In this article, we will look at the symptoms and treatment of cholangitis. This is a pathology, which is an inflammatory process in the biliary tract, which in most cases is non-specific, that is, it is usually caused by non-specific pathogens that can provoke some other inflammatory conditions.
Description
The disease is considered very common and quite often it is accompanied by other disorders in the gastrointestinal tract. Cholangitis is a gastroenterological problem, however, in the event of the development of certain complications, it requires surgical intervention methods.
Bile ducts are equally often affected along their entire length - both small ducts inside the liver and large ones outside.
Not everyone knows the symptoms of cholangitis.
Statistics
This disease is most often diagnosed in older age categories - from about 45 to 60 years, but inIn recent years, there has been a tendency to rejuvenate this pathology, and more and more patients aged 35-40 years are admitted to hospitals with signs of this disease. Most often, women of these age categories suffer from inflammation of the bile ducts.
Symptoms and treatment of cholangitis in adults and children will be discussed below.
Isolated forms of pathology are much less common than combined ones. This means that in cases of detection of this disease, other pathologies of the gastrointestinal tract should also be diagnosed, since such diseases may not manifest themselves or their symptoms may be lost against the background of the main symptoms of cholangitis. In most cases, inflammatory lesions of the biliary tract are combined with acute or chronic varieties of diseases of the digestive tract, such as:
- Gastritis.
- Duodenitis.
- Cholecystitis.
- Gastroduodenitis.
- Hepatitis.
- Pancreatitis.
- Cholelithiasis.
- Disorders of the papilla of Vater (the area where the bile duct flows into the duodenum).
Causes of disease
Inflammatory disorders in the biliary tract are usually caused by a certain infectious agent that enters them in various ways. The causative agents of this pathology are most often the following infections:
- E. coli.
- Different forms of staphylococcus.
- Proteas.
- Different types of enterococci.
- Non-clostridial anaerobic infections.
BIn some cases, this disease is not amenable to the main methods of conservative treatment, so here we are talking about infection of the biliary tract with the following specific pathogens:
- Koch's Wand (Mycobacterium tuberculosis).
- Pale spirochete (syphilitic infection).
- Typhoid bacillus.
Often, the symptoms of cholangitis of this kind, that is, provoked by specific infections, may not be diagnosed, because they are lost against the background of the main manifestations of the classical form of the disease that such an infectious agent caused. This is especially true of sluggish and latent (hidden) forms of inflammatory lesions of the biliary tract.
Comorbidities
In addition, some cases of bile duct damage by parasitic pathogens are described in the following major diseases:
- Opisthorchiasis, which is a lesion of the body by opisthorchis flatworms, which usually live in the ducts of the liver, as well as the pancreas.
- Ascariasis, which is a parasitism of worms in certain parts of the small intestine.
- Giardiasis, caused by Giardia, single-celled organisms that can invade the small intestine.
- Strongyloidosis - the penetration of roundworms through the skin into the lumen of the respiratory tract, and from there into the intestines.
- Clonorchiasis, which is a helminthic lesion of the hepatic ductsand pancreas.
- Fasciolosis, which is the introduction of helminths into the lumen of the bile ducts and pancreatic ducts.
Methods of pathogen penetration
In most cases, the infectious agent enters the bile ducts in the following ways:
- Through normal migration.
- Hematogenous - through blood flow through the central vein of the liver (portal vein).
- Lymphogenous way, that is, with the flow of lymph, most often with inflammatory lesions of the gallbladder, as well as the pancreas or intestines.
In addition, some viral agent can play a certain role in the development of this pathological phenomenon. As a rule, with such a lesion, not only the main, but also small bile ducts passing inside the liver can be involved. This is observed, for example, in viral hepatitis.
Symptoms of cholangitis appear depending on the type of disease.
Disease types
In almost half of all clinical cases, the infectious agent of cholangitis is considered to be a mixed microflora, when two or more pathogens are present in the body. In some cases, there is a combined infectious agent in the form of bacteria and protozoa, viruses and parasites, and so on.
