Cholangitis, what is it? Symptoms and Treatment

Cholangitis - an inflammatory lesion as the intrahepatic and extrahepatic bile ducts. In most cases, the disease is diagnosed in the female, men suffer from the disease less frequently. The main risk group consists of older people - from fifty to sixty years. Extremely rare disease occurs in children.

The disease has no specific symptoms, why conduct a wide range of laboratory and instrumental examinations required to establish the correct diagnosis. The most typical clinical manifestations can be regarded as the development of jaundice, the appearance of severe pain under the right ribs, as well as an increase in body temperature.

In the treatment of the disease is dominated by conservative methods, however, may require surgical intervention for severe flow.

What it is?

Cholangitis - an inflammation of the bile ducts as a result of penetration of infection of the gall bladder, intestines, blood vessels (most commonly) or lymphatic system (rarely). A common cause of cholangitis is toxoplasmosis, carriers of Toxoplasma - cats.

The causes of cholangitis

Allocate acute, chronic and primary sclerosing cholangitis.

Extremely rare disease is the primary, most often a complication of cholangitis cholecystitis, pancreatitis and cholelithiasis. May also occur on the background of tumors of the bile ducts, biliary tract abnormalities development after surgery on abdominal organs. The emergence of the disease contribute cholestasis, biliary tract damage mucosal stone cicatricial constriction. A bacterial infection is against this background that leads to the development of acute or chronic cholangitis. There are cholangitis caused by parasitic infestations (opisthorchis, strongiloidy, Giardia).

Distinguish primary sclerosing cholangitis, which is not associated with infection inflammation. The disease is caused by autoimmune inflammation, when there are disturbances in the immune system and produce its own antibodies against healthy, normal body tissues, resulting in the gradual narrowing both extrahepatic and intrahepatic bile ducts. The causes of the disease is not fully known. It plays an important role family and genetic predisposition, stress.

Classification

Depending on the flow duration are the following embodiments pathology:

1. Acute. The most frequent variant at which manifest the typical symptoms develop within 1-2 days.
2. Chronic. The most difficult to diagnose variant. It can occur alone or in the outcome of the acute form. The clinical picture in this case is often blurred - often the only complaint of patients is loose stools or intermittent abdominal pain.
3. Fulminant fulminant. The most severe and dangerous form, in which all signs of the disease and blood poisoning appear suddenly and progress rapidly (within hours). Fulminant ends in death in 90-100% of cases, even though the timely and quality medical care.

The second important point in determining the shape of Pathology - type inflammation. In any diagnosis must indicate this nuance, as further therapeutic tactics depends on it.

Currently, doctors are the following options:

form of the disease	Acute or chronic?	a brief description of
Serous	It may be acute or chronic, but often the first option	The most favorable option pathology at which rarely develops sepsis. The cavity ducts offline pus - inflammation manifests increased production of serous fluid.
Fibrinopurulent serous	It may be acute or chronic, but often the first option	Proceeds by analogy with the serous form. The main difference lies in the inflammation - in the body fluid present in addition to protein (fibrinous) overlay.
sclerosing	only chronic	Hidden slow-progressive form of disease, in which virtually no characteristic features. Danger of developing severe irreversible liver damage, up to biliary cirrhosis.
Necrotic	only sharp	It is the final stage of purulent cholangitis, wherein the body wall begin to die. The greatest danger is the possibility of penetration of particles of dead tissue, bile and pus in the blood. The logical result of this is the development of septicemia and shock.
Purulent	As a rule, acute	Severe form in which a body cavity is a large number of bacteria and aggressively flows inflammation. When it is often marked by the development of sepsis and possibly the emergence of infectious-toxic shock.

The symptoms of cholangitis

Despite the fact that different types of cholangitis, there are several (including the already mentioned primary sclerosing cholangitis, and so holetsistoholangit. D.), Their symptoms are quite similar.

These characteristic features of cholangitis are listed below.

1. Pain in the right upper quadrant.
2. Bitter taste in the mouth, Nausea, severe retching.
3. An increase in liver size.
4. Weakness, lethargy.
5. Yellowing of the skin and whites of the eyes. It occurs due to bile stasis.
6. High fever, chills. Particularly characteristic symptoms such, if there is an acute cholangitis.

In the acute form of the disease, all these symptoms will be expressed very clearly, so do not miss them would be difficult. Here in the chronic form the symptoms somewhat muted instead fever low-grade fever occurs, instead of the constant vomiting - a slight nausea, pain is not as strong in the upper quadrant. On the one hand, a chronic form of the disease is less painful for the patient, on the other - people often decides not endure too much pain, and in the case of cholangitis it can have dire effects.

