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 common bile duct infection, papillitis is a defeat of the region of the fat nipple). As a rule, it occurs against the background of impaired bile ducts. To provoke inflammation can infection of bile. Often, pathology occurs along with the common bile duct cysts, as well as bile duct cancer. There is a disease on the background of the entry of pathogens of bacterial infection in the bile ducts.

ICD-10 code

This disease belongs to the cycle - other bile duct diseases (K83). However, in this case, the states that relate to the gall bladder (K81-K82), the bladder duct (K81-K82) postcholecystectomy syndrome (K91.5) are excluded.

K83.0 Cholangitis. Cholangitis: ascending, primary, recurrent, sclerosing, secondary, stenosing and purulent. Completely excluded: cholangic liver abscess (K75.0) cholangitis with choledocholithiasis (K80.3-K80.4) chronic non-venous destructive cholangitis (K74.3).

K83.1 Blockage 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. The rupture of the bile duct. K83.3 Fistula of the bile duct. Choledochoduodenal fistula. K83.4 Spasm of sphincter of Oddi. K83.5 The biliary cyst. K83.8 Other specified diseases of the biliary tract. Spikes, atrophy, hypertrophy of the bile duct, ulcer. K83.9 Disease of the bile ducts is not dilated.

Causes of Cholangitis

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

To date, the possibility of parasitic cholangitis due to the penetration of fascioliasis, clonorchosis, and ascariasis is not completely excluded. An important condition for the appearance of the disease is stagnation of bile, as well as the presence of infection. There are several reasons that prevent the outflow of bile. Obturation can result from a primary pathological process. It is he who provokes the development of bile hypertension, which leads to the appearance of a change in the physico-chemical properties of bile.

A common cause is the presence of benign pancreatic structures, Caroli's disease, dyskinesia sphincter. To lead to the disease can throw the contents of the small intestine in the biliary tract, as well as complications arising from reconstructive operations on the bile ducts. There are several ways in which the infection enters the bile ducts. Often, everything happens hematogenously, or lymphogenous. Pathogens are able to become microorganisms of the intestinal microflora, which are found in associations. Most often the disease is bacterial in nature. It can be provoked by representatives of the enterobacteria family, gram-positive microorganisms, non-spore forming anaerobes.

[1], [2], [3], [4], [5]

Pathogenesis

The main causative illness is its combination with a violation of the outflow of bile. In its pure form it is not so common, basically it is combined with cholecystitis or hepatitis. Basically, the problem is caused by a bacterial infection. It can penetrate the bile ducts through the intestine or along with the blood stream. Most often, the pathogen is E. Coli. Very rarely is enterococcus, staphylococcus and anaerobic infection.

The mechanism of development lies in stagnation of bile. This is observed when the stone is obstructed. Provoke the phenomenon is capable of a cyst of the bile duct, an ulcer, endoscopic manipulations on the common bile duct. In general, any problems associated with the outflow of bile. Therefore, timely problems eliminated, can reduce the risk of the disease. By nature, the inflammation of the disease is divided into several species. So, cholangitis can be catarrhal, purulent and diphtheric.

Symptoms of cholangitis

An acute form of the disease can occur against a background of complication with total obstruction of the gallbladder. Very rarely everything happens as a complication of choledoch. The clinical picture of the manifestation includes malaise, jaundice, pain syndrome in the scapula, forearm. All this can flow into a fever, nausea, vomiting. The person is troubled by confusion, there is arterial hypotension. Thrombocytopenia is observed in patients. It is a manifestation of intravascular coagulopathy.

The acute form of the disease has a slightly different symptomatology. More precisely, it has a more acute current. In most cases, people are disturbed by dyspeptic disorders that occur without fever and jaundice. Pain syndrome is absent. In the intervals between exacerbations, the symptomatology is 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 like sepsis. So, a person is chroned by a chill and a fever alternating between each other. Severe form is accompanied by septic shock and kidney failure. The frequency of fever depends on the pathogen, which provoked the disease. Extremely difficult to pass pneumococcal cholangitis. Once the bile hypertension is reduced, the symptomatology disappears. During an exacerbation the liver is capable to increase in sizes.

In chronic course, everything is accompanied by blunt pain, a feeling of pressure, itching, mild jaundice of the mucous membranes. Often manifests itself unmotivated subfebrile. In elderly people there is a pronounced asthenic syndrome. It is characterized by fever and pain.

