Acute obstructive suppurative cholangitis is a severe form of acute cholangitis caused by biliary tract obstruction and bacterial infection. The increased intrabiliary pressure leads to damage to the liver-biliary blood barrier, with a large number of bacteria and toxins entering the blood circulation, causing a systemic severe infectious disease mainly involving liver and biliary system damage, with complications of multi-organ damage.
English | 中文 | Русский | Français | Deutsch | Español | Português | عربي | 日本語 | 한국어 | Italiano | Ελληνικά | ภาษาไทย | Tiếng Việt |
Acute obstructive suppurative cholangitis
- Contents
-
1. What are the causes of the onset of acute obstructive suppurative cholangitis?
2. What complications can acute obstructive suppurative cholangitis easily lead to?
3. What are the typical symptoms of acute obstructive suppurative cholangitis?
4. How to prevent acute obstructive suppurative cholangitis?
5. What kinds of laboratory tests should be done for acute obstructive suppurative cholangitis?
6. Dietary taboos for patients with acute obstructive suppurative cholangitis
7. The routine methods of Western medicine for the treatment of acute obstructive suppurative cholangitis
1. What are the causes of the onset of acute obstructive suppurative cholangitis?
The characteristics of this disease are acute suppurative cholangitis and empyema associated with biliary obstruction. A large number of bacterial endotoxins enter the blood, leading to a series of severe complications such as mixed sepsis of multi-pathogenic, strong virulence, anaerobic and aerobic bacteria, endotoxemia, azotemia, hyperbilirubinemia, toxic hepatitis, infectious shock, and multi-organ failure. Among them, infectious shock, biliary liver abscess, septicemia, and multi-organ failure are the main causes of patient death.
2. What complications can acute obstructive suppurative cholangitis easily lead to?
The incidence rate of the main complications of this disease is the highest in renal function failure (abbreviated as renal failure) at 23.14%, followed by respiratory function failure (abbreviated as respiratory failure) at 14.88%, liver function failure at 13.22%, circulatory failure at 9.92%, and disseminated intravascular coagulation (DIC) at 3.31%. The mortality rate of multi-organ failure is 94.4%, significantly higher than that of single organ failure (33.3%).Acute obstructive suppurative cholangitis. The mortality rate of concurrent organ function failure is 79.2%.Antibody-forming cells. Concomitant multi-system organ failure is the most important cause of death. The level of total serum bilirubin is an important factor affecting the occurrence of multi-system organ failure. When the total serum bilirubin is >160μmol/L, single organ failure often progresses to multi-system organ failure.
3. What are the typical symptoms of acute obstructive suppurative cholangitis?
The basic clinical manifestations of acute cholangitis are consistent with its main pathological process, which is manifested as follows:
The first stage
Patients often have biliary tract diseases or a history of biliary tract surgery. On this basis, biliary obstruction and infection occur, leading to acute symptoms such as abdominal pain, fever, jaundice, etc. However, due to the difference in the location of biliary obstruction, the degree of abdominal pain and jaundice can vary greatly, and the symptoms of acute biliary infection are common to various cholangitis.
Stage 2
Due to severe biliary suppurative inflammation, biliary hypertension, endotoxemia, sepsis, the patient shows persistent remittent fever or jaundice gradually worsens, indicating that liver function is damaged, consciousness changes, pulse rapid and weak, and toxic symptoms.
Stage 3
At this time, the disease develops towards a severe stage, with microcirculatory disorders, water, electrolyte, and acid-base imbalance, and the patient shows infectious shock, blood pressure drop, oliguria, and the gradual loss of homeostasis of the internal environment. The function of the main organs is impaired.
Stage 4
At this stage, the symptoms are mainly multiple organ system failure, with the liver, kidney, heart, lung, gastrointestinal, coagulation, and other systems sequentially or alternately appearing functional damage, forming a severe combination. If the condition further develops and biliary obstruction and biliary hypertension are not relieved, it will threaten the patient's life.
4. How to prevent acute obstructive suppurative cholangitis
This disease needs to take three-level prevention measures, the specific content is as follows:
First-level prevention
Acute suppurative cholangitis is a serious complication of cholelithiasis and biliary ascaridiasis, so the primary prevention of this disease is mainly aimed at the prevention and treatment of cholelithiasis and biliary ascaridiasis.
