Cholangitis: symptoms, treatment and consequences

In this article, we will consider 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 caused, as a rule, 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 case of the development of certain complications, it requires methods of surgical intervention.

The bile ducts are equally often affected along their entire length - both small ducts inside the liver and large ducts outside.

Symptoms of cholangitis are not known to everyone.

Statistical data

This disease is most often diagnosed in older age groups - from about 45 to 60 years, but in recent years there has been a tendency to rejuvenate this pathology, and more and more patients aged 35-40 are admitted to hospitals with signs of this disease. Mostly women of these age categories suffer from inflammation of the bile ducts.

Symptoms and treatment of cholangitis in adults and children are discussed below.

Isolated forms of pathology are much less common than combined ones. This means that in cases of the detection of this disease, other pathologies of the gastrointestinal tract should also be diagnosed, since such diseases may not occur 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:

1. Gastritis
2. Duodenitis.
3. Cholecystitis.
4. Gastroduodenitis.
5. Hepatitis.
6. Pancreatitis
7. Gallstone disease.
8. Disorders of the Vater papilla (the site where the bile duct flows into the duodenum).

The causes of the disease

Inflammatory disorders in the biliary tract causes, as a rule, a certain infectious agent, which gets into them in various ways. The causative agents of this pathology are most often the following infections:

1. E. coli.
2. Various forms of staphylococcus.
3. Proteins.
4. Different types of enterococci.
5. Non-clostridial anaerobic infections .

In some cases, this disease does not lend itself to the main methods of conservative treatment, therefore, we are talking about infection of the biliary tract with the following specific pathogens:

1. Koch's bacillus (Mycobacterium tuberculosis).
2. Pale spirochete (syphilitic infection).
3. 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 a similar infectious agent caused. In particular, this applies to sluggish and latent (hidden) forms of inflammatory lesions of the biliary tract.

Associated pathologies

In addition, some cases of damage to the bile duct by parasitic pathogens are described in the following major diseases:

1. Opisthorchiasis, which is a defeat of the body by the flat worms of opisthorchis, living, as a rule, in the ducts of the liver, as well as the pancreas.
2. Ascaridosis, which is a parasitism of worms in certain parts of the small intestine.
3. Giardiasis, the causative agents of which are giardia, are unicellular organisms that can invade the small intestine.
4. Strongyloidosis is the penetration of roundworms through the skin into the lumens of the respiratory tract, and from there into the intestines.
5. Clonorchiasis, which is a helminth lesion of the hepatic ducts and pancreas.
6. Fascioliasis, which is the introduction of helminths into the lumens of the biliary tract and ducts of the pancreas.

Pathogen penetration methods

In most cases, an infectious agent penetrates the bile duct in the following ways:

1. By normal migration.
2. The hematogenous route is through blood flow through the central vein of the liver (portal vein).
3. By the lymphogenous route, that is, with lymphatic flow, most often with inflammatory lesions of the gallbladder, as well as the pancreas or intestines.

In addition, a viral agent may play a 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, with viral hepatitis.

Symptoms of cholangitis appear depending on the type of ailment.

Types of disease

In almost half of all clinical cases, mixed microflora is considered the infectious pathogen of cholangitis, when two or more pathogens are present in the body. In some cases, a combined infectious agent is noted 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 this case is called "aseptic cholangitis", which literally means "sterile."

This form of pathology is mainly of an enzymatic nature, when active pancreatic juice begins to irritate from the inside of the wall of the biliary tract. In most cases, this is observed with pancreatobiliary reflux, in which the secreted pancreas enters the bile ducts, and this should not normally happen. 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 such a disease, and it occurs due to inflammation of the bile ducts of an autoimmune nature, when killer cells are produced in the body that damage their own tissues.

Suspicion that the disease is of an autoimmune nature appears, as a rule, if the patient has signs of immune pathologies such as:

1. Ulcerative colitis of a nonspecific form, when the formation of ulcers of the mucosa occurs throughout the large intestine.
2. Crohn's disease, characterized by the formation of granulomas throughout the gastrointestinal tract.
3. Vasculitis, which leads to inflammation and subsequent destruction of the walls of blood vessels.
4. Rheumatoid arthritis, which is a pathology of connective tissue, accompanied by joint deformities.
5. Thyroiditis is an inflammatory process that occurs in the thyroid gland.

The penetration of infectious pathogens into the biliary tract is sometimes facilitated by stagnation of bile - cholestasis, which is mainly observed with the following pathologies:

1. Biliary dyskinesia, that is, a violation of their motor functions.
2. Congenital anomalies of the ducts of the gallbladder - all kinds of kinks and squeezes.
3. Cysts of the common bile duct.
4. Oncological damage to the bile ducts.
5. Choledocholithiasis, which is the process of formation of stones in the bile duct.
6. Stenosis, or narrowing, of the Vater papilla.