First signs

Much depends on what form of ailment a person has. Thus, chronic cholangitis is characterized by asymptomatic flow, which is accompanied by an acute form, but only occasionally. This condition is characterized by the presence of fever, severe cramping pains in the abdomen and chest. Particularly manifested is weakness, nausea, vomiting and a sharp drop in blood pressure. For these symptoms, it is possible to diagnose.

Chronic cholangitis does not have the first symptoms, since it is practically asymptomatic. This is the main danger. The disease can lead to a kidney coma. Therefore, if there is any discomfort or having problems associated with the development of cholangitis, it is worthwhile to seek help from a medical institution. The chronic form is characterized by the appearance of pain syndrome of varying intensity. A person feels tired, it is pricked by skin itching, as well as a fever. Often there is redness of the palms. The terminal phalanges of the fingers can thicken.

[6], [7], [8]

The triad is sharko with cholangitis

The acute form of the disease is characterized by the presence of a triad of sharko. It consists of three main symptoms. As a rule, it is pain in the upper right quadrant of the abdomen, fever and jaundice. Determining the presence of the last two symptoms is very simple. To do this, it is enough to examine the liver, it is clearly enlarged and this is noticeable on palpation.

There is also a symptom of Murphy. It is characterized by the presence of point sensitivity in the gallbladder. To define it simply at carrying out a palpation. There is a sensitivity in the right hypochondrium. Usually it spreads across the entire width of the liver. Liver swelling can have a different degree of severity. Therefore, the presence of this symptom is easy to determine. If we correctly assess the clinical manifestations, then the treatment will not only be correct, but also effective.

Therefore, patients with the presence of cholecystitis or biliary colic are sent to ultrasound. This will confirm or deny the existence of the problem. If the pathology is not detected in time, it can actively progress. This adds a couple more symptoms, namely confusion and septic shock. These signs, together with the Charcot triad, can lead to death. Decisions on hospitalization and treatment should be made in one hour.

Sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a condition for which the production of antibodies to the bile ducts is characteristic. All this is accompanied by a violation of the outflow of bile. The causes of this form of the disease are unknown. It is suggested that the problem is related to the presence of an infectious agent, which is a provoking factor in people with a genetic predisposition.

Men are subject 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. Almost 70% of cholangitis is accompanied by ulcerative colitis. It can be combined with diabetes, as well as thyroiditis.

The disease does not show itself brightly. The symptomatology is simple, it consists in changing biochemical parameters. Most often accompanied by a lack of signs. At the beginning of the disease a person begins to lose weight sharply, he has itchy skin, pain in the right hypochondrium, and jaundice. If the symptoms begin to manifest themselves, then the process has a difficult course. Fever is not specific.

Diagnosis of the disease consists in the study of serum. The condition is characterized by an increase in alkaline phosphatase, as well as bilirubin, γ-globulin levels, IgM. During the ultrasound examination, 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 hepatic-cellular insufficiency.

Acute cholangitis

The acute course of the disease is characterized by chills, as well as fever. Do not exclude profuse sweat, the appearance of bitterness in the mouth, as well as vomiting. Often there are pains in the right hypochondrium. Sometimes the pain syndrome is too intense. The liver can grow in size, accompanied by jaundice and skin itching.

Sometimes there is fever, aching pain in the right hypochondrium. There is weakness, fatigue. Man quickly gets tired, he is shivering. The liver and spleen are of considerable size. The disease can carry a complication. They are characterized by the presence of suppuration, necrosis.

The disease often leads to sclerosis of the bile ducts. All this over time flows to the development of hepatitis. The outcome of the situation is cirrhosis of the liver. The diagnosis is made according to the symptoms. With palpation, the liver is significantly enlarged. To confirm the diagnosis, a number of X-ray and laboratory studies are performed. In the anamnesis - a disease of the gallbladder.

[9], [10], [11], [12], [13],

Chronic cholangitis

This disease is characterized by chills that are accompanied or alternating with fever. The person is being tormented by profuse sweating, bitterness in the mouth, as well as vomiting and pain syndrome in the right hypochondrium. The liver can increase significantly. Often there is jaundice, as well as skin itching. In the blood there is an elevated level of leukocytes.

Chronic form of the disease occurs against the background of the previously existing acute period. The clinical picture is similar. A person suffers from a high subfebrile temperature, as well as yellowness sclera. Appearing aching pain in the right hypochondrium. The victim quickly becomes tired, he has weakness, sharp weight loss. The liver and spleen are enlarged.

Chronic form can lead to a number of complications. There may be festering, hepatitis and even cirrhosis of the liver. Therefore, it is impossible to tolerate this disease, especially its progression. When palpation, a sharp increase in the liver is felt. It is important to diagnose the disease in time and start treating it.

