Cholangitis

Cholangitis – an inflammation of bilious channels. This hard proceeding disease which can be independent, but is more often combined with an inflammation of a gall bladder or liver.

Cholangitis reasons

Disturbance of passability of bilious channels and accession of an infection is the main reason for a cholangitis. Disturbance of passability of bilious channels often arises at a choledocholithiasis – formation of gallstones in biliary tract. Cicatricial narrowings of biliary tract owing to chronic cholecystitis, removal of a gall bladder (a postcholecystectomy syndrome), a cyst or a tumor of the general bilious channel can be other reasons of the broken outflow of bile.

Quite often outflow of bile is broken as a result of a helminthic invasion. Bilious channels can be blocked by ascarids. Such parasitic diseases as an opisthorchosis, echinococcosis, шистостомоз, can also lead a lambliasis to emergence of a cholangitis.

The infection generally gets to bilious ways from intestines as at stagnation of bile the mechanism interfering penetration of intestinal contents into the above-located parts of digestive tract is broken. In addition to the ascending (intestinal) way of hit of an infection there is also a descending way when the infection gets into bilious ways with a blood flow or a lymph from other inflammatory center in an abdominal cavity.

Types of a cholangitis

On character of a current distinguish an acute and chronic cholangitis.

The acute cholangitis depending on a type of an inflammation can take the following forms:

• Catarral cholangitis at which there is hypostasis of a mucous membrane of bilious channels. This form in the absence of treatment passes into a chronic inflammation, and further leads to cicatricial narrowing of channels;
• Purulent cholangitis. Bilious channels are filled purulent separated, mixed with bile. This form often extends to a gall bladder and a liver, involving these bodies also in a purulent inflammation;
• Diphtheritic cholangitis. The mucous membrane of bilious ways ulcerates, and then nekrotizirutsya that leads to destruction of walls of bilious channels and purulent fusion of surrounding fabrics including a liver;
• Necrotic cholangitis. Arises at hit to bilious canals of aggressive enzymes of a pancreas that leads to development of sites of a necrosis of a mucous membrane of bilious ways.

The chronic cholangitis on character of a current can be latent (hidden), recurrent, septic and abscessing.

Special form of a chronic cholangitis – a sclerosing cholangitis. This initially chronic inflammation arising without infectious agent, presumably autoimmune character. At the same time in bilious ways there is an inflammation leading to a sklerozirovaniye – to hardening and overgrowing of a gleam of channels that in turn leads to cirrhosis. The sclerosing cholangitis will not respond to treatment, has the slow progressing current and on average within 10 years leads to heavy disturbances with a possible lethal outcome.

Cholangitis symptoms

Cholangitis symptoms in an acute form are shown violently, there is fever with a fever and pouring then, pain as bilious colic – quite intensive, aching, with localization in right hypochondrium, sometimes giving to a shovel and a shoulder. It is followed by nausea, vomiting. Integuments and scleras accept yellow color, the skin itch develops.

Cholangitis symptoms in an acute form at patients of advanced age and children have some differences. At elderly people pain can be absent, and at scanty symptoms of a cholangitis the inflammation, nevertheless, takes heavy, usually purulent form.

The cholangitis in an acute form occurs at children seldom, generally as consecutive infection (usually streptococcal) at other disease. The acute cholangitis at children proceeds very violently, cholangitis symptoms in this case are not specific and inherent to any acute inflammation of digestive tract in this connection the acute cholangitis at children can be accepted to other gastrointestinal disease.

Cholangitis symptoms in a chronic form are less expressed, the megalgia is inherent only in the presence of stones in bilious channels. The main symptoms of a cholangitis in this case is the general weakness and increased fatigue, inexplicable periodic rises in temperature, a skin itch. The thickening of trailer phalanxes of fingers and reddening of palms belongs to signs of a cholangitis.

The chronic cholangitis causes decrease in body weight owing to lack of appetite and nausea in children, constant intoxication leads to anemia, pallor or yellowness of skin, physical development of the child is slowed down, there can be a lag and in the general development, chronic headaches develop.

Diagnosis of a cholangitis

The diagnosis is made on the basis of characteristic symptoms of a cholangitis, careful survey and data of hardware and laboratory researches:

• Ultrasonography of a gall bladder, liver and bilious channels;
• Radio isotope research of bilious ways;
• Intravenous holangiografiya (the roentgenoscopy of bilious ways with intravenous administration of a contrast agent allowing to see inside - and extrahepatic channels);
• Retrograde pankreatokholangiografiya (roentgenoscopy of bilious ways and a pancreas with endoscopic administration of contrast medium);
• Holangiomanometriya (measurement of pressure in bilious channels);
• Holedokhoskopiya (endoscopic research of bilious channels);
• General and biochemical analysis of blood;
• Laboratory research of bile.

Treatment of a cholangitis

Treatment of a cholangitis can be conservative or surgical, depending on a disease form. Treatment of a cholangitis is performed only in a hospital, in view of danger of development of heavy complications – purulent abscesses of a liver and gall bladder, peritonitis, and at a chronic cholangitis of cirrhosis.

Conservative methods of treatment of a cholangitis are applied when there is no mechanical obstacle to outflow of bile on biliary tract. In this case appoint antibacterial drugs (antibiotics of a broad spectrum of activity and streptocides), medicinal substances reducing intoxication (intravenous administration of Haemodesum, etc.), the improving bile outflows, spasmolysants (for example, Dyuspatalin).

In case conservative treatment does not yield results, and also in all cases when it is impossible to create normal outflow of bile medicamentous means, resort to surgical treatment of a cholangitis. A choice method now, in the absence of contraindications (purulent, necrotic processes, abscesses), is the endoscopic technique.

This way allows to carry out drainage of bilious channels, a removing calculus, elimination of stenoses (narrowings), without resorting to extensive band operation that allows to lower an operational injury, to avoid bleeding, to improve recovery. In the presence of more severe forms of a cholangitis perform band operation, deleting the sites which underwent purulent fusion or necrotic disintegration. In the post-operational period appoint antibacterial therapy.