Acute cholangitis

Symptoms of acute cholangitis

In the first stage of acute cholangitis, the main symptom is high body temperature with severe, recurring chills. The onset is sudden and violent. Body temperature rises daily or once every 2-3 days. Cramping pain in the right side and right hypochondrium, vomiting are also characteristic. Pronounced weakness develops, blood pressure decreases.

In the second stage, the symptoms described above are joined by an enlarged liver, it is sharply painful, liver function tests are disrupted, subictericity occurs, and then - slight jaundice. By the end of the first week, the spleen enlarges. Pneumococcal cholangitis is especially severe, most often complicated by the development of liver abscesses.

In the third stage, if there is no improvement, a picture of liver failure with severe jaundice develops, at the same time, severe changes in the urine appear, urea and creatinine in the blood increase (hepatorenal syndrome), cardiac activity is significantly impaired (tachycardia, muffled heart sounds, arrhythmia, dystrophic changes in the myocardium on the ECG), collapses are possible, pancreatitis often occurs.

In the fourth, final stage, severe hepatic and renal failure and coma develop.

Acute catarrhal cholangitis is manifested by an increase in body temperature, chills, enlargement and pain of the liver, but the severity of intoxication does not reach a very severe degree.

Purulent cholangitis is very severe, characterized by severe intoxication up to the development of bacterial-toxic shock. Often, CNS damage in the form of prostration, clouding of consciousness. Purulent cholangitis is often complicated by subdiaphragmatic, intra-influenza abscess, reactive exudative pleurisy and pleural empyema, lung abscess, peritonitis, endocarditis, pancreatitis.

Laboratory data

1. General blood analysis: moderate or high (more than 1.5-109/l) leukocytosis, left shift in blood count, toxic granularity of neutrophils, increased ESR.
2. Biochemical blood test: increased bilirubin content with a predominance of the conjugated fraction, _a2- and gamma-globulins, transaminases, alkaline phosphatase, gamma-glutamyl transpeptidase, sialic acids, fibrin, seromucoid.
3. General urine analysis: appearance of protein, cylinders, bilirubin.

Instrumental data

Chromatic fractional duodenal sounding. Portion B: a large amount of small columnar epithelium. Portion C: decreased concentration of the lipid complex, increased content of sialic acids, fibrin, transaminases, seeding of abundant bacterial flora, possible detection of a large number of leukocytes. Ultrasound examination - an increase in the size of the liver, dilation of the intrahepatic bile ducts.

Survey program

• General blood, urine, and stool analysis. Urine test for bile pigments.
• Biochemical blood test: total protein and its fractions, sialic acids, fibrin, seromucoid, transaminases, aldolase, alkaline phosphatase, bilirubin, gamma-glutamyl transpeptidase, 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 bile ducts.

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