[14], [15], [16], [17], [18], [19]

Bacterial cholangitis

Most often, the classical form itself appears, namely the Triad of Charcot. The person is piercing with pain, accompanied by all 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, there is headache, chills. During the examination, the doctor notices an enlarged liver, as well as pain in the right side. Practically in all cases leukocytosis is observed.

Diagnosis is carried out by passing laboratory tests. Instrumental research is actively conducted. Usually, it's enough to donate blood. Additionally, you can pass a coprogram and urinalysis, but after the doctor's approval. There are ultrasound, ECG and CT. It is important to diagnose the problem in time and begin treatment.

[20], [21], [22], [23], [24]

Giardiasis cholangitis

This disease causes ordinary lamblia. There is a pathology in both adults and children. Transmitted mainly through unwashed hands, by penetrating into the mouth. Bacteria live in the duodenum, as well as the upper intestine. Sometimes occur in the gallbladder.

Determine the presence of the problem is not so simple, because it is closely related to other diseases of the intestine, as well as bile ducts. Diagnosis of pathology is possible only when the simplest lamblia is found. Despite this, the symptomatology is still observed. So, a person pierces the 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. The problem can only be solved by observing special food. Observation with a gastroenterologist is mandatory.

Purulent cholangitis

This pathology is clinically manifested in the form of fever and jaundice. A person can have a confused consciousness, as well as an arterial hypotension. Over time, kidney failure may develop, as a consequence of this - thrombocytopenia. The condition should be eliminated by medical intervention.

Diagnose everything with the help of the delivery of laboratory studies. Usually, people are sent to a blood culture, the number of leukocytes. Consider indicators of the functionality of the kidneys. There is an ultrasound. Even with negative results, endoscopic cholangiography is recommended.

Treatment consists in the use of broad-spectrum antibiotics. Detailed information about medications of this type will be provided below. Eliminate the problem is not so difficult, but the work is painstaking. Therefore, it is advisable to seek help from a doctor when the first symptom occurs. Complex elimination of the problem will help to remove the disease once and for all.

Cholangitis after gallbladder removal

From the liver, bile must enter the gallbladder. Here it accumulates and reaches a certain concentration. As soon as the food enters the body, the concentrated bile is sent to the duodenum and then participates in the digestion and assimilation of fats.

When an operation is performed to remove the gallbladder, bile begins to directly enter the duodenum. It comes directly from the liver. But bile is less concentrated, it is simply unable to perform its basic function. In the process of digestion, it does not participate, or rather does not give the desired result.

In order to avoid complications, a person must follow a special diet. Otherwise, stagnation of bile in the liver. The danger of the development of the inflammatory process is at a high level. The first can appear cholangitis. The patient should eat a little and often, 6-7 times. In this case there will be no complications.

[25], [26], [27], [28], [29], [30], [31], [32]

Calculous cholangitis

This pathology does not occur just like that. For its development, there must be a special push. 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 are significantly weakened. Only, thus, the development of the disease is possible.

Often, everything occurs against the background of the presence of cholecystitis. The fact is that the focus of infection is too close to the liver and ducts. Therefore, its penetration into the biliary tract is very likely. Plus, there is stagnation of bile, which greatly exacerbates the situation. Stagnation always leads to the development of a strong 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. For a person suffering from cholangitis at this stage is characterized by the presence of high fever, jaundice and dull pain in the liver.

[33], [34], [35],

Autoimmune cholangitis

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

The main symptoms are immune cholangitis. However, the definition of the disease is ambiguous. It is not clear why it developed. More precisely, how does the disease intersect with the syndrome of primary biliary cirrhosis, as well as hepatitis. Cholangitis of this type can take the form of an independent disease. To see this fine line is not so simple. There is a problem not so often, but only in 5-10% of cases.

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

[36], [37], [38], [39], [40], [41], [42], [43], [44]

Biliary cholangitis

The disease is an idiopathic liver disease. In general, the problem is only adults. Suffer them mostly middle-aged women. Young men are also subjected to it. The disease is characterized by diffuse inflammatory and fibrous changes in the whole biliary tree.

The main reason for the appearance of the problem has not yet been identified. There are several basic signs that indicate the presence of the disease. So, often the cholangitis is associated with other autoimmune diseases. The presence of circulating antibodies in the blood often provokes the development of pathology. During it, the bile ducts are affected. Provoke a disease is capable of family predisposition.

It is not so easy to detect a problem. Usually it goes in combination with another problem. It is necessary to take blood tests and examine the liver. This will help to track the level of leukocytes, as well as other key indicators. Then qualitative treatment is appointed.

