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Chronic cholangitis
Last reviewed: 23.04.2024
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Chronic cholangitis is a chronic bacterial inflammation of the bile ducts (extrahepatic and intrahepatic).
Symptoms of chronic cholangitis
Latent form: pain and soreness in the right hypochondrium are indistinct or absent, weakness, chills, subfebrile body temperature, occasionally itching, icteric skin and visible mucous membranes, gradual enlargement of the liver.
Recurrent form: pain in the right side and soreness in the right hypochondrium during palpation, nausea, bitterness in the mouth, itching; in the period of exacerbation - jaundice, fever, prolonged subfebrile condition is possible; with a prolonged course - thickening of the terminal phalanges in the form of tympanic sticks and nails in the form of hour glasses, the liver and spleen are enlarged, dense.
A protracted septic form: severe course with fever, chills, pain in the right hypochondrium, enlargement of the liver, spleen, severe intoxication, kidney damage, jaundice. Recalls septic endocarditis.
Sclerosing (stenosing) form: general weakness, malaise, fever, chills, itching, jaundice, enlarged liver, spleen.
In the later stages of chronic cholangitis, the development of biliary cirrhosis is possible.
Laboratory data
The same as with acute cholangitis, but for chronic anemia is more natural.
Instrumental data
The same as with acute cholangitis. Intravenous cholangiography or endoscopic retrograde pancreatocholangiography reveals enlarged bile ducts (extra- and intrahepatic), with sclerosing cholangitis - intrahepatic ducts in the form of rods, often sharply narrowed with reduced branching, narrowing in some sections or throughout the common bile duct.
Survey program
Same as with acute cholangitis. In addition, in difficult differential-diagnostic cases, laparoscopy with cholangiography and targeted liver biopsy is necessary.
Diagnosis of chronic cholangitis
The diagnosis is formulated proceeding from the etiological and pathogenetic features of cholangitis and its role in a number of other manifestations of the pathological process.
Primary cholangitis develops as an independent disease. Among them, primary sclerosing cholangitis is a disease of a presumed autoimmune nature. The "eastern cholangitis" is also described as the primary one, an insufficiently studied form, endemic for some regions of Asia and, possibly, associated with a clonorchosis. With secondary symptomatic cholangitis, the first place is a disease that is a prerequisite for its development or associated with it. True, with cholestatic hepatitis and primary biliary cirrhosis it is not customary to stipulate the participation of cholangitis in the formation of a pathological process, but it is appropriate to imply. If the cholangitis acts as an independent disease, its primary importance should be reflected in the diagnosis. This emphasizes the isolation of such rare forms from the absolute predominant frequency of secondary cholangitis.
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