Primary sclerosing cholangitis ICD 10. Primary sclerosing cholangitis
Primary sclerosing cholangitis, bacterial cholangitis
Version: MedElement Disease Directory
Cholangitis (K83.0)
Gastroenterology
general information
Short description
Cholangitis- inflammatory disease of the extra- and intrahepatic bile ducts, which has an acute or chronic recurrent course. Inflammatory diseases of the gallbladder are much less common.
Notes
1. To this subsection included:
1.1 Bacterial cholangitis.
1.2 Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease characterized by inflammation and progressive fibrosis Fibrosis is the proliferation of fibrous connective tissue, occurring, for example, as a result of inflammation.
intra- and extrahepatic bile ducts, which consistently leads to their narrowing, obliteration, ductopenia Ductopenia is a syndrome of disappearing bile ducts.
and, as a consequence, to the development of liver cirrhosis and cholangiocellular carcinoma.
2. From this subsection excluded s:
- cholangitis with liver abscess ();
- cholangitis and choledocholithiasis (K80.3 -, K80.4);
- chronic destructive non-purulent cholangitis in primary biliary cirrhosis ().
Progressive cholangitis;
Cholangitis, unspecified;
Primary cholangitis;
Periodic cholangitis;
Sclerosing cholangitis;
- secondary cholangitis;
Stenosing cholangitis;
Purulent cholangitis.
4. Synonyms:
Bacterial cholangitis;
Bacterial cholangitis;
- primary sclerosing cholangitis.
Classification
There is currently no clear comprehensive classification of cholangitis. The following types of cholangitis are roughly distinguished. Some forms of cholangitis (cholangitis with cholelithiasis, ischemic cholangitis and others) are classified in other headings.
I. According to the clinical course: acute and chronic cholangitis (some authors also distinguish recurrent cholangitis).
II. Primary and secondary(as complications of diseases, manipulations).
III. By the nature of the process:
2. Sclerosing:
2.1 Primary sclerosing cholangitis (PSC):
- in combination with nonspecific ulcerative colitis (UC);
- without UC.
2.2 Secondary sclerosing cholangitis:
2.2.1 Toxic damage:
- with the introduction of formaldehyde and absolute alcohol into echinococcal cysts;
- taking thiobendazole.
2.2.2 Ischemic damage:
- with thrombosis of the hepatic artery after liver transplantation;
- in case of transplant rejection reaction;
- when 5-fluorouracil is administered into the hepatic artery during tumor chemotherapy;
- during operations on the bile ducts.
2.2.3 Bile duct stones, including choledocholithiasis.
2.2.4 Congenital anomalies of the bile ducts:
- common bile duct cyst;
- Caroli's disease.
2.2.5 Cytomegalovirus infection or cryptosporidiosis in AIDS.
2.2.6 Histiocytosis.
2.2.7 Cholangiocarcinoma.
Primary sclerosing cholangitis is also classified according to stages(severity of bile duct damage and fibrosis):
- stage 1 (early changes) - damage to the bile ducts and inflammation limited to the area of the portal tract;
- stage 2 - spread of inflammation and fibrosis beyond the portal tract;
- stage 3 - reduction in the number of bile ducts and bridging fibrosis;
- stage 4 (terminal) - development of liver cirrhosis.
Etiology and pathogenesis
Bacterial cholangitis
Etiology
The spectrum of pathogens causing bacterial infections in cholangitis corresponds to the spectrum of intestinal microflora (Escherichia coli, Proteus vulgaris, Enterococcus). With purulent cholangitis, in more than 90% of patients, several pathogens are detected in the bile at the same time and, in addition, positive results of blood culture for sterility are recorded.
Pathogenesis
Microorganisms can enter the bile ducts as a result of dysfunction of the duodenal nipple (a condition after endoscopic retrograde cholangiopancreatography, ERCP) or can be introduced into the bile ducts by hematogenous or lymphogenous route.
(PSH)
The etiopathogenesis of PSC is unknown. Toxins, infectious agents and immune disorders are considered possible etiological factors.
Excessive copper deposition in liver tissue was found in patients with PSC. However, chelation therapy in these patients turned out to be ineffective, which indicates the secondary nature of copper overload (in particular, this is typical for patients with primary biliary cirrhosis).
The epithelium of the intrahepatic bile ducts is affected by cytomegalovirus and reovirus type 3, but the likelihood of detecting these viruses in all patients with PSC remains hypothetical.
The possibility of a genetic predisposition to the disease is indicated by the high incidence of various autoimmune disorders (including the liver - autoimmune cross syndrome) in patients with PSC. The HLA-B8 and HLA-DR3 loci, which are often detected in patients with autoimmune diseases, are also found in patients with PSC.
In PSC, T-lymphocytes and immune-mediated mechanisms are actively involved in damage to the bile ducts, the action of which is manifested by lymphoplasmacytic infiltration, accumulation of eosinophils and obliterating phlebitis.
Pathogenesis of ductopenia and cholestasis in PSC:
Decreased secretion as a result of exposure to proinflammatory cytokines;
Impaired expression and functional activity of transporter molecules;
Blockage of the bile ducts as a result of chronic inflammation and fibrosis;
Retention of bile acids and activation of apoptosis Apoptosis is the programmed death of a cell using internal mechanisms.
hepatocytes.
Epidemiology
Cholangitis
Mortality varies between 13-88%.
Geography. There has been an increase in frequency in Southeast Asia.
Floor. No difference
Age. Mostly occurs in adults, the average age of onset is 50-60 years.
Primary sclerosing cholangitis
Prevalence is estimated to average 6.3 cases per 100,000 population.
Gender and age. The disease usually begins between the ages of 20 and 30, although it can also appear in childhood. About 70% of patients with PSC are men. The average age of diagnosis for them is about 40 years.
Patients with PSC but without inflammatory bowel disease are more likely to be older women at diagnosis.
The true incidence of PSC in the population is unknown, but it is increasing every year due to improved diagnostic methods. It is assumed that in some countries the underestimation of the prevalence of the disease is significant (underestimated by 3-4 times).
Risk factors and groups
- young men (25-45 years old);
- patients with nonspecific ulcerative colitis of any age and gender;
- patients with type 1 diabetes mellitus;
- patients with a family history.
Symptoms, course
Bacterial cholangitis
Classic symptoms of cholangitis: pain in the right hypochondrium, chills, fever, Charcot's triad (a combination of fever, chills and jaundice).
The pain is usually localized in the epigastric region and is intense and colicky in nature.
Fever, as a rule, is intermittent, but in elderly patients and people in a state of immunosuppression it can be low-grade.
In the case when the described symptoms are accompanied by signs of sepsis in the form of arterial hypotension and mental disorders, this symptom complex is called Reynold's pentad.
