Cholangitis

Cholangitis is an inflammatory process in the bile ducts (cholangiolitis is a lesion of small bile ducts; cholangitis or angiocholitis is a lesion of larger intra- and extrahepatic bile ducts; choledochitis is a lesion of the common bile duct; papillitis is a lesion of the Vater's papilla). As a rule, it occurs against the background of obstruction of the bile ducts. Infection of the bile can provoke inflammation. Often, the pathology occurs together with cysts of the common bile duct, as well as bile duct cancer. The disease occurs against the background of the penetration of bacterial infection agents into the bile ducts.

ICD-10 code

This disease belongs to the cycle - other diseases of the biliary tract (K83). However, 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, stenosing and suppurative. Totally excludes: cholangitic liver abscess (K75.0) cholangitis with choledocholithiasis (K80.3-K80.4) chronic non-suppurative destructive cholangitis (K74.3).

K83.1 Obstruction of bile duct. Occlusion, stenosis of bile duct without stones, narrowing. Totally excluded: with cholelithiasis (K80).

K83.2 Perforation of bile duct. Rupture of bile duct. K83.3 Bile duct fistula. Choledochoduodenal fistula. K83.4 Spasm of sphincter of Oddi. K83.5 Bile cyst. K83.8 Other specified diseases of biliary tract. Adhesions, atrophy, hypertrophy of bile duct, ulcer. K83.9 Disease of biliary tract, unspecified.

Causes of cholangitis

The main cause of this disease is the presence of a concrement in the bile ducts. In addition, a special role is played by the etiological factor, which includes iatrogenia, parasitic invasions, foreign bodies, cysts of the common bile duct and Caroli's disease.

Today, the possibility of parasitic cholangitis as a result of fascioliasis, clonorchiasis, and ascariasis penetrating the body is not completely excluded. An important condition for the appearance of the disease is bile stagnation, as well as the presence of infection. There are several reasons that prevent the outflow of bile. Obstruction can be the result of a primary pathological process. It is this that provokes the development of biliary hypertension, which leads to changes in the physicochemical properties of bile.

A common cause is the presence of benign structures of the pancreas, Caroli's disease, sphincter dyskinesia. The disease can be caused by the reflux of small intestinal contents into the biliary tract, as well as complications that arise as a result of reconstructive operations on the bile ducts. There are several ways in which the infection gets into the bile ducts. Often, everything happens hematogenously or lymphogenously. Microorganisms of the intestinal microflora, which are found in associations, can become pathogens. Most often, the disease has a bacterial nature. It can be provoked by representatives of the enterobacteria family, gram-positive microorganisms, non-spore-forming anaerobes.

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Pathogenesis

The main causative agent of the disease is its combination with a violation of the outflow of bile. In its pure form, it is not so common, 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 with the bloodstream. Most often, the pathogen is E. coli. Very 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, endoscopic manipulations on the common bile duct. In general, any problems associated with the outflow of bile. Therefore, problems eliminated in time can reduce the risk of developing the disease. By the nature of the inflammation, the disease is divided into several types. Thus, cholangitis can be catarrhal, purulent and diphtheritic.

Symptoms of Cholangitis

The acute form of the disease can occur against the background of complications with total obstruction of the gallbladder. It is extremely rare that it occurs as a complication of the common bile duct. The clinical picture of manifestation includes malaise, jaundice, pain in the shoulder blade, forearm. All this can flow into fever, nausea, vomiting. The person is bothered by confusion, arterial hypotension is observed. Patients have 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 bothered by dyspeptic disorders that occur without fever and jaundice. There is no pain syndrome. In between exacerbations, the symptoms can be completely absent. If the liver is also affected, then to all the signs are added those that correspond to parenchymatous jaundice.

Sometimes the disease can start like sepsis. Thus, a person is plagued by alternating chills and fever. A 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. As soon as biliary hypertension decreases, the symptoms disappear. During an exacerbation, the liver can increase in size.

In chronic course everything is accompanied by dull pains, feeling of pressure, itching, slight yellowness of mucous membranes. Often manifests itself as unmotivated subfebrile temperature. In elderly people there is a pronounced asthenic syndrome. 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 the presence of elevated temperature, severe cramping pain in the abdomen and chest. Weakness, nausea, vomiting and a sharp decrease in blood pressure are especially pronounced. Based on these symptoms, it is possible to make a diagnosis.

