Cholangitis laboratory diagnosis. Chronic cholangitis: symptoms and treatment, nutritional recommendations

Cholangitis is an inflammation of the bile ducts that occurs as a result of infection through blood or lymph coming from the gallbladder or intestines. The syndrome rarely develops on its own, most often occurring as a complication of hepatitis, pancreatitis, gallstone formation, gastroduodenitis, if the patient ignored their symptoms and did not engage in treatment.

Classification

Determining the type of disease plays an important role in drawing up a treatment regimen. Cholangitis is classified according to several groups of symptoms. According to the nature of the course, acute and chronic forms are distinguished. According to pathomorphological changes, the acute form is divided into subtypes:

purulent - characterized by melting of the walls of the biliary tract and the formation of many internal abscesses;
catarrhal - it is characterized by swelling of the mucous membranes lining the inner surface of the biliary tract, excessive blood flow to them and oversaturation with leukocytes with further exfoliation of epithelial cells;
diphtheritic - begins with the appearance of ulcers on the mucous membranes, desquamation of the epithelium and leukocyte infiltration of the walls, followed by tissue death;
necrotic - occurs with the formation of dead areas that arise under the influence of the aggressive enzymatic activity of the pancreas.

Chronic cholangitis is divided into the following forms:

sclerosing (with the proliferation of connective tissue);
latent;
recurrent;
long-term septic;
abscess.

Based on the location of the inflammatory process, they are divided into:

choledochitis (inflamed common duct);
angiocholitis (intra- and extrahepatic bile ducts are affected);
papillitis (inflammation of the large duodenal papilla).

By origin, cholangitis is:

The chronic form of the disease is more common than the acute form and develops after an exacerbation of the disease and as an independent disease, initially taking a protracted course.

Cholangitis of the sclerosing type is a special form of the disease. Initially having a chronic form, inflammation in the bile ducts occurs without prior infection. The inflammatory process leads to tissue sclerosis - when hardening, they completely block the lumen of the ducts, thereby causing cirrhosis of the liver. This disease cannot be treated; slow progress (about 10 years) ends in the formation of severe disorders followed by death.

Main reasons

In most cases, cholangitis occurs as a result of an infection in the bile ducts. The most common infectious agents are:

coli;
staphylococcus;
enterococcus;
non-clostridial anaerobic infection;
pale spirochete;
typhoid bacillus.

The infection can spread upward. In this case, pathogenic bacteria enter the bile ducts:

from the duodenum;
through the blood through the portal vein;
through the lymph (as a complication of pancreatitis, enteritis, cholecystitis).

The main prerequisite for the formation of a pathological condition of the bile ducts is their impaired patency, which contributes to the stagnation of bile and is an unfavorable factor in the penetration of infection. The patency of the bile ducts is impaired in the following diseases:

choledocholithiasis - stone formation in the biliary system;
chronic cholecystitis, accompanied by narrowing of the lumen of the ducts as a result of tissue scarring;
postcholecystectomy syndrome - a pathological condition that occurs after excision of the gallbladder;
cystosis or tumor process of another etiology with localization in the bile duct;
duodenal nipple stenosis;
cholestasis is difficult bile secretion that occurs with biliary dyskinesia.

With the development of a descending type of infection, microorganisms affect the extra- and intrahepatic bile ducts, penetrating from the affected abdominal organs located above the gallbladder.

Cholangitis can also be provoked by endoscopic manipulations for the treatment or examination of the bile ducts, as a result of which the integrity of the walls was damaged: common bile duct stenting, retrograde cholangiopancreatography, sphincterotomy. Damaged mucous membranes become especially vulnerable to bacteriological infections, so after any invasive examination or surgery you should regularly visit a doctor to monitor the healing process.

Symptoms

In adults and young children, cholangitis develops differently. Adult patients rarely complain of pain in the acute stage. Their primary symptoms are mild, but if left untreated, the disease quickly progresses, turning into a purulent complicated form, with extensive internal inflammation, fraught with general sepsis.

In children, the acute form of cholangitis practically does not occur. Most often it begins after the addition of a secondary streptococcal infection. The signs of the disease are nonspecific, the symptoms largely coincide with other gastrointestinal diseases, so if they occur, you should consult a doctor who will carry out a differential diagnosis, on the basis of which an effective treatment regimen will be drawn up.

The following signs indicate the development of acute cholangitis:

aching pain in the right hypochondrium, radiating to the shoulder joint or to the scapula area;
fever, accompanied by chills and intense sweating;
attacks of nausea leading to vomiting;
jaundice accompanied by severe skin itching.

