This disease is often confused with cholecystitis, but these are completely different diseases. In the article, we will take a closer look at what chronic cholangitis is and how it manifests itself. Let's get acquainted with the causes and symptoms. At the end of the article, we will analyze the directions of diagnosis, the treatment regimen for chronic cholangitis. And we will find out what disease prevention can be.
What is this?
Chronic cholecystitis and cholangitis are united by the fact that they are diseases of the gallbladder. The difference is in the location of the organ damage, the course of the disease.
Chronic cholangitis is an inflammation of the bile ducts, both external and internal ducts. It is characterized by a long, relapsing course (which is why the disease is called chronic). Can eventually lead to cholestasis.
Chronic cholangitis. What is the disease? Inflammatory processes in the bile ducts due to the penetration of infection into them from the organs of the digestive tract (gall bladder, intestines), blood vessels. Less often, the infection can get through the lymphatic tract. One of the common reasonsdisease is toxoplasmosis. And the carriers of Toxoplasma itself are domestic cats.
Basic information about the disease
Among the main clinical signs of chronic cholangitis are severe pain in the liver area, fever, chills, jaundice. The main direction of diagnostics here today is called ultrasonography of the pancreas and the bile ducts leading to it. They also use methods such as retrograde cholangiopancreatography, computed tomography of the bile ducts, as well as general and biochemical blood tests.
As for the treatment of chronic cholangitis, the most effective is the combined option. It is a combination of antibacterial conservative, analgesic therapy, detoxification, as well as surgical decompression of the biliary tract.
As for chronic cholangitis in the ICD-10, it is designated under the code K83.0.
Statistics
Let's turn now to world medical statistics. Unlike chronic cholecystitis, cholangitis is much less common. As in comparison with other inflammatory diseases of the hepatobiliary system.
Mostly pathology develops in adults. The average age of patients is 50 years. There are no observations of more frequent exposure of men or women to the disease.
In most cases, it manifests itself against the background of already existing diseases of the liver and gallbladder. It is noted that in 37% of cases the disease will be diagnosed after cholecystectomy.
It's impossible not tosay about the specific form of the disease - sclerosing cholangitis. It progresses against the background of the relative he alth of the person. Develops slowly over an average of 10 years. And as a result, it leads to irreversible liver damage. There are no reliable data on the true figures for the incidence of the sclerosing form, since so far its diagnosis is difficult. But, it must be said that in recent years the number of recorded cases has increased. Which, first of all, indicates an improvement in the quality of diagnostics.
If we talk about mortality from chronic cholangitis, then there are no clear figures. Depending on the timing of the detection of the disease, the correctness of therapy, it ranges from 15 to 90%.
Reasons
Is it possible to develop chronic cholangitis after removal of the gallbladder? Yes, in many cases. This disease is more of a bacterial nature. Almost all pathogens that are present in the digestive tract can cause it:
- Proteas.
- Enterococci.
- E. coli.
- Klebsiella and others
In almost all cases, infection with several of these pathogens is noted simultaneously. And at the same time, only one single agent, a bacterium, is very rarely found during bile cultures. In many cases, with a chronic type of cholangitis, the presence of bacteria in the patient's blood is also detected (positive culture for blood sterility).
As we have already said, various surgical, diagnostic,therapeutic interventions affecting the biliary tract. They can be performed against the background of both congenital developmental anomalies and various infectious processes.
What contributes to the development of the disease?
What can contribute to the entry of bacteria, intestinal microflora into the biliary tract? This is usually the following:
- Violation of the functioning of the duodenal papilla.
- Both lymphogenous and hematogenous dissemination of various bacterial agents.
This mechanism of infection of the bile ducts can be observed in the following:
- Anomalies in the development of the bile ducts themselves, the presence of congenital cysts, etc.
- Stenoses and deformities of the biliary tract after surgery or endoscopic interventions.
- Tumours of the biliary tract or the pancreas itself.
- Cholestasis due to cholelithiasis.
- Invasion of parasites.
As a rule, the formation of chronic cholangitis requires a combination of three factors:
- Translocation (getting) of intestinal microflora into the bile ducts.
- Cholelithiasis.
- Increased intraductal pressure.
It should be noted that the chronic form of cholangitis can also form as a continuation of acute cholangitis. But the primary purely chronic course of the disease cannot be ruled out.
Main early symptoms
The main symptom of chronic cholangitisadvocates the identification of the so-called Charcot triad. It includes the following:
- Moderate pain felt in the right hypochondrium.
- Chills - an increase in the patient's body temperature to subfebrile levels.
- Jaundice.
As for the signs of chronic cholangitis, the patient suffers from dull, low-intensity, aching pains. After biliary colic, he feels moderate fever, slight chills.
As for the clinical picture, here it is erased, recurrent. Therefore, patients, as a rule, rarely pay attention to the first symptoms of the disease.
Main symptoms in advanced stage
If you go to the signs of chronic cholangitis (cholecystitis is a completely different disease) already at a late stage, you can notice the following:
- Ictericity (in simple terms, yellowness) of both the skin and mucous membranes.
- Fatigue.
- General weakness (generally expressed in the elderly patient).