[45], [46], [47], [48], [49], [50]

Stenosing cholangitis

The onset of the disease is asymptomatic. Everything develops gradually, so for a long time a person does not bother. The first manifestation is an increase in the activity of g-glutamyltranspeptidase (GGTP) and serum alkaline phosphatase (APF). I mean, there are no visual manifestations. Identify the problem only by donating blood.

Asymptomatic flow is especially dangerous, because it can lead to the development of cirrhosis of the liver, as well as portal hypertension. But thus signs of a cholestasis it is not observed. Most often, "cryptogenic cirrhosis" is diagnosed directly.

Much better when the disease begins to manifest itself. This will avoid possible complications and save a person. Everything manifests itself in the form of fever, rapid fatigue, constant pain. There may be a change in body weight, as well as skin itching. At a progressive stage, jaundice develops. Gradually there is hepatic cell failure, as a consequence of this - is formed biliary cirrhosis.

Diagnosis of pathology is possible solely through laboratory research. The disease is manifested by minor hyperbilirubinemia and an increase in the IgM level, an increase in the level of the CEC (70% of cases).

Recurrent cholangitis

If the outflow of bile is disturbed constantly, the disease progresses and becomes chronic. Multiple repetition of this process leads to the fact that the pathology is constantly present and permeates the person everywhere. Naturally, everything alternates with periods of calm and a serious manifestation of the disease.

For the period of exacerbation there is a sharp pain in the right hypochondrium. All this is accompanied by fever, jaundice and skin itching. The outflow of bile is able to recover spontaneously. But this happens in the so-called periods of calm. Then the pain gradually ceases, the person's condition improves, signs of jaundice are not observed. The person feels much better. But this state is not for long. Over time, the phase of active manifestation of pathology will come. Symptom is constantly repeated. It is important to maintain a person's condition. Otherwise, the condition will deteriorate significantly. Constantly occurring relapses predict the development of a chronic form.

Hematogenous cholangitis

It is characterized by hematogenous spread of the pathogen of infection. The disease can proceed in different ways. So, its forms can be diverse. The variant of development depends on the reason why the cholangitis appeared.

At the heart of all forms of development are bacteria or protozoan microorganisms that penetrate the body. Most often this is a conditionally pathogenic microflora, lamblia, helminths. Serving as a background for the development of the disease can inflammation of the gallbladder, the presence of stones in it, as well as helminthic invasion. Stagnation of bile provokes the development of cholangitis.

Pathology is characterized by an acute onset. Usually a sharp rise in temperature, up to 40 degrees, is recorded. In parallel, a person feels pain in the right side. And the pain syndrome can be of different intensity. Sometimes he just looks like a colick. The entire right half, side, shoulder, neck and area of the scapula can pull. In these places there are bundles of nerve endings. When progressing, itching, nausea, vomiting, and an eating disorder occur.

Cholangitis in children

The acute form of the disease in children is extremely rare. Basically, it carries a secondary form. Initially, the baby can transfer streptococcal etiology, and then this pathology will arise. Sometimes it has serious consequences. So, pleurisy, abscess of the lung, sepsis and pancreatitis are not excluded. If the treatment method is chosen incorrectly, development of toxic liver dystrophy is possible.

Primary pathology has acute symptoms. If it is chronic, then there are no signs. Only occasionally the baby feels pain in the right hypochondrium, it is pestered with weakness, chills and fever. Usually, this manifestation is characteristic of the acute phase. In the secondary development, biliary cirrhosis is not excluded. It is very difficult to diagnose, and in itself the disease has a complex course.

Influence on the development of pathology in a child can: stagnation of bile, 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. At the same time, not only the gallbladder suffers, but also the lungs, liver tissue, pancreas.

To treat this form is better surgically. Because this depends on the further condition of the child. Admit the chronic form is not worth it. There can be many consequences. It is important to observe proper nutrition.

[51], [52], [53], [54], [55], [56], [57]

Classification of cholangitis

On the etiology:

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

With the flow:

1. Acute.
2. Chronic.

By pathogenesis:

Most often the cholangitis is bacterial in nature and the causative agents are most often E. Coli, enterococci, Friedlander's bacillus, pneumococci, streptococci.

Primary (bacterial, helminthic, autoimmune).

