Cholangitis: symptoms and treatment
Cholangitis is an inflammation of the bile ducts. Various factors can provoke it, but with this disease, bile stagnation is always observed. Sometimes pathology manifests itself with acute symptoms and leads to the development of serious complications. The manifestations of the disease depend on its form and stage of development.
Cholangitis should be treated by a physician after a thorough diagnosis. The therapy is mainly medication. Most often women suffer from cholangitis. Elderly people (50-60 years old) are at risk. In children, inflammation of the bile ducts is rarely diagnosed.
- What is cholangitis
- Types and forms of the disease
- Causes of occurrence
- Cholangitis symptoms
- Which doctor should I go to?
- Cholangitis treatment
- Diet in the acute period of cholangitis
- Complications and consequences
- Forecast and prevention
What is cholangitis?
Cholangitis is a pathology accompanied by a violation of the liver and inflammation of the bile ducts. With the disease, stagnation of bile occurs. This can be caused by various reasons. Often, the disease develops against the background of a bacterial infection.
With cholangitis, the function of the digestive tract as a whole suffers. The patient may be diagnosed with hepatitis, gastroduodenitis, pancreatitis, cholelithiasis, cholecystitis.
Types and forms of the disease
Depending on the cause of the disorder, the following forms of cholangitis are distinguished:
Depending on the characteristics of the course of the disease, the following types are distinguished:
- Acute cholangitis. The disorder has a vivid clinical picture. The patient's state of health deteriorates significantly.
- Chronic cholangitis. The disease is exacerbated, then it happens in remission. When the acute phase has passed, the person will not experience any symptoms of the disorder.
Acute cholangitis is infectious in nature. The disorder develops unexpectedly for the patient himself. The bile ducts become inflamed, and bile begins to accumulate in them. Sometimes there is a complete blockage of the pathways. If the disease has a mild course, then it is possible to cope with it with medication. The operation is resorted to when complications develop.
Acute cholangitis occurs in various forms, including:
Catarrhal cholangitis. This damage to the bile ducts is considered the easiest. The mucous membrane of the biliary tract turns red and swells. The symptoms of the disorder in the patient are mild, there is no treatment. Therefore, it is catarrhal cholangitis that often becomes chronic.
Diphtheric cholangitis. The mucous membrane of the biliary tract becomes covered with ulcers, on which a film forms. Under them, areas of necrosis begin to grow rapidly. Often, diphtheria cholangitis from the biliary tract passes to the liver.
Purulent cholangitis. Pus begins to accumulate in the bile ducts. The inflammation progresses rapidly, spreading to nearby tissues and organs.
Necrotizing cholangitis. The biliary tract undergoes necrosis, as enzymes produced by the pancreas enter them. It is they who begin to eat away at the ducts from the inside. This form of cholangitis is the most dangerous because it can cause inflammation of the peritoneum or liver.
If we consider cholangitis in the general structure of diseases of the hepatobiliary system, then it is not often diagnosed. Inflammation of the bile ducts is mainly a secondary disorder that occurs against the background of other pathologies of the gastrointestinal tract. A particular danger in this regard is the defeat of the gallbladder and liver. In 1/3 of patients, cholangitis is a consequence of the removal of the gallbladder.
Cholangitis can have a different course:
- Latent form. In this case, the symptoms of pathology are completely absent.
- Recurrent form. The disease is aggravated, then subsides.
- Septic form. Pus accumulates in the ducts. The disease has a severe course and can cause death of the patient.
- Absolute form. In the biliary tract, abscess areas are formed, filled with purulent masses.
Separately, it is necessary to highlight such a form of the disease as primary sclerosing cholangitis. In this disorder, inflammation is non-infectious. As the pathology progresses, the biliary tract narrows, the outflow of bile is impaired. At the terminal stage of the disease, they completely overgrow, the patient develops cirrhosis of the liver.
Sclerotic cholangitis is a severe pathology. It is impossible to completely get rid of the disease. For 10 years, these patients develop irreversible changes in the liver.