As for the age of the patient over 60 years, the diagnosis in this case is significantly difficult. The clinical picture will not correspond to the severity of the inflammatory process occurring in the bile ducts. The symptoms are too blurred, so it is difficult even for a specialist to establish a correct diagnosis.
Complications of the disease
This form of the disease, like purulent chronic cholangitis, can lead to the fact that the infection penetrates into the systemic circulation. And this is already fraught with developmentseptic biliary shock. Its result in 30% of cases is lethal.
The following complications are no less dangerous for the life and he alth of the patient:
- Porto-caval thrombosis.
- Liver abscess.
- Another kind of septic manifestations.
As for the chronic sclerosing form, it can result in the following consequences:
- Hepatocellular carcinoma.
- Cirrhosis of the liver.
Laboratory diagnostics
If you even suspect symptoms of a chronic type of cholangitis, you should definitely seek advice from a gastroenterologist. To make a preliminary diagnosis, the doctor makes sure that the patient has Charcot's triad.
Further, to clarify the verdict, it is necessary to pass a number of laboratory tests. Here the following is revealed:
- Complete blood count. If the patient has chronic cholangitis, high leukocytosis, increased ESR, as well as a neutrophilic shift in leukocyte formulas will be detected.
- Biochemical blood test. If the diagnosis is correct, then the results of the screening will be an increased level of bilirubin, the activity of G-GTP and alkaline phosphatase.
- Microbiological research. In almost all patients, intestinal microflora is found in bile. In half of patients, bacteria are also found in the blood.
Instrumental diagnostics
Also, doctors turn to instrumental diagnostic methods. In particular, ultrasonography of the bilepathways and the pancreatic pathway itself. Here you can see thickening and some expansion of the walls of the biliary tract.
No less important is computed tomography, which is widespread today. It not only confirms the data obtained during the ultrasound examination, but also helps to identify the complications of the purulent form of chronic cholangitis in time. In particular, various purulent abscesses and pylephlebitis.
To perform retrograde cholangiopancreatography, an additional consultation with an endoscopist is required. Such an examination helps not only to visualize the calculi located in the biliary tract, but also to point out their specific extensions.
Recently, ERCP has been replaced by magnetic resonance cholangiopancreatography. Its undoubted advantage is that it is a non-invasive diagnostic method. It not only reveals the symptoms of chronic cholangitis, but also helps to establish the causes of its development.
If diagnostic tests are performed just before surgery, transhepatic cholangiography may be used. The needle is passed through the patient's skin and then through his bile ducts. This is how contrasting and drainage of the latter are carried out.
Similarities to other diseases
When diagnosing chronic cholangitis, specialists need to be especially careful - the disease is similar in its manifestations, symptoms with a number of other pathologies and diseases:
- Bile duct blockage (observed with gallstones).
- Viral hepatitis.
- Calculous and pungentcholecystitis.
- Tumors of the bile duct, liver or pancreas.
- Bile duct strictures due to other cause.
Drug therapy
In the article, we analyze, among other things, the symptoms and treatment of chronic cholangitis. As for therapy, it is predominantly outpatient. Hospitalization in the gastroenterology department of a hospital is required only in special cases:
- Malignant cholestasis.
- Severe illness.
- The advanced age of the patient.
Drug treatment here is preliminary - this is the first stage to the surgical unloading of the bile ducts. In particular, the body is detoxified, the patient is prescribed antimicrobial and painkillers. Prior to obtaining bacterial cultures, broad-spectrum antibiotics are prescribed. These are penicillins that can penetrate into bile, cephalosporins and aminoglycosides. If the nature of the infection is parasitic, appropriate drugs are prescribed additionally.
Surgery
The main goal of surgery for chronic cholangitis is the removal of stones from the bile ducts, which can improve and stabilize the outflow of bile. That is, the biliary tract is drained.
For this purpose, the following operations are carried out:
- External biliary drainage.
- Transhepatic percutaneous drainage.
- Nasobiliary type of drainage (performed with RPCH).
- Extractioncalculi from choledochus.
- Extraction of calculi from the bile ducts with RAH.
- Balloon endoscopic dilatation of the sphincter of Oddi.
- Endoscopic stenting of the common bile duct.
As for rehabilitation in the postoperative period, it is very important to follow a special diet for chronic cholangitis. It is compiled by your doctor. It is important to include foods rich in both vitamins and vegetable oils in the diet. The diet must be combined with choleretic and antibacterial therapy.
Prevention and forecasts
Do not forget that the chronic type of cholangitis is a rather serious disease, ignoring which, incorrect or untimely treatment can be fatal. The prognosis of the disease here worsens the following:
- Female.
- Old age.
- Prolonged hyperthermia - more than two weeks (increased body temperature).
- Anemia.
- Disorders of consciousness.
- Inadequate liver and kidney function.
Prevention in this case is secondary. Comes down to two important areas:
- Carrying out preventive diagnostics of the liver, gallbladder and digestive tract as a whole.
- Timely treatment of diseases, infections, pathologies that can cause cholangitis.
We got acquainted with a rather serious disease - inflammation of the bile ducts of an infectious nature. Chronic cholangitis is dangerous because its symptoms(especially at an early stage) are erased. We need a comprehensive diagnosis - both laboratory and instrumental. The patient will have medical, surgical treatment, diet.
