often, cholangiocarcinoma develops at the age of 60-70 years.