Primary sclerosing cholangitis
Patients with primary sclerosing cholangitis (PSC) exhibit many of the clinical features characteristic of primary biliary cirrhosis (PBC). The disease usually begins unnoticed and it is difficult to retrospectively record the time interval of the onset of the disease.
Some signs of the disease may appear in 75% of patients with PSC within 1-2 years before diagnosis.
Main complaints are associated with increasing general weakness and skin itching, which is subsequently accompanied by jaundice. This triad of symptoms is typical for 2/3 of patients.
If clinical signs of cholangitis appear (pain in the right hypochondrium, fever and jaundice), it is necessary to exclude the possibility of complications (choledocholithiasis and others). At the stage of clinical manifestations, jaundice in combination with hepatosplenomegaly is detected in 75% of patients. Melasma and xanthelasmas (xanthomas) are observed less frequently than in patients with PBC.
Initial symptoms in 29 patients with PSC(after S. Sherlock, J. Dooley, 1999)
| Symptom | Number of patients | % |
| Jaundice | 21 | 72 |
| Itching | 20 | 69 |
| Reducing body weight | 23 | 79 |
| Pain in the right upper quadrant of the abdomen | 21 | 72 |
| Acute cholangitis | 13 | 45 |
| Bleeding from esophageal varices | 4 | 14 |
| Malaise | 1 | 3 |
| Asymptomatic | 2 | 7 |
| Total | 29 |
PSC is often combined with lesions of other organs and systems. Diseases associated with PSC:
Chronic inflammatory bowel diseases (UC, Crohn's disease);
Pancreatitis;
Joint diseases;
Sarcoidosis;
Celiac disease;
Thyroiditis;
Autoimmune hepatitis type 1.
Always, even in the absence of symptoms of intestinal disease, UC (and in rare cases Crohn's disease) should be excluded by performing sigmoidoscopy and biopsy of the rectal mucosa. PSC may be detected earlier or later than colitis. Colitis is usually chronic, diffuse, and mild to moderate in severity. The activity of cholangitis is inversely proportional to the activity of colitis. Remissions are usually long-term.
Diagnostics
The basis for diagnosing any cholangitis is the study of the clinical symptoms of the disease.
Bacterial cholangitis
1. Ultrasound. In acute cholangitis, the following are often detected: thickening of the walls of the bile ducts, increased echogenicity, the presence of gas bubbles in the bile ducts, sometimes some dilation of the ducts and unclear visualization of the lumen.
Cholangitis can often lead to the development of acute cholecystitis or develop in parallel with it. After clinical recovery from cholangitis, the echographic picture of the liver may reveal multiple hyperechoic point and small focal inclusions in the parenchyma Parenchyma is a set of main functioning elements of an internal organ, limited by connective tissue stroma and capsule.
in the areas where the intrahepatic ducts are located.
One of the common causes of cholangitis and cholecystocholangitis in some regions may be opisthorchiasis Opisthorchiasis is a helminthiasis from the group of trematodes caused by the cat fluke (Opisthorchis felineus) or the squirrel fluke (Opisthorchis viverrini); manifests itself in the early phase with the phenomena of cholangitis, pancreatitis and allergies; Humans become infected by eating infected fish.
.
2. CT scan also allows you to see the expansion of intra- and extrahepatic bile ducts.
3. If obstruction of the bile ducts is suspected, perform ERCP ERCP - endoscopic retrograde cholangiopancreatography
.
Primary sclerosing cholangitis
1. ERCP- the method of choice; transhepatic cholangiography can also be successfully used. The diagnostic criterion is the identification of areas of uneven narrowing and expansion (clearness) of the intra- and extrahepatic bile ducts.
2.Ultrasound detects thickening of the bile duct walls and signs of portal hypertension Portal hypertension is venous hypertension (increased hydrostatic pressure in the veins) in the portal vein system.
.
3. CT scan allows visualization of minimally dilated areas along the bile ducts.
Laboratory diagnostics
Bacterial cholangitis
1. Signs of inflammation:
- leukocytosis with a shift of the formula to the left;
- increase in ESR ESR - erythrocyte sedimentation rate (nonspecific laboratory blood indicator, reflecting the ratio of plasma protein fractions)
.
2. Cholestasis: increased activity of alkaline phosphatase, GGT Gamma-glutamyl transpeptidase (GGT) is an enzyme involved in amino acid metabolism
, bilirubin concentration.
3. Cytolysis (rarely): increased activity of serum transaminases.
Notes:
1. High bilirubin levels occur mainly in patients with malignant obstruction.
2. A simultaneous increase in amylase indicates a possible obstruction in the area of the Vater nipple.
3. Blood culture results are positive in almost 50% of patients. Bile culture results are positive in almost all patients.
Several organisms have been identified as the most common (in approximately 60% of patients): Escherichia coli, Klebsiella, Enterococcus species. Of the anaerobic pathogens, Bacteroides fragilis was the most frequently isolated culture.
Primary sclerosing cholangitis(PSH)
1. Cholestasis:
- increase in alkaline phosphatase activity 3 times higher than normal Attention!
;
Bilirubin levels fluctuate significantly and in rare cases exceed 170 µmol/l;
- in all patients with severe and prolonged cholestasis, the content of ceruloplasmin and copper in the blood serum may increase.
2. Levels of gamma globulins and IgM increase in 30 and 50% of cases, respectively.
3. Low titers of anti-smooth muscle antibodies (SMA) may be detected in the serum; p-ANCA is present in 84% of patients; anticardiolipin (ACL) antibodies - in 66% of cases; antinuclear antibodies (ANA) - in 53% of cases. Antimitochondrial antibodies (AMA) are usually absent.
4. Eosinophilia (rare).
Notes:
1. Some patients with hypothyroidism, hypophosphatemia, magnesium or zinc deficiency may have normal alkaline phosphatase levels.
2. Hypoalbuminenmia is sometimes noted, which occurs either in the later stages of the disease or in the presence of an active stage of inflammatory bowel disease.
Biopsy and morphological examination of liver tissue
Morphological studies of liver tissue are carried out to confirm the diagnosis of PSC (morphological data are especially valuable in cases of damage to small bile ducts).
Stage 1. The early stage of bile canaliculus damage does not have specific signs. Focal atrophy and disruption of epithelial alignment are typical. Hyperplasia is not typical Hyperplasia is an increase in the number of cells, intracellular structures, intercellular fibrous formations due to enhanced organ function or as a result of pathological tissue neoplasm.
biliary epithelium, characteristic of patients with primary biliary cirrhosis. Possible focal obliteration Obliteration is the occlusion of the cavity of an internal organ, canal, blood or lymph vessel.
and division of the bile ducts. Signs of moderate lymphocytic inflammatory infiltration are visible in the portal tracts. Sometimes lymphoid follicles without germinal centers are visible, rarely granulomas.