In the absence of adequate measures to treat acute cholangitis, the pathology becomes chronic, which is characterized by the following manifestations:

decreased performance, constant weakness;
hyperemic and itchy skin (most often on the palms);
increased body temperature outside of colds;
thickening of the distal (nail) phalanges of the fingers.

In childhood, cholangitis leads to weight loss, as the child constantly feels sick and refuses to eat. Intoxication caused by the activity of microorganisms and decay products formed during extensive purulent inflammation leads to the development of an anemic state. The patient's skin is pale, the sclera is yellow. The child may complain of constant headaches. If cholangitis is not treated at this stage, the progression of the disease can lead to slower physical development.

Diagnosis of the disease

Since it is not possible to recognize this disease by external signs, only a presumptive diagnosis is made on the basis of a physical examination. Its clarification is carried out on the basis of a comprehensive examination of the patient, including the following laboratory and hardware examinations:

Liver tests will determine the biochemical composition of the blood (to draw up a treatment plan, the doctor will need information about the level of bilirubin, transaminases, alkaline phosphatase, alpha-amylase).
Examination of the contents of the duodenum using duodenal intubation and bacteriological culture of bile will help identify the type of microorganisms that caused cholangitis.
Analysis for helminthic infestations (roundworms, lamblia, etc.).
Ultrasound, CT, and ultrasonography determine the nature of pathological changes in the bile ducts, their narrowing or expansion, the localization of inflamed areas and the nature of local blood circulation. A hardware examination will make it possible to assess the condition of the bile ducts and liver themselves.
In combination with hardware techniques, endoscopic research methods are used for diagnosis: transhepatic cholangiography, retrograde cholangiopancreatography.

Diagnosis begins with laboratory tests, based on the results of which the doctor will determine the necessary additional studies he needs to draw up a treatment plan.

Complications

If you ignore the first signs of cholangitis and do not diagnose and treat this disease in time, the inflammatory process in the bile ducts can lead to the following serious conditions:

Crohn's disease;
liver cirrhosis;
development of hepatic coma;
acute liver or kidney failure;
hepatitis;
blood poisoning;
peritonitis;
infectious-toxic shock.

Treatment

When the diagnosis of cholangitis is confirmed, the main vector of treatment becomes the removal of the internal inflammatory process. At the same time, intoxication of the body is eliminated and measures are taken to relieve processes that cause compression of the bile ducts. If there are concomitant diseases of the biliary system, gastrointestinal tract, liver or kidneys, a course of medication is required to correct them.

To suppress pathogenic microflora, combinatorial drug treatment with broad-spectrum antibiotics (cephalosporins, metronidazole, aminoglycosides) is recommended. To remove intoxication as quickly as possible, blood plasma is purified (plasmapheresis). To consolidate the obtained treatment results beyond the acute stage of cholangitis, physiotherapeutic procedures help stabilize the patient’s condition.

The general well-being of the patient during this period is well affected by the use of therapeutic mud, treatment with paraffin applications, high-concentration sodium chloride baths, physiotherapy using high-frequency magnetic fields, medicinal electrophoresis, and deep heating with currents.

Advanced cholangitis in its chronic form does not respond to conservative treatment. At this stage, the ducts are often so deformed that it is no longer possible to restore their patency with a course of antibiotics.

Surgical treatment is recommended when all methods of conservative therapy have already been applied, but it has not been possible to normalize the outflow of bile. Endoscopic procedures are considered the most effective method of surgical treatment of advanced forms of cholangitis - minimally invasive and with a short rehabilitation period. Endoscopic techniques are contraindicated in necrotic and purulent processes, and are also excluded in the presence of multiple abscesses in the lumen of the biliary tract.

Surgical interventions are performed to eliminate decompression of the affected tracts. Their format is determined by the prevalence of the inflammatory process and the nature of pathological changes. Thus, as part of the surgical treatment of sclerosing cholangitis, doctors recommend a liver transplant.

Diet

Diet therapy is an integral part of the treatment of all diseases associated with impaired functionality of the organs responsible for digestion. Nutrition during inflammatory processes in the bile ducts should be organized in such a way as to normalize the functioning of the biliary system and reduce the load on the liver.

For this purpose, fasting is prescribed in the first 2 days of treatment for acute cholangitis. After this, easily digestible foods are gradually introduced into the diet. During treatment, foods high in fat, smoked foods, over-salted, spicy and fried foods are completely excluded.

wholemeal bread;
fermented milk products with minimal fat content;
vegetables - can be eaten raw, but preference is given to stewed or boiled, as well as steamed vegetable dishes;
eggs;
pasta;
porridge.