Types of cholangitis, depending on the location of the inflammatory process:
- Choledochitis. Inflammation of the common bile duct called common bile duct.
- Angiocholitis. Inflammation of the small bile ducts.
- Papillitis. Inflammation of the papilla of Vater. It is located in the place where the common bile duct flows into the duodenum.
- Total inflammation of the biliary tract system.
Causes of occurrence
The main reason for the development of cholangitis is an infectious process. The most common causative agents of infection are E. coli, Proteus and Enterococcus. If a patient develops purulent inflammation, then when analyzing bile, several representatives of the infectious flora are sown in it at once. Such an analysis is of no small importance, since according to its results it will be possible to select the optimal treatment.
Infection can enter the bile ducts in several ways:
- Ascending. Bacteria rise into the bile duct from the duodenum 12 through the mucous membranes.
- By blood, through the portal vein.
- Through the lymphatic vessels. The pancreas, intestines and gallbladder can be the source of infection.
Sometimes the bile ducts become inflamed due to the ingestion of pancreatic enzymes. They have an aggressive effect, so the walls of the ducts corrode, their necrosis occurs. In this case, experts point to aseptic inflammation.
Sclerosing cholangitis is an autoimmune pathology. With it, the immune system's own cells begin to produce antibodies that destroy the tissues of the bile ducts.
It is not easy to diagnose cholangitis, since each patient has a different course and gives various symptoms. Bile duct inflammation can often be confused with other diseases. In some cases, cholangitis does not manifest itself at all. However, there are certain indications that bile duct involvement is suspected.
Acute, chronic and sclerosing cholangitis gives various symptoms.
For acute cholangitis
Acute cholangitis symptoms:
- The pain is concentrated in the chest on the right side. It gives to the stomach, shoulder and shoulder blade.
- The body temperature rises to 40 ° C, the patient shivers.
- The person is sick and vomits.
- Blood pressure drops sharply.
- Weakness increases.
- Itching occurs.
- The dermis and mucous membranes become yellow.
- Consciousness is clouded.
- There is a possibility of developing a hepatic coma.
For chronic cholangitis
Chronic cholangitis is accompanied by symptoms such as:
- Weak pain. It can be intense only when there are stones in the gallbladder.
- Itchy skin.
- Pressing or bursting feeling in the right hypochondrium.
- Increased body temperature. Her jumps occur from time to time.
- Increased fatigue.
- Hyperemia of the palms, thickening of the fingers.
With sclerosing cholangitis
- Pain in the right hypochondrium and in the abdomen (mainly in its upper part).
- Itching and yellowing of the skin.
- Increase in body temperature up to 38 ° C.
To diagnose cholangitis, you will need not only an analysis of the existing symptoms, but also instrumental and laboratory examination.
Primary diagnostic procedures:
- Patient interview.
- Study of the patient's history.
- Examination of the skin and mucous membranes, palpation of the abdominal wall, the area of the right hypochondrium.
Collection of laboratory data:
Blood test (general and biochemical). Patients with cholangitis will have increased levels of bilirubin, transaminases, and alkaline phosphatase.
- Bacterial culture of bile. Its fence is carried out during duodenal intubation.
- Stool microscopy. This study will rule out parasite infestation.
Instrumental examination methods include:
- Ultrasound examination of the abdominal organs.
- CT scan.
- Ultrasonography of the bile ducts.
- Electronic cholegraphy.
- MRPHG. This method makes it possible to diagnose biliary obstruction.
Cholangitis gives similar symptoms with various diseases.
Therefore, it is necessary to carry out differential diagnostics with such disorders as:
- Non-calculous cholecystitis.
- Viral hepatitis.
- Primary biliary cirrhosis.
- Empyema of the pleura.
- Pneumonia affecting the right lung.
Which doctor should I go to?
Cholangitis is treated by a gastroenterologist. Also, a person may need the help of a nutritionist, physiotherapist, surgeon. During the examination, it will be necessary to visit an endoscopist and an ultrasound diagnostician.