However, inflammation of the bile ducts can also develop without the participation of certain pathogens. The disease in such a case is called "aseptic cholangitis", which literally means "sterile".
This form of pathology inmainly has an enzymatic nature, when the active pancreatic juice begins to irritate the walls of the biliary tract from the inside. In most cases, this is observed with pancreatobiliary reflux, in which the secreted pancreas enters the biliary tract, and this should not normally occur. As a result, symptoms of cholangitis occur. Initially, the inflammatory process occurs without the participation of infectious agents, however, pathogens can join at different stages of the disease.
Autoimmune cholangitis
Sclerosing cholangitis is also a type of this disease, and it occurs due to inflammation of the bile ducts of an autoimmune nature, when the body produces killer cells that affect its own tissues.
Suspicion that the disease is of an autoimmune nature appears, as a rule, if the patient has parallel signs of such pathologies of the immune nature as:
- Ulcerative colitis of non-specific form, when the formation of ulcers of the mucosa occurs throughout the large intestine.
- Crohn's disease characterized by the formation of granulomas throughout the gastrointestinal tract.
- Vasculitis, which leads to inflammation and subsequent destruction of the walls of blood vessels.
- Rheumatoid arthritis, which is a pathology of the connective tissue, accompanied by deformities of the joints.
- Thyroiditis is an inflammatory process in the thyroid gland.
Penetrationinfectious pathogens in the biliary tract is sometimes relieved by stagnation of bile - cholestasis, which is mainly observed in the following pathologies:
- Dyskinesia of the biliary tract, that is, a violation of their motor functions.
- Congenital anomalies of the gallbladder ducts - all kinds of kinks and pressures.
- Choledochocysts.
- Cancer of the bile ducts.
- Choledocholithiasis, which is the process of formation of stones in the bile duct.
- Stenosis, or narrowing, of the papilla of Vater.
The main reason for the occurrence of symptoms of sclerosing cholangitis may be some damage to the walls of the biliary tract during endoscopic procedures, which include:
- Retrograde cholangiopancreatography, which is the introduction of a contrast agent using a probe into the bile ducts.
- Stenting, that is, the installation of special scaffolds that maintain the normal shape of the biliary tract.
- Sphincterotomy, or dissection, of the sphincter of Oddi, when the muscles at the junction of the choledochus and the common pancreatic duct are involved.
- Surgical treatment of liver diseases, for example after cholecystectomy.
Symptoms and treatment of cholangitis are of interest to many.
Course of the disease and symptoms
Depending on what negative changes occur in the walls of the biliary tract, the acute form is divided into purulent, catarrhal, necrotic and diphtheric. The symptoms of cholangitis depend on itsvarieties. Nevertheless, there is a list of the main signs, which include:
- Fever and hyperthermia.
- Pain in the abdomen.
- Intoxication.
- Dyspepsia.
- Jaundice.
- Excessive sweating.
Pain is usually localized in the right hypochondrium and can radiate to the arm, neck, etc.
A symptom of chronic cholangitis is Charcot's triad - moderate pain in the right hypochondrium, chills and subfebrile fever, jaundice. The nature of the pain is usually dull, aching, low-intensity.
There is a moderate fever, accompanied by mild chills. The symptoms are erased, so the first manifestations of the disease are ignored.
Much later in comparison with the appearance of the first pain symptoms and dyspepsia, jaundice develops, which is a yellowing of the skin, sclera and mucous membranes. This is due to the accumulation of bile pigments. If the course of cholangitis is complex, then some disturbances in consciousness and symptoms of shock are added.
Symptoms of cholangitis in children
Manifestations of acute cholangitis in children are rare. Most often this is a consequence of a streptococcal infection. Symptoms are violent, with fever and intense pain. In children, signs can be disguised as any other pathology of the gastrointestinal tract. Patients are characterized by the presence of dyspepsia, observed with the frequent use of fatty, heavy foods. In addition, there is general weakness, increasedfatigue and redness of the palms.