If the patient feels well, you can add boiled or baked low-fat dietary meat (rabbit, turkey, veal) to the diet.

To avoid intense bile formation, throughout the entire course of treatment you need to eat in small portions, taking breaks between meals of 2–3 hours.

Drinking regimen is of particular importance in the treatment of cholangitis. Drinking up to 1.5 liters of pure water without gas per day will provide the patient with favorable conditions for eliminating toxins. Instead of water, you can drink a decoction of rose hips or dried fruits, ginger or green tea - they relieve nausea well and help detoxify the body.

Eating food from the list of prohibited foods will reduce the effectiveness of treatment and may cause relapse of cholangitis even during a period of long-term remission.

Prevention and prognosis

With timely treatment of the acute form of the disease, not complicated by sepsis, abscess formation or functional failure of the liver or kidneys, the pathology is cured by conservative methods. Factors that worsen the prognosis are old age, chronic course of the disease, fever that persists for 14 days or longer, anemia, and female gender.

Chronic forms of cholangitis often occur with complications requiring surgical intervention. The inflammatory process that lasts for years can lead to disability, and in this case there is a high probability of death. The cause of death is septic shock, which occurs as a consequence of systemic blood poisoning and occurs in cases where the patient refuses treatment.

This disease is often confused with cholecystitis, but these are completely different diseases. In the article we will look in detail at what chronic cholangitis is and how it manifests itself. Let's get acquainted with the causes and symptoms. At the end of the article, we will analyze the diagnostic directions and treatment regimen for chronic cholangitis. And we will find out what prevention of the disease can be.

What is this?

Chronic cholecystitis and cholangitis are united by the fact that they are diseases of the gallbladder. The difference is in the location of the organ damage and the course of the disease.

Chronic cholangitis is an inflammation of the bile ducts, both external and internal ducts. It is characterized by a long, relapsing course (which is why the disease is called chronic). May ultimately lead to cholestasis.

Chronic cholangitis. What kind of disease? Inflammatory processes in the bile ducts due to the penetration of infection into them from the digestive tract (gallbladder, intestines), blood vessels. Less commonly, the infection can enter through the lymphatic tract. One of the common causes of the disease is toxoplasmosis. Domestic cats are carriers of Toxoplasma itself.

Basic information about the disease

Among the main clinical signs of chronic cholangitis are severe pain in the liver area, fever, chills, and jaundice. The main diagnostic direction here today is ultrasonography of the pancreas and the bile ducts leading to it. Techniques such as retrograde cholangiopancreatography, computed tomography of the bile ducts, as well as general and biochemical blood tests are also used.

As for the treatment of chronic cholangitis, the most effective is the combined option. This is a combination of antibacterial conservative, analgesic therapy, detoxification, as well as surgical decompression of the biliary tract.

As for chronic cholangitis in ICD-10, it is designated under code K83.0.

Statistics

Let us now turn to world medical statistics. Unlike chronic cholecystitis, cholangitis is much less common. As in comparison with other inflammatory diseases of the hepatobiliary system.

The pathology mainly develops in adults. The average age of patients is 50 years. There are no observations of a more frequent susceptibility to the disease in men or women.

In most cases, it manifests itself against the background of existing diseases of the liver and gall bladder. It is noted that in 37% of cases the disease will be diagnosed after cholecystectomy.

It is impossible not to mention the specific form of the disease - sclerosing cholangitis. It progresses against the background of relative health of the person. Develops slowly over an average of 10 years. And ultimately leads to irreversible liver damage. There is no reliable data on the true incidence rates of the sclerosing form, since its diagnosis is still difficult. But, it must be said that recently the number of recorded cases has increased. Which, first of all, indicates an improvement in the quality of diagnostics.

If we talk about mortality from the chronic form of cholangitis, there are no clear figures. Depending on the timing of detection of the disease and the correctness of therapy, it ranges from 15 to 90%.

Reasons

Is it possible to develop chronic cholangitis after removal of the gallbladder? Yes, in many cases. This disease is more bacterial in nature. It can be caused by almost all pathogens that are present in the digestive tract:

Proteas.
Enterococci.
Escherichia coli.
Klebsiella etc.

In almost all cases, infection with several such pathogens is observed simultaneously. And at the same time, it is very rare that when bile is cultured, only one single bacterial agent is detected. In many cases, with the chronic type of cholangitis, the presence of bacteria in the patient’s blood is also detected (positive culture for blood sterility).

As we have already said, risk factors for this disease are various surgical, diagnostic, and therapeutic interventions affecting the bile ducts. They can be performed against the background of both congenital developmental anomalies and various infectious processes.

