Chronic cholangitis

Introduction to chronic cholangitis Most of chronic cholangitis is the result of acute cholangitis. After acute cholangitis is treated by non-surgical treatment, acute inflammation is controlled, but the primary cause of bile duct is not solved (such as intrahepatic bile duct stones, biliary ascariasis or Oddi sphincter) Stenosis, etc.), the inflammatory lesions in the bile duct become chronic, and the bile duct wall is thickened. Due to the presence of obstructive lesions, the bile duct often expands, with a diameter of 2 to 3 cm or even 5 cm. When the bile duct obstruction becomes complete or the bacterial infection is aggravated, it can cause acute inflammation. Repeated acute episodes will further aggravate the degree of chronic inflammation of the bile duct, especially in the lower end of the bile duct oddi sphincter and intrahepatic bile duct. In the branch, after repeated acute episodes, it often causes hyperplasia and stenosis of the fibrous scar tissue at the lower end of the bile duct, and the environment of the branches of the intrahepatic bile duct is narrowed, which further increases the degree of obstruction of the bile duct inside and outside the liver. basic knowledge The proportion of illness: 0.06% Susceptible people: no special people Mode of infection: non-infectious Complications: acute suppurative cholangitis

Causes of chronic cholangitis

Chronic non-specific infection (25%):

This disease is thought to be associated with ulcerative colitis. In the case of infectious bowel disease, intestinal bacteria invade the biliary system from the portal vein, forming chronic inflammation, hyperplasia of the bile duct wall fibrous tissue, and narrowing the bile duct wall.

Autoimmune disease (30%):

This disease is often accompanied by ulcerative colitis, and some are associated with diseases such as segmental enteritis, chronic fibrotic thyroiditis (Riedls thyroiditis) and retroperitoneal fibroinflammatory sclerosis. The immune complexes in the patient's serum are often higher than normal, and when these substances precipitate in the tissue, they can cause local inflammation. Badenheimer measured the immune complexes in the serum of patients with primary sclerosing cholangitis, whether or not with ulcerative colitis, their immune complexes in serum were significantly higher than healthy controls. In patients with ulcerative colitis, a certain proportion of anti-nuclear antibodies and anti-smooth muscle antibodies in serum are positive, supporting the views of these patients on the incidence and immune factors. However, the application of hormone or immunosuppressive drugs can improve the symptoms, but it does not improve the pathological changes of the bile ducts, nor can it change the course of the patients. Therefore, whether primary sclerosing cholangitis is related to immune factors remains to be confirmed by further research.

Precancerous lesions and other factors (15%):

Clinically, patients with chronic cholangitis are diagnosed after a period of follow-up. The disease is considered to be a slow-growing cholangiocarcinoma, or it is thought to be converted into cholangiocarcinoma. The disease is related to congenital factors, roundworm infection, alcoholism, lithic acid and other factors.

Chronic cholangitis prevention

(1) Pay attention to food hygiene to prevent infection; when inflammation occurs, apply effective antibiotics in time.

(2) Reasonable blending of recipes, it is not advisable to eat too much animal fat-containing foods such as fatty meat and animal oil.

(3) When there are intestinal insects (mainly aphids), timely use of deworming drugs, the amount should be sufficient, in order to prevent the lack of medication, aphids active and easy to drill into the biliary tract, causing obstruction, causing cholecystitis.

Chronic cholangitis complications Complications Acute suppurative cholangitis

Complications include suppurative cholangitis, gallbladder gangrene, empyema, and perforation.

Chronic cholangitis symptoms Common symptoms Painful high fever abdominal pain jaundice triple cold war bile excretion obstructed gallbladder water abdomen discomfort biliary syndrome

Generally no specific symptoms, can be manifested as middle and upper abdominal discomfort and pain, sometimes or colic attacks, can increase the pain of the upper abdomen after eating greasy food, generally have fever and jaundice, abdominal signs are not obvious, but only There is mild tenderness in the upper abdomen, and the gallbladder is not swollen. If an acute attack occurs, the clinical manifestations of abdominal pain, chills, hyperthermia and jaundice are found.

Chronic cholangitis check

1, B-ultrasound can be found in the expansion of the common bile duct, thickening of the wall, and sometimes can show the stones in the bile duct or mites.

2, intravenous cholangiography showed bile duct dilatation, often with contrast agent emptying delay phenomenon.

3, ERCP can clearly show the expansion of the bile duct and bile duct stones and other lesions, and can understand the presence or absence of stenosis in the bile duct.

Diagnosis and diagnosis of chronic cholangitis

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.

In infancy, it should be differentiated from biliary atresia and various types of hepatitis. Ultrasound examination is helpful for diagnosis. It should be differentiated from chronic hepatitis in older children.

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