This disease is often confused with cholecystitis, but these are completely different diseases. In the article we will consider in detail what chronic cholangitis is and how it manifests itself. 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 find out what the prevention of the disease can be.
What is it?
Chronic cholecystitis and cholangitis are combined in 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, moreover, both the external and internal ducts. It is characterized by a long, recurrent course (therefore, the disease is called chronic). It can ultimately lead to cholestasis.
Chronic cholangitis. What kind of disease? Inflammatory processes in the bile ducts due to the penetration of infections from the digestive tract (gall bladder, intestines), blood vessels. Less commonly, infection can get through the lymphatic tract. One of the common causes of the disease is toxoplasmosis. And the carriers of toxoplasma itself are domestic cats.
Basic information about the disease
Among the main clinical signs of chronic cholangitis, severe pain in the liver zone, fever, chills, jaundice are distinguished. The main direction of diagnosis here today is called ultrasonography of the pancreas and the biliary tract leading to it. They also use techniques such as retrograde cholangiopancreatography, computed tomography of the bile ducts, as well as a general and biochemical blood test.
As for the treatment of chronic cholangitis, the combined option is the most effective. This 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 indicated under the code K83.0.
Statistical data
Let us 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.
Basically, pathology develops in adults. The average age of patients is 50 years. There are no observations of a more frequent exposure to the disease in men or women.
In most cases, it manifests itself against the background of existing diseases of the liver and gall bladder. It is noted that in 37% of cases, the disease will be diagnosed after cholecystectomy.
We can not say about the specific form of the disease - sclerosing cholangitis. It progresses against the background of relative human health. It develops slowly over an average of 10 years. And in the end, it leads to irreversible liver damage. There are no reliable data on the true numbers of incidence of the sclerosing form, since so far its diagnosis is difficult. But I must say that recently the number of recorded cases has increased. That, first of all, indicates an improvement in the quality of diagnostics.
If we talk about mortality from the chronic form of 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%.
Causes
Is it possible to develop chronic cholangitis after gallbladder removal? Yes, in many cases. This disease is more bacterial in nature. It can cause almost all pathogens that are present in the digestive tract:
- Proteins.
- Enterococci.
- E. coli.
- Klebsiella and so on.
In almost all cases, infection with several such pathogens is noted at the same time. And at the same time, it is very rare that only a single bacterial agent is found during bile cultures. In many cases, with the 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, the risk factors for this disease are various surgical, diagnostic, therapeutic interventions affecting the biliary tract. They can be performed against the background of both congenital malformations 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:
- Impaired 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 with the following:
- Anomalies in the development of the biliary tract itself, the presence of congenital cysts, etc.
- Stenosis and deformity of the biliary tract after surgery or endoscopic measures.
- Tumors of the biliary tract or the pancreas itself.
- Cholestasis, developed against the background of cholelithiasis.
- Parasite infestations.
As a rule, the formation of chronic cholangitis requires a combination of three factors:
- Translocation (entry) 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 one cannot exclude the primary purely chronic course of the disease.
The main symptoms at an early stage
The main symptom of chronic cholangitis is the identification of the so-called Charcot triad. It includes the following:
- Mild pain felt in the right hypochondrium.
- Chills - an increase in the patient's body temperature to subfebrile indicators.
- Jaundice.
As for the signs of chronic cholangitis, the patient suffers from dull, mild, aching pains. After biliary colic, he feels mild fever, mild chills.
As for the clinical picture, then here it is worn out, recurring. Therefore, patients, as a rule, rarely pay attention to the first symptoms of the disease.
The main symptoms in the late stage
If we proceed to the signs of chronic cholangitis (cholecystitis is a completely different disease) already at a late stage, then we can notice the following:
- Icterus (in simple words yellowness) of both the skin and mucous membrane.
- Fatigue.
- General weakness (generally expressed in the elderly patient).
As for the age of the patient more than 60 years, the diagnosis in this case is significantly difficult. The clinical picture will not correspond to the severity of the inflammatory process that occurs in the bile ducts. Symptoms are too erased, so it’s difficult even for a specialist to establish the correct diagnosis.
