cholangitis
Introduction
Introduction to cholangitis Biliary tract inflammation is mainly caused by biliary inflammation, and cholecystitis is called gallbladder inflammation. The two often occur at the same time, mostly secondary to bacterial infection on the basis of cholestasis. Bacteria can reach the biliary tract through the lymphatic or bloodstream, or retrograde from the intestine through the duodenal papilla into the biliary tract. In the future, it is more common in China. Can be divided into acute and chronic types. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: gallstones
Cause
Cause of cholangitis
Biliary obstruction (50%):
Acute inflammatory episodes can occur when bile duct obstruction becomes complete or where bacterial infection is exacerbated. Repeated acute episodes will further aggravate the degree of chronic inflammation of the bile duct, especially in the branches of the oddi sphincter and the intrahepatic bile duct in the lower end of the bile duct. After repeated acute episodes, the scar tissue at the lower end of the bile duct may often be caused. Hyperplasia and stenosis, as well as the narrow environment of the branches of the intrahepatic bile duct, thus more serious the degree of obstruction of the bile duct inside and outside the liver.
Acute suppurative cholangitis biliary obstruction (most commonly biliary obstruction) causes biliary stasis and rapid increase in bile duct pressure resulting in acute suppurative biliary infection, most of which is the result of acute cholangitis. Due to the presence of obstructive lesions, the bile duct often expands to a diameter of 2 to 3 cm, or even 5 cm.
Intrabiliary lesions (30%):
Acute non-surgical treatment of acute cholangitis, control of acute inflammation, but did not resolve the primary cause of bile duct (such as intrahepatic bile duct stones, biliary ascariasis or Oddi sphincter stenosis, etc.), biliary inflammatory lesions turned chronic, bile duct The wall is thickened. Chronic cholangitis is the result of the legacy of acute cholangitis.
Prevention
Cholangitis prevention
1. Pay attention to rest, and make the living quarters, work and rest.
2. Avoid alcohol and tobacco, spicy and stimulate cold food, reduce oil intake.
3. Eat less foods rich in cellulose such as kohlrabi and celery.
4. Pay attention to adjusting emotions and maintain a good mental state.
Complication
Cholangitis complications Complications gallstones
Can be complicated by gallstones, obstructive jaundice, primary pancreatitis.
Symptom
Common symptoms of bile duct inflammation High fever chills abdominal pain nausea and vomiting jaundice hypotension intestinal flatulence hepatomegaly irritability
The pathogen is mainly Gram-negative bacilli, which is most common in Escherichia coli. The onset of this disease is acute and dangerous, and it is one of the main causes of death of gallstone patients in China. The disease often manifests as upper and middle abdominal discomfort, pain, or colic pain. After eating greasy food, it can aggravate upper abdominal pain, rarely fever and jaundice, abdominal signs are not obvious, but only upper abdominal tenderness, gallbladder Not swollen. If an acute attack occurs, there will be abdominal pain, chills, high fever and jaundice. In addition to Charcot triads with acute cholangitis (abdominal pain, chills, fever, jaundice), there is also a suppressed performance of shock and nervous system, called Reynolds five-link. The onset of the disease is often abrupt, sudden and severe pain in the lower right flank or right upper abdomen.
Examine
Cholangitis check
1. B-ultrasound: It is the most convenient and convenient, rapid and non-invasive diagnostic method to show the extent and extent of bile duct enlargement to estimate the obstruction site. Stones, aphids, liver abscess larger than lcm diameter, subgingival abscess, etc. can be found.
2. chest and abdomen X-ray film: help to diagnose empyema pneumonia, lung abscess, pericardial empyema, underarm abscess, pleurisy and so on.
3. CT scan: CT images of AFC can not only see signs of hepatic bile duct dilatation, stones, tumors, enlargement of the liver, atrophy, etc., and hepatic abscess can be found in fashion. If you suspect acute severe pancreatitis, you can have a CT scan.
4. Endoscopic retrograde biliary drainage (ERBD), percutaneous transhepatic drainage (PTCD): can determine the cause and location of biliary obstruction, but also can be used for emergency decompression drainage, but it can aggravate biliary infection or cause infection. The risk of bile spilling into the abdominal cavity.
5. Magnetic resonance cholangiopancreatography (MRCP): A detailed view of the intrahepatic bile duct tree, the location and extent of the obstruction. The image is not restricted by the obstruction site, and it is a non-invasive biliary imaging technique, which has become an ideal imaging examination method.
Diagnosis
Diagnosis and differentiation of cholangitis
The following checks are possible to confirm the diagnosis:
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. May suggest that the disease may be associated with pancreatitis. Or suggesting an abnormal confluence of the pancreaticobiliary duct, the high concentration of pancreatic amylase that flows back into the bile duct directly enters the blood through the capillary bile duct and causes hyperamylasemia. At the same time, the total bilirubin, 5' nuclear tannase, alkaline phosphatase and transaminase were all increased, and returned to normal during the remission period. In the long-term course, there is hepatocyte damage, and it is normal in the examination of asymptomatic cases.
2, B-type ultrasound imaging: with direct vision, tracking and dynamic observation and other advantages. Such as biliary obstruction and expansion, can correctly identify the location and extent of liquid content, the degree and length of bile duct expansion, the diagnostic accuracy rate of up to 94%. It should be used as a diagnostic method for routine examinations.
3, percutaneous transhepatic cholangiography (PTC) in the case of hepatic bile duct dilatation is easy to successfully, can clearly show the intrahepatic bile duct and its direction, to determine the extent of bile duct expansion and expansion. In the case of jaundice, the cause or obstruction site can be identified, and the pathological changes of the bile duct wall and its internal organs can be observed, and the cause of the obstruction can be identified according to the characteristics of the image.
4, endoscopic retrograde cholangiopancreatography (ERCP) by means of duodenoscopy can be directly injected into the bile duct and pancreatic duct through the nipple opening cannula, to identify the extent of bile duct dilatation and obstruction, and can display pancreas The length and abnormality of the common pathway of the bile duct.
5, gastrointestinal barium meal examination: larger cystic dilatation can show duodenal shift to the left front, duodenal frame enlargement, orphaned impression. Its diagnostic value has been replaced by ultrasound.
6, intraoperative cholangiography: direct injection of contrast agent into the common bile duct during surgery, can display all images of intrahepatic, external bile duct system and pancreatic duct, to understand the extent of intrahepatic bile duct dilatation, pancreatic duct bile duct reflux, Helps choose surgery and postoperative treatment.
