Cholangitis

Cholangitis is a nonspecific inflammation of the bile ducts. It is most often combined with choledocholithiasis, common bile duct cysts, bile duct cancer.

Symptoms, course. The clinical picture depends on the presence or absence of acute destructive cholecystitis, which is often complicated by cholangitis. The disease usually begins with a painful attack resembling a hepatic colic (manifestation of choledocholithiasis), after which mechanical jaundice, fever, itching, is quickly manifested. When examining the ikterichnost skin, on the skin, traces of scratching, the tongue is wet, covered, the stomach is not swollen. With palpation of the abdomen, some rigidity of the muscles in the right hypochondrium, soreness, with deep palpation is determined by an increase in the size of the liver, its edge is rounded. The temperature is sometimes hectic, chills. In the blood-leukocytosis with a shift to the left. Hyperbilirubinemia is mainly due to direct bilirubin, an increase in alkaline phosphatase, a moderate increase in hepatic enzymes (ALT, ACT) due to toxic damage to the hepatic parenchyma. An important help in establishing the diagnosis of cholangitis may be an ultrasound examination of the liver and bile ducts.

Complications. Formation of multiple liver abscesses, sepsis, hepatic-renal failure.

Treatment. The management of patients with cholangitis presents considerable difficulties, they are caused by the presence of purulent process, mechanical jaundice and acute destructive cholecystitis. Each of these moments requires an early resolution, but patients with mechanical jaundice do not tolerate prolonged and traumatic surgical interventions. Therefore, it is expedient in the first place to ensure an adequate outflow of bile, which simultaneously reduces the clinical manifestations of cholangitis, intoxication. The second stage is carried out by radical intervention aimed at eliminating the cause of cholangitis.

For the purpose of decompression of the biliary tract, endoscopic papillosphincterotomy is performed after a preliminary retrograde cholangiography. With residual stones of choledochus, after papillosphincterotomy, concrements from biliary tracts are sometimes seen, the phenomena of cholangitis stop and the question of the need for a repeated operation disappears. The prognosis is serious.