Disease complications
Such a form of the disease as purulent chronic cholangitis can lead to the fact that the infection enters the systemic circulation. And this is already fraught with the development of septic biliary shock. Its result in 30% of cases is lethal.
The following complications are no less dangerous for the life and health of the patient:
- Porto-caval thrombosis.
- Abscess of the liver.
- Other 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 identify suspicions of symptoms of a chronic type of cholangitis, you must definitely consult a specialist gastroenterologist. To make a preliminary diagnosis, the doctor makes sure that the patient has the Charcot triad.
Further, to clarify the verdict, it is necessary to pass a number of laboratory tests. Here the following comes to light:
- General blood analysis. If the patient has chronic cholangitis, high leukocytosis, increased ESR, as well as a neutrophilic shift in leukocyte formulas will be detected.
- Blood chemistry. 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 studies. In almost all patients, intestinal microflora is found in bile. In half of the patients, bacteria are also found in the blood.
Diagnostics is instrumental
Doctors also turn to instrumental diagnostic techniques. In particular, an ultrasonography of the biliary tract and the pancreas itself is performed. Here you can see a thickening and some expansion of the walls of the biliary tract.
No less important is the widespread computed tomography today. It not only confirms the data obtained by ultrasound examination, but also helps to determine the complications of the purulent form of chronic cholangitis in time. In particular, various purulent abscesses and pylephlebitis.
In order to conduct retrograde cholangiopancreatography, consultation with an endoscopist is additionally required. Such an examination helps not only to visualize calculi located in the biliary tract, but also to indicate their specific extensions.
Recently, ERCP has been replaced by magnetic resonance pancreatocholangiography. 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 examinations are performed immediately before surgery, transhepatic cholangiography may be used. The needle is passed through the patient’s skin, and then through his biliary tract. Thus, contrasting and drainage of the latter are carried out.
Similarity with other diseases
When diagnosing chronic cholangitis, specialists need to be especially careful - the disease is similar in manifestations, symptoms with a number of other pathologies and diseases:
- Blockage of the bile ducts (observed with cholelithiasis).
- Viral hepatitis.
- Calculous and acute cholecystitis.
- Tumors of the bile duct, liver, or pancreas.
- Bile duct strictures for another reason.
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 gastroenterological department of the hospital is required only in special cases:
- Malignant cholestasis.
- Severe course of the disease.
- The old age of the patient.
Drug treatment is preliminary here - this is the first stage to surgical unloading of the bile ducts. In particular, detoxification of the body is carried out, the patient is prescribed antimicrobial and painkillers. Broad antibiotics are prescribed before bacterial culture. These are penicillins that can penetrate into bile, cephalosporins and aminoglycosides. If the nature of the infection is parasitic, appropriate drugs are prescribed additionally.
Surgical intervention
The main goal of the surgical operation in the chronic form of cholangitis is the removal of calculi from the bile ducts, which can improve and stabilize the outflow of bile. That is, drainage of the biliary tract is performed.
For this purpose, the following operations are carried out:
- External drainage of the biliary tract.
- Transhepatic percutaneous drainage.
- Nasobiliary type of drainage (performed with RPCH).
- Extraction of calculi from common bile ducts.
- Extraction of calculi from the bile ducts with RAHG.
- 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 healthcare provider. It is important to include foods rich in both vitamins and vegetable oils in the diet. The diet must be combined with the conduct of choleretic and antibacterial therapy.
Prevention and Predictions
Do not forget that the chronic type of cholangitis is a rather serious disease, the neglect of which, improper or untimely treatment can turn out to be fatal. The prognosis of the disease here worsens the following:
- Female.
- Old age.
- Long-term hyperthermia - more than two weeks (fever).
- Anemia.
- Disorders of consciousness.
- Inadequate liver and kidney function.
Prevention in this case is secondary. It boils down to two important areas:
- Conducting a preventive diagnosis of the liver, gall bladder and digestive tract as a whole.
- Timely treatment of diseases, infections, pathologies that can cause cholangitis.
We met with a fairly serious disease - inflammation of the bile ducts of an infectious nature. Chronic cholangitis is dangerous because its symptoms (especially in the early stages) are erased. We need a comprehensive diagnosis - both laboratory and instrumental. The patient will have medical, surgical treatment, diet.