Small bile duct twist

Introduction The bile duct is a conduit from which the bile is transported from the liver to the duodenum. Hepatocytes continue to produce bile concentrate and are stored in the gallbladder. When fat enters the duodenum, it stimulates the gallbladder to secrete bile intermittently to help break down fat. Biliary duct hyperplasia is caused by biliary tube distortion after cirrhosis. Biliary cirrhosis is caused by long-term intrahepatic biliary retention or more obstruction of the extrahepatic biliary tract. The former is called primary biliary cirrhosis, and the latter is called secondary biliary sclerosis. Primary people are even rarer.

Cause

Common causes are obstruction of the bile duct system, such as gallstones, tumors (pancreatic head cancer, Vater ampullary carcinoma) and other compression of the extrahepatic biliary tract, causing stenosis and atresia. In children, due to congenital atresia of the extrahepatic biliary tract, followed by cysts of the common bile duct, biliary cirrhosis and so on. This type of cirrhosis can be caused by complete occlusion of the biliary system for more than 6 months.

Pathological changes: early liver volume often increases, the surface is smooth or fine-grained, medium hardness, equivalent to incomplete separation. The liver's appearance is often stained by dark bile into dark green or greenish brown. Microscopically, hepatic cytoplasmic bile pigment deposition, hepatocytes degeneration and necrosis, manifested as hepatocyte volume increased, cytoplasm loosening network, nuclear disappearance, known as reticular or feathery necrosis. Capillary tube cholestatic, gallbladder plug formation. The bile duct in the necrotic area is ruptured and the bile overflows to form a "biliary lake." Biliary duct dilatation and small bile duct hyperplasia in the portal area, fibrous tissue hyperplasia and lobular reconstruction are much lighter than portal vein and post-necrotic cirrhosis. In the case of bile duct infection, there is a large amount of neutrophil infiltration or even microabscess formation in the connective tissue of the portal area and hyperplasia.

an examination

Related inspection

Cholangioscopic cholangiography

1 middle-aged women, the skin is obviously itchy, liver, yellow tumor;

2 serum total cholesterol increased significantly, serum bilirubin was mild, moderately elevated, alkaline phosphatase increased, and bile acid concentration increased;

3IgM is elevated, positive for anti-mitochondrial antibodies and high titer. If you can get a piece of histological evidence, it will help to confirm the diagnosis.

Differential diagnosis

Bile duct rupture: refers to the complete rupture or partial defect of the damaged bile duct, or the biliary forceps are squeezed or sewed to cause inflammation and fibrosis of the bile leakage, and finally cause bile duct stenosis or occlusion. Bile duct fracture is common in the scarring of the bile duct caused by bile duct injury, that is, benign biliary stricture.

Bile duct obstruction: refers to any part of the bile duct excretion due to bile duct lesions, tube wall disease, infiltration and compression outside the tube wall, causing bile duct mechanical obstruction due to poor bile excretion or even complete blockage. The direct hazard is normal. Secreted bile can not be excreted smoothly into the intestines, leading to indigestion, cholestasis, jaundice, abnormal liver function, followed by a series of pathophysiological changes such as decreased body function and multiple organ failure, and even death. How to deal with this type of disease, we discuss endoscopic treatment and surgical treatment.

Extrahepatic bile duct stones: can be originated in the bile duct system, or can be discharged from the gallbladder to the bile duct. Most patients with bile duct stones have biliary colic after the fat meal and postural changes. This is because the stones move downward in the bile duct, stimulate bile duct spasm, and block bile flow. Abdominal pain occurs mostly under the xiphoid process and the right upper abdomen. The paroxysmal severe knife-like colic is often radiated to the back of the right back shoulder, and there are gastrointestinal symptoms such as nausea and vomiting. If the stones in the bile duct cannot be smoothly discharged into the intestine and continue to block the bile duct, it will cause inflammation in the bile duct. At the same time, the internal pressure of the bile duct is increased, and the bacteria in the biliary tract will be retrogradely spread. The pathogenic bacteria and toxins pass through the hepatic sinus to the hepatic vein, and then go retrograde into the systemic circulation to cause symptoms of systemic infection, such as chills and high fever. If the biliary tract is completely blocked by stones, acute suppurative cholangitis may occur, which is a very dangerous disease. If the treatment is not timely, it will lead to death in a short period of time. Because bile can not flow into the intestine, it will appear yellow acne after 1 to 2 days of obstruction, urine color turns yellow, and the color changes and turns white. Such obstructive jaundice, if not cured for a long time, can cause chronic cholestatic cirrhosis, and eventually portal hypertension. Colic and jaundice in many patients with extrahepatic bile duct stones often resolve within a week or so of the attack. This is because the bile ducts expand after the stones block the bile ducts, allowing the embolized stones to loosen or drain into the intestines. However, if the internal causes of the patient's stones are not completely solved, such as biliary tract infection, biliary stricture, biliary malformation, etc., the symptoms still recur in the near future. The patient's xiphoid and right upper abdomen are deeply tender, and sometimes the upper abdomen also touches the enlarged gallbladder.

Hepatobiliary stones: that is, intrahepatic bile duct stones, refers to primary bile duct stones above the bifurcation of the hepatic duct, most of which are pigmented stones with bilirubin calcium as the main component. Although intrahepatic bile duct stones are part of primary bile duct stones, they have their specificity. If they coexist with extrahepatic bile duct stones, they are often similar to the clinical manifestations of extrahepatic bile duct stones. Because the intrahepatic bile duct is deeply hidden in the liver tissue, its branch and anatomical structure are complex, the location, quantity and size of the stone are uncertain. The diagnosis and treatment are far more difficult than the extrahepatic bile duct stones. It is still difficult to treat the hepatobiliary system and the effect is not satisfactory. The disease.

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