Stage 2. Characteristic signs of lobular hepatitis, often reminiscent of autoimmune hepatitis or chronic hepatitis C. Proliferation of the bile ducts is typical (usually focal). Moderate fibrosis of the portal tracts is possible. At this stage, signs of hepatitis have a more serious prognostic significance than damage to the bile ducts.
Stage 3. Typical (not pathognomonic Pathognomonic - characteristic of a given disease (about a sign).
) sign of PSC - periductular fibrosis ("onion peel symptom"). The presence of ductopenia and fibrous fields in areas of loss of bile canaliculi is very characteristic.
In the portal tracts, only the branches of the portal vein and hepatic artery are visible (the bile ducts are obliterated). The parenchyma is dissected by portoportal fibrous septa, the inflammatory infiltrate is less pronounced Infiltrate is an area of tissue characterized by the accumulation of cellular elements that are usually unusual for it, increased volume and increased density.
. In the periportal zones, copper deposits, intralobular cholestasis, and, in some cases, Mallory bodies are detected.
Stage 4. Characterized by widespread fibrosis of the biliary type with signs of biliary cirrhosis of the liver. This fact may complicate the differential diagnosis between PSC and primary biliary cirrhosis.
Differential diagnosis
Bacterial cholangitis should be differentiated from infectious hepatitis, as well as from infectious and non-infectious lesions of other parts of the biliary tract, gallbladder, and pancreas.
Primary sclerosing cholangitis differentiated from the cholestatic form of sarcoidosis (granulomatous lesions of the bile canaliculi are not typical for sarcoidosis).
Primary biliary cirrhosis is another, more common, cholestatic disease in which the bile canaliculi are affected by immune inflammation. In diagnostically unclear cases, the determination of antimitochondrial antibodies is indicated.
Complications
Bacterial cholangitis
The main complication is “septic” or “acute biliary septic” shock, which is hemodynamic disturbances that develop as a result of the penetration of microorganisms from bile into the systemic circulation. Such shock is diagnosed in 10-30% of patients with biliary tract infection; its development is accompanied by high mortality.
Possible development of an abscess Abscess - a cavity filled with pus and delimited from surrounding tissues and organs by a pyogenic membrane
liver, phlebitis Phlebitis - inflammation of the vein wall
portal vein and other purulent-septic complications.
Primary sclerosing cholangitis:
- bacterial cholangitis;
- cholangiocarcinoma (10-30%);
- increased risk of developing colorectal cancer.
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Related diseases and their treatment
Title: Chronic cholangitis.
Description
Inflammatory disease of the biliary tract (both intra- and extrahepatic ducts), characterized by a long-term recurrent course and leading to cholestasis. The main clinical signs are a combination of pain in the liver, high fever, chills and jaundice. The diagnosis is established on the basis of ultrasonography of the pancreas and biliary tract, retrograde cholangiopancreatography, computed tomography of the biliary tract, biochemical and general blood tests. Combined treatment: conservative antibacterial therapy, pain relief, detoxification, surgical decompression of the biliary tract.
Additional facts
Chronic cholangitis is much less common than other inflammatory diseases of the hepatobiliary system. This pathology develops mainly in the adult population (average age is about 50 years), with no significant differences in incidence between men and women. Most often, chronic cholangitis occurs against the background of other diseases of the liver and gallbladder; in 37% of cases it forms after cholecystectomy. There is a special form of this disease - primary sclerosing cholangitis, which develops against a background of relative health, slowly progresses and leads to irreversible liver damage over about ten years. The true incidence of sclerosing cholangitis is unknown, since its diagnosis is difficult. Among patients, young men predominate (the disease manifests itself at the age of 20-25 years). In recent years, there has been a trend of increasing cases of sclerosing cholangitis, which is associated primarily with improved diagnosis. Depending on the timing of detection and the course of the disease, mortality in chronic cholangitis can vary between 15-90%.
Causes
Symptoms
The clinical picture of chronic cholangitis is characterized by the identification of Charcot's triad - it is manifested by a combination of moderate pain in the right hypochondrium, chills and fever to subfebrile levels, and jaundice. The pain is usually dull, aching, low-intensity. Some time after biliary colic, the patient notices a moderate fever accompanied by mild chills. The clinical picture of chronic cholangitis is usually blurred and recurrent, so patients do not always attach importance to the first manifestations of the disease. In later stages of the disease, icterus of the skin and mucous membranes may appear. General weakness and increased fatigue gradually develop, especially pronounced in old age. After 60 years, the diagnosis of chronic cholangitis is usually difficult, since the clinical picture does not correspond to the severity of the inflammatory process, the symptoms are erased, so the diagnosis is made late.
Diagnostics
Consultation with a gastroenterologist is required for all patients with suspected biliary tract pathology. The basis for making a correct diagnosis is determining the patient's Charcot triad. Further examination begins with laboratory tests. A general blood test for chronic cholangitis reveals high leukocytosis, a neutrophil shift in the leukocyte count, and an increased ESR. Biochemical screening reveals an increase in the level of bilirubin, alkaline phosphatase and G-GTP activity, and rarely - the activity of transaminases and alpha-amylase. Microbiological studies in almost 100% of patients indicate the presence of intestinal flora in the bile, in half of the patients - in the blood.
Instrumental diagnostic methods have also found widespread use in chronic cholangitis. Thus, ultrasonography of the pancreas and bile ducts indicates expansion and thickening of the walls of the bile ducts. CT scan of the biliary tract will not only confirm the data obtained during ultrasound, but will also help identify complications of purulent cholangitis (liver abscesses, pylephlebitis).
A consultation with an endoscopist is needed to conduct retrograde cholangiopancreatography, which will help visualize stones in the biliary tract and indicate their expansion. In recent years, magnetic resonance cholangiopancreatography has replaced ERCP, as it is a non-invasive technique that allows not only to identify signs of chronic cholangitis, but also to determine the causes of its development. If a diagnostic search is carried out before surgery, percutaneous transhepatic cholangiography can be used - through a needle inserted into the bile ducts, not only their contrast is carried out, but also drainage.
Differential diagnosis
Chronic cholangitis should be differentiated from viral hepatitis, blockage of the bile ducts due to cholelithiasis, acute and calculous cholecystitis, tumors (of the liver, pancreas, bile ducts), strictures of the bile ducts of other etiologies.
Primary sclerosing cholangitis is a chronic cholestatic syndrome characterized by areas of inflammation, fibrosis and narrowing in the intrahepatic and extrahepatic bile ducts.
In approximately 80% of patients, primary sclerosing cholangitis is combined with ulcerative colitis. The disease leads to obliteration of the biliary tract with cirrhosis, liver failure and, sometimes, cholangiocarcinoma.
In the early stages of the disease, symptoms of ulcerative colitis are noted, and symptoms such as weakness and itching appear late.
