Causes, symptoms, methods of diagnosis and treatment of cholangitis
Cholangitis is a group of diseases accompanied by inflammation in the bile ducts located inside and outside the liver. This is a serious pathology that often ends with the development of purulent-septic complications and death.
Causes of bacterial cholangitis
The most common cause of cholangitis is a bacterial infection. Microorganisms enter the bile ducts most often from the intestine through the choledochus (a common channel that connects the biliary tract and pancreatic duct). Moreover, it is often preceded by diagnostic studies, such as retrograde cholangiopancreatography. The second and third reason is the introduction of microbes directly into the ducts with the help of blood or lymph.
Escherichia coli, proteus, enterococcus - normal representatives of the intestinal microflora are most often identified as the causative agent during the examination. In almost all patients, several microbes are detected in the bile at once.
The development of cholangitis is facilitated by all factors that increase the pressure in the bile ducts and cause congestion in them. Among them:
- congenital developmental anomalies;
- their narrowing and deformations caused by surgical interventions or endoscopic procedures;
- stones in choledochus;
- tumors of the ducts, heads of the pancreas, pharyngeal nipple;
- parasitic lesions of the gastrointestinal tract.
Only a combination of stagnation, increased pressure and bacterial infection leads to the development of cholangitis.
Symptoms of cholangitis
The onset of the disease is usually acute with the appearance of the so-called Charcot triad:
- chills;
- fever;
- pain in the region of the right hypochondrium.
By nature, the pain is colic-like, extremely intense. Temperature rises alternate with periods of normothermia, although in the elderly and people with severely reduced immunity (as a result of infections (including HIV), as a result of taking immunosuppressants), fever may be absent or subfebrile (temperature up to 37.5 degrees).
The development of a septic condition causes a drop in blood pressure and mental disorders, and then we are talking about the pentad of Reynolds symptoms.
Chronic cholangitis, being in remission, does not manifest itself. In case of exacerbation, its symptoms fully correspond to the acute form of the disease.
Diagnosis of cholangitis
The most important thing for detecting the disease is a careful study of the symptoms. Diagnostic studies are only a supplement to the clinical examination. Laboratory test data show an increase in the level of leukocytes with a shift of the formula to the left, an increase in ESR, biochemical changes (increase in alkaline phosphatase, bilirubin), sometimes - an increase in ALT and AST.
Of the instrumental methods, ultrasound and computer tomography are informative, allowing to see the expansion of the hepatic ducts. If there is a suspicion of their blockage, an endoscopic retrograde cholecystopancreatography is performed, during which it is possible to perform a papillosphincterotomy (dissection of the large duodenal (fater) nipple in order to remove the stone that blocked the duct).
Treatment of cholangitis
Surgeons treat any type of bacterial cholangitis. The patient should be immediately taken to a hospital, where all necessary measures are taken.
Drug therapy, according to clinical recommendations, is considered as a measure preceding decompression treatment. The essence of the latter is aimed at reducing the pressure in the ducts. For this use:
- endoscopic papillosphincterotomy;
- introduction of an endoprosthesis into the common bile duct;
- removal of the stoma of the hepatic duct to the skin.
At the same time, conservative therapy is conducted according to the following principles:
Primary sclerosing cholangitis
This type of cholangitis develops as a result of autoimmune damage to the cells of the bile ducts, which can be triggered by a viral or bacterial attack. The causes of the disease have not been fully elucidated and, unfortunately, this sharply limits the ability of doctors to fight it.
It is almost impossible to notice the moment of the onset of PSH. Obvious symptoms develop already when the disease is on the verge of cirrhosis. Nevertheless, certain signs, such as weakness, itching of the skin, may appear 1-2 years before this moment.
In 75% of patients, the diagnosis is made only when jaundice, enlargement of the liver and spleen are detected. In most of them, the disease is associated with other pathologies - pancreatitis, sarcoidosis, celiac disease, thyroiditis, etc.
Treatment of primary sclerosing cholangitis, unfortunately, does not lead to recovery, but only improves the quality of life and postpones the transition of the process to liver cirrhosis. The following are used as therapeutic and surgical measures:
- reception of hepatoprotectors, antimetabolites, glucocorticoids (ursodeoxycholic acid, prednisone, azathioprine);
- balloon dilatation of sclerosed ducts of the liver;
- reconstructive operations;
- liver transplantation.
Timely started comprehensive treatment of any type of cholangitis significantly increases the patient's chances of recovery or at least long-term survival (in the case of PSC). The site Dobrobut.com recommends to be treated by specialists, and to contact them immediately at the first signs of discomfort in the body.
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