What contributes to the development of the disease?

What can contribute to the entry of bacteria and intestinal microflora into the biliary tract? Usually it's the following:

Impaired functioning of the duodenal papilla.
Both lymphogenous and hematogenous dissemination of various bacterial agents.

This mechanism of infection of the bile ducts can be observed in the following:

As a rule, for the formation of chronic cholangitis, a combination of three factors is necessary:

Translocation (entry) of intestinal microflora into the bile ducts.
Cholelithiasis.
Increased intraductal pressure.

It should be noted that the chronic form of cholangitis can also develop as a continuation of acute cholangitis. But we cannot exclude a primary, purely chronic course of the disease.

Main symptoms at an early stage

The main symptom of chronic cholangitis is the identification of the so-called Charcot triad. It includes the following:

Moderate pain felt in the right hypochondrium.
Chills - an increase in the patient’s body temperature to subfebrile levels.
Jaundice.

As for the signs of chronic cholangitis, the patient suffers from dull, low-intensity, aching pain. After biliary colic, he feels a moderate fever and mild chills.

As for the clinical picture, it is erased and recurrent. Therefore, patients, as a rule, rarely pay attention to the first symptoms of the disease.

Main symptoms in the late stage

If we move on to the signs of chronic cholangitis (cholecystitis is a completely different disease) already at a late stage, you will notice the following:

Icterus (in simple words, jaundice) of both the skin and mucous membrane.
Increased fatigue.
General weakness (generally expressed when the patient is elderly).

As for the patient’s age over 60 years, diagnosis in this case is significantly difficult. The clinical picture will not correspond to the severity of the inflammatory process occurring in the bile ducts. The symptoms are too vague, so it is difficult even for a specialist to establish the correct diagnosis.

Complications of the disease

This form of the disease, such as purulent chronic cholangitis, can lead to the infection entering the systemic bloodstream. And this is already fraught with the development of septic biliary shock. Its result in 30% of cases is lethal.

The following complications are no less dangerous to the life and health of the patient:

Porto-caval thrombosis.
Liver abscess.
Other types of septic manifestations.

As for the sclerosing chronic form, it can result in the following consequences:

Hepatocellular carcinoma.
Cirrhosis.

Laboratory diagnostics

If you even suspect symptoms of a chronic type of cholangitis, you should definitely seek advice from a gastroenterologist. To make a preliminary diagnosis, the doctor makes sure that the patient has Charcot's triad.

General blood test. If the patient has chronic cholangitis, high leukocytosis, increased ESR, as well as a neutrophilic shift in leukocyte formulas will be detected.
Biochemical blood test. If the diagnosis is established correctly, then the results of screening will be an increased level of bilirubin, G-GTP activity and alkaline phosphatase.
Microbiological research. In almost all patients, intestinal microflora is found in the bile. In half of the patients, bacteria are also found in the blood.

Instrumental diagnostics

Doctors also turn to instrumental diagnostic methods. In particular, ultrasonography of the biliary tract and the pancreas itself is performed. Here you can see thickening and some expansion of the walls of the biliary tract.

Computed tomography, which is widespread today, is no less important. It not only confirms the data obtained during ultrasound examination, but also helps to timely identify complications of the purulent form of chronic cholangitis. In particular, various purulent abscesses and pylephlebitis.

To perform retrograde cholangiopancreatography, an additional consultation with an endoscopist is required. Such an examination helps not only to visualize the stones located in the bile ducts, but also to indicate their specific extensions.

Recently, ERCP has been replaced by magnetic resonance cholangiopancreatography. Its undoubted advantage is that it is a non-invasive diagnostic method. It not only identifies the symptoms of chronic cholangitis, but also helps to establish the causes of its development.

If diagnostic tests are performed immediately before surgery, transhepatic cholangiography may be used. The needle is passed through the patient's skin and then through his bile duct. This is how contrasting and drainage of the latter are carried out.

Similarities with other diseases

When diagnosing chronic cholangitis, specialists need to be especially careful - the disease is similar in its manifestations and symptoms to a number of other pathologies and diseases:

Blockage of the bile ducts (observed in cholelithiasis).
Viral hepatitis.
Calculous and acute cholecystitis.
Tumors of the bile ducts, liver or pancreas.
Bile duct strictures due to another reason.

Drug therapy

In the article we examine, among other things, the symptoms and treatment of chronic cholangitis. As for therapy, it is predominantly outpatient. Hospitalization to the gastroenterology department of a hospital is required only in special cases:

Malignant cholestasis.
Severe course of the disease.
Advanced age of the patient.