Diagnosis of the disease is based on ERCP or MRCP.
There are no specific treatment methods. If the lesion is severe, liver transplantation is indicated.
- Epidemiology of primary sclerosing cholangitis
The worldwide prevalence of primary sclerosing cholangitis is unknown. The prevalence of the disease in the United States is about 6.3 cases per 100,000 population. In Scandinavian countries, the prevalence of this disease is slightly higher.
In approximately 80% of patients, primary sclerosing cholangitis is combined with chronic inflammatory bowel disease (primarily ulcerative colitis). However, in Japan, the combination of ulcerative colitis and primary sclerosing cholangitis is observed in only 23% of cases.
Approximately 70% of patients with primary sclerosing cholangitis are men. The average age of sick men is about 40 years.
In women, primary sclerosing cholangitis is usually not combined with ulcerative colitis and the disease develops at an older age than in men.
- ICD-10 code
K83.0 Cholangitis.
Upon examination, severe jaundice, loss of body weight and, sometimes, traces of scratching due to itching are revealed.
Hepatomegaly is common, and approximately 1/3 of patients also have splenomegaly.
With the progression of primary sclerosing cholangitis, signs of liver failure are observed: dilation of the veins on the anterior abdominal wall ("head of the medusa"), ascites and muscle atrophy.
- Differential diagnosis
Since primary sclerosing cholangitis, along with skin itching and jaundice, is usually accompanied by a rise in body temperature (often with chills), it must be differentiated from chronic bacterial cholangitis.
In chronic bacterial cholangitis, there is always leukocytosis (more than 15,000 per μl) and an increase in ESR (up to 30 mm/h or more), which is not typical for primary sclerosing cholangitis.
In chronic bacterial cholangitis, which has developed as a result of obstruction of the bile ducts, there is an expansion of the lumen of the bile ducts, which can be confirmed using ultrasound, and especially ERCP, which allows not only to detect choledocholithiasis or stricture, but also to eliminate the cause of cholestasis.
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Cholangitis is an inflammatory process in the bile ducts (cholangiolitis - damage to small bile ducts; cholangitis or angiocholitis - damage to larger intra- and extrahepatic bile ducts; choledochitis - damage to the common bile duct; papillitis - damage to the papilla of Vater). As a rule, it occurs against the background of obstruction of the biliary tract. Infection of the bile can provoke inflammation. Often the pathology occurs together with cysts of the common bile duct, as well as cancer of the bile ducts. The disease occurs when bacterial pathogens enter the bile ducts.
ICD-10 code
This disease belongs to the cycle - other diseases of the biliary tract (K83). True, in this case, conditions that relate to the gallbladder (K81-K82), cystic duct (K81-K82) and postcholecystectomy syndrome (K91.5) are excluded.
K83.0 Cholangitis. Cholangitis: ascending, primary, recurrent, sclerosing, secondary, stenotic and purulent. Completely excluded: cholangitis liver abscess (K75.0) cholangitis with choledocholithiasis (K80.3-K80.4) chronic non-purulent destructive cholangitis (K74.3).
K83.1 Obstruction of the bile duct. Occlusion, stenosis of the bile duct without stones, narrowing. Completely excluded: with cholelithiasis (K80).
K83.2 Perforation of the bile duct. Rupture of the bile duct. K83.3 Bile duct fistula. Choledochoduodenal fistula. K83.4 Spasm of the sphincter of Oddi. K83.5 Gall cyst. K83.8 Other specified diseases of the biliary tract. Adhesions, atrophy, hypertrophy of the bile duct, ulcer. K83.9 Disease of the biliary tract, undiagnosed.
ICD-10 code
K83.0 Cholangitis
K80.3 Bile duct stones with cholangitis
A common cause is the presence of benign structures of the pancreas, Caroli disease, sphincter dyskinesia. The disease can be caused by the reflux of the contents of the small intestine into the biliary tract, as well as complications resulting from reconstructive operations on the bile ducts. There are several routes through which the infection enters the bile ducts. Often everything happens hematogenously, or lymphogenously. The causative agents can be microorganisms of the intestinal microflora that are found in associations. Most often the disease is bacterial in nature. It can be provoked by representatives of the Enterobacteriaceae family, gram-positive microorganisms, and non-spore-forming anaerobes.
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Pathogenesis
The main cause of the disease is its combination with a violation of the outflow of bile. In its pure form it does not occur so often; it is mainly combined with cholecystitis or hepatitis. The problem is mainly caused by a bacterial infection. It can penetrate the bile ducts through the intestines or along with the bloodstream. The most common pathogen is Escherichia coli. Extremely rarely it is enterococcus, staphylococcus and anaerobic infection.
The mechanism of development lies in the stagnation of bile. This is observed when the passages are blocked by a stone. The phenomenon can be provoked by a bile duct cyst, ulcer, or endoscopic manipulation of the common bile duct. In general, any problems associated with the outflow of bile. Therefore, problems resolved in time can reduce the risk of developing the disease. Based on the nature of inflammation, the disease is divided into several types. Thus, cholangitis can be catarrhal, purulent and diphtheric.
Symptoms of cholangitis
The acute form of the disease can occur against the background of complications due to total obstruction of the gallbladder. It is extremely rare that everything occurs as a complication of the common bile duct. The clinical picture of the manifestation includes malaise, jaundice, pain in the scapula and forearm. All this can lead to fever, nausea, and vomiting. The person suffers from confusion and arterial hypotension is observed. Patients experience thrombocytopenia. It is a manifestation of intravascular coagulopathy.
The acute form of the disease has slightly different symptoms. More precisely, it has a more acute course. In most cases, a person is plagued by dyspeptic disorders that occur without fever and jaundice. There is no pain syndrome. In the intervals between exacerbations, symptoms may be completely absent. If the liver is also affected, then to all the signs are added those that correspond to parenchymal jaundice.
Sometimes the disease can begin similar to sepsis. So, a person is plagued by alternating chills and fever. The severe form is accompanied by septic shock and renal failure. The frequency of fever depends on the pathogen that provoked the disease. Pneumococcal cholangitis is extremely difficult to resolve. As soon as biliary hypertension decreases, symptoms disappear. During an exacerbation, the liver can increase in size.
In the chronic course, everything is accompanied by dull pain, a feeling of pressure, itching, and slight yellowness of the mucous membranes. Often manifests himself unmotivated by low-grade fever. In older people, severe asthenic syndrome is observed. It is characterized by fever and pain.
First signs
Much depends on what form of the disease a person has. Thus, chronic cholangitis is characterized by an asymptomatic course, which is accompanied by an acute form, but only occasionally. This condition is characterized by fever, severe cramping pain in the abdomen and chest. Weakness, nausea, vomiting and a sharp drop in blood pressure are especially pronounced. Based on these symptoms, it is possible to make a diagnosis.