Chronic cholangitis has no initial symptoms, as it proceeds almost asymptomatically. This is the main danger. The disease can lead to renal coma. Therefore, if any discomfort or problems accompanying the development of cholangitis appear, it is worth seeking help from a medical institution. The chronic form is characterized by the appearance of pain syndrome of varying intensity. A person feels tired, he is bothered by itchy skin, as well as 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. As a rule, this is pain in the right upper quadrant of the abdomen, fever and jaundice. It is very easy to determine the presence of the last two signs. 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 symptom. It is characterized by the presence of point sensitivity in the gallbladder area. It is easy to determine by palpation. Sensitivity is observed in the right hypochondrium. Usually it 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 be not only correct, but also effective.

Therefore, patients with cholecystitis or biliary colic are sent for ultrasound. This will confirm or refute the fact of the problem. If the pathology is not identified in a timely manner, it can actively progress. In this case, a couple more symptoms are added, namely, confusion and septic shock. These signs, together with the Charcot triad, can lead to death. The decision on 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 assumed 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 much more susceptible to this phenomenon than women. The pathology develops at the age of 25-45 years. In some cases, it happens in young children. In almost 70% of cases, cholangitis is accompanied by nonspecific 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, there is a lack of signs. At the onset of the disease, a person begins to lose weight sharply, he has itchy skin, pain in the right hypochondrium, and jaundice. If symptoms begin to manifest themselves, it means that the process is severe. Fever is not specific.

Diagnosis of the disease involves examining the blood serum. The condition is characterized by an increase in alkaline phosphatase, as well as bilirubin, the level of γ-globulins, IgM. During 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 insufficiency.

Acute cholangitis

The acute course of the disease is characterized by chills and fever. Profuse sweating, bitterness in the mouth, and vomiting are possible. Pain in the right hypochondrium is common. Sometimes the pain syndrome is too intense. The liver can increase in size, accompanied by jaundice and skin itching.

Sometimes there is a high temperature, aching pain in the right hypochondrium. There is weakness, fatigue. A person gets tired quickly, he shivered. The liver and spleen are characterized by a considerable size. The disease can entail complications. They are characterized by the presence of suppuration, necrosis.

The disease often leads to sclerosis of the bile ducts. All this eventually flows into the development of hepatitis. The outcome of the situation is liver cirrhosis. The diagnosis is made based on symptoms. When palpated, the liver is significantly enlarged. To confirm the diagnosis, a number of X-ray and laboratory studies are carried out. The anamnesis includes gallbladder disease.

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Chronic cholangitis

This disease is characterized by chills, which are accompanied or alternate with fever. The person is bothered by profuse sweating, bitterness in the mouth, as well as vomiting and pain in the right hypochondrium. The liver can significantly increase in size. Jaundice and skin itching often occur. An increased level of leukocytes is observed in the blood.

The chronic form of the disease occurs against the background of a previously existing acute period. The clinical picture is similar. The person is bothered by elevated subfebrile temperature, as well as yellowness of the sclera. Aching pains appear in the right hypochondrium. The victim quickly gets tired, he shows weakness, and sharp weight loss. The liver and spleen are rather enlarged.

The chronic form can lead to a number of complications. Suppuration, hepatitis and even liver cirrhosis may occur. Therefore, this disease, especially its progression, cannot be allowed. When palpated, a sharp increase in the liver is felt. It is important to diagnose the disease in time and begin its treatment.

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Bacterial cholangitis

The most common form is the classic one, namely the Charcot Triad. The person is tormented by pain, accompanied by jaundice and fever. The pain is 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, there is a headache, chills. During the examination, the doctor notices an enlarged liver, as well as pain in the right side. In almost all cases, leukocytosis is observed.

Diagnostics are carried out by passing laboratory tests. Instrumental studies are actively carried out. Usually, blood donation is enough. Additionally, you can pass a coprogram and urine analysis, but after the doctor's approval. Ultrasound, ECG and CT are carried out. It is important to diagnose the problem in time and begin treatment.

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Giardiasis 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 parts of the intestine. Sometimes they are found in the gallbladder.

It is not so easy to determine the presence of the problem, because it is closely related to other diseases of the intestines, as well as the biliary tract. The pathology can be diagnosed only if the simplest lamblia are detected. Despite this, the symptoms are still observed. Thus, a person is bothered by pain in the right hypochondrium, nausea, dizziness, as well as problems with the gastrointestinal tract. Heartburn, diarrhea or constipation may appear. Sometimes there is an increase in temperature, as well as pain syndromes in the liver. The problem can be eliminated only by following a special diet. Observation by a gastroenterologist is mandatory.

