Chronic Cholangitis

　　At each stage, we all have things to worry about. For the disease of chronic cholangitis, we do not know how to face it. Chronic cholangitis is a chronic disease, so when we all get this disease, we should never be afraid. In order to let everyone stay away from chronic cholangitis, we will give you a detailed introduction to the etiology of chronic cholangitis below.

　　1. Chronic Non-specific Infection:It is believed that this disease is related to ulcerative colitis. In infectious enteritis, intestinal bacteria enter the biliary system via the portal vein, causing chronic inflammation, fibrosis of the bile duct wall, and narrowing of the bile duct wall. Some reports indicate that bacteria were grown in portal vein blood cultures during colon resection due to ulcerative colitis; when bacteria were injected into the portal vein of animals, inflammation was found around the bile ducts. However, some people believe that there is no fundamental connection between this disease and ulcerative colitis. Whether or not accompanied by ulcerative colitis, it does not change the natural course and outcome of primary biliary cholangitis.

　　2. Autoimmune diseases:This disease is often accompanied by ulcerative colitis, and some are accompanied by segmental colitis, chronic fibrous thyroiditis, and retroperitoneal fibrosing sclerosis, etc. The immune complexes in the serum of patients are often higher than those of normal people. When these substances precipitate in the tissue, they can cause local inflammation. Badenheimer measured the immune complexes in the serum of patients with primary biliary cholangitis, regardless of whether they were accompanied by ulcerative colitis, their serum immune complexes were significantly higher than the healthy control group. Patients with ulcerative colitis have a certain proportion of positive antinuclear antibodies and antismooth muscle antibodies, which supports the view that the onset of these patients is related to immune factors. However, the use of hormones or immunosuppressants can improve the symptoms, but it does not improve the pathological changes of the bile ducts and cannot change the course of the disease. Therefore, whether primary biliary cholangitis is related to immune factors still needs further research to be confirmed.

　　3. Precancerous lesions:Patients with chronic cholangitis in clinical practice are diagnosed after a period of follow-up. It is believed that the disease is a slowly developing cholangiocarcinoma, or it is believed that the disease will transform into cholangiocarcinoma.

　　4. Other factors:The disease is related to congenital factors, Strongyloides infection, alcoholism, lithocholic acid, and other factors.

　　The etiology of chronic cholangitis is very clear as we have introduced above. Many diseases will be encountered by people in life, and we don't know how to face these diseases. Only by better understanding the diseases around us can we understand the etiology of chronic cholangitis, which is very important for everyone. In our daily lives, we should have an in-depth understanding of diseases.

　　Chronic cholangitis is a disease caused by inflammation of the bile ducts. Many of us have seen chronic cholangitis in many people. Although this disease is common, people are not very knowledgeable about it. In order to let more people understand chronic cholangitis, we will go with the experts to understand the complications of chronic cholangitis below. 50% of patients may have chronic liver disease, portal hypertension, ascites, portosystemic encephalopathy, bone metabolic diseases, diarrhea, steatorrhea, lack of fat-soluble vitamins, and liver failure, and a series of consequences caused by liver function damage will appear with the progression of the disease. The complications include bacteremia, cholelithiasis, and cholangiocarcinoma.

　　1. Bacteremia:It can occur repeatedly and may be secondary to chronic biliary tract infection or hematogenous bacterial dissemination. The frequency and severity of bacteremia in patients are difficult to estimate, which may lead to infections of the liver abscess or other organs (such as heart valves).

　　2. Cholelithiasis:About 1/3 of patients have a history of cholecystectomy at some stage of the disease process, of which about 20% are asymptomatic gallstones. The ultrasound examination results of patients show that 25% have gallstones. Since most patients are young males, this indicates an increased incidence of cholelithiasis.