Secondary and symptomatic:

1. On the basis of underarmed horsstasis:
   1. Stones of hepatocholedoch.
   2. Cicatricial and inflammatory strictures of the main bile ducts and large duodenal nipple.
   3. Malignant and benign tumors with occlusion of hepatocholedochus or large duodenal nipple.
   4. Pancreatitis with compression of choledoch.
2. On the basis of diseases without subhepatic cholestasis:
   1. Bioliodigestive anastomoses and fistulas.
   2. Insufficiency of the sphincter of Oddi.
   3. Postoperative cholangitis.
   4. Cholestatic hepatitis and biliary cirrhosis.

By the type of inflammation and morphological changes:

1. Catarrhal.
2. Purulent.
3. Obstructive.
4. Destructive nugget.

By the nature of complications:

1. Abscesses of the liver.
2. Necrosis and perforation of hepatocholedoch.
3. Sepsis with extrahepatic foci of foci.
4. Bacterial-toxic shock.
5. Acute kidney failure.

[58], [59], [60], [61], [62], [63], [64], [65],

Effects

If there is no timely treatment, then the inflammatory process can become more serious. Gradually, it spreads to the peritoneum, because of this, the development of peritonitis is possible. Pathology can "throw" on the surrounding tissue. As a result, subfunctional and intrahepatic abscesses begin to form. Often there is a sepsis, and also a toxic shock. The last complication develops against the background of bacterial form of cholangitis.

The condition of the patients becomes extremely difficult. Sometimes it is impossible to do without resuscitation. Inflammatory process for a long time can lead to sclerotic changes. As a result, the disease takes a chronic form and leads to the development of biliary cirrhosis.

Self-medication and attempts to eliminate pathology by alternative means, on the contrary will exacerbate the situation. And in general, such interference is unacceptable. After all, time may be lost, and pathology will take a more serious character. In the later stages of the forecast is not the most favorable.

[66], [67], [68], [69], [70],

Complications

If a person is not given timely treatment, complications can be burdensome. Most often, it ends with cirrhosis of the liver. In order to prevent such a development of events, it is enough to start treatment in time. Often, cholangitis leads to peritonitis. The peritoneum becomes inflamed, the surrounding tissues are also affected. As a consequence, the development of toxic shock is possible. The patient is difficult to tolerate all the symptoms, he needs help in the form of resuscitation.

A prolonged inflammatory process leads to the appearance of a chronic form of the disease. This can lead to changes in the tissues of the liver. Eventually, biliary cirrhosis develops.

Dealing with an independent problem in this case is silly. While a person will try to remove all signs, the disease will start to progress and it is not always possible to save the victim. This should be treated with complete seriousness.

[71], [72], [73], [74], [75], [76], [77]

Diagnosis of cholangitis

To suspect the existence of a problem simply by the triad of Charcot. So, the diagnosis is carried out against the background of laboratory and instrumental research. Biochemical tests can testify to cholestasis. In the presence of cholangitis, there is an increase in the level of bilirubin, as well as a-amylase and alkaline phosphatase.

To identify the pathogens of the disease, fractional duodenal sounding is carried out together with bacteriological bile culture. Practically in 60% of cases for a pathology the mixed bacterial flora is characteristic. To exclude the presence of parasites, feces are examined for the presence of helminth eggs and other protozoa in the eggs.

There are visualizing methods for assessing the state. Usually, this is ultrasound of the abdominal cavity and liver. It will allow to determine the presence of inflammatory process, increase of organs. Computer tomography is not often performed. This will allow to see the exact image of the bile ducts and their enlargement, as well as the presence of focal changes.

Widely used and instrumental diagnostics. She takes a leading position in the definition of pathology. Thus, endoscopic retrograde pancreatocholangiography, as well as magnetic resonance pancreatocholangiography, is used as its source. On the received pictures it is possible to see bile-excreting ways and the reason of their obstruction.

Differential diagnosis is necessary only in the presence of viral hepatitis, right-sided pneumonia, as well as primary biliary cirrhosis.

[78], [79], [80], [81], [82]

Analyzes with cholangitis

An experienced specialist is able to diagnose only one examination. After all, it is worth listening to the patient and doing the palpation so that the picture becomes more and less understandable. But, nevertheless, analyzes are necessary in order to clarify at what stage the disease is located. This will identify the processes that accompany it and assess the situation as a whole. An important place in this business is the functionality of the liver and other organs.

First, 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. There is also a urine test. For this pathology, a positive reaction to bilirubin is characteristic.

A biochemical blood test is performed. It shows the level of bilirubin, as well as gamma globulins, amylase, alkaline phase-phase and alpha-2 globulins. It is recommended to pass a blood test for sterility. This will eliminate or confirm the presence of bacteria. This analysis is carried out exclusively in specialized institutions, because it requires compliance with certain rules. Assign and duodenal sounding. This procedure will make bile extraction and study it.