Surgery

The main goal of surgery for chronic cholangitis is to remove stones from the bile ducts, which can improve and stabilize the flow of bile. That is, drainage of the biliary tract is carried out.

For this purpose, the following operations are carried out:

External drainage of the biliary tract.
Transhepatic percutaneous drainage.
Nasobiliary type of drainage (performed during RPCG).
Extraction of stones from common bile ducts.
Extraction of stones from the bile ducts during RAC.
Balloon endoscopic dilatation of the sphincter of Oddi.
Endoscopic stenting of the common bile duct.

As for rehabilitation in the postoperative period, it is very important to follow a special diet for chronic cholangitis. It is compiled by your attending physician. It is important to include in your diet foods rich in both vitamins and vegetable oils. The diet must be combined with choleretic and antibacterial therapy.

Prevention and prognosis

We must not forget that the chronic type of cholangitis is a rather serious disease, which if ignored, incorrectly or untimely treatment can result in death. The prognosis of the disease here is worsened by the following:

Female gender.
Advanced age.
Prolonged hyperthermia - more than two weeks (increased body temperature).
Anemia.
Disorders of consciousness.
Insufficient liver and kidney function.

Prevention in this case is secondary. It comes down to two important areas:

Carrying out preventive diagnostics of the liver, gall bladder and digestive tract as a whole.
Timely treatment of diseases, infections, pathologies that can cause cholangitis.

We became acquainted with a rather serious disease - inflammation of the bile ducts of an infectious nature. Chronic cholangitis is dangerous because its symptoms (especially in the early stages) are erased. We need comprehensive diagnostics - both laboratory and instrumental. The patient will undergo medication, surgery, and diet.

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Cholangitis is a disease in which an inflammatory process forms in the intrahepatic and extrahepatic bile ducts. Pathology most often develops in women aged 50–60 years. It rarely occurs as an independent disease, most often in combination with hepatitis, cholelithiasis, cholecystitis, and oncological diseases of the bile ducts and bladder.

Reasons

The main reasons for the formation of cholangitis:

Classification

According to the nature of the course, the disease is divided into acute and chronic forms.

Acute cholangitis

Acute cholangitis, depending on the type of inflammatory process, is divided into the following types:

Diphtheritic. The mucous membrane of the bile ducts becomes covered with ulcers, necrosis (death, necrosis) of tissues is noted, due to this, the walls of the ducts are destroyed and suppuration of the surrounding tissues and liver occurs;
Catarrhal. The mildest form of the disease, with this form, the mucous membrane of the ducts swells and becomes hyperemic. In the absence of treatment, this type becomes chronic, subsequently scarring of the ducts occurs;
Purulent. The ducts are filled with purulent contents mixed with bile. May spread to the liver, gall bladder;
Necrotic. It is formed against the background of the penetration of enzymes (protease, amylase) of the pancreas into the ducts, due to this the mucous membranes die.

Chronic cholangitis

Chronic cholangitis has 4 types of course:

Latent (hidden), there are no symptoms of the disease;
Recurrent. Has relapse (exacerbation) and remission (no symptoms);
Septic. The severe form occurs as sepsis (blood poisoning);
Abscessing. Purulent process with the formation of abscesses (purulent cavity).

Chronic sclerosing cholangitis

Separately, there is chronic sclerosing (autoimmune, associated with a malfunction of the immune system, killer antibodies are produced against healthy tissues, cells of the body), a type of cholangitis, which is not an infectious process, but at the same time an inflammatory process is formed in the ducts.

Due to chronic sclerosing cholangitis, liver cirrhosis can occur!

The bile ducts harden, the lumen narrows, cannot be treated, and the disease progresses slowly (over 10 years). As a result, a fatal outcome is possible.

Symptoms

Acute cholangitis has a rapid course, characterized by Charcot's triad: hyperthermia (high temperature), jaundice, pain in the right hypochondrium.

The disease manifests itself with the following symptoms:

In severe cases, shock and impaired consciousness may occur (Reynold's pentad).

In children, cholangitis is a rare disease, characterized by acute, nonspecific, intense symptoms, the clinical picture of the course is the same as in other pathologies of the gastrointestinal tract (dyspepsia, intestinal disorders, epigastric pain, etc.). Due to this, making a correct diagnosis is difficult.

Chronic cholangitis in adults is characterized by the following symptoms:

Periodic rise in temperature;
Increased fatigue, weakness;
Itching of the skin;
Hyperemia (redness) of the palms;
Thickening of the terminal phalanges of the fingers;
Intense pain only if there are stones in the ducts.

