胆管炎

　　Cholangitis is often secondary to bacterial infection (mainly Escherichia coli, Enterobacter, and Staphylococcus spp.) on the basis of bile stasis. Bacteria can reach the bile duct via the lymphatic or blood pathways, or they can enter the bile duct retrogradely from the intestine through the duodenal papilla. The specific etiology is as follows:
　　1. Low immunity causing biliary tract infection: Biliary tract infection can cause inflammation of the bile duct.
　　2. Emotional imbalance: It can lead to the obstruction of bile excretion and trigger cholangitis.
　　3. Diet: It is important to have a moderate diet and avoid overeating. It is advisable to eat less high-fat and cholesterol-rich foods and pay attention to dietary hygiene.
　　4. Intestinal parasitic diseases: The invasion of worms into the bile duct can cause cholangitis, and their remnants and eggs can become the 'core' of stones.

　　In addition to its clinical manifestations, cholangitis can also lead to other diseases. Due to long-term irritation of the gallbladder wall by inflammation, complications such as gallstones, cholecystitis, choleperitonitis, and even toxic shock may occur.

　　The causative bacteria of cholangitis are mainly Gram-negative bacilli, with Escherichia coli being the most common. Cholangitis patients often have an acute and severe onset, which is one of the main causes of death in patients with gallstones in China. 　　

      Patients with cholangitis often present with discomfort or pain in the upper middle abdomen, or severe pain attacks, which may worsen after eating greasy foods. Fever and jaundice are rare, and abdominal signs are not prominent, with only mild tenderness in the upper abdomen and no enlargement of the gallbladder. In case of an acute attack, the triad of symptoms, including abdominal pain, chills, high fever, and jaundice, may occur. In addition to the classic Charcot triad of acute cholangitis (abdominal pain, chills, high fever, and jaundice), there may also be signs of shock and depression of the central nervous system, known as the Reynolds pentad. 　　

    The disease often starts abruptly with sudden onset of severe, persistent pain under the sternum or in the upper right abdomen. This is followed by chills and remittent fever, with body temperature potentially exceeding 40℃. Nausea, vomiting, and jaundice are common, but the severity of jaundice may not correspond to the severity of the illness. Nearly half of the patients may experience restlessness, confusion, drowsiness, and even coma, which are signs of central nervous system depression. Simultaneously, there may be a drop in blood pressure, often indicating the occurrence of sepsis and infectious shock, indicating a serious condition.

　　Preventive measures for cholangitis:

　　1. Pay attention to rest more, and keep a regular life and work rhythm, with moderate work and rest.

　　2. Abstain from smoking and drinking, spicy and cold foods, and reduce the intake of fats.

　　During the illness, the liver's ability to metabolize alcohol is extremely low, and drinking is easy to cause liver function deterioration. Try not to eat high-fat foods to avoid increasing the burden on the liver and gallbladder and aggravating the condition.

　　3. Eat less vegetables such as turnips and celery that are rich in fiber.

　　Due to abnormal bile secretion, poor digestive ability, and increased peristalsis of the gastrointestinal tract, it can cause biliary colic. At the same time, it is best to adopt the principle of small and frequent meals to reduce the burden on the liver and gallbladder.

　　4. Pay attention to adjusting one's mood and maintaining a good psychological state.

　　Liver and gallbladder diseases are prone to stagnation, and it is best to promote the smooth flow of Qi. If one is depressed, it will lead to the reversal of Qi movement, disharmony of Yin and Yang, and induction or aggravation of disease symptoms.

　　5. Pay attention to appropriate exercise.

　　Appropriate exercise can improve the body's immunity, but one must not over-exercise, otherwise it will increase the burden on the liver and gallbladder, which is not conducive to the recovery of the condition.

　　Cholangitis examination items:

　　Ultrasound is the most commonly used simple, quick, and non-invasive auxiliary diagnostic method. It can show the extent and degree of bile duct dilation to estimate the location of obstruction, and can detect stones, worms, liver abscesses larger than 1 cm in diameter, subdiaphragmatic abscesses, etc.