Chronic cholangitis does not have the first symptoms, as it is practically asymptomatic. This is the main danger. The disease can lead to renal coma. Therefore, if any discomfort occurs or there are problems accompanying the development of cholangitis, you should seek help from a medical institution. The chronic form is characterized by the appearance of pain of varying intensity. A person feels tired, itchy skin, and an increase in temperature. Redness of the palms is often observed. The terminal phalanges of the fingers can thicken.
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Charcot's triad for cholangitis
The acute form of the disease is characterized by the presence of Charcot's triad. It consists of three main symptoms. Typically, this is pain in the right upper quadrant of the abdomen, fever and jaundice. Determining the presence of the last two signs is very simple. To do this, it is enough to examine the liver; it is clearly enlarged and this is noticeable upon palpation.
There is also Murphy's sign. It is characterized by the presence of point sensitivity in the area of the gallbladder. This can be easily determined by palpation. There is sensitivity in the right hypochondrium. It usually spreads across the entire width of the liver. Liver edema can have varying degrees of severity. Therefore, it is easy to determine the presence of this symptom. If the clinical manifestations are correctly assessed, the treatment will not only be correct, but also effective.
Therefore, patients with cholecystitis or biliary colic are referred for ultrasound. This will confirm or deny the existence of a problem. If the pathology is not identified in a timely manner, it can actively progress. This adds a couple more symptoms, namely confusion and septic shock. These signs, together with Charcot's triad, can lead to death. Decisions regarding hospitalization and treatment must be made within an hour.
Sclerosing cholangitis
Primary sclerosing cholangitis (PSC) is a condition characterized by the production of antibodies to the bile ducts. All this is accompanied by a violation of the outflow of bile. The causes of this form of the disease are unknown. It is believed that the problem is associated with the presence of an infectious agent, which is a provoking factor in people with a genetic predisposition.
Men are susceptible to this phenomenon much more often than women. Pathology develops at the age of 25-45 years. In some cases, this happens in young children. In almost 70% of cases, cholangitis is accompanied by ulcerative colitis. It can be combined with diabetes mellitus, as well as thyroiditis.
The disease does not manifest itself clearly. The symptoms are simple; they consist of changes in biochemical parameters. Most often accompanied by the absence of signs. At the beginning of the disease, a person begins to lose weight sharply, he experiences itchy skin, pain in the right hypochondrium, and jaundice. If symptoms begin to manifest themselves, then the process is severe. Fever is not specific.
Diagnosis of the disease consists of examining blood serum. The condition is characterized by an increase in alkaline phosphatase, as well as bilirubin, the level of γ-globulins, and IgM. During an ultrasound, thickening of the walls of the bile ducts is observed. The disease is characterized by the development of liver damage, which is accompanied by cirrhosis and hepatocellular failure.
Acute cholangitis
The acute course of the disease is characterized by chills and fever. Profuse sweating, bitterness in the mouth, and vomiting cannot be ruled out. Often there is pain in the right hypochondrium. Sometimes the pain is too intense. The liver can increase in size, accompanied by jaundice and itchy skin.
Sometimes there is elevated temperature and aching pain in the right hypochondrium. There is weakness and fatigue. A person gets tired quickly and gets chills. The liver and spleen are characterized by considerable size. The disease can lead to complications. They are characterized by the presence of suppuration and necrosis.
The disease often leads to sclerosis of the bile ducts. All this eventually leads to the development of hepatitis. The outcome of the situation is cirrhosis of the liver. The diagnosis is made by symptoms. On palpation, the liver is significantly enlarged. To confirm the diagnosis, a number of x-ray and laboratory tests are performed. History of gallbladder disease.
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Chronic cholangitis
This disease is characterized by chills, which are accompanied or alternated by fever. A person is plagued by profuse sweating, bitterness in the mouth, as well as vomiting and pain in the right hypochondrium. The liver may become significantly enlarged. Jaundice and skin itching often occur. There is an increased level of leukocytes in the blood.
The chronic form of the disease occurs against the background of a previously existing acute period. The clinical picture is similar. A person is bothered by an elevated subfebrile temperature, as well as yellowness of the sclera. Aching pain appears in the area of the right hypochondrium. The victim quickly gets tired, he shows weakness, and sudden weight loss. The liver and spleen are rather enlarged.
The chronic form can lead to a number of complications. Suppuration, hepatitis and even cirrhosis of the liver may occur. Therefore, it is impossible to allow this disease, especially its progression. On palpation, a sharp enlargement of the liver is felt. It is important to diagnose the disease in time and begin its treatment.
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Bacterial cholangitis
Most often, the classical form manifests itself, namely Charcot's Triad. The person is plagued by pain, accompanied by jaundice and fever. Pain sensations are localized mainly in the epigastric region. Most often, patients complain of intense or colicky pain. In rare cases, discomfort is felt.
This pathology is characterized by an increase in temperature, up to 39 degrees. Sometimes it is much higher. In addition, headache and chills are observed. During the examination, the doctor notices an enlarged liver, as well as pain in the right side. In almost all cases, leukocytosis is observed.
Diagnosis is carried out by laboratory tests. Instrumental research is being actively carried out. Usually, donating blood is enough. Additionally, you can take a coprogram and a urine test, but only after the doctor’s approval. Ultrasound, ECG and CT are performed. It is important to diagnose the problem in time and begin treatment.
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Giardia cholangitis
This disease is caused by common lamblia. The pathology occurs in both adults and children. It is transmitted mainly through unwashed hands, by penetration into the mouth. Bacteria live in the duodenum, as well as the upper intestines. Sometimes found in the gallbladder.
Determining the presence of a problem is not so easy, because it is closely related to other diseases of the intestines, as well as the biliary tract. Pathology can be diagnosed only by detecting the simplest Giardia. Despite this, symptoms are still observed. So, a person suffers from pain in the right hypochondrium, nausea, dizziness, as well as problems with the gastrointestinal tract. Heartburn, diarrhea, or constipation may occur. Sometimes there is an increase in temperature, as well as pain syndromes in the liver area. The problem can be eliminated only by following a special diet. Observation by a gastroenterologist is mandatory.
Purulent cholangitis
Clinically, this pathology manifests itself in the form of fever and jaundice. The person may experience confusion and hypotension. Over time, renal failure may develop, resulting in thrombocytopenia. The condition must be eliminated by medical intervention.
Everything can be diagnosed through laboratory tests. Usually, the person is referred for blood culture and white blood cell count. Consider indicators of kidney functionality. An ultrasound is performed. Even with negative results, endoscopic cholangiography is recommended.
Treatment consists of using broad-spectrum antibiotics. Detailed information about medications of this type will be provided below. Fixing the problem is not that difficult, but the work is painstaking. Therefore, it is advisable to seek help from a doctor when the first symptoms appear. Comprehensive elimination of the problem will help eliminate the disease once and for all.