In children, chronic cholangitis manifests itself as follows::

Diagnosis of the disease

The diagnosis of cholangitis is made based on the patient’s complaints, taking an anamnesis (when symptoms first appeared, illnesses of relatives, past illnesses, etc.). The doctor conducts a thorough examination (palpation of the abdominal cavity, examination of the skin, sclera of the eyes), and prescribes a set of examinations for the patient.

Diagnostic studies include:

Treatment methods

Treatment of acute cholangitis should be carried out in a hospital, as the patient may require emergency surgery. Depending on the degree of violation of bile excretion and the type of disease, the doctor selects individual tactics of therapeutic measures.

Drug therapy

Conservative (medicine treatment) therapy is carried out if the patient does not have mechanical obstacles to the outflow of bile from the gallbladder.

The main drugs for the treatment of cholangitis:

Physiotherapeutic treatment

During the period of remission, physiotherapeutic treatment is prescribed :

Surgical intervention

In case of ineffective drug treatment or bile outflow disorders, surgery is indicated:

Endoscopic technique. Drainage (insertion of a catheter to drain contents) of the biliary tract is performed, stenosis (narrowing) is eliminated, and stones are removed without resorting to abdominal surgery. This method allows you to avoid bleeding, reduce the risk of surgical injury, and speed up the period of rehabilitation (recovery) after manipulation;
Abdominal surgery – resection (removal) of affected (purulent, dead) areas.

Traditional medicine

Traditional medicine recipes for the treatment of cholangitis:

Diet

In the acute stage of the disease, hunger is prescribed; after the exacerbation subsides, meals should be in small portions, at least 5-6 times a day, the interval between meals is no more than 4 hours. All dishes are steamed, baked, boiled.

Authorized Products:

Lean varieties of meat, poultry, fish;
Soups with vegetable broth, milk;
Bran bread, pasta;
Cereals, cereals;
Fermented milk products;
Vegetables, greens;
Not sour berries, fruits;
Compotes, juices, weak tea.

Limit sugar consumption to 70 grams. per day, up to 1 egg per day.

Prohibited Products:

Fresh baked goods, bread;
Canned food;
Smoked, fatty, spicy foods;
Mushroom broth;
Semi-finished products;
Hot seasonings, spices;
Ice cream, chocolate, confectionery with rich cream;
Coffee, carbonated drinks, alcohol, cocoa.

Complications

If treatment is not started in a timely manner or therapy is ineffective, the patient may develop the following complications:

Cholangitis can be fatal; if symptoms appear, be sure to consult a doctor!

Viral hepatitis (liver infection)
Cholecystitis (inflammation of the gallbladder);
Primary biliary cirrhosis (chronic, inflammatory liver disease);
Pleural empyema (accumulation of pus in the lungs - pleural cavity);
Pneumonia (pneumonia);
Lethal outcome.

Digestive disorder. Such dyspeptic disorders may indicate a wide variety of gastrointestinal disorders.

However, most often they develop against the background of cholangitis. The diagnosis is quite serious, so the course of the disease should not be neglected.

In the absence of timely treatment, dangerous complications may arise that will threaten the life and health of the patient.

What is this pathology?

Acute brings severe discomfort and pain. The attack can be so severe that the patient loses consciousness. Chronic form occurs with mild symptoms, however, it slowly affects most of the bile ducts in the liver and beyond.

Cholangitis was discovered in the 19th century. The study of this disease was carried out mainly by European doctors.

Rapid technological progress in the 20th century made it possible for scientists to study this pathology in more detail and identify the causes of the inflammatory process.

By the end of the 20th century, many effective ways to treat cholangitis appeared in medicine.

All people are at risk. This type of gastrointestinal disorder occurs in men and women of different age categories. However, most often the disease is diagnosed in women aged 50-60 years.

Doctors attribute this to the fact that hormonal levels change, metabolism slows down, and the level of immunity decreases.

Additional risk factors are:

unbalanced diet;
insufficient sleep;
exposure to stress;
unfavorable environmental situation in the place of residence;
smoking;
alcohol abuse.

The key to successful treatment is timely access to the hospital. If any abnormalities are detected that indicate the possible presence of cholangitis, the patient should urgently visit a therapist or gastroenterologist.

Reasons for the development of cholangitis

First of all, the doctor finds out why the inflammatory process appeared in the bile ducts. The choice of further treatment tactics depends on this.

To get rid of the disease completely, it is imperative to eliminate the root cause.

There are many factors that can cause cholangitis to develop.

In addition to the above factors, an incorrect lifestyle can become a stimulus for the development of cholangitis. Excessive consumption of fatty and fried foods negatively affects the condition of the liver. If harmful foods are consumed frequently, the bile ducts may become inflamed.