　　Chest and abdominal X-ray films are helpful in diagnosing empyema, pneumonia, lung abscess, pericardial effusion, subdiaphragmatic abscess, pleurisy, etc.

　　CT scanning of AFC's CT images can not only show signs such as bile duct dilation, stones, tumors, liver enlargement, atrophy, etc., but sometimes it can also detect liver abscess. If acute severe pancreatitis is suspected, CT examination can be performed.

　　Endoscopic retrograde bile duct drainage (ERBD) and percutaneous liver puncture drainage (PTCD) can not only determine the cause and location of bile duct obstruction, but also can perform emergency decompression and drainage, but there is a risk of aggravating bile duct infection or causing bile juice to leak into the peritoneal cavity.

　　Magnetic Resonance Cholangiopancreatography (MRCP) can fully display the full picture of the intrahepatic bile duct tree and the location and extent of obstruction. The image is not limited by the site of obstruction and is a non-invasive bile duct imaging technique, which has become a relatively ideal imaging examination method.

　　Dietary precautions for patients with cholangitis:

　　Try to reduce the intake of fat, especially animal fat, and avoid eating fatty meat and fried foods as much as possible. Replace animal oil with vegetable oil as much as possible.

　　A considerable number of gallbladder inflammation and gallstone formation are indeed related to the high content of cholesterol in the body and metabolic disorders, therefore, it is necessary to limit the intake of high-cholesterol foods such as fish roe, yolks of various eggs, and the liver, kidneys, hearts, and brains of various carnivorous animals.

　　3. Cooking should be done by steaming, boiling, stewing, or braising, and it is best to avoid eating fried, baked, grilled, smoked, or pickled foods in large quantities.

　　4. Increase the intake of foods rich in high-quality protein and carbohydrates such as fish, lean meat, dairy products, fresh vegetables, and fruits to ensure calorie supply and promote the formation of glycogen, protecting the liver.

　　5. Eat more tomatoes, corn, carrots, and other foods rich in vitamin A to maintain the integrity of gallbladder epithelial cells and prevent the shedding of epithelial cells to form the core of stones, thereby causing stones or increasing the size and number of stones.

　　6. If possible, drink more fresh vegetable or melon juice, such as watermelon juice, orange juice, carrot juice, etc., and increase the frequency and quantity of drinking water and eating, to increase the secretion and excretion of bile, and alleviate inflammation and bile stasis.

　　7. Eat less vegetables rich in fiber, such as turnips and celery, to avoid increased peristalsis of the gastrointestinal tract due to difficulty in digestion, which may trigger biliary colic.

　　8. Avoid smoking, drinking, and eating spicy and irritating foods, such as mustard oil, to prevent stimulation of the gastrointestinal tract and exacerbation of the condition.

　　9. Prefer light, easy-to-digest, low-fiber, temperature-appropriate, non-irritating, low-fat liquid or semi-liquid diet. Do not eat and drink excessively for a moment's pleasure, as this may cause unnecessary trouble and even induce biliary bleeding, which may be life-threatening.

　　1. Surgical Treatment

　　① Biliary Dilation Support Drainage Surgery: Place a tube support or U-shaped tube for drainage within the bile duct.

　　② Biliary-enteric Anastomosis Support Drainage Surgery: Select various forms of biliary-enteric anastomosis surgery, place an internal support through the anastomosis or through the hepatic drainage tube.

　　③ Excision of the Narrowed Segment of the Bile Duct: Anastomosis of the bile duct ends or incision and shaping of the narrowed segment, repair surgery with a vascular pedicle of the gallbladder flap, round ligament, or jejunal flap.

　　④ Cholangioplasty: Increase the diameter of the bile duct.

　　⑤ In Situ Liver Transplantation: with persistent jaundice and biliary cirrhosis.

　　Disadvantages: high risk, high cost, obvious side effects, and prone to infection.

　　2. Drug Treatment

　　Antibiotics, immunosuppressants, corticosteroids, antifibrotic drugs, penicillamine, and other treatments for choangitis.

　　Disadvantages: severe side effects, prone to induce other complications, and strong dependence.