What Is Cholangitis?

Biliary inflammation is mainly called cholangitis, and cholecystitis is mainly called cholecystitis. The two often occur at the same time, mostly secondary to bacterial infections on the basis of cholestasis. Bacteria can reach the biliary tract through the lymphatic or blood tract, and can also retrogradely enter the biliary tract from the intestine through the duodenal papilla. The latter is more common in our country. Can be divided into two types of acute and chronic.

Basic Information

English name

cholangitis; angiocholitis

Visiting department

surgical

Common locations

bile duct

Common causes

Secondary bacterial (mostly E. coli) infections based on cholestasis

Common symptoms

Mid-upper abdominal discomfort, soreness, or colic, worsening after eating fatty foods; acute triad of abdominal pain, chills, fever, and jaundice

Etiology of cholangitis

Acute suppurative cholangitis is an acute purulent infection of the biliary tract caused by bile stasis and rapid increase in bile duct pressure caused by bile duct obstruction (the most common is gallstone obstruction).

After non-surgical treatment of acute cholangitis, the acute inflammation is controlled, but the primary etiology in the bile ducts (such as bile duct stones inside and outside the liver, biliary tsutsugamushi, or Odhi sphincter stenosis, etc.) has not been resolved. Thickens the bile duct wall.

Clinical manifestations of cholangitis

The pathogenic bacteria are mainly Gram-negative bacilli, most commonly E. coli. The onset of this disease is rapid and dangerous, and it is one of the leading causes of death of gallstone patients in China.

The disease often manifests as discomfort in the middle and upper abdomen, bloating, or colic. After eating greasy food, the pain in the upper abdomen can be aggravated. Fever and jaundice are rarely seen. Abdominal signs are not obvious. Only mild tenderness in the upper abdomen and gallbladder Does not swell. If an acute attack occurs, there will be a triad of abdominal pain, chills, fever, and jaundice. In addition to the Charcot triad of acute cholangitis (abdominal pain, chills, high fever, jaundice), there are also shocks, and the central nervous system is inhibited, which is called the Reynolds pentagram.

The onset of this disease is often rapid, with severe, persistent pain under the xiphoid or right upper quadrant. Then, chills and relaxation-type hyperthermia occur, and body temperature can exceed 40 ° C. Often accompanied by nausea, vomiting, and jaundice, but the severity of jaundice and the severity of the disease may not be consistent. Nearly half of the patients showed signs of central nervous system depression such as irritability, disturbance of consciousness, drowsiness and even coma. At the same time, blood pressure often decreased. Patients are often reminded that septicemia and septic shock have occurred and that they are critically ill.

Cholangitis examination

The following tests can be done to confirm the diagnosis:

Biochemical inspection

Determination of blood and urine amylase can determine whether it is accompanied by pancreatitis. The values of total bilirubin, 5 nucleotidease, alkaline phosphatase, and transaminase were all increased, and all returned to normal during the remission period. People with chronic disease have liver cell damage.

2. Type B ultrasound imaging

When the biliary obstruction is dilated, the location and scope of the fluid content, the extent and length of bile duct dilatation can be accurately detected, and the diagnostic accuracy is high.

3. Percutaneous liver cholangiography (PTC)

In patients with bile duct dilatation, the intrahepatic bile duct and its flow direction can be displayed, and the scope of bile duct dilatation and dilation can be clarified. For jaundice cases, the etiology or obstruction can be identified, and the pathological changes of the bile duct wall and its interior can be observed, and the cause of the obstruction can be identified according to the characteristics of its image.

4. Endoscopic retrograde cholangiopancreatography (ERCP)

With duodenoscope, the nipple cannula can be intubated, and the contrast agent is directly injected into the bile duct and pancreatic duct.

5. Barium meal examination

Its diagnostic value has been replaced by ultrasound. The larger cystic dilatation can show that the duodenum is shifted to the left and front, the duodenal frame is enlarged, and the shape is solitary.

6. Intraoperative biliary angiography

Injecting the contrast agent directly into the common bile duct during the operation can display all the images of the intrahepatic, external bile duct system and pancreatic duct, understand the extent of intrahepatic bile duct expansion, and the reflux of the pancreatic duct and bile duct. Postoperative management.

Cholangitis diagnosis

It is not difficult to draw a diagnosis based on clinical manifestations and related examinations.

Differential diagnosis of cholangitis

It should be distinguished from cholecystitis and pancreatitis.

Cholangitis complications

Can be complicated by gallbladder stones, obstructive jaundice, biliary pancreatitis.

Cholangitis treatment

Chronic cholangitis

Surgical methods are used to remove obstruction factors to ensure smooth bile duct drainage. In an acute attack, control the infection first, and then perform surgery after the condition is stable. Cut bile ducts to remove stones or tapeworms, and drain T-shaped tubes. If there is sphincter stenosis of Oudi, sphincteroplasty can be used. If there is obstruction of the lower end of common bile duct, it can be used for common bile duct drainage such as common bile duct duodenal anastomosis or bile duct jejunum Roux-y anastomosis. To remove the infected lesions, the gallbladder should be removed. Patients with intrahepatic bile duct stenosis must thoroughly understand the pathological changes and relieve the cause of obstruction. Such as incision of the intrahepatic bile duct stenosis and removal of intrahepatic stones, and then Roux-y bile duct jejunum anastomosis. Oedipal sphincteroplasty and bile duodenal anastomosis are prone to reflux cholangitis.

2. Acute cholangitis

Surgical removal of bile duct obstruction, reducing bile duct pressure and smooth drainage. However, in the early stage of the disease, when acute simple cholangitis is not serious, non-surgical methods can be used first.

It is ineffective for non-surgical treatment and develops from simple cholangitis to acute obstructive suppurative cholangitis. Surgical treatment should be adopted in time. Non-surgical treatment includes the application of antispasmodic, analgesic, and choleretic drugs. Among them, 50% magnesium sulfate solution often has a good effect, the dosage is 30 ~ 50ml once or 10ml 3 times a day; gastrointestinal decompression is also often used; The combined application of large-dose broad-spectrum antibiotics is important. Although the concentration of antibiotics in bile can not reach the concentration required for treatment during bile duct obstruction, it can effectively treat bacteremia and sepsis. Common antibiotics are gentamicin and chloramphenicol. Voxel, vanguardin and ampicillin. Appropriate antibiotics should be adjusted based on blood or bile bacterial cultures and drug sensitivity tests. If shock is present, anti-shock therapy should be proactive. If the condition does not improve significantly after 12 to 24 hours of non-surgical treatment, surgery should be performed immediately. Even if shock is not easily corrected, surgical drainage should be sought. Symptoms are more serious from the beginning, especially in cases with deep jaundice, and surgery should be performed in a timely manner. Surgical mortality is still as high as 25-30%. Surgical methods should be simple and effective, mainly bile duct incision and drainage. It should be noted that the drainage tube must be placed proximal to the bile duct obstruction. Drainage on the distal side of the obstruction is ineffective and the condition cannot be relieved. If conditions permit, it can also be removed.

Cholangitis prevention

Pay attention to diet hygiene to prevent infection; apply antibiotics promptly when inflammation occurs; formulate recipes reasonably, and do not eat too much food containing animal fats; when intestinal worms (mainly tapeworms) are infected, apply deworming drugs in time; In case of insufficient medication, tapeworms can easily penetrate into the biliary tract, causing obstruction and causing cholecystitis.