What happens if not treated?

In the absence of early treatment with inflammation of the bile ducts extend to the peritoneum - peritonitis occurs (Inflammation of the peritoneum) of the surrounding tissue - formed subdiaphragmatic, intrahepatic abscess, sepsis, bacterial-toxic shock. The condition of patients becomes extremely difficult and requires resuscitation.

Prolonged inflammation in chronic cholangitis causes sclerotic changes in the tissues of the liver and biliary cirrhosis development.

Self-medication and treatment cholangitis folk remedies unacceptable, since it can be lost during the treatment. In the later stages of the disease prognosis is poor.

Diagnostics

Diagnosis is based on the characteristic symptoms cholangitis, careful inspection and data hardware and laboratory studies:

1. Ultrasound of the gall bladder, the liver and bile ducts;
2. Radioisotope study biliary tract;
3. General and biochemical blood test;
4. Laboratory examination of the bile.
5. Holangiomanometriya (pressure measurement inside the bile duct);
6. Holedohoskopiya (biliary endoscopy);
7. Retrograde cholangiopancreatography (fluoroscopy biliary tract and of the pancreas with endoscopic introduction of the contrast agent);
8. Intravenous cholangiography (fluoroscopy biliary tract with intravenous contrast agent, allowing to see the intra- and extrahepatic ducts).

How to treat cholangitis?

cholangitis treatment is carried out only in a hospital. Folk remedies that people want to spend at home, are not conducive to recovery. There must be medical, therapeutic, and sometimes surgery.

Than to treat cholangitis? The doctor prescribes medication, if there is a normal flow of bile:

• antibiotics;
• antispasmodics;
• sulfonamides;
• Medications that reduce toxicity;
• Medicines that improve the flow of bile;
• Worming medication.

In case of failure of conservative treatment resort to surgery. Endoscopy performed with biliary drainage, removing the restriction, removing stones. When purulent inflammation abdominal surgery performed to remove or suppurative necrotic areas. Sometimes performed cholecystectomy - removal of the gallbladder or complete liver transplant.

medication

As indicated above, widely used drugs that reduce pain, eliminate infection and promote rapid recovery of the body.

The most popular drugs are:

1. Meverin. The tool has a spasmolytic effect. It is used for symptomatic treatment of pain. Means strong, so it is sufficient to use one capsule at intervals of 12 hours. For maximum effect it is recommended to apply it for 20 minutes before eating. Contraindications: Children under 15 years, pregnancy, hypersensitivity. Side effects were noted.
2. Drotaverinum. The drug has a spasmolytic effect. It allows you to remove the pain and improve the patient's condition. Use means necessary for 1-2 tablets 2-3 times daily. It all depends on the intensity of pain. Duration of an individual. Can not take the medication for people with high hypersensitivity, pregnant women, and patients with hepatic and renal insufficiency. Side effects: tachycardia, nausea, vomiting, headache.
3. Ademeteonin. The preparation possesses hepatoprotective (protects the liver tissue) activity. It allows you to protect the liver from the negative impact on it. Accepted need of 400-800 mg per day. Supportive therapy - 2-3 tablets a day. Duration of reception is assigned individually. Contraindications: hypersensitivity. Side effects: pain in the chest, in the stomach.
4. Albendazole. The drug is used to remove parasites from the body. Enough 400 mg per day for an active elimination problem. In general, the dose is prescribed individually. Contraindications: Pregnancy, lactation, hypersensitivity and children up to 2 years. Adverse reactions: dizziness, nausea, vomiting, dyspepsia, impaired kidney function.
5. Rifampicin. In the last decade, it is widely used to relieve itching in patients with cholangitis. He is able to increase the activity of hepatic microsomal enzymes. Thus, it accelerated sulfoksidatsii di- and monohydroxy bile acids. It is recommended to take 10 mg per kilogram of body weight. treatment and long-delayed by several months. It all depends on the condition of the patient. Use during pregnancy, childhood, and during breast-feeding is not recommended.
6. 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 body weight. The maximum dosage should not exceed 1200 mg per day. Contraindications include pregnancy, hypersensitivity and lactation. Possible side reactions such as nausea, vomiting, symptoms amplification.
7. Cholestyramine. This tool has an affinity for bile acids. It is able to bind them into a tight complex in the intestine. Derived drug with faeces, which significantly reduces pruritus. Daily is sufficient to use one teaspoon of the drug 3 times a day. It is advisable to do it for 40 minutes before a meal, or through a similar time after drinking it. The course of treatment may vary depending on the condition of the person. A minimum of one month. The drug is administered in low doses. It can cause poor absorption of vitamins and calcium. Pregnant women can not take it. A similar requirement is put forward for people with increased hypersensitivity. Adverse reactions: nausea, vomiting, intestinal disorders.