The patient with cholangitis is hospitalized. He must be under the constant supervision of specialists, since at any time he may need the help of a surgeon. Therapy depends on the severity of the pathological process.
The main tasks facing the doctor:
- Relief of inflammation.
- Removal of intoxication from the body.
- Unloading of the biliary tract.
Cholangitis conservative treatment
A conservative treatment regimen is based on the following points:
- Compliance with bed rest.
- Therapeutic fasting. The diet should be as lightweight as possible. The patient should receive pureed soups, puréed vegetables, minced meat, fermented milk drinks, etc.
- Antibiotics and drugs to rid the body of parasites.
- Preparations for the relief of inflammation.
- Antispasmodics for pain relief.
- Infusion therapy is performed to relieve intoxication from the body. The patient is injected with electrolytes, proteins, salt preparations, glucose, blood cells.
- Hepatoprotectors are designed to protect liver cells from destruction.
- Plasmapheresis. The procedure for purifying the blood is carried out with severe intoxication of the body.
Medication for cholangitis
A patient with cholangitis is prescribed broad-spectrum antibiotics. They are selected individually. The duration of treatment is 14 days. The most commonly prescribed drugs are:
Metronidazole. The patient is prescribed 1 tablet 2-3 times a day (sometimes the dose is increased to 4-5 tablets a day). Possible side effects: nausea, vomiting, dizziness, weakness, metallic taste in the mouth. It is forbidden to use Metronidazole to treat pregnant and lactating women, as well as patients with individual drug intolerance.
Tetracycline. Adults are prescribed 200-250 mg per day. For children, the dose is calculated at 20-25 mg per kg of body weight. It is forbidden to prescribe the drug to lactating and pregnant women, patients with kidney and liver disease. Side effects from the treatment include: dysbiosis, the appearance of pigmented areas on the skin, allergic reactions, inflammation of the mucous membranes.
Levomycetin. The drug is prescribed for? -1 tablet 3-4 times a day. The daily dose should not be more than 2 g. It is prohibited to take the drug for psoriasis, eczema, pregnancy, lactation and hypersensitivity to its components. During treatment, side effects such as fever, allergic reactions, vomiting, nausea, and anemia may develop.
In addition to antibiotics, they use pain relievers, antispasmodics, and means to eliminate parasites from the body.
These can be medications such as:
Drotaverin. The drug eliminates pain, improves the general well-being of the patient. He is prescribed 1-2 tablets 2-3 times a day. The drug is taken as long as necessary. It is not recommended for pregnant women, patients with renal and hepatic insufficiency. During treatment, side effects such as nausea, vomiting, headaches, tachycardia may develop.
Meverin. This is a drug with a pronounced analgesic effect, it works for 12 hours. You need to take 1 capsule 20 minutes before meals. Contraindications to treatment with Meverin: age less than 15 years, pregnancy, hypersensitivity to the components of the drug. The drug has no side effects. It is produced in Ukraine.
Nemozole. It is an antiparasitic agent. It is taken 400 mg once. Contraindications to treatment with Nemozole: pregnancy, breastfeeding, age under 2 years. During treatment, side effects such as vomiting, nausea, dizziness, deterioration of the gastrointestinal tract and urinary system may develop.
Heptral. This drug helps protect the liver, which often suffers from cholangitis. 1-2 tablets are prescribed per day. It is forbidden to take the drug with individual intolerance to its components. During treatment, side effects may develop such as: abdominal pain, chest pain.
Ursosan. This drug allows you to get rid of itching and reduce the toxic effects of bile acids on the body. The dose is calculated based on body weight, 15-20 mg per kg of body weight. The maximum daily dosage is equal to 1200 mg. Ursosan should not be prescribed to pregnant and lactating women, as well as to patients with hypersensitivity to ursodeoxycholic acid. During treatment, side effects such as nausea, vomiting, and itching may develop.
