Bile duct dilatation
Introduction
Introduction to bile duct dilatation Biliary dilatation is a more common congenital biliary malformation. It was previously thought to be a lesion limited to the common bile duct, so it is called congenital choledochal cyst. Vater first reported in 1723, and Douglas gave a detailed introduction to his symptoms and pathology in 1852. For more than a century, with the deepening of the understanding of this disease, in recent years, cholangiography has found that dilated lesions can occur in any part of the liver and extrahepatic biliary tract. There are many types according to their location, morphology, number, etc. It is different. basic knowledge Sickness ratio: 2-3% Susceptible people: no specific people Mode of infection: non-infectious Complications: cholangitis, pancreatitis
Cause
Causes of bile duct dilatation
There are many related theories of etiology, and it has not yet been determined. Most of them are considered congenital diseases, and some have been considered to be involved in the formation of acquired factors. There are three main theories:
Congenital anomalies (35%):
It is believed that during the embryonic development period, the original cholangiocarcinoma cells proliferate as a cord-like entity, and then gradually cavitation and permeation. If a part of the epithelial cells proliferate excessively, the vacuolization becomes excessive expansion and vacuolization.
Some scholars believe that the formation of bile duct dilatation requires the participation of congenital and acquired factors. The weak development of the bile duct wall caused by hyperproliferation of bile duct epithelial cells and excessive vacuolation in embryonic period is a congenital factor, coupled with acquired acquired nature. Factors such as end-obstruction of the common bile duct secondary to pancreatitis or ampullary inflammation and consequent increase in intra-biliary pressure will eventually lead to bile duct dilatation.
Abnormal pancreaticobiliary duct (25%):
It is believed that because the embryonic common bile duct and the main pancreatic duct are not normally separated, the junction of the two is far from the Vater ampulla, the common channel of the pancreaticobiliary duct is too long, and the angle of the main pancreatic duct and the common bile duct is Near the right angle intersects, therefore, the location of the pancreatic duct bile duct is not in the duodenal papilla, but outside the wall of the ten finger, there is no local sphincter, which loses the function of the chicken, causing the pancreatic juice and bile to flow back together, when the pancreatic juice is excessively secreted. The increase in pressure causes the bile duct to expand. In recent years, retrograde cholangiopancreatography confirmed that the pancreatic duct bile duct flow is as high as 90-100%, and the amylase content in the dilated bile duct is increased. In the animal experiment, pancreatic juice is observed after entering the biliary tract. The activity of amylase, trypsin and elastase is enhanced, which may be the main cause of bile duct injury.
Viral infection (20%):
It is believed that biliary atresia, neonatal hepatitis and biliary dilatation are the causes of inflammation of the liver and gallbladder. After viral infection, the liver undergoes giant cell degeneration, and the bile duct epithelium is damaged, leading to luminal occlusion (biliary atresia) or weak wall (Bile duct expansion), but the current support for this speaker has seen a reduction.
Prevention
Biliary dilatation prevention
The disease has a high incidence in Asia and can occur at any age, from newborn to old age, but 75% of cases are diagnosed before the age of 10, with more women than men: 3: 1, pay attention to rest, work and rest, life orderly.
Complication
Complications of bile duct dilatation Complications cholangitis pancreatitis
Biliary dilatation of the lesion and relative stenosis of the distal bile duct cause poor bile drainage or even obstruction is the root cause of complications. The main complications are:
1. Recurrent ascending cholangitis.
2. Biliary cirrhosis.
3. The bile duct is perforated or ruptured.
4. Recurrent pancreatitis.
5. Stone formation and wall cancer.
Symptom
Symptoms of bile duct dilatation Common symptoms Retardation of abdominal pain Biliary obstruction Liver fibrosis Right upper abdominal pain Astragalus abdominal mass Gallbladder hypersensitivity Gallbladder contractile dysfunction Bile duct fracture
The first symptoms in most cases occur between the ages of 1 and 3, but the final diagnosis is often much later. The cystic type accounts for a quarter of the disease within 1 year old, and its clinical symptoms are mainly abdominal mass, while the fusiform type is more common after 1 year old, mainly abdominal pain and jaundice. Abdominal masses, abdominal pain, and jaundice are considered to be classic triple symptoms of biliary dilatation. The abdominal mass is located in the right upper abdomen. Under the costal margin, the giant can occupy the right abdomen. The mass is smooth and spherical, and it can have obvious cystic elasticity. When the capsule is filled with bile, it can be solid, like a tumor. However, there is often a change in size. In the period of infection, pain, and jaundice, the mass enlarges. After the symptoms are relieved, the mass can be slightly retracted into a small bile duct cyst. Because of the deep position, it is difficult to reach.
Examine
Examination of bile duct dilatation
(1) Biochemical examination: The determination of blood and urine amylase should be regarded as a routine examination in the onset of abdominal pain, which is helpful for diagnosis.
(B) B-mode ultrasound imaging.
(C) percutaneous transhepatic cholangiography (PTC).
(D) endoscopic retrograde cholangiopancreatography (ERCP).
(5) Gastrointestinal barium meal examination.
(6) intraoperative cholangiography.
For the above various examination methods, ultrasound examination and biochemical determination are generally performed at the time of clinical examination. For example, if the clinical examination is performed, the diagnosis can be established. If the clinical diagnosis fails, the diagnosis is required. ERCP examination, if subject to age and equipment, PTC examination, if necessary, supplemented by other inspection methods.
Diagnosis
Diagnosis and differentiation of bile duct dilatation
The diagnosis of bile duct dilatation can be considered based on three main symptoms that occur intermittently from an early age, namely abdominal pain, abdominal mass and jaundice. If the symptoms recur, the likelihood of diagnosis is greatly increased. The sac-like cases are mainly abdominal mass, and the age of onset is earlier. Diagnosis can be made by percussion combined with ultrasound examination. The fusiform case is mainly characterized by abdominal pain. In addition to the ultrasound examination, it must be accompanied by ERCP or PTC examination in order to correctly diagnose.