Cholangitis after gallbladder removal
From the liver, bile must flow into the gallbladder. Here it accumulates and reaches a certain concentration. As soon as food enters the body, concentrated bile is sent to the duodenum and then participates in the digestion and absorption of fats.
When surgery is performed to remove the gallbladder, bile begins to flow directly into the duodenum. It comes directly from the liver. But bile is less concentrated; it is simply unable to perform its main function. It does not participate in the digestion process, or rather does not give the necessary result.
In order to avoid complications, a person must follow a special diet. Otherwise, stagnation of bile in the liver will occur. The danger of developing an inflammatory process is at a high level. Cholangitis may appear first. The patient should eat little and often, 6-7 times. In this case, there will be no complications.
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Calculous cholangitis
This pathology does not arise just like that. For its development there must be a special impetus. As a rule, it consists in the presence of an infectious focus in the body. In order to defeat the immune system, the infection must be very strong and the body's functions must be significantly weakened. Only in this way is the development of the disease possible.
Often everything occurs against the background of cholecystitis. The fact is that the source of infection is located too close to the liver and ducts. Therefore, its penetration into the bile ducts is quite likely. Plus, there is stagnation of bile, which significantly aggravates the situation. Stagnation always leads to the development of a severe infection.
Inflammation can lead to swelling and redness. They are the companions of inflammation. It is important to pay attention to the main symptoms in time and begin treatment. A person suffering from cholangitis at this stage is characterized by high fever, jaundice and dull pain in the liver area.
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Autoimmune cholangitis
The disease, in its histological characteristics, resembles primary biliary cirrhosis. However, it is characterized by the presence of anti-myochondrial antibodies, as well as antinuclear antibodies and/or anti-smooth muscle antibodies. Thus, the disease is considered idiopathic, with a mixed pattern of hepatitis and cholestasis present.
The main symptoms are immune cholangitis. However, the definition of the disease is ambiguous. It is not clear for what reasons it developed. More precisely, how the disease intersects with the syndrome of primary biliary cirrhosis, as well as hepatitis. Cholangitis of this type can take the form of an independent disease. Seeing this fine line is not so easy. The problem does not occur so often, but only in 5-10% of cases.
It is important to start diagnosing the disease on time. Moreover, it is necessary to correctly determine what form the pathology is in. Correct diagnosis and treatment will help cope with the problem.
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Biliary cholangitis
The disease is an idiopathic liver pathology. The problem mainly affects only adults. It mainly affects middle-aged women. Young men are also susceptible to it. The disease is characterized by diffuse inflammatory and fibrotic changes throughout the biliary tree.
The root cause of the problem has not yet been identified. There are several main signs that indicate the presence of the disease. Thus, cholangitis is often associated with other autoimmune diseases. The presence of antibodies circulating in the blood often provokes the development of pathology. During it, the bile ducts are affected. A family predisposition can provoke the disease.
Finding the problem is not so easy. Usually it comes in combination with another problem. It is necessary to take blood tests and examine the liver. This will help track your white blood cell count as well as other vital signs. Then quality treatment is prescribed.
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Stenosing cholangitis
The onset of the disease is asymptomatic. Everything develops gradually, so nothing bothers a person for a long time. The first manifestation is an increase in serum g-glutamyl transpeptidase (GGTP) and alkaline phosphatase (ALP) activity. That is, there are no visual manifestations. The problem can only be identified by donating blood.
An asymptomatic course is especially dangerous, because it can lead to the development of liver cirrhosis, as well as portal hypertension. But no signs of cholestasis are observed. Most often, “cryptogenic cirrhosis” is diagnosed directly.
It is much better when the disease begins to manifest itself. This will avoid possible complications and save the person. Everything manifests itself in the form of fever, fatigue, and constant pain. There may be changes in body weight, as well as itchy skin. At an advanced stage, jaundice develops. Gradually, liver cell failure appears, and as a consequence, biliary cirrhosis forms.
Pathology can be diagnosed exclusively through laboratory tests. The disease is manifested by slight hyperbilirubinemia and an increase in the level of IgM, an increase in the level of CEC (70% of cases).
Recurrent cholangitis
If the outflow of bile is constantly disrupted, the disease progresses and becomes chronic. Repeated repetition of this process leads to the fact that pathology is constantly present and pesters a person everywhere. Naturally, everything alternates between periods of calm and serious manifestations of the disease.
The period of exacerbation is characterized by the presence of acute pain in the right hypochondrium. All this is accompanied by fever, jaundice and itchy skin. The outflow of bile can spontaneously recover. But this happens during so-called periods of calm. Then the pain gradually subsides, the person’s condition improves, and no signs of jaundice are observed. The person feels much better. But this state will not last long. Over time, a phase of active manifestation of the pathology will begin. The symptoms are constantly recurring. It is important to maintain a person's condition. Otherwise, the condition will worsen significantly. Constantly occurring relapses predict the development of a chronic form.
Hematogenous cholangitis
It is characterized by hematogenous spread of the infectious agent. The disease can progress in different ways. So, its forms can be varied. The development option depends on the reason why cholangitis appeared.
All forms of development are based on bacteria or protozoan microorganisms that penetrate the body. Most often these are opportunistic microflora, Giardia, helminths. Inflammation of the gallbladder, the presence of stones in it, as well as helminthic infestation can serve as a background for the development of the disease. Stagnation of bile provokes the development of cholangitis.
The pathology is characterized by an acute onset. Usually a sharp rise in temperature is recorded, up to 40 degrees. In parallel with this, the person feels pain in the right side. Moreover, the pain syndrome can be of varying intensity. Sometimes it just feels like colic. The entire right half, side, shoulder, neck and shoulder blade area can pull. In these places there are bundles of nerve endings. As it progresses, skin itching, nausea, vomiting, and loss of appetite appear.
Cholangitis in children
The acute form of the disease in children is extremely rare. It mainly carries a secondary form. Initially, the baby may suffer from streptococcal etiology, and then this pathology will arise. Sometimes it has dire consequences. So, pleurisy, lung abscess, sepsis and pancreatitis cannot be ruled out. If the treatment method is chosen incorrectly, toxic liver dystrophy may develop.
Primary pathology has acute symptoms. If it is chronic, then there are no signs. Only occasionally does the baby feel pain in the right hypochondrium; he is plagued by weakness, chills and fever. Typically, this manifestation is characteristic of the acute phase. With secondary development, biliary cirrhosis of the liver cannot be excluded. Diagnosis is very difficult, and the disease itself has a complex course.
This form is best treated surgically. Because the future condition of the child depends on this. You should not allow it to become chronic. There can be many consequences. It is important to maintain proper nutrition.