Complications
If such a disease is not cured in a timely manner, very serious complications can develop, which include:
- Cholecystopancreatitis.
- Cirrhosis of the liver.
- Hepatitis.
- Peritonitis.
- Liver abscesses.
- Liver failure.
- Hepatic encephalopathy.
- Sepsis.
- Infectious-toxic shock.
Treatment of symptoms of cholangitis with alternative methods will be discussed later.
Diagnosis
Based on the clinical manifestations of this disease, in the diagnosis of cholangitis, as a rule, various physical, instrumental and laboratory research methods are used.
When examining a patient, yellowness of the skin, the condition of the tongue and skin lesions are determined. Informative will also be the study of feces and urine. The feces of a patient with cholangitis is characterized by a light shade. Bile enzymes in the blood can darken urine (the characteristic color of beer).
On palpation there is severe pain in the right hypochondrium.
Instrumental methods used to diagnose cholangitis include:
- Ultrasound and ultrasonography of the biliary tract, which allows you to evaluate the external features of the biliary tract, determine the presence of structural pathologies in them, in particular expansion, as well as disorders in the liver.
- Computed tomography, which is used to evaluate the same parameters that are determined by ultrasound, using computer slices.
- Endoscopic retrograde cholangiopancreatography.
- Magnetic resonance cholangiopancreatography.
- Percutaneous transhepatic cholangiography.
- Duodenal sounding.
Laboratory diagnostic methods:
- Complete blood count.
- Biochemical liver test.
- Bacteriological culture of bile.
- Fecal analysis.
Differential diagnosis of this disease is carried out, as a rule, in the presence of the following pathologies:
- Cholelithiasis.
- Primary cirrhosis of the liver.
- Acalculous cholecystitis.
- Empyema of the right pleura.
- Right-sided pneumonia.
The symptoms and treatment of chronic cholangitis are closely related.
Treatment
Cholangitis is usually treated conservatively or surgically. The choice of method of therapy largely depends on the cause of the development of pathology, its degree and complications.
The main objectives of the treatment of this disease are the elimination of intoxication and inflammation and decompression of the biliary tract.
Traditional treatment is based on the following activities:
- Bed rest.
- Starvation followed by a strict diet.
- Drugs that are able to eliminate the causative agent of the infectious process - antibiotics, antiparasitics, etc.
- Anti-inflammatorymedicines.
- Anspasmodics that are used for severe pain.
- Infusion therapy used to eliminate intoxication.
- Hepatoprotectors to protect liver cells from damage that can occur due to bile stasis in the ducts.
- For severe intoxication, plasmapheresis is used.
If necessary, surgical correction is used, the methods of which also include the use of various methods of surgical interventions.
We covered the main symptoms of cholangitis.
Treatment with folk remedies
In nature, there are a large number of medicinal plants that help with diseases of the liver, gallbladder and biliary tract. However, in the acute period, such treatment should not be carried out.
- Cholagogue collection. In equal parts, you need to take herbs of knotweed, yarrow and calendula flowers. Then 2 tablespoons of raw materials are brewed with boiling water (500 ml) and infused for one hour. The infusion is filtered and drunk half a cup 3 times a day half an hour before meals. The course lasts 30 days.
- The recipe will help restore the bile ducts and improve the composition of bile. The collection includes equal parts chamomile, sandy immortelle and corn stigmas. 2 tbsp. l. pour 500 ml of boiling water over the mixture and heat in a water bath for 30 minutes, then leave to infuse for one hour. Take half a cup instead of regular tea.
- Recipe for lazy people. The mint-honey mixture is very effective and does not require dailycooking. Dry crushed peppermint leaves and flower honey are mixed in equal parts. The drug is taken twice a day for 1 tsp, washed down with warm tea. Mint can increase bile secretion by 10 times.
So, in the article we looked at the symptoms and treatment of cholangitis.
