Cholangitis
Cholangitis is a disease of the digestive system characterized by the development of inflammatory processes of the bile duct, which can be acute and chronic.
CAUSES OF CHOLANGITIS
Most cases of cholangitis are associated with the penetration of microorganisms into the bile ducts – proteus, E. coli, enterococci, staphylococci, in rare cases mycobacterium tuberculosis, pale spirochete, etc. viral hepatitis can cause damage to small ducts, worm infestations – ascariasis, opisthorchiasis, fasciolosis – all these diseases can also cause cholangitis.
In aseptic conditions, inflammation can develop as a result of irritation of the bile ducts and their walls with pancreatic juice. Aseptic sclerosing cholangitis may also develop, the cause of which is autoimmune processes, colitis (ulcerative), vasculitis, Crohn’s disease and others.
CLASSIFICATION OF CHOLANGITIS
According to the course of inflammatory processes, acute and chronic cholangitis are distinguished. Acute cholangitis is divided into subspecies: diphtheria (formation of fibrinous films), catarrhal (hyperemia and edema of the walls of the bile ducts), necrotic, purulent (melting of the walls). Chronic cholangitis also has subspecies – septic, sclerosing, abscessing, latent, recurrent.
According to the localization of the inflammatory process, papillitis (inflammation of the fater papilla), angiocholitis (ducts inside and outside the liver), choledochitis (inflammation of the common bile duct) are distinguished.
SYMPTOMS OF CHOLANGITIS
With the development of acute cholangitis, a triad of symptoms (Charcot) is characteristic – pain in the right hypochondrium with jaundice, fever syndrome.
The disease begins with an increase in temperature to 40 degrees, chills appear, increased sweating. The patient complains of severe pain in the right hypochondrium, which by nature resemble biliary colic. Pain radiates to the right shoulder, shoulder blade, sometimes to the neck. The patient’s condition deteriorates rapidly, intoxication syndrome increases, weakness, loss of appetite. Nausea and vomiting appear, intestinal disorders in the form of diarrhea. Over time, ictericity (jaundice) of the skin and mucous membranes appears. Jaundice is usually accompanied by severe itching, which increases at night. The patient wakes up at night, combs the itchy skin, violating its integrity.
In severe cases, loss of consciousness is possible, the development of a shock state is a Reynolds pentad.
With the development of chronic cholangitis, the symptoms are erased, blurred, however, over time, the symptoms worsen. Jaundice develops late, indicates the neglect of the inflammatory process, dull pain of a minor intensity, there is a feeling of bursting in the epigastric region.
diagnostics
Biochemical blood test – cholestasis, increased bilirubin, alkaline phosphatase is also increased
Fractional duodenal probing, bacteriological bile culture
Examination of feces on helminth eggs
Ultrasound of the abdominal cavity, liver
Ultrasonography
Computed tomography
Pancreatocholangiography
TREATMENT OF CHOLANGITIS
Bed rest, starvation diet
Antispasmodic drugs, anti-inflammatory, antibacterial therapy in the infectious process, taking into account the sensitivity of the pathogen, antiparasitic drugs
Plasmapheresis – in severe cases
Inductothermy, UHF, diathermy, electrophoresis, mud applications, paraffin therapy, various types of baths
Surgical interventions – stenting of the choledochus, drainage of the bile ducts and other types of surgical interventions
With sclerosing cholangitis, a donor liver transplant is indicated