Suppurative cholangitis

Clinically, this pathology manifests itself in the form of fever and jaundice. A person may have confusion, as well as arterial hypotension. Over time, renal failure may develop, as a consequence of this - thrombocytopenia. The condition must be eliminated by medical intervention.

Everything can be diagnosed by passing laboratory tests. Usually, a person is sent for blood culture, the number of leukocytes. The indicators of kidney functionality are considered. An ultrasound is performed. Even if its results are negative, it is recommended to conduct endoscopic cholangiography.

Treatment involves the use of broad-spectrum antibiotics. Detailed information on medications of this type will be provided below. It is not that difficult to eliminate the problem, 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 to 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 the gallbladder is removed, bile begins to flow directly into the duodenum. This happens 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, bile will stagnate in the liver. The risk of developing an inflammatory process is high. 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 just appear. For its development, a special push must occur. 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 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 worsens 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 temperature, jaundice and dull pain in the liver area.

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Autoimmune cholangitis

The disease resembles primary biliary cirrhosis in its histological features. However, it is characterized by the presence of antimyochondrial antibodies, as well as antinuclear antibodies and/or antibodies to smooth muscles. Thus, the disease is considered idiopathic, with a mixed picture of hepatitis and cholestasis.

The main symptoms are immune cholangitis. However, the definition of the disease is ambiguous. After all, 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 be an independent disease. It is not so easy to see this fine line. The problem is not so common, but only in 5-10% of cases.

It is important to start diagnosing the disease in time. Moreover, it is necessary to correctly determine what form the pathology is in. Correct diagnosis and treatment will help to cope with the problem.

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Biliary cholangitis

The disease is an idiopathic liver pathology. The problem mainly affects adults. It mainly affects middle-aged women. Young men are also susceptible to it. The disease is characterized by diffuse inflammatory and fibrous changes in the entire biliary tree.

The main 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. Family predisposition can provoke the disease.

It is not easy to detect the problem. Usually it is combined with another problem. It is necessary to take blood tests and examine the liver. This will help to track the level of white blood cells, as well as other key indicators. Then high-quality treatment is prescribed.

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Stenosing cholangitis

The onset of the disease is asymptomatic. Everything develops gradually, so for a long time nothing bothers a person. The first manifestation is an increase in the activity of g-glutamyl transpeptidase (GGTP) and alkaline phosphatase (ALP) of the serum. That is, there are no visual manifestations. The problem can only be identified by donating blood.

Asymptomatic course is especially dangerous, because it can lead to the development of liver cirrhosis, as well as portal hypertension. But there are no signs of cholestasis. Most often, "cryptogenic cirrhosis" is diagnosed directly.

It is much better when the disease begins to manifest itself. This will help to avoid possible complications and save a person. Everything manifests itself in the form of fever, rapid fatigue, constant pain. Changes in body weight are possible, as well as skin itching. Jaundice develops at a progressive stage. Gradually, hepatocellular insufficiency appears, as a consequence of this, biliary cirrhosis is formed.

The pathology can be diagnosed exclusively through laboratory tests. The disease manifests itself as minor hyperbilirubinemia and an increase in the IgM level, an increase in the CIC level (70% of cases).

Recurrent cholangitis

If the bile outflow is constantly disrupted, the disease progresses and becomes chronic. Multiple repetitions of this process lead to the pathology being constantly present and bothering 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 itching. The outflow of bile can spontaneously recover. But this happens in the so-called periods of calm. Then the pain gradually subsides, the person's condition improves, there are no signs of jaundice. The person feels much better. But this condition does not last long. Over time, the phase of active manifestation of the pathology will come. The symptoms are constantly repeated. It is important to maintain the person's condition. Otherwise, the condition will significantly worsen. 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 proceed in different ways. Thus, its forms can be varied. The variant of development depends on the reason for which cholangitis appeared.

All forms of development are based on bacteria or protozoa that penetrate the body. Most often, these are opportunistic microflora, lamblia, and helminths. Inflammation of the gallbladder, the presence of stones in it, and helminthic invasion 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, a person feels pain in the right side. Moreover, the pain syndrome can be of varying intensity. Sometimes it simply resembles colic. The entire right half, side, shoulder, neck and shoulder blade area can pull. In these places there are bundles of nerve endings. With progression, skin itching, nausea, vomiting, and loss of appetite appear.