The main reason for the occurrence of symptoms of sclerosing cholangitis can be some damage to the walls of the biliary tract during endoscopic manipulations, which include:

1. Retrograde pancreatocholangiography, which is the introduction of a contrast agent using a probe into the bile ducts.
2. Stenting, that is, the installation of special scaffolds that support the normal shape of the biliary tract.
3. Sphincterotomy, or dissection, of the sphincter of Oddi, when muscles are involved at the junction of the common bile duct and common duct of the pancreas.
4. Surgical treatment of liver diseases, for example after cholecystectomy.

Symptoms and treatment of cholangitis are of interest to many.

The course of the disease and symptoms

Depending on what negative changes occur in the walls of the bile ducts, the acute form is divided into purulent, catarrhal, necrotic and diphtheria. Symptoms of cholangitis depend on its variety. Nevertheless, there is a list of the main features, which include:

1. Fever and hyperthermia.
2. Pain in the abdomen.
3. Intoxication.
4. Dyspepsia.
5. Jaundice.
6. Severe sweating.

Pain, as a rule, is localized in the region of the right hypochondrium and can radiate to the arm, neck, etc.

A symptom of chronic cholangitis is the Charcot triad - moderate pain in the right hypochondrium, chills and low-grade fever, jaundice. The nature of the pain is usually dull, aching, of low intensity.

Mild fever is noted, accompanied by unexpressed chills. Symptoms are erased, so the first manifestations of the disease remain without attention.

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 from the side of consciousness and symptoms of shock join.

Symptoms of cholangitis in children

Manifestations of acute cholangitis in children are rare. Most often this is a consequence of streptococcal infection. The symptoms are violent, with fever and intense pain. In children, signs can be masked by any other gastrointestinal pathology. Patients are characterized by the presence of dyspepsia, observed with frequent use of fatty, heavy foods. In addition, general weakness, increased fatigue and redness of the palms are noted.

Complications

If such a disease is not cured in a timely manner, very serious complications can develop, which include:

1. Cholecystopancreatitis.
2. Cirrhosis of the liver.
3. Hepatitis.
4. Peritonitis.
5. Abscesses of the liver.
6. Liver failure.
7. Hepatic encephalopathy.
8. Sepsis.
9. Infectious toxic shock.

Treatment of cholangitis symptoms with alternative methods will be considered later.

Diagnostics

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. The study of feces and urine will also be informative. The feces of a patient with cholangitis is characterized by a light shade. Due to the ingress of bile enzymes into the blood, urine (the characteristic color of beer) may darken.

On palpation, severe pain in the right hypochondrium is observed.

Instrumental methods used to diagnose cholangitis include:

1. Ultrasound and ultrasonography of the biliary tract, which allows to evaluate the external features of the biliary tract, to determine the presence of pathologies of the structure, in particular expansion, as well as violations in the liver.
2. Computed tomography, which is used to evaluate the same parameters that are determined using ultrasound, using computer slices.
3. Endoscopic retrograde pancreatocholangiography.
4. Magnetic resonance pancreatocholangiography.
5. Percutaneous transhepatic cholangiography.
6. Duodenal sounding.
   

Laboratory diagnostic methods:

1. General blood analysis.
2. Biochemical liver test.
3. Bacteriological culture of bile.
4. Fecal analysis.

Differential diagnosis of this disease is carried out, as a rule, in the presence of the following pathologies:

1. Cholelithiasis.
2. Primary cirrhosis of the liver.
3. Stoneless cholecystitis.
4. Pleural empyema on the right.
5. Right-sided pneumonia.

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 the 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.

The following measures are the basis of traditional treatment:

1. Bed rest.
2. Starvation, followed by a strict diet.
3. Medications that can eliminate the causative agent of the infectious process - antibiotics, antiparasitic drugs, etc.
4. Anti-inflammatory medications.
5. Antispasmodics, which are used for severe pain.
6. Infusion therapy used to eliminate intoxication.
7. Hepatoprotectors to protect liver cells from disorders that can occur due to stagnation of bile in the ducts.
8. With severe intoxication, plasmapheresis is used.

If necessary, apply surgical correction, the methods of which also include the use of various methods of surgical intervention.

We examined 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, gall bladder and bile ducts. 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 insisted 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 of chamomile pharmacy, immortelle sandy and corn stigmas. 2 tbsp. l pour the mixture with 500 ml of boiling water and warm in a water bath for 30 minutes, then leave to brew for one hour. Take half a cup instead of regular tea.
• The recipe for the lazy. Mint-honey mixture is very effective and does not require daily preparation. Dry shredded 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. Peppermint can increase bile secretion by 10 times.

So, in the article we examined the symptoms and treatment of cholangitis.