To suppress the infection used broad-spectrum antibiotics. These include Metronidazole, Tetracycline and levometsitin. They can not take more than 2 weeks in individual dosage.

1. Tetracycline. This drug has a bacteriostatic action. Apply it should be 200 -250 mg 2-3 times a day. For children enough - 20-25 mg / kg. The duration of treatment is assigned individually. Hypersensitivity, pregnancy, lactation, liver and kidneys. Side effects: skin pigmentation, inflammation of the mucous membranes, bacteria overgrowth, allergic reactions. Usually the drug is well tolerated.
2. Metronidazole. It is an antimicrobial agent. It is used for one tablet 2-3 times a day. In special cases, the dosage is increased to 4-5 tablets. Independently to make adjustments is not necessary, the tool has a number of side effects. Thus, it is possible nausea, vomiting, weakness, the presence of a metallic taste in the mouth, dizziness. When the symptoms should seek medical advice. Contraindications: pregnancy, infancy, hypersensitivity and lactation.
3. Levometsitin. Medication actively destroys bacteria. Apply it must be 250-500 mg 3-4 times a day. The daily dose should not exceed 2 grams. The nature of the treatment and dosage of the treating physician. Contraindications: pregnancy, lactation, psoriasis, eczema, hypersensitivity. Side effects: anemia, nausea, vomiting, fever, allergic reactions.

It is also worth to note at once that it is not necessary to resort to traditional medicine in the presence of such a disease. After all, as long as man will pick up his optimal treatment, pathology starts to progress.

Nutrition and diet

Diet for cholangitis includes adhering to these rules:

• frequent and fractional consumption of food;
• use only warm food;
• grinding and thorough chewing products;
• complete rejection of fatty and spicy dishes, smoked and preservatives;
• cooking should be carried out only by boiling, stewing, steaming or baking without adding fat;
• abundant drinking regime - need to drink at least two liters of liquid. Allowed all drinks, except for strong coffee and soda;
• diet dietary enrichment grades of meat, fish and poultry, cereals, especially buckwheat and oatmeal, defatted fermented dairy products, fruits and vegetables after passing the heat processing.

All recommendations about diet provides a gastroenterologist or a nutritionist.

physiotherapy

In remission prescribed physiotherapy:

1. UHF (high-frequency electromagnetic field);
2. Paraffin (thermotherapy using a heated wax);
3. Diathermy (using alternating current);
4. Sodium chloride bath (mineral water);
5. Electrophoresis (influence of electric pulses);
6. Inductothermy (application of high-frequency magnetic field);
7. Mud (using a heated mud);
8. Microwave therapy (influence of the electromagnetic field oscillations of the microwave range);
9. Ozokeritotherapy (thermotherapy using medical hot mineral wax - oil substance, a waxy consistency).

Surgical intervention

When ineffective drug therapy, disorders of bile flow operation is shown:

1. Abdominal surgery - resection (removal) of affected (pus, necrotic) sites.
2. Endoscopic technique. Produce drainage (the introduction of the catheter to drain the contents), biliary tract, eliminate stenosis (narrowing), concrements removed without resorting to open surgery. This method avoids the bleeding, reduce the risk of surgical trauma to accelerate the rehabilitation period (recovery) after the manipulation.

Forecast

The prognosis of the disease depends entirely on the condition of the person, and flow forms, as well as the outflow of bile. If the treatment was carried out in a timely manner, no complications should not be. Rapid intervention leads to a positive result. But, it is important to maintain the body to not relapse. Constant repetition pattern of pathology leading to chronicity. In this case, the prognosis can be extremely unfavorable.

If we talk about the later stages of the disease, then it all depends on the treatment. But still, the probability of poor prognosis in several times higher. Save a man is not always possible, especially if he had cirrhosis of the liver. Here we need only organ transplantation. Can worsen the prognosis additional symptoms related to acute liver failure, cirrhosis, and liver abscesses. At risk are women over the age of 50 years. Therefore, it is important to take the survey and respond to any symptoms in a timely manner.

prevention

Prevention of cholangitis is a timely treatment of other disorders of the digestive tract (gastroduodenitis, cholecystitis and the like), parasitic infestations and observation at the gastroenterologist after surgical interventions on the gallbladder and zholchevyvodyaschih ways.