Cholangitis in children

The acute form of the disease in children is extremely rare. Basically, it carries a secondary form. Initially, the baby can suffer from streptococcal etiology, and then this pathology will arise. Sometimes it carries severe consequences. Thus, pleurisy, lung abscess, sepsis and pancreatitis are not excluded. If the treatment method is chosen incorrectly, toxic liver dystrophy may develop.

Primary pathology has acute symptoms. If it is chronic, there are no signs. Only occasionally does the baby feel pain in the right hypochondrium, he is bothered by weakness, chills and fever. Usually, such a manifestation is characteristic of the acute phase. With secondary development, biliary cirrhosis of the liver is not excluded. It is very difficult to diagnose, and the disease itself has a complex course.

The development of pathology in a child can be influenced by: bile stagnation, the presence of scars on the internal surfaces of the bile ducts, the presence of parasites, as well as a violation of the integrity of the bile duct membrane. In this case, not only the gallbladder suffers, but also the lungs, liver tissue, and pancreas.

It is better to treat this form surgically. Because the child's further condition depends on it. It is not worth allowing the chronic form. There can be many consequences. It is important to follow a proper diet.

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Classification of cholangitis

By etiology:

1. Bacterial.
2. Helminthic.
3. Toxic and toxic-allergic.
4. Viral.
5. Autoimmune.

Downstream:

1. Spicy.
2. Chronic.

By pathogenesis:

Most often, cholangitis is of bacterial origin and the causative agents are most often E. coli, enterococci, Friedlander's bacillus, pneumococci, and streptococci.

Primary (bacterial, helminthic, autoimmune).

Secondary and symptomatic:

1. On the basis of subpelvic cholestasis:
   1. Hepatobiliary stones.
   2. Cicatricial and inflammatory strictures of the main bile ducts and the large duodenal papilla.
   3. Malignant and benign tumors with occlusion of the hepatobiliary duct or major duodenal papilla.
   4. Pancreatitis with compression of the common bile duct.
2. Due to diseases without subhepatic cholestasis:
   1. Biliodigestive anastomoses and fistulas.
   2. Sphincter of Oddi insufficiency.
   3. Postoperative cholangitis.
   4. Cholestatic hepatitis and biliary cirrhosis of the liver.

By type of inflammation and morphological changes:

1. Catarrhal.
2. Purulent.
3. Obstructive.
4. Destructive non-purulent.

By the nature of complications:

1. Liver abscesses.
2. Necrosis and perforation of the hepatocholedocus.
3. Sepsis with extrahepatic purulent foci.
4. Bacterial toxic shock.
5. Acute renal failure.

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Consequences

If timely treatment is absent, the inflammatory process can become more serious. Gradually, it spreads to the peritoneum, which can lead to peritonitis. The pathology can "spread" to surrounding tissues. As a result, subdiaphragmatic and intrahepatic abscesses begin to form. Sepsis and toxic shock often occur. The latter complication develops against the background of the bacterial form of cholangitis.

The condition of 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 becomes chronic and leads to the development of biliary cirrhosis of the liver.

Self-medication and attempts to eliminate the pathology with folk remedies, on the contrary, will worsen the situation. And in general, such intervention is unacceptable. After all, time can be lost, and the pathology will take on a more serious character. In the later stages, the prognosis is far from the most favorable.

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Complications

If a person is not prescribed timely treatment, complications can be aggravating. Most often, everything ends in cirrhosis of the liver. In order to prevent such a development of events, it is enough to start treatment on time. Cholangitis often leads to peritonitis. The peritoneum becomes inflamed, the surrounding tissues are also affected. As a result, toxic shock may develop. The patient has a hard time with all the symptoms, he 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 of the liver takes its development.

Trying to eliminate the problem on your own in this case 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 very seriously.

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Diagnosis of cholangitis

It is easy to suspect the presence of a problem based on Charcot's triad. Thus, diagnostics are carried out against the background of laboratory and instrumental studies. Biochemical tests can indicate cholestasis. In the presence of cholangitis, an increase in the level of bilirubin, as well as a-amylase and alkaline phosphatase is noted.

