Acute cholangitis
Last reviewed: 23.04.2024
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Symptoms of acute cholangitis
In the first stage of acute cholangitis, the main symptom is a high body temperature with tremendous repetitive chills. The onset is sudden, violent. Body temperature rises daily or 1 time in 2-3 days. Cramping pain in the right side and in the right hypochondrium, vomiting is also characteristic . Developed weakness, low blood pressure.
In the second stage, the enlargement of the liver is added to the symptoms described above, it is sharply painful, liver functional tests are broken, subic- ticity arises, and then a slight jaundice. By the end of the first week, the spleen is enlarged. Especially hard are pneumococcal cholangitis, most often complicated by the development of liver abscesses.
In the third stage, if there is no improvement, the liver failure develops with severe jaundice, concomitant changes in the urine occur, urea and creatinine increase in the blood (hepatorenal syndrome), cardiac activity is significantly impaired (tachycardia, deaf cardiac tones, arrhythmia, dystrophic changes myocardium on the ECG), collapse is possible, pancreatitis often occurs.
In the fourth, final stage, marked hepatic-renal failure, coma develop.
Acute catarrhal cholangitis is manifested by increased body temperature, chills, liver enlargement and pain, but the severity of intoxication does not reach a very serious degree.
Purulent cholangitis proceeds very hard, characterized by severe intoxication until the development of bacterial-toxic shock. Quite often the defeat of the central nervous system in the form of prostration, obscuration of consciousness. Purulent cholangitis is often complicated by a sub-diaphragm, an intra-vaginal abscess, reactive exudative pleurisy and pleural empyema, lung abscess, peritonitis, endocarditis, pancreatitis.
Laboratory data
- Total blood anilia: moderate or high (more than 1.5-109 / L) leukocytosis, a shift of the blood formula to the left, toxic granularity of neutrophils, an increase in ESR.
- Biochemical analysis of blood: an increase in the content of bilirubin with predominance of the conjugated fraction, and 2 - and y-globulins, transaminases, alkaline phosphatase, y-glutamyltranspeptidase, sialic acids, fibrin, seromucoid.
- General analysis of urine: the appearance of protein, cylinders, bilirubin.
Instrumental data
Chromatic fractional duodenal sounding. Portion B: Large amount of small cylindrical epithelium. Portion C: decrease in the concentration of the lipid complex, increase in the content of sialic acids, fibrin, transaminases, sowing of abundant bacterial flora, it is possible to detect a large number of leukocytes. Ultrasound examination - increase in liver size, enlargement of intrahepatic bile ducts.
Survey program
- General analysis of blood, urine, feces. Examination of urine on bile pigments.
- Biochemical blood test: total protein and its fractions, sialic acids, fibrin, seromucoid, transaminases, aldolase, alkaline phosphatase, bilirubin, gamma-glutamyltranspeptidase, urea, creatinine.
- Blood test for sterility.
- Duodenal fractional sounding with bacteriological examination of portions B and C and determination of flora sensitivity to antibiotics.
- Ultrasound examination of the liver and biliary tract.
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