[83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93]

Instrumental diagnostics

This method of research includes several main areas. So, the first of them - ultrasound, in other words, usually ultrasound. Thanks to it you can detect an increase in the size of the liver and notice the enlargement of the bile ducts.

The second variant of instrumental diagnostics consists in retrograde cholangipancreatography (ERCPG). It is this method that is fundamental. It is an x-ray examination of the bile ducts by introducing a special contrast medium into them using an endoscope. The technique allows you to study changes in the biliary tract. With a primary cholangitis, changes in the person are visible.

Widely used and magnetic resonance cholangiography. A special place is given to computed tomography. Also used is duodenal sounding. It allows you to examine the bile and see in it any changes. All methods can be used alone or in combination. Much depends on the patient's condition.

Ultrasound diagnosis

It is possible to detect changes in the liver and abdominal cavity using ultrasound. Foci of infection, changes in size and shape immediately should prompt a specialist to think that the patient has cholangitis. Naturally, everything is combined with laboratory tests and symptomatology.

In the study, the uneven width of the lumen of the bile ducts is clearly visible. They increase significantly inside the kidneys or outside, in addition they are echogenic. Unevenness is clearly visible. Portal arteries occupy a prominent position. In case of complications, changes in the contours of the liver are visible. There is an echogenic material in the lumen of the duct.

Ultrasound can provide an accurate diagnosis. Confirm it with endoscopic retrograde cholangiography. Naturally, all is supported by a biopsy and clinical data. Based on the data obtained, a diagnosis is made and a person is given quality treatment.

Differential diagnostics

This technique includes a blood test. Thanks to him, you can identify the presence of an inflammatory process in the body. Usually this is indicated by an increase in ESR and leukocytes. Not the last role is given to biochemical analysis of blood. This study shows the level of bilirubin, especially the direct fraction. The level of alkaline phase-phase and din-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 a toxic liver damage. Without differential diagnosis, in principle, it is impossible to manage. Laboratory tests are especially important.

A general urine test is also performed. Here you can see the appearance of bile pigments. The feces are surrendered to the presence in it of eggs of helminths and other simple organisms. Differential diagnosis strictly interacts with the instrumental.

[94], [95], [96]

Treatment of cholangitis

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

With a conservative elimination, the patient during the first three days should give up food, and then proceed to a sparing diet. This will make it possible to suppress the vital activity of pathogens. After all, they can not get water from anywhere. Together with special nutrition antibiotics of a wide spectrum are applied. Metronidazole is commonly used. In order to reduce pain, spasmolytics and analgesics are used. It is recommended to pay attention to Drotaverin and Meverin. If a person has severe intoxication, he is injected with a glucose-saline solution.

If pathology was caused by parasites, special attention is paid to anthelmintic agents. It can be Albendazole, Mebendazole. To protect the liver when bile is stagnant, it is recommended to use Ademethionin. More detailed information about these medicines will be provided below.

Surgery is a liver transplant. Usually it is used for cirrhosis, recurrent bacterial cholangitis and persistent jaundice.

Medications

As mentioned above, drugs that reduce pain syndrome, eliminate infection and promote rapid recovery of the body are widely used. The most popular drugs are: Drotaverin, Meverin, Albendazole, Ademethionine, Hallestiramine, Ursodeoxycholic acid and Rifampicin. Antibiotics are treated separately.