To identify pathogens of the disease, fractional duodenal sounding is performed together with bacteriological culture of bile. In almost 60% of cases, mixed bacterial flora is characteristic of the pathology. To exclude the presence of parasites, a study of feces is performed for the presence of helminth eggs and other protozoa.

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, enlargement of organs. Computed tomography is not so often performed. 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. They take the leading position in determining pathology. Thus, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography act as such. 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 can make a diagnosis based on just one examination. After all, it is worth listening to the patient and performing a palpation so that the picture becomes more or less clear. But, nevertheless, tests are necessary in order to clarify what phase the disease is in. This will allow identifying the accompanying processes and assessing 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 offered 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 taken. 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 phosphatase and alpha-2 globulins. It is recommended to take a blood test for sterility. This will allow you to exclude 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 method includes several main directions. Thus, the first of them is ultrasound examination, in simpler terms, usually ultrasound. Thanks to it, it is possible to detect an increase in the size of the liver and notice the expansion of the bile ducts.

The second option of instrumental diagnostics is retrograde cholangipancreatography (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. In primary cholangitis, the changes are especially visible.

Magnetic resonance cholangiography is also widely used. A special place is given to computer tomography. Duodenal sounding is also used. It allows examining bile and seeing any changes in it. All methods can be used both independently and in combination. Much depends on the patient's condition.

Ultrasound diagnostics

Changes in the liver and abdominal cavity can be detected using ultrasound. Infection foci, changes in size and shape should immediately prompt the specialist to think that the victim has cholangitis. Naturally, everything is combined with laboratory tests and the symptoms that appear.

The examination clearly shows the uneven width of the bile duct lumen. They are significantly enlarged inside the kidneys or outside, and they are echogenic. The unevenness is clearly visible. The portal arteries are prominent. In complications, changes in the liver contours are visible. Echoic material is observed in the duct lumen.

Ultrasound examination allows to make an accurate diagnosis. It can be confirmed by 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 method includes a blood test. It can detect the presence of an inflammatory process in the body. This is usually indicated by an increase in ESR and leukocytes. Biochemical blood analysis plays an important role. This study shows the level of bilirubin, especially the direct fraction. The level of alkaline phosphatase and gamma-glutamyl transpeptidase is determined. These indicators are closely related to the outflow of bile. Any changes in them indicate the presence of disturbances during this process. Increased transaminase activity indicates toxic liver damage. In principle, it is impossible to do without differential diagnostics. Laboratory tests are especially important.

A general urine analysis is also performed. Here, the appearance of bile pigments can be noticed. Feces are submitted for the presence of helminth eggs and other protozoa. Differential diagnostics strictly interacts with instrumental diagnostics.

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Treatment of cholangitis

Patients who have a violation of the outflow of bile must be immediately hospitalized. Naturally, hospitalization takes place exclusively in a hospital with a surgical profile. Such assistance may be needed at any time. After all, the process of eliminating the pathology is both conservative and surgical. The method of treatment directly depends on the stage of the disease.

In conservative treatment, the patient must abstain from food for the first three days and then begin a gentle diet. This will suppress the vital activity of pathogens. After all, they have nowhere to get nourishment from. Along with special nutrition, broad-spectrum antibiotics are used. Metronidazole is usually used. In order to reduce pain, antispasmodics and analgesics are used. It is recommended to pay attention to Drotaverine and Meverin. If a person has severe intoxication, he is given a glucose-salt solution.

If the pathology was provoked by parasites, then special attention is paid to antihelminthic drugs. This may be Albendazole, Mebendazole. To protect the liver during bile stasis, it is recommended to use Ademetionine. More detailed information about these medications will be presented below.

The surgical intervention is liver transplantation. It is usually used for cirrhosis, recurrent bacterial cholangitis and persistent jaundice.

Medicines

As stated above, drugs that reduce pain, eliminate infection and promote rapid recovery are widely used. The most popular drugs are: Drotaverine, Meverin, Albendazole, Ademeteonine, Cholestyramine, Ursodeoxycholic acid and Rifampicin. Antibiotics are considered separately.

