acute cholangitis
Introduction
Introduction to acute cholangitis Acute cholangitis refers to acute inflammation that occurs in the bile duct. Abdominal pain, fever, and jaundice are the main manifestations. It belongs to the category of abdominal pain, hypochondriac pain, chest tightness and jaundice in traditional Chinese medicine. The diameter of the common bile duct is 6.8 ram at 12 years old and 9.2 mm at 70 years old. The physiological stenosis at the end of the common bile duct also becomes narrower with age, which increases the bile discharge resistance. The occurrence of gallstones is about 10% in people under 30 years old, 25% to 30% in those aged 50 to 60, and 55% in those over 80 years old. It has been reported that the infection rate of bile is 28% in the group of 40 to 50 years old, 68% in the group of 61 to 70 years old, and 85% in the group of 71 to 80 years old. From another perspective, acute cholangitis is a manifestation of the development of a variety of biliary disorders to a more severe stage. Classification of acute cholangitis: 1, the most common cause of acute obstructive suppurative cholangitis is bile duct obstruction caused by sudden embolism of gallstone, biliary stasis, rapid rise of bile duct pressure, causing different degrees of damage to the mucosal barrier of the bile duct, for bacterial invasion And breeding provides conditions that trigger a suppurative infection. Mainly Gram-negative bacilli infection, of which E. coli is the most common, followed by Proteus, Pseudomonas aeruginosa and the like. Mixed infections can account for about 40%. Acute suppurative cholangitis accounts for 5% of acute cholangitis in the elderly, and its incidence is rapid, rapid progress, and the disease is severe. The mortality rate is as high as 4.5% to 43.5% (20% to 87.5% reported abroad), which is the most common biliary tract disease. Dangerous emergency. According to the location of the obstruction can be divided into 2 types. (1) Extrahepatic obstruction type: The above three symptoms of abdominal cramps, chills and high fever and jaundice are characteristic. Abdominal pain often occurs first, in the upper abdomen or right upper abdomen, with persistent pain and paroxysmal aggravation of colic: immediate chills and fever. Astragalus appeared several hours or days after the onset of the attack, which is obstructive jaundice: the body is obviously tender and muscle tension is observed under the sword and the right upper abdomen. Some patients can reach the enlarged gallbladder or swollen liver and have tenderness. The peripheral blood leukocytes were significantly increased. Urinary bilirubin was positive, and total blood bilirubin and direct bilirubin and alanine aminotransferase (SGPT) were elevated. In severe cases with hypotension or shock: if not treated in time, you can stun and die within a few hours. Based on the above clinical manifestations, it is not difficult to make a diagnosis. (2) Intrahepatic obstruction type: similar to the extrahepatic obstruction type, with systemic symptoms of suppurative infection such as abdominal pain, chills, high fever, pulse rate, and increased white blood cells. Hypotension and shock can also occur in severe cases. However, because there is only one side of the intrahepatic bile duct obstruction, it may not appear jaundice or only a slight jaundice. SGPT is elevated in the first time of this disease. After repeated attacks for many years, the SGPT is no longer elevated after liver tissue fibrosis at the site of the disease. At this time, the scanning does not absorb the radionuclide region, which is characterized by hepatic space occupying. Lesion." Abdominal pain is generally not too heavy, and the weight is only a minority. The site of pain often varies from lesion to lesion, and clinically, left liver lesions are more common. According to the above clinical manifestations, the disease can be suspected. If there is a history of previous surgery or intrahepatic bile duct stones, stenosis, etc., the diagnosis is more clear. However, a corresponding examination should be performed to rule out pancreatitis and myocardial infarction. 2, the majority of acute non-suppurative ascending cholangitis in the elderly belong to this type. The cause of the disease is caused by the spread of infected bile along the bile duct. The first is bacterial infection of the intestines. In addition, when various causes cause systemic infection, bacteria can enter the common bile duct through the blood and lymph. Partial obstruction of the common bile duct caused by stones, bile duct aphids, surgical scars, tumor compression, physiological stenosis, etc., is often a favorable condition for bacteria to stay and grow in the bile duct. Partial obstruction can rapidly evolve into a more complete obstruction after the onset of disease, which makes the condition worse, and even develops into acute suppurative cholangitis. Clinical manifestations: only mild alternating heat and cold, jaundice, right upper quadrant pain and tenderness, sometimes accompanied by gastrointestinal symptoms such as loss of appetite, nausea, vomiting, but no signs of toxic shock and central nervous system. If the treatment is timely, the course of the disease is more peaceful. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: cirrhosis, biliary bleeding, shock
Cause
Cause of acute cholangitis
1. Infection: Bacterial or parasitic infections can cause acute inflammation of the bile duct.
2, pancreatic juice reflux: pancreatic juice into the bile duct, activated pancreatic enzymes corrode the bile duct and produce chemical inflammation, on this basis is also prone to secondary infection.
3, bile duct stenosis: bile duct stones can not only cause bile flow, but also due to mechanical stimulation to cause inflammation or ulceration of the bile duct wall; surgical trauma, or angiographic examination, can cause damage to the bile duct wall, crusting and narrow, so that Poor flow leads to infection and inflammation.