• Drotaverine. The drug has an antispasmodic effect. It allows you to remove the pain syndrome and improve the patient's condition. Use the product is necessary for 1-2 tablets, 2-3 times a day. Everything depends on the intensity of the pain syndrome. Duration of reception is individual. Do not take medication for people with hypersensitivity, pregnant women, as well as patients with hepatic and renal insufficiency. Side effects: tachycardia, nausea, vomiting, headache.
• Méverine. The agent has an antispasmodic effect. It is used for symptomatic therapy of pain syndrome. The product is strong, so it is sufficient to use one capsule at a frequency of 12 hours. To achieve maximum effect, it is recommended to use it 20 minutes before eating. Contraindications: children under 15 years of age, pregnancy, hypersensitivity. Side effects: not noted.
• Albendazole. The drug is used to remove parasites from the body. Enough 400 mg per day to actively fix the problem. In general, the dose is administered individually. Contraindications: pregnancy, lactation, hypersensitivity and children under 2 years. Adverse reactions: dizziness, nausea, vomiting, dyspepsia, impaired renal function.
• Ademeteon. The drug has a hepatoprotective (protective tissue of the liver) activity. It helps protect the liver from negative effects on it. Take the drug you need 400-800 mg per day. Maintenance therapy - 2-3 tablets a day. Duration of reception is assigned individually. Contraindications: hypersensitivity. Side effects: pain syndrome behind the sternum, in the abdomen.
• Cholestyramine. This drug has an affinity for bile acids. It is able to bind them as a lasting complex in the intestine. The drug is withdrawn along with the feces, which significantly reduces the itching of the skin. Daily enough to use one teaspoon of the drug 3 times a day. It is advisable to do this 40 minutes before a meal, or after 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 low doses. It can cause poor absorption of vitamins and calcium. Pregnant women should not take it. A similar requirement is advanced to people with hypersensitivity. Adverse reactions: nausea, vomiting, intestinal disorders.
• Ursodeoxycholic acid. It can significantly reduce the itching and reduce the amount of toxic bile acids formed. Daily appoint 15-20 mg per kilogram of weight. The maximum dosage should not exceed 1200 mg per day. Contraindications include pregnancy, hypersensitivity and the period of breastfeeding. Possible adverse reactions in the form of nausea, vomiting, increased symptomatology.
• Rifampicin. In the last decade, it is widely used to relieve pruritus in patients with cholangitis. It is able to increase the activity of hepatic microsomal enzymes. Thus, the sulfoxidation of di- and monohydroxyl 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 condition of the patient himself. It is not recommended to use it during pregnancy, in childhood and during lactation.

Antibiotics for cholangitis

To suppress infection, antibiotics of a wide spectrum are used. These include Metronidazole, Tetracycline and Levomycitin. Take them can be no more than 2 weeks in an individual dosage.

• Metronidazole. It is an antimicrobial drug. Apply it one tablet 2-3 times a day. In special cases, the dosage is increased to 4-5 tablets. Independently make adjustments are not worth it, the tool has a number of side effects. Thus, nausea, vomiting, weakness, the presence of metallic taste in the mouth, dizziness are possible. If you have any symptoms, you should consult your doctor. Contraindications: pregnancy, child age, hypersensitivity and the period of breastfeeding.
• Tetracycline. This drug has a bacteriostatic effect. Apply it to 200-250 mg 2-3 times a day. For children enough - 20-25 mg / kg. The duration of treatment is determined on an individual basis. Contraindications: hypersensitivity, pregnancy, lactation, impaired liver and kidney function. Side effects: skin pigmentation, inflammation of the mucous membranes, dysbiosis, allergic reactions. Usually the drug is well tolerated.
• Levomycitin. The drug actively destroys the bacteria. It should be used for 250-500 mg 3-4 times a day. The daily dose should not exceed 2 grams. The nature of treatment and dosage is prescribed by the attending physician. Contraindications: pregnancy, lactation period, psoriasis, eczema, hypersensitivity. Side effects: anemia, nausea, vomiting, fever, allergic reactions.

[97], [98]

Alternative treatment

It should be noted immediately that in the presence of such a disease resort to the help of alternative medicine is not worth it. After all while the person will pick up to itself optimum treatment, the pathology will start to progress. Cirrhosis of the liver and other complications are a tremendous threat to human life. This fact needs to be understood and does not attempt to solve the problem on its own. Yes, there are alternative methods of treatment, but nevertheless without specialized preparations it is impossible to manage.

• Recipe 1. To make it, you need to take 6 tablespoons of nettle dioecious, 3 tablespoons of turnips and flowers immortelle sand. In the amount of 2 tablespoons, the stigmas of corn and the herb of St. John's wort are taken. All this is intermixed. For cooking, just take 2 spoons of the collection and mix them with honey. After that everything is filled with boiling water in the amount of 500 ml. To insist means it is necessary during 2 hours. Then apply 3-6 times a day for half a glass.
• Recipe 2. To prepare a universal remedy, it is worth taking half a kilogram of honey and 500 ml of olive oil. All this is mixed with each other and for effectiveness 2 lemons are added, or rather their juice. All products are mixed together and taken one tablespoon 3 times a day for 40 minutes before meals.

[99], [100], [101], [102], [103], [104], [105]

Herbal Treatment

Herbs can help in many situations and even cope with the problems of outflow of bile. True, they can only be used as maintenance therapy. Self-use is not worth it.