• Drotaverine. The drug has an antispasmodic effect. It helps relieve pain and improve the patient's condition. The drug should be taken 1-2 tablets, 2-3 times a day. Everything depends on the intensity of the pain syndrome. The duration of administration is individual. The drug should not be taken by people with increased hypersensitivity, pregnant women, as well as patients with liver and kidney failure. Side effects: tachycardia, nausea, vomiting, headache.
• Meverin. The product has an antispasmodic effect. It is used for symptomatic therapy of pain syndrome. The product is strong, so it is enough to use one capsule every 12 hours. To achieve the maximum effect, it is recommended to use it 20 minutes before eating. Contraindications: children under 15, pregnancy, hypersensitivity. Side effects: none noted.
• Albendazole. The drug is used to remove parasites from the body. 400 mg per day is enough to actively eliminate the problem. In general, the dose is prescribed individually. Contraindications: pregnancy, lactation, hypersensitivity and children under 2 years of age. Side effects: dizziness, nausea, vomiting, dyspepsia, kidney dysfunction.
• Ademeteonin. The drug has hepatoprotective (protective liver tissue) activity. It helps protect the liver from negative effects on it. The drug should be taken at 400-800 mg per day. Maintenance therapy - 2-3 tablets per day. The duration of administration is prescribed individually. Contraindications: hypersensitivity. Side effects: pain syndrome behind the breastbone, in the abdomen.
• Cholestyramine. This drug has an affinity for bile acids. It is able to bind them in the form of a strong complex in the intestine. The drug is excreted with feces, which significantly reduces skin itching. It is enough to use one teaspoon of the drug 3 times a day. It is advisable to do this 40 minutes before a meal, or the same time after eating it. The course of treatment may vary depending on the person's condition. The minimum is one month. The drug is used in reduced doses. It can cause poor absorption of vitamins and calcium. Pregnant women should not take it. A similar requirement is put forward to people with increased hypersensitivity. Side effects: nausea, vomiting, intestinal disorders.
• Ursodeoxycholic acid. It allows to significantly reduce itching and decrease the amount of formed toxic bile acids. Daily prescribed 15-20 mg per kilogram of weight. The maximum dosage should not exceed 1200 mg per day. Contraindications include pregnancy, hypersensitivity and breastfeeding. Side effects in the form of nausea, vomiting, increased symptoms are possible.
• Rifampicin. In the last decade, it has been widely used to relieve itching in patients with cholangitis. It can increase the activity of liver microsomal enzymes. Thus, sulfoxidation of di- and monohydroxy bile acids is accelerated. It is recommended to take 10 mg per kilogram of weight. The course of treatment is long and lasts for several months. Everything depends on the patient's condition. It is not recommended to use during pregnancy, childhood and breastfeeding.

Antibiotics for cholangitis

Broad-spectrum antibiotics are used to suppress the infection. These include Metronidazole, Tetracycline and Levomycetin. They can be taken for no more than 2 weeks in an individual dosage.

• Metronidazole. This is an antimicrobial drug. It is used one tablet 2-3 times a day. In special cases, the dosage is increased to 4-5 tablets. You should not make adjustments on your own, the drug has a number of side effects. Thus, nausea, vomiting, weakness, metallic taste in the mouth, 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 200-250 mg 2-3 times a day. For children, 20-25 mg/kg is enough. The duration of treatment is prescribed individually. Contraindications: hypersensitivity, pregnancy, lactation, liver and kidney dysfunction. Side effects: skin pigmentation, inflammation of the mucous membranes, dysbacteriosis, allergic reactions. The drug is usually well tolerated.
• Levomycetin. The drug actively destroys bacteria. It should be used at 250-500 mg 3-4 times a day. The daily dose should not exceed 2 grams. The nature of the treatment and dosage are prescribed by the attending physician. Contraindications: pregnancy, lactation, psoriasis, eczema, hypersensitivity. Side effects: anemia, nausea, vomiting, fever, allergic reactions.

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Folk remedies

It is worth noting right away that if you have such a disease, you should not resort to traditional medicine. After all, while a person is choosing the best treatment for himself, the pathology will begin to progress. Liver cirrhosis and other complications pose a colossal threat to human life. This fact must be understood and you should not try to eliminate the problem on your own. Yes, there are traditional methods of treatment, but you still cannot do without specialized drugs.

• Recipe 1. To prepare it, take 6 tablespoons of stinging nettle, 3 tablespoons of agrimony herb and sandy immortelle flowers. Take 2 tablespoons of corn silk and St. John's wort. Mix all of this together. To prepare it, just take 2 tablespoons of the mixture and mix them with honey. Then pour 500 ml of boiling water over it. Let the remedy sit for 2 hours. Then apply half a glass 3-6 times a day.
• Recipe 2. To prepare a universal remedy, take half a kilogram of honey and 500 ml of olive oil. Mix all of this together and add 2 lemons, or rather their juice, for effectiveness. Mix all of the products together and take one tablespoon 3 times a day 40 minutes before meals.