Prevention
Acute cholangitis prevention
1. Primary prevention of acute suppurative cholangitis is a serious complication of biliary tract biliary tract mites, so the primary prevention of the disease is mainly for the prevention and treatment of hepatolithiasis and biliary tract mites 1 prevention and treatment of hepatolithiasis. The key is to prevent and eliminate pathogenic factors. Patients who have been diagnosed with hepatolithiasis should be highly alert to the occurrence of this disease, especially in the case of concurrent biliary infections. Early use of high-dose sensitive antibiotics to fight infection, pay attention to water, electrolytes and acid-base balance, strengthen systemic support for the treatment of biliary tract infections, surgery as soon as possible under the conditions of the whole body, to remove the smooth drainage of stones, so as to prevent the occurrence of AFC. 2 prevention and treatment of biliary ascariasis. When the mites enter the biliary tract, they cause different degrees of obstruction of the biliary tract. Increase biliary pressure, when combined with bacterial infection, can induce AFC In addition, biliary ascariasis is also an important factor in the formation of hepatolithiasis.
2. Secondary prevention AFC disease develops rapidly, and toxic shock can occur soon. Therefore, the secondary prevention of the disease is mainly early diagnosis, early treatment according to the history of recurrent biliary tract disease, high fever, chills, jaundice, systemic poisoning symptoms and signs of peritonitis, combined with B-ultrasound, diagnosis is not difficult. Once diagnosed, it should actively resist infection, anti-shock, use sufficient amount of sensitive antibiotics, supplement blood volume to correct acidosis, prevent and treat biliary sepsis, and prepare for emergency surgery. The principle of surgery is to relieve obstruction, decompression biliary tract, and smooth drainage, and strive to be simple and fast. For patients with advanced age and poor general condition, PTCD or transnasal bile duct drainage can be performed first. After general improvement, active systemic support therapy and anti-infective measures should be performed after surgery.
3. Three-stage prevention of toxic shock and biliary sepsis in the early stage of AFC, if not treated in time, the prognosis is very poor, and the mortality rate is extremely high.
Complication
Acute cholangitis complications Complications cirrhosis biliary hemorrhagic shock
Cirrhosis of the liver, biliary bleeding, shock.
Symptom
Acute cholangitis symptoms Common symptoms biliary colic high fever chills abdominal pain with jaundice leukocytosis right upper quadrant pain jaundice hypotension fever Charcot triad shock
The clinical manifestations of acute cholangitis, disparity in severity, vary greatly, often accompanied by gallbladder inflammation.
1, abdominal pain, the degree of pain from faint dull pain to severe cramps, persistent or paroxysmal. The pain is mostly to the right under the xiphoid process. The inflammation of the intrahepatic bile duct can be painful in the liver area or the left upper abdomen, often radiating to the back or right shoulder. Inflammation develops into the bile duct serosa and surrounding it may have abdominal muscle tension and rebound tenderness.
2, aversion to cold fever or high fever, slightly aversion to cold or chills. Can be accompanied by heart rate, pulse speed.
3, jaundice appeared soon after fever. Or only see the sclera yellowish, you can also have a whole body yellow stain.
4, gastrointestinal symptoms often have nausea and vomiting, poor appetite, abdominal distension and other symptoms. The pain does not relieve after vomiting. There are also people who spit out mites.
5, liver and liver intrahepatic bile duct inflammation is often accompanied by liver enlargement, tenderness and pain in the liver area.
Examine
Examination of acute cholangitis
1, blood: leukocytosis, neutrophils increased. Increased bilirubin, increased -glutamyl transpeptidase and alkaline phosphatase; also increased alanine aminotransferase and amylase.
2, urine: urinary bile reduction, urinary bilirubin positive, amylase may also increase.
3, B-ultrasound: bile duct expansion, thickening of the wall, may have stones, mites and cholecystitis.
4, X-ray and CT: cholangiography showed bile duct dilatation or stones.
Diagnosis
Diagnosis and diagnosis of acute cholangitis
diagnosis
1, medical history and symptoms see clinical manifestations.
2, laboratory inspection
(1) Blood: leukocytosis, increased neutrophils. Increased bilirubin, increased -glutamyl transpeptidase and alkaline phosphatase; also increased alanine aminotransferase and amylase.
(2) Urine: urinary biliary tract is reduced, urinary bilirubin is positive, and amylase may also be increased.
(3) B-ultrasound examination: bile duct dilatation, thickening of the wall, may have stones, mites and cholecystitis.
(4) X-ray and CT: cholangiography can be seen dilated bile duct or
1. The biliary aphid has a very cramping pain, which is a burst of hair, a pain in the top of the drill, and stones after vomiting.
The differential diagnosis can be temporarily relieved, generally no obvious fever, and the abdominal signs are lighter. Imaging studies can detect aphids in the bile duct.
2, acute pancreatitis abdominal pain, fever, vomiting and other symptoms and acute cholangitis similar, but the increase in blood and urine amylase and imaging examination can be identified.
3, bile duct stones bile duct stones are also often accompanied by mild bile duct inflammation, but the imaging examination has the presence of stones without obvious signs of infection is the difference between the two: with Charcot triad can be diagnosed acute cholangitis; in the Charcot triad On the basis of blood pressure drop, shock is called quadruple sign, plus slang, lethargy, coma and other mental symptoms called Reynold five-link, with four or five signs can be diagnosed as acute severe cholangitis; B Super or cholangiography, can be found in the site of bile duct dilatation, the location and nature of obstruction or stenosis, with or without liver abscess, gallbladder.