• Recipe 1. It is necessary to take a tablespoon of St. John's wort and fill it with a glass of boiling water. Then put on a fire and boil for about 15 minutes. The received product is taken on a quarter cup 3 times a day. The broth is able to have a pronounced anti-inflammatory effect, and also to provoke an outflow of bile.
• Recipe 2. A spoonful of mashed potatoes should be filled with a glass of boiling water. The remedy is infused for 2 hours. Take it a quarter of a glass three times a day. The remedy is really effective, but pregnant women can not take it.
• Recipe 3. Take 100 grams of stigmas corn and mix with 75 grams of marigolds and yarrow. All this is poured into two glasses of boiling water (it is enough to collect 2 tablespoons). At night, the remedy is left alone. In the morning, everything is filtered and used 100 ml up to 4 times a day.

Homeopathy

Homeopathic remedies have long time gained popularity and special distribution. But nevertheless, it is recommended to resort to the help of standard methods of treatment. If we talk about homeopathy, it is effective, but not for everyone. To combat cholangitis using a variety of means.

• Arsenicum album. It is a poisonous substance. Assign it to people who suffer from pruritus, which intensifies during the night. Often, the drug causes an allergic reaction, nausea and indigestion.
• Baptisia tinctoria (wild indigo family of legumes). The drug is widely used in the chronic form of the disease. Especially if it flows together with fever, bright dreams and hot sensations in the morning.
• Berberis vulgaris (barberry). It is used in the presence of bitterness in the mouth, aching pains, and also dryness in the oral cavity. Possible development of pain during movement.
• Bryonya alba (perestupen white). A remedy is prescribed for very painful palpation and the presence of a pathological process in the liver.
• Kuprum (copper) and zincum (zinc). Widely used in severe spasms of the gallbladder. They are able to have an anti-inflammatory effect.
• Lycopodium of Clavatum. Used for cholangitis, accompanied by liver disease. Especially when there is a pronounced symptomatology. In this case, we mean bitterness in the mouth, a violation of appetite, heartburn.

A full list of medications can be consulted by a homeopath physician. It is he who prescribes this or that remedy, depending on the condition of the person and the symptoms.

Diet with cholangitis

When the disease occurs in an acute form, it is recommended to listen to the menu at number 5a. If the flow is chronic, diet 5 is perfect. Now it is worth considering them in more detail.

• Diet number 5. You need to eat food 5 times a day, in small portions. To eat before going to bed is forbidden, in any case, heavily eat up. Sharp and spicy dishes are prohibited. Refuse to have from garlic, horse-radish and radish. Alcohol is strictly prohibited. Fatty meat and fish should be deposited 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. Include in the diet is buckwheat, lean meat, fish, cottage cheese and oatmeal. Once the condition improves, you can switch to vegetable and milk soups. Lenten meat and fish are allowed. You can eat cookies, fresh vegetables (cabbage, carrots and potatoes). The bread is allowed, but slightly dried. Honey, sugar and berries are very useful. You can create a diet yourself, starting from the list of allowed products.
• The diet number 5a. You can eat absolutely any cereals, but they need to be thoroughly boiled. Meat and fish are used in a steam form. You can not fry anything! Do not eat raw fruits and vegetables. Under the ban is rye bread. It is advisable to spend monodetic days on apples or cottage cheese. To eliminate constipation, the diet is diluted with dried fruits, beets and vegetable juices. When the condition improves, you can go on a diet at number 5.

[106], [107], [108]

Prevention

Prevention in the presence of a chronic inflammatory process is to prevent the development of severe exacerbations. To achieve this will allow the fight against stagnation of bile. To do this, people need to eat right and do morning exercises. Emptying the bowels should also be normal. You need to eat foods that will prevent constipation. If you have gastrointestinal diseases, you need to fight them. Strengthens the nervous system. It is important to organize proper nutrition, eliminate bad habits, including smoking and alcohol.

All patients who suffer from a chronic form of pathology should always be under clinical supervision. It is important to carry out anti-relapse treatment, this is done 1-2 times a year, depending on the condition of a person and the progression of pathology. It is necessary to constantly use mineral water, cholagogue and medical food. It is advisable to periodically send 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 flow, as well as the outflow of bile. If the 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 maintain the body so that there is no relapse. Constant repetition of the pathology pattern leads to a chronic course. In this case, the forecast can be extremely unfavorable.

If we talk about the late stages of pathology, then everything depends on the treatment. But all the same, the probability of an unfavorable forecast is several times higher. It is not always possible to save a person, especially if he has cirrhosis of the liver. Only organ transplantation is needed here. To worsen the prognosis are additional symptoms related to acute liver failure, cirrhosis and liver abscess. Women at the age of over 50 are at risk. Therefore it is important to undergo examinations and respond to any symptoms in a timely manner.