The course of therapy is prescribed strictly by a doctor. Self-medication can lead to serious complications. The main task of the patient is to seek help in a timely manner. The doctor determines the cause. Treatment is aimed primarily at eliminating the provoking factor, and then at relieving symptoms and alleviating the patient’s condition.

Clinical picture and diagnostic methods for this disorder

The acute form is expressed quite clearly. The patient's body temperature rises sharply to 38-40 degrees. A sharp stabbing pain appears on the right under the rib. Sometimes the discomfort is overwhelming.

During an attack, a person complains of pain in the right shoulder blade and collarbone. The intoxication of the body is so strong that the patient feels weakness and nausea.

For acute cholangitis dyspeptic disorders appear. Diarrhea, bloating can also be signs of acute cholangitis. After a few days, jaundice appears. The skin and sclera become yellow due to excessive release of toxins.

In some cases, patients with the acute form experience disturbances of consciousness. They manifest themselves in fainting, hallucinations, disturbances in speech and coordination of movements. In this case, it is necessary to urgently call an ambulance.

Chronic form It is less severe, however, it is dangerous because it constantly progresses. In the initial stages of the disease, a person does not even realize that he is sick. Discomfort in the area of the right hypochondrium is minor. The patient feels heaviness, especially after eating.

Jaundice appears only a few months after the onset of the inflammatory process. Body temperature rarely rises and does not exceed 37.5 degrees. Dyspeptic disorders are mild or completely absent.

To make an accurate diagnosis The doctor sends the patient for laboratory tests and clinical studies. Biochemical samples are taken and duodenal intubation is performed. In addition, it is mandatory to undergo tests for the presence of eggs of various helminths. An ultrasound examination of the abdominal organs is also recommended.. The doctor insists on undergoing a CT scan of the bile ducts.

Treatment methods for cholangitis

Depending on the causes of the disorder, the form and severity of the disease in traditional medicine medical or surgical treatment is carried out. Medicines are prescribed exclusively by the attending physician. You cannot choose medications on your own, since through ignorance you can harm the body more.

When long-term remission occurs, the patient is sent to undergo physiological procedures. These include electrophoresis, ozokerite therapy, microwave treatment, inductothermy, baths with sodium and chloride. After completing the main course of treatment, the patient may be sent to a dispensary.

Surgery carried out only in cases where it is impossible to normalize the flow of bile with the help of medications. There are several types of surgical treatment. The doctor tells the patient about each of them at the appointment.

It is not recommended to resort to traditional methods of therapy. They can be used as an additional treatment, however, traditional medicine should never be completely excluded. This can lead to serious consequences, including cirrhosis of the liver.

Prevention of inflammation of the bile ducts

It is much easier to prevent a disease than to deal with its consequences in the future. To prevent the development of primary or recurrent cholangitis, It is necessary to follow simple principles of a healthy lifestyle:

quitting smoking;
refusal to drink alcoholic beverages;
regular exercise;
daily walks in the fresh air;
good sleep;
healthy eating;
avoidance of stressful situations.

A preventive examination should never be neglected. It is better to spend a little free time consulting a doctor than to spend a long and tedious time treating an advanced form of pathology.

Prognosis for cholangitis

As a rule, with timely treatment, the prognosis is always favorable. The time of therapy depends on the reasons for which the disease occurred. In general, the rehabilitation period lasts from two weeks to two months. If after this the patient goes for recovery to a dispensary or sanatorium, then the body quickly returns to normal, all processes are completely restored.

In advanced cases When treatment was started too late, complications such as abscess, acute liver failure, and cirrhosis may develop. However, in most cases, the diagnosis is made early, so consequences can be avoided.

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Statistics show that in recent years the number of patients with cholangitis has increased significantly. This is due to the fact that people have little awareness about this disease. By increasing awareness, the number of patients with a similar diagnosis can be significantly reduced.

People must know the following facts:

Cholangitis is an inflammatory process in the liver. In this case, the bile ducts become inflamed and metabolism is disrupted.
The causes of the disease are bacterial infections, helminths, hepatitis and bad habits.
Symptoms manifest themselves as pain in the right hypochondrium, jaundice, fever, diarrhea.
Treatment is carried out using conservative methods. Sometimes surgery may be necessary.
Timely initiation of therapy guarantees a speedy recovery and the absence of complications.

The liver is one of the most important organs of the human body along with the heart, brain, and lungs. There are many tasks that the liver performs: filtering all kinds of toxins, producing glycogen, and storing some vitamins (A, D, B12). Refers to liver functions and bile synthesis. Bile is initially collected in the hepatic bile ducts and then travels along the common bile duct to the gallbladder. Inflammation of these bile ducts is the main feature of a fairly common disease - cholangitis.