　　3. Cholangiocarcinoma:Autopsy reports show that 50% of patients have cholangiocarcinoma on the pathological basis. Cholangiocarcinoma patients usually have liver cirrhosis, portal hypertension, and a long course of ulcerative colitis (UC). They are usually older and have progressive changes in cholangiography, such as bile duct cystic dilatation, which suggests the occurrence of cholangiocarcinoma. If the patient's bilirubin rises from 85.5μmol/L (5mg/dl) to 171μmol/L (10mg/dl) within a short time, it should be considered as a malignant change, but it needs to be confirmed by biopsy or surgery. Mayo Clinic performed liver transplantation on 60 patients, and only one had intraportal total bile duct and right and left hepatic duct papillary dysplasia (considered as non-invasive papillary dysplasia), and no cholangitis or cholangiocarcinoma was seen, so the incidence of cholangiocarcinoma may not be high. It is generally considered that the incidence rate is 10% to 15%.

　　We have already understood what symptoms chronic cholangitis can complicate. In this society, people often fight against diseases, so we need to understand diseases. Chronic cholangitis can bring harm to us in life, so we need to have a very clear understanding of diseases. In life, we need to understand diseases.

　　Chronic cholangitis is a disease with a relatively slow onset. This disease generally requires a long period of accumulation before it is contracted, so people need to understand chronic cholangitis. Then, what are the symptoms and manifestations of chronic cholangitis? We will introduce them in detail below.

　　The onset of chronic cholangitis is often subtle, with no obvious prodromal symptoms or specific symptoms. Jaundice is often discovered accidentally and progresses. Because the bile duct is often not completely blocked, there are rarely grayish-white stools. Clinically, it is often misdiagnosed as 'acute infectious hepatitis'. With the aggravation of jaundice, there may be pruritus of the skin. If there is biliary tract infection, there may be upper right abdominal pain, fever, and chills. As the condition progresses, with the prolongation of jaundice, the patient may appear enlargement of the liver and spleen. In the later stage, due to liver failure, ascites, oliguria, and hepatic encephalopathy may occur.

　　Chronic cholangitis is divided into asymptomatic and symptomatic types according to clinical symptoms:

　　1. Asymptomatic patients have no obvious symptoms and are often in the early or early stage of the disease. Although imaging examinations show the manifestations of cholangitis, the patients have no jaundice.

　　2. Symptoms can be divided into mild and severe cases. Mild patients have discomfort, fatigue, loss of appetite, weight loss, abdominal pain, fever, jaundice, pruritus, and without symptoms and signs of portal hypertension. Severe patients have obvious jaundice, enlargement of the liver and spleen, ascites, encephalopathy, or esophageal variceal bleeding, and other late-stage symptoms of liver cirrhosis.

　　At any time, we will not have an in-depth understanding of the diseases around us. The harm of each disease is different, so the degree of attention people need to pay is also different. No disease should disturb our lives, so we need to understand the symptoms of diseases, so that we can discover the diseases around us through the symptoms and achieve early detection and early treatment.

　　Among all diseases, we are most afraid of chronic diseases because chronic diseases gradually destroy our bodies, and in many cases, we will not find them. Therefore, we need to pay special attention to chronic cholangitis, a chronic disease. How to prevent chronic cholangitis is something many people want to know. Let's take a look at it together below.

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

　　(2) Reasonably allocate the diet, avoid eating too much food containing animal fats, such as lard and animal oil, etc.;

　　(3) When there are intestinal worms (mainly ascaris), apply vermifuge in time, the amount should be sufficient to prevent insufficient medication, as ascaris are active and easy to penetrate into the bile duct, causing obstruction and leading to cholecystitis.

　　Gallbladder ultrasound examination MRI examination of liver, gallbladder, pancreas, spleen Liver, gallbladder, spleen CT examination

　　1. Ultrasound examination can detect dilation of the common bile duct, thickening of the vessel wall, and sometimes even show shadows of bile duct stones or worms.

　　2. Intra-venous bile duct造影 shows bile duct dilation, and there is often a phenomenon of delayed contrast agent emptying.

　　3. ERCP can clearly show the dilated bile duct and bile duct stones, and can understand whether there is stenosis in the intrahepatic and extrahepatic bile ducts.

　　The diet of patients with chronic cholangitis should be light and easy to digest, with an emphasis on vegetables and fruits, a reasonable diet, and adequate nutrition. In addition, patients should also avoid spicy, greasy, and cold foods.

　　Surgical treatment can be used for chronic cholangitis