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Classification of cholangitis
By etiology:
- Bacterial.
- Helminthic.
- Toxic and toxic-allergic.
- Viral.
- Autoimmune.
With the flow:
- Spicy.
- Chronic.
By pathogenesis:
Most often, cholangitis is of a bacterial nature and the causative agents are most often Escherichia coli, enterococci, Friedlander's bacillus, pneumococci, streptococci.
Consequences
If there is no timely treatment, the inflammatory process can become more serious. Gradually it spreads to the peritoneum, which can lead to the development of peritonitis. Pathology can “spread” to surrounding tissues. As a result, subphrenic and intrahepatic abscesses begin to form. Sepsis and toxic shock often occur. The last complication develops against the background of a bacterial form of cholangitis.
The condition of the patients becomes extremely serious. Sometimes it is impossible to do without resuscitation measures. The inflammatory process over a long period of time can lead to sclerotic changes. As a result, the disease takes a chronic form and leads to the development of biliary cirrhosis of the liver.
Self-medication and attempts to eliminate pathology with folk remedies, on the contrary, will worsen the situation. And in general, such interference is unacceptable. After all, time may be lost, and the pathology will become more serious. In the later stages, the prognosis is far from the most favorable.
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Complications
If a person is not given timely treatment, complications can be aggravating. Most often it ends in cirrhosis of the liver. In order to prevent such developments, it is enough to start treatment on time. Often cholangitis leads to peritonitis. The peritoneum becomes inflamed, and the surrounding tissues are also affected. As a consequence of this, toxic shock may develop. The patient has a hard time with all the symptoms and needs help in the form of resuscitation measures.
A long-term inflammatory process leads to the appearance of a chronic form of the disease. This can lead to changes in liver tissue. Ultimately, biliary cirrhosis takes its toll.
In this case, trying to fix the problem yourself is stupid. While a person tries to remove all the signs, the disease will begin to progress and it is not always possible to save the victim. This should be taken with complete seriousness.
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Diagnosis of cholangitis
It’s easy to suspect a problem using Charcot’s triad. Thus, diagnosis is carried out against the background of laboratory and instrumental studies. Biochemical tests can indicate cholestasis. In the presence of cholangitis, there is an increase in the level of bilirubin, as well as a-amylase and alkaline phosphatase.
There are visualization methods for assessing the condition. As a rule, this is an ultrasound of the abdominal cavity and liver. It will allow you to determine the presence of an inflammatory process and organ enlargement. CT scans are not performed very often. This will allow you to see an accurate image of the bile ducts and their expansion, as well as the presence of focal changes.
Instrumental diagnostics are also widely used. It occupies a leading position in the definition of pathology. So, it is endoscopic retrograde cholangiopancreatography, as well as magnetic resonance cholangiopancreatography. The resulting images show the bile ducts and the cause of their obstruction.
Differential diagnosis is necessary only in the presence of viral hepatitis, right-sided pneumonia, and primary biliary cirrhosis.
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Tests for cholangitis
An experienced specialist is able to make a diagnosis with just one examination. After all, it is worth listening to the patient and palpating so that the picture becomes more or less clear. But, nevertheless, tests are necessary in order to clarify in what phase the disease is located. This will allow us to identify the processes accompanying it and assess the situation as a whole. After all, an important place in this matter is given to the functionality of the liver and other organs.
First of all, the patient is asked to take a blood test. Thanks to it, the level of leukocytes is determined. A significant increase in them indicates an inflammatory process in the gallbladder. A urine test is also given. This pathology is characterized by a positive reaction to bilirubin.
A biochemical blood test is performed. It shows the level of bilirubin, as well as gamma globulins, amylase, alkaline fast phase and alpha-2 globulins. It is recommended to take a blood test for sterility. This will rule out or confirm the presence of bacteria. This analysis is carried out exclusively in specialized institutions, because it requires compliance with certain rules. Duodenal intubation is also prescribed. This procedure will allow you to collect bile and study it.
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Instrumental diagnostics
This research methodology includes several main directions. So, the first of them is an ultrasound examination, in other words, usually an ultrasound. Thanks to it, you can detect an increase in the size of the liver and notice the expansion of the bile ducts.
The second option for instrumental diagnosis is retrograde cholangiopancreatography (ERCP). This method is the main one. It is an X-ray examination of the bile ducts by introducing a special contrast agent into them using an endoscope. The technique allows you to study changes in the bile ducts. With primary cholangitis, changes in the person are visible.
Magnetic resonance cholangiography is also widely used. A special place is given to computed tomography. Duodenal intubation is also used. It allows you to examine the bile and see any changes in it. All methods can be used either independently or in combination. Much depends on the condition of the patient himself.
Ultrasound diagnostics
You can notice changes in the liver and abdominal cavity using ultrasound. Foci of infection, changes in size and shape should immediately lead the specialist to the idea that the victim has cholangitis. Naturally, everything is combined with laboratory tests and manifested symptoms.
The examination clearly shows the uneven width of the lumen of the bile ducts. They increase significantly inside or outside the kidneys, and they are echogenic. The unevenness is clearly visible. The portal arteries occupy a protruding position. With complications, changes in the contours of the liver are visible. Echogenic material is observed in the lumen of the duct.
Ultrasound examination allows for an accurate diagnosis. It can be confirmed using endoscopic retrograde cholangiography. Naturally, everything is supported by biopsy and clinical data. Based on the data obtained, a diagnosis is made and the person is prescribed high-quality treatment.
Differential diagnostics
This technique includes a blood test. Thanks to it, it is possible to detect the presence of an inflammatory process in the body. This is usually indicated by an increase in ESR and leukocytes. Not the least role is given to biochemical blood analysis. This study shows the level of bilirubin, especially the direct fraction. The level of alkaline fast phase and gamma-glutamyl transpeptidase is determined. These indicators are closely related to the outflow of bile. Any changes in them indicate the presence of violations during this process. An increase in transaminase activity indicates toxic liver damage. In principle, it is impossible to do without differential diagnosis. Laboratory tests are especially important.
A general urine test is also performed. Here you can notice the appearance of bile pigments. Feces are tested for the presence of helminth eggs and other protozoan organisms. Differential diagnosis strictly interacts with instrumental diagnostics.
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With conservative elimination, the patient must refuse food during the first three days, and then begin a gentle diet. This will suppress the activity of pathogens. After all, they have nowhere to get food from. Broad-spectrum antibiotics are used along with a special diet. Metronidazole is commonly used. In order to reduce pain, antispasmodics and analgesics are used. It is recommended to pay attention to Drotaverine and Meverine. If a person is severely intoxicated, he is given a glucose-saline solution.
The surgical intervention is liver transplantation. It is commonly used for cirrhosis, recurrent bacterial cholangitis and persistent jaundice.