Second-level prevention
Antibody-forming cells. The disease develops rapidly, and toxic shock can occur soon. Therefore, the second-level prevention of this disease is mainly early diagnosis and early treatment. Based on the history of recurrent biliary disease, with high fever, chills, jaundice, systemic toxic symptoms, and signs of peritonitis, combined with ultrasound examination, the diagnosis is not difficult. Once diagnosed, active anti-infection, anti-shock, and the use of sufficient amounts of sensitive antibiotics should be carried out, blood volume should be supplemented, acidosis should be corrected, biliary sepsis should be prevented and treated, and emergency surgery should be prepared at the same time. The principle of surgery is to relieve obstruction, decompress the bile duct, and ensure smooth drainage, striving for simplicity and speed. For elderly patients with poor general condition, nasobiliary drainage can be performed first, and then surgery can be performed after the general condition is improved. Active systemic support therapy and anti-infection measures should still be carried out after surgery.
Third-level prevention
Antibody-forming cells. Toxic shock and biliary sepsis can occur early, and if not treated in time, the prognosis is very poor with a high mortality rate.
5. What laboratory tests are needed for acute obstructive suppurative cholangitis
For patients with severe acute cholangitis, the examination of peripheral venous blood platelet count and platelet aggregation rate (AGG) is required. The results show that the platelet count and AGG of patients with severe acute cholangitis are significantly decreased, indicating that the changes in platelet count and aggregation are closely related to the pathological degree and prognosis, and the clinical determination of platelet count and AGG is of great significance for determining the degree of illness and evaluating the prognosis.
1. Ultrasound
Ultrasound is the most commonly used simple, quick, and non-invasive auxiliary diagnostic method, which can show the extent and degree of bile duct dilation to estimate the site of obstruction, and can detect stones, worms, liver abscesses larger than 1 cm in diameter, subdiaphragmatic abscesses, and other conditions.
2. Thoracoabdominal X-ray film
X-ray films are helpful in diagnosing empyema, pneumonia, lung abscess, pericardial effusion, subdiaphragmatic abscess, pleurisy, and other conditions. In patients with reflux cholangitis after biliary-enteric anastomosis, abdominal X-ray films may show gas accumulation in the bile ducts, and upper gastrointestinal barium meal shows intestinal bile reflux. Abdominal X-ray films can also provide differential diagnosis at the same time, such as excluding intestinal obstruction and gastrointestinal perforation.
3. CT scan
The CT images of this disease not only show signs of bile duct dilation, calculi, tumors, liver enlargement and atrophy, but sometimes liver abscesses can also be found. If acute severe pancreatitis is suspected, a CT scan can be performed.
6. Dietary taboos for patients with acute obstructive suppurative cholangitis
Patients with acute obstructive suppurative cholangitis should pay attention to light diet, and can drink more fresh vegetables or fruit juices in their daily life, such as watermelon juice, orange juice, carrot juice, etc., and increase the frequency and quantity of drinking and eating to increase the secretion and excretion of bile, reduce inflammation and bile stasis.
7. Conventional methods for treating acute obstructive suppurative cholangitis with Western medicine
Timely surgery to relieve obstruction and drain the bile duct is the most important measure for treating this disease. The following methods should be adopted according to the condition:
First, Non-surgical Therapy
1. In cases of shock, shock treatment should be given first, and attention should be paid to the prevention and treatment of acute renal failure.
2. Correct metabolic acidosis, and infuse an appropriate amount of sodium bicarbonate based on the results of blood biochemical tests.
3. Broad-spectrum antibiotics should be administered intravenously, and then adjusted according to the results of bile and blood bacterial cultures and antibiotic sensitivity testing.
4. Analgesics and antispasmodics should be administered, dehydration corrected, and large doses of vitamin C and vitamin K1 given intravenously.
5. If conditions permit, fiberoptic duodenoscopy and nasobiliary drainage can be performed.
After the above emergency treatment, the condition may tend to stabilize, with stable blood pressure, reduced abdominal pain, and decreased body temperature. After the overall condition improves, surgery should be performed at a later date, otherwise, active surgery should be carried out while anti-shock treatment is being given.
Second, Surgical Treatment
The basic surgical method is the cholecystotomy and drainage. For those with concurrent cholecystitis and calculi, the gallstones can be removed simultaneously and cholecystostomy drainage can be performed. After the condition improves, a second operation should be performed. It is advisable to first explore the common bile duct during surgery, remove the gallstones in the bile duct, and place a T-shaped drainage tube. If there is obstruction at the opening of the hepatic duct, it must be expanded or the narrowed area cut open. Try to remove the stones above the stricture, and then place one arm of the drainage tube above the stricture into the hepatic duct, so as to achieve the purpose of sufficient drainage. However, for critically ill patients, it is not advisable to perform overly complex surgery.
Recommend: Pancreatic injury , Splenic Rupture , Chronic pancreatitis , Liver rupture , Echinococcosis of the liver , Budd-Chiari syndrome