Cholangiolithiasis and Cholangitis
Introduction
Introduction to bile duct stones and cholangitis Bile duct stones are divided into primary and secondary. Primary bile duct stones refer to stones originating in the bile duct system (including intrahepatic bile duct). The nature of stones is mostly pigmentation containing a large amount of bilirubin calcium. Mixed stones. There must be stones in the gallbladder. In China, most of the bile duct stones belong to this category. Secondary bile duct stones are stones formed by gallstones entering the common bile duct through the enlarged cystic duct. The shape and nature of the stones are the same as those in the gallbladder. Most of them are multi-faceted cholesterol mixed stones. Due to secondary biliary infection, the outer layer of the stone carries bilirubin calcium. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific people Mode of infection: non-infectious Complications: septic shock
Cause
Bile duct stones and the cause of cholangitis
The main causes of bile duct stones are:
1. Biliary infection, biliary aphid, cholestasis.
2. Biliary tract infection causes biliary tract inflammation, and the role of bacteria creates conditions for gallstone formation.
3. The biliary mites can become the core of gallstones, and even the gallstones can be composed of worms.
4. Bile stasis can cause the accumulation of bile components, which is conducive to the formation of gallstones.
Cholangiopathic biliary obstruction (most commonly biliary obstruction) causes bile stasis, and the pressure in the bile duct is rapidly increased, resulting in acute suppurative infection of the biliary tract. The infected strain is mainly Gram-negative bacilli, of which E. coli is the most common.
Prevention
Bile duct stones and cholangitis prevention
Bile duct stones and cholangitis are interdependent and mutually causal. Most of the cholangitis have gallstones. The biliary stones are closely related to the biliary mites. The eggs or mites of the mites are precipitated in the bile duct to form the core of the stones. The biliary ascariasis is important. Therefore, it is necessary to pay attention to food hygiene, prevent "sickness from entering the mouth", and find that the intestinal mites are dewormed in time. If the bile duct stones are less than 1.0cm, try the combination of traditional Chinese and Western medicine. Can discharge gallstones, such as stones caused by bile duct obstruction and cholangitis, should go to hospital for treatment.
Complication
Bile duct stones and cholangitis complications Complications septic shock
1. Toxemia and septic shock.
2. Liver, kidney, lung, heart, brain and other multiple organ failure.
3. Biliary fibrosis stenosis.
4. Biliary cirrhosis.
5. Portal hypertension.
Symptom
Common bile duct stones and cholangitis symptoms Common symptoms abdominal pain acute abdominal pain triad pruritus jaundice Xia Keshi triad high fever chills gallbladder hypersensitivity bile duct obstruction
There are typical Charcot triads, especially those with a history of gallstones in the past. The diagnosis of common bile duct stones is generally not difficult, but if only one or two symptoms in the triad are present, the diagnosis often needs some help. Auxiliary examination method, for patients without jaundice can be used for venous cholangiography, can show intra-biliary calculus and dilated bile duct, and in patients with jaundice must be associated with tumor or intrahepatic cholestasis caused by obstructive jaundice, and liver disease Or hepatic jaundice caused by hepatitis, etc., when the tumor (such as cancer of the head of the pancreas or ampullary carcinoma) obstructs the bile duct, the jaundice generally shows progressive deepening, and the gallbladder can often be swollen and swollen and not tender during physical examination, and often There is cachexia, and jaundice caused by liver disease or hepatitis is generally mild, and there is no history of abdominal cramps. Liver function tests often have obvious abnormalities. Intrahepatic cholestasis usually has no history of abdominal pain, and may have a history of taking special drugs. B-ultrasound examination of the latter two diseases showed no expansion of the sac and bile duct, and bile duct obstruction caused by bile duct stones, in addition to biliary colic, there is a typical history of volcanic jaundice If there is no infection, liver function is generally within the normal range, the diagnosis is difficult, application PTC, CT, ERCP hepatobiliary developer as well as isotopic and other tests, often helpful in differential diagnosis.
The typical clinical manifestations of common bile duct stones are biliary colic, fever, chills and jaundice, which is the Charcot triad, but many patients lack complete triad manifestations. Most patients have sudden angina under the xiphoid. Radiation to the right shoulder and back, but there are also a few people can be completely painless, only feeling abdominal discomfort and discomfort, about 2 / 3 of patients after the onset of acute abdominal pain, chills and high fever, usually 12 to 24 hours after abdominal pain began to appear Astragalus, at this time, abdominal pain has often been relieved, jaundice is generally not very deep, and has the characteristics of volatility. Sometimes jaundice can also be the only clinical manifestation of a few patients with choledocholithiasis. The jaundice often has darker urine and lighter stool color. As well as skin itching, etc., there are tenderness and muscle tension in the upper abdomen and upper right abdomen during physical examination, gallbladder often can not be sputum, in patients with longer course of disease and swollen liver and spleen, liver texture is hard.
Examine
Examination of bile duct stones and cholangitis
1. Leukocytes rise, the nucleus moves to the left, and serum bilirubin measurement suggests obstructive jaundice.
2. B-ultrasound has stones in the bile duct.
3. Oral gallbladder angiography without gallbladder is not developed, PTC, ERCP examination see intrahepatic bile duct dilatation, bile duct obstruction and so on.
4. CT examination has bile duct dilatation or stone presence.
5. Magnetic resonance cholangiography (MRICP) can show biliary and bile duct lesions.
Diagnosis
Diagnosis and diagnosis of bile duct stones and cholangitis
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Liver and biliary tract tumors, tumors around the ampulla.
2. Various acute and chronic hepatitis.
3. Cholecystitis, gallstones.
4. Sclerosing cholangitis.