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Herbal treatment

Herbs can help in many situations and even cope with problems of bile outflow. However, they can only be used as a supportive therapy. You should not use them on your own.

• Recipe 1. Take a tablespoon of St. John's wort and pour a glass of boiling water over it. Then put it on the fire and boil for about 15 minutes. The resulting remedy is taken a quarter of a 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. Let the remedy brew for 2 hours. Take a quarter of a glass 3 times a day. The remedy is really effective, but pregnant women should not take it.
• Recipe 3. Take 100 grams of corn silk and mix with 75 grams of marigold and yarrow. Pour two glasses of boiling water over all of this (2 tablespoons of the mixture is enough). Leave the remedy alone overnight. In the morning, strain everything and take 100 ml up to 4 times a day.

Homeopathy

Homeopathic remedies have long been popular and especially widespread. But still, it is recommended to resort to standard treatment methods. If we talk about homeopathy, it is effective, but not suitable for everyone. Various means are used to combat cholangitis.

• Arsenicum album. It is a poisonous substance. It is prescribed to people who suffer from skin itching, which intensifies at night. The drug often causes an allergic reaction, nausea and stomach upset.
• Baptisia tinctoria (wild indigo of the legume family). The drug is widely used in the chronic form of the disease. Especially if it occurs together with high temperature, vivid dreams and sensations of heat in the morning.
• Berberis vulgaris (barberry). Used for bitterness in the mouth, aching pain, and dryness in the mouth. Pain syndrome may develop during movement.
• Bryonia alba (white bryony). The remedy is prescribed for very painful palpation and the presence of a pathological process in the liver.
• Cuprum (copper) and zincum (zinc). Widely used for severe spasms of the gallbladder. Capable of providing anti-inflammatory action.
• Lycopodium clavatum. Used for cholangitis accompanied by liver disease. Especially when there are pronounced symptoms. In this case, we mean bitterness in the mouth, loss of appetite, heartburn.

A complete list of medications can be found at a homeopathic doctor. It is he who prescribes one or another remedy depending on the person's condition and symptoms.

Diet for cholangitis

When the disease is acute, it is recommended to listen to menu number 5a. If the course is chronic, then diet 5 is perfect. Now it is worth considering them in more detail.

• Diet #5. You need to eat 5 times a day, in small portions. Eating before bed is prohibited, at least not to overeat. Spicy and hot dishes are prohibited. You will have to give up garlic, horseradish and radish. Alcohol is strictly prohibited. Fatty meat and fish should be put aside until better times. A person consumes up to 3,500 kilocalories per day. The daily norm is 90-100 grams of proteins, 100 grams of lipids and 400 grams of carbohydrates. Buckwheat, lean meat, fish, cottage cheese and oatmeal should be included in the 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, bland vegetables (cabbage, carrots and potatoes). Bread is allowed, but slightly dried. Honey, sugar and berry infusions are very useful. You can make up your own diet based on the list of permitted products.
• Diet No. 5a. You can eat absolutely any cereals, but they need to be thoroughly boiled. Meat and fish are eaten steamed. Nothing can be fried! 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.

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Prevention

Prevention in the presence of a chronic inflammatory process consists of preventing the development of severe exacerbations. This can be achieved by combating bile stagnation. To do this, a person needs to eat right and do morning exercises. Bowel movements should also be normal. You need to eat foods that will prevent constipation. If you have gastrointestinal diseases, you need to fight them. Strengthening the nervous system helps. It is important to organize proper nutrition, eliminate bad habits, including smoking and alcohol.

All patients suffering from the chronic form of pathology should always be under dispensary observation. It is important to conduct 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 drink mineral water, choleretic agents and therapeutic nutrition. It is advisable to periodically send patients to health resorts and preventoriums.

Forecast

The prognosis for the disease depends entirely on the person's condition and the form of the course, as well as the outflow of bile. If the treatment was carried out in a timely manner, there should be no complications. Rapid 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 pathological picture leads to a chronic course. In this case, the prognosis can be extremely unfavorable.

If we talk about the late stages of the 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. Here, only an organ transplant is needed. 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.