Cholangitis

Description:

Cholangitis - the nonspecific inflammation of bilious channels arising owing to disturbance of passability of biliary tract and infection of bile. Most often at a cholangitis from bile sow E. coli. It is most often combined with a choledocholithiasis, choledochal cysts, a bile duct carcinoma.

Cholangitis symptoms:

about character of a current allocate acute and chronic cholangites. The acute cholangitis depending on expressiveness of inflammatory changes of a wall of bilious channels can be catarral, purulent, diphtheritic and necrotic. Distinguish from forms of a chronic cholangitis latent, recurrent, it is long current septic, abscessing and sclerosing.

Symptoms, current. The clinical picture depends on existence or absence of the acute destructive cholecystitis which is quite often complicated by a cholangitis. The disease usually begins with the painful attack reminding hepatic colic (manifestation of a choledocholithiasis) then mechanical jaundice, temperature increase, a skin itch is quickly shown. At survey an ikterichnost of integuments, on skin having combed traces, language wet, it is laid over, the stomach is not blown up. At a stomach palpation some muscle tension in right hypochondrium, morbidity, at a deep palpation is defined increase in the sizes of a liver, its edge is rounded. Temperature sometimes gektichesky type, fever. In blood leukocytosis with shift to the left. A hyperbilirubinemia generally at the expense of direct bilirubin, increase in an alkaline phosphatase, moderate increase in liver enzymes (ALT, ACT) due to toxic defeat of a hepatic parenchyma. Ultrasound examination of a liver and biliary tract can give essential help in establishment of the diagnosis of a cholangitis.

In the absence of timely treatment the inflammation from a wall of bilious channels passes to surrounding fabrics and can cause treatment of a hepatoduodenal sheaf bile and peritonitis, formation of intra hepatic abscesses, development of sclerous changes in tissue of a liver and secondary biliary cirrhosis.

Cholangitis reasons:

In most cases the cholangitis arises at hit of causative agents of a bacterial infection to bilious canals from a duodenum gleam (the ascending infection), hematogenous (through system of a portal vein) or lymphogenous (at diseases of a gall bladder, pancreas or large intestine) way.

Treatment of the Cholangitis:

The patient with suspicion on a cholangitis needs urgent hospitalization as treatment preferential operational. At a pre-medical stage appoint the spasmolytic and anti-inflammatory drugs, antibiotics of a broad spectrum of activity which do not have hepatotoxic properties.

Tactics of maintaining patients with a cholangitis presents considerable difficulties, they are caused by existence of purulent process, mechanical jaundice and acute destructive cholecystitis. Each of these moments demands the fastest permission, however patients with mechanical jaundice do not transfer long and traumatic operative measures. Therefore it is reasonable to provide first of all adequate outflow of bile that at the same time reduces clinical manifestations of a cholangitis, intoxication. The second stage carry out the radical intervention directed to elimination of an origin of a cholangitis.

In a hospital carry out disintoxication and antibacterial therapy and train the patient for an operative measure. The greatest distribution at an acute cholangitis was gained by endoscopic methods of the drainage of bilious channels providing normal outflow of bile. The forecast of a catarral cholangitis at timely treatment favorable. At a purulent, diphtheritic and necrotic cholangitis the forecast more serious also depends on expressiveness морфол. changes, the general condition of the patient, and also from the factor which caused a cholangitis. At it is long current chronic a cholangitis biliary cirrhosis or the abscessing cholangitis which forecast adverse can develop. Prevention consists in early detection and treatment of diseases of biliary tract and area of a big duodenal nipple.

For the purpose of a decompression of bilious ways carry out an endoscopic papillosfinkterotomiya after a preliminary retrograde holangiografiya. At residual stones of a holedokh after a papillosfinkterotomiya the otkhozhdeniye of concrements from biliary tract is sometimes noted, the phenomena of a cholangitis are stopped and the question of need of repeated operation disappears. The forecast is serious.