Rifampicin. The drug allows you to cope with itching, it increases the activity of liver enzymes. The daily dose is 10 mg / kg of body weight. It is forbidden to prescribe the drug to nursing mothers, women in position and children.
When the acute stage of cholangitis can be overcome, the patient is referred for physiotherapy.
He may be assigned procedures such as:
- UHF. The body is affected by electromagnetic fields.
- Diathermy. Treatment with alternating currents.
- Electrophoresis. The body is affected by electrical impulses.
- Inductometry. Treatment with high frequency magnetic fields.
- Mud applications. Treatment with warm mud.
- Microwave therapy. The body is influenced by electromagnetic fields.
- Ozonokeritotherapy. The human body is influenced by heated ozokerite. It is a petroleum based substance.
- Paraffin therapy.
- Reception of mineral baths.
Surgical treatment of cholangitis
If necessary, the patient is prepared for surgery.
These can be procedures such as:
- Endoscopic papillosphincterotomy. During the procedure, the papilla of Vaters is dissected, which has been narrowed.
- Removal of stones from the biliary tract using an endoscope.
- Stenting of the common bile duct using endoscopic equipment. A special device is inserted into the bile duct to prevent it from narrowing.
- Percutaneous transhepatic drainage of the biliary tract. Bile is taken out, for which direct drainage is installed.
Doctors prefer minimally invasive techniques using an endoscope. This procedure allows you to carry out all the necessary manipulations without making large incisions in the abdominal cavity. The use of an endoscope makes it possible to avoid massive blood loss and quickly recover the patient after surgery. However, with the development of a purulent complication, cavity intervention is indicated.
Diet in the acute period of cholangitis
In acute cholangitis, the patient is transferred to the treatment table at number 5A. For chronic inflammation, you need to adhere to table number 5.
Diet number 5. assumes compliance with the following recommendations:
- You need to eat 5 times a day, in small portions.
- They refuse to eat before going to bed. Only a light snack is possible.
- Spicy and spicy dishes, garlic, horseradish, radish are prohibited. …
- The daily caloric content is 3500 kcal, where proteins account for 100 g, for fats 100 g, for carbohydrates 400 g.
- The menu should include such products as: buckwheat, cottage cheese, oatmeal, low-fat meat and fish.
- After you feel better, you can add vegetable and milk soups, baked and fresh vegetables, and dried bread to the menu.
Read more: Diet number 5: table of products, menus, diet principles
Diet number 5A assumes compliance with the following rules:
- You can eat any cereals, but they need to be boiled.
- Steamed meat and fish.
- Frying, as a cooking method, is prohibited.
- Do not include fresh fruits and vegetables in the diet.
- Rye bread is prohibited.
- It is recommended to spend fasting days on cottage cheese and apples.
- To avoid constipation, a person should eat beets, vegetable juices, dried fruits.
Complications and consequences
If there is no treatment for cholangitis, then the likelihood of developing complications such as:
- Inflammation of the liver tissue.
- Biliary cirrhosis of the liver.
- Liver abscess.
- Infectious toxic shock.
- Liver failure.
- Hepatic encephalopathy with brain damage.
Video: transfer Live Healthy - "bile will bring cirrhosis":
Forecast and prevention
If the patient develops an abscess, cirrhosis, hepatic or renal failure, sepsis, then the prognosis worsens, the likelihood of death increases. Adequate treatment of catarrhal cholangitis leads to a full recovery. Less favorable prognosis for patients with necrotic, diphtheria and purulent forms of the disease. When the inflammation is prolonged and becomes chronic, a person can become disabled.
In order to prevent the development of cholangitis, it is necessary to treat diseases of the digestive system in time, to get rid of parasites. If an operation has been performed on the gallbladder or on the biliary tract, regular observation by a gastroenterologist is necessary.
Author of the article: Kletkin Maxim Evgenievich | Hepatologist
Education: Diploma in the specialty "General Medicine" received at the Military Medical Academy. S. M. Kirov (2007). At the Voronezh Medical Academy. NN Burdenko graduated from residency in the specialty "Hepatologist" (2012).