Medicines
As mentioned above, drugs are widely used that reduce pain, eliminate infection and promote rapid recovery of the body. The most popular drugs are: Drotaverine, Meverine, Albendazole, Ademeteonine, Hollestyramine, Ursodeoxycholic acid and Rifampicin. Antibiotics are considered separately.
Broad-spectrum antibiotics are used to suppress infection. These include Metronidazole, Tetracycline and Levomecitin. You can take them for no more than 2 weeks in an individual dosage.
- Metronidazole. This is an antimicrobial drug. Take it one tablet 2-3 times a day. In special cases, the dosage is increased to 4-5 tablets. You should not make adjustments yourself; the product has a number of side effects. Thus, nausea, vomiting, weakness, a metallic taste in the mouth, and dizziness are possible. If symptoms appear, you should consult a doctor. Contraindications: pregnancy, childhood, hypersensitivity and breastfeeding.
- Tetracycline. This drug has a bacteriostatic effect. It should be used at a dose of 200-250 mg 2-3 times a day. For children, 20-25 mg/kg is enough. The duration of treatment is determined individually. Contraindications: hypersensitivity, pregnancy, lactation, impaired liver and kidney function. Side effects: skin pigmentation, inflammation of the mucous membranes, dysbacteriosis, allergic reactions. Usually the drug is well tolerated. ]
- Recipe 1. To prepare it you need to take 6 tablespoons of stinging nettle, 3 tablespoons of agrimony herb and sandy immortelle flowers. Corn silk and St. John's wort herb are taken in the amount of 2 tablespoons. All this is mixed together. To prepare, just take 2 tablespoons of the mixture and mix them with honey. After which everything is poured with boiling water in the amount of 500 ml. The product must be infused for 2 hours. Then use half a glass 3-6 times a day. ], , , , ,
- Recipe 1. You need to take a tablespoon of St. John's wort herb and pour a glass of boiling water over it. Then put on fire and boil for about 15 minutes. The resulting product is taken a quarter glass 3 times a day. The decoction can have a pronounced anti-inflammatory effect, as well as provoke the outflow of bile.
- Recipe 2. Pour a glass of boiling water over a spoonful of oregano herb. The product is infused for 2 hours. You need to take it a quarter glass 3 times a day. The product is really effective, but pregnant girls should not take it.
- Recipe 3. Take 100 grams of corn silks and mix with 75 grams of marigolds and yarrow. All this is poured with two glasses of boiling water (it is enough to take 2 tablespoons). Leave the product alone at night. In the morning, everything is filtered and consumed 100 ml up to 4 times a day.
- Arsenicum album. It is a poisonous substance. It is prescribed to people who suffer from itchy skin that worsens at night. The drug often causes an allergic reaction, nausea and stomach upset.
- Baptisia tinctoria (wild indigo legume). The drug is widely used in the chronic form of the disease. Especially if it occurs along with elevated temperature, vivid dreams and feelings of heat in the morning.
- Berberis vulgaris (barberry). It is used in cases of bitterness in the mouth, aching pain, and dryness in the oral cavity. Pain syndrome may develop when moving.
- Bryonia alba (white footstep). The remedy is prescribed for very painful palpation and the presence of a pathological process in the liver.
- Cuprum (copper) and zinc (zinc). Widely used for severe spasms of the gallbladder. Can have an anti-inflammatory effect.
- Lycopodium clavatum. Used for cholangitis accompanied by liver diseases. Especially when there are pronounced symptoms. In this case we mean bitterness in the mouth, loss of appetite, heartburn.
- Diet No. 5. You need to eat food 5 times a day, in small portions. It is forbidden to eat before bed, at least not to overeat. Hot and spicy dishes are prohibited. You will have to give up garlic, horseradish and radish. Alcohol is strictly prohibited. Fatty meat and fish should be put off until better times. A person consumes up to 3500 kilocalories per day. The daily norm is 90-100 grams of proteins, 100 grams of lipids and 400 grams of carbohydrates. It is worth including buckwheat, lean meat, fish, cottage cheese and oatmeal in your diet. As soon as the condition improves, you can switch to vegetable and milk soups. Lean meat and fish are allowed. You can eat cookies, unleavened vegetables (cabbage, carrots and potatoes). Bread is allowed, but slightly dried. Honey, sugar and berry infusions are very useful. You can create a diet yourself, based on the list of permitted foods.
- Diet No. 5a. You can eat absolutely any cereal, but they need to be boiled thoroughly. Meat and fish are consumed steamed. You can't fry anything! You should not eat raw fruits and vegetables. Rye bread is prohibited. It is advisable to spend mono-diet days on apples or cottage cheese. To avoid constipation, the diet is diluted with dried fruits, beets and vegetable juices. When the condition improves, you can switch to diet number 5.
Traditional treatment
It is worth noting right away that if you have such a disease, you should not resort to the help of traditional medicine. After all, while a person chooses the optimal treatment for himself, the pathology will begin to progress. Liver cirrhosis and other complications pose a colossal threat to human life. You need to understand this fact and not try to fix the problem yourself. Yes, there are traditional methods of treatment, but still it is impossible to do without specialized drugs.
Herbal treatment
Herbs can help in many situations and even cope with problems with the outflow of bile. True, they can be used exclusively as maintenance therapy. You should not use them yourself.
Homeopathy
Homeopathic remedies have long gained popularity and special distribution. But still, it is recommended to resort to standard treatment methods. If we talk about homeopathy, it is effective, but it is not suitable for everyone. A variety of means are used to combat cholangitis.
A complete list of medications can be found from a homeopathic doctor. It is he who prescribes this or that remedy depending on the person’s condition and symptoms.
Diet for cholangitis
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All patients who suffer from a chronic form of the pathology should always be under medical supervision. It is important to carry out anti-relapse treatment; this is done 1-2 times a year, depending on the person’s condition and the progression of the pathology. It is necessary to constantly consume mineral water, choleretic agents and therapeutic nutrition. It is advisable to periodically refer patients to health resorts and dispensaries.
Forecast
The prognosis for the disease depends entirely on the condition of the person and the form of the course, as well as the outflow of bile. If treatment was carried out in a timely manner, then there should be no complications. Quick intervention leads to a positive result. But it is important to support the body so that a relapse does not occur. Constant repetition of the pathology picture leads to a chronic course. In this case, the prognosis can be extremely unfavorable.
If we talk about the later stages of pathology, then everything depends on the treatment. But still, the probability of an unfavorable prognosis is several times higher. It is not always possible to save a person, especially if he has cirrhosis of the liver. The only thing needed here is organ transplantation. Additional symptoms related to acute liver failure, cirrhosis and liver abscess can worsen the prognosis. Women over 50 years of age are at risk. Therefore, it is important to undergo examinations and respond to any symptoms in a timely manner.