Causes

The occurrence and development of cholangitis is facilitated by two factors: stagnation of bile and the presence of infection. This combination of circumstances can be caused by the following reasons:

In addition to these reasons, inflammation of the bile ducts can be provoked by some viruses - for example,.

Classification of types of disease

The previous section discussed various types of cholangitis, which differed in the causes of the disease. So, for example, there are bacterial, viral, autoimmune and helminthic types of disease. However, cholangitis is also divided according to other characteristics. The main types will be discussed below.

Primary sclerosing type

A little was said above about what primary sclerosing cholangitis is, but it would be useful to consider this issue in a little more detail. It’s worth starting with the fact that this is chronic cholangitis, in which scars form in the bile ducts. As a result, bile cannot move normally through the channels, which means that the liver does not work as it should.

The reasons that contribute to the development of a disease such as primary sclerosing cholangitis are not fully understood, but it is assumed that this is associated with autoimmune diseases. People whose relatives had this disease fall into the risk category. Also, primary sclerosing cholangitis occurs somewhat more often in men than in women.

Purulent type of disease

Purulent cholangitis is usually bacterial in nature and is characterized by the presence of wounds on the walls of the bile ducts. The wounds begin to fester over time, and in some cases tissue necrosis may even begin. This type of disease sometimes behaves like acute cholangitis, and sometimes takes a chronic form.

The purulent type of cholangitis is dangerous, first of all, because its disease picture is similar to other varieties of this disease, and improper and untimely treatment can lead to severe complications: liver failure, the occurrence of many abscesses in the liver, purulent intoxication, etc.

Cholecystocholangitis

Manifestations of the disease

Despite the fact that there are several different types of cholangitis (including the already mentioned primary sclerosing cholangitis, cholecystocholangitis, etc.), their symptoms are quite similar. These characteristic signs of cholangitis will be listed below.

Yellowing of the skin and whites of the eyes. Occurs due to stagnation of bile.
Severe fever, chills. Such symptoms are especially characteristic if there is acute cholangitis.
Painful sensations in the right hypochondrium.
Bitterness in the mouth, nausea, strong vomiting.
Enlargement of the liver.
Weakness, lethargy.

In the acute form of the disease, all these symptoms will be very pronounced, so it will be difficult not to notice them. But in the chronic form, all the symptoms are somewhat muted: instead of fever, there is low-grade fever, instead of constant vomiting, there is slight nausea, pain in the hypochondrium is not so severe. On the one hand, the chronic form of the disease is less painful for the patient, on the other hand, a person often decides to endure not too severe pain, and in the case of cholangitis this can have disastrous consequences.

Diagnostic methods

The symptoms of cholangitis, especially acute, are pronounced and indicate the presence of problems with the liver, however, in order to make an accurate diagnosis and prescribe treatment for cholangitis, a number of additional tests are required. Here are the main ones:

Treatment for cholangitis

Treatment of cholangitis can be carried out both in an outpatient clinic and in a hospital department. The patient must be freed from physical activity. Treatment methods work in combination, so it is important not to miss any aspect of it.

Nutrition method

A diet for cholangitis involves avoiding fatty foods, alcohol, fried foods, dishes with a lot of spices, smoked meats, and canned food. You should also not eat garlic and onions. You need to eat small and often so as not to overload the liver. The following products will be beneficial:

Lean types of meat (veal, chicken fillet, rabbit) and fish (hake, pike perch).
Low-fat fermented milk products (kefir, fermented baked milk, low-fat cottage cheese).
Porridge, especially buckwheat and oatmeal.
Vegetables – boiled or steamed.

Also, with cholangitis, the drinking regime is important - you need to drink at least 1.5–2 liters of clean water per day.

Drug treatment

During acute attacks, treatment of cholangitis involves taking medications that can relieve inflammation. Usually these are broad-spectrum antibiotics, such as tetracycline, biomycin. Sedatives and painkillers are prescribed to relieve pain.

Conservative therapy

When acute inflammation has been relieved, general treatment methods are used to improve the patient’s condition. Good results in this regard are achieved by staying at mineral water resorts; some physiotherapy (diathermy, UHF), special sets of exercises, mud and paraffin applications are also recommended.

In conclusion, it can be noted that the symptoms of cholangitis are sometimes not too noticeable, but it is important to pay attention to them in time. Treatment of cholangitis at the present time is not too difficult, especially in the early stages, but if the disease is neglected, the complications can be very serious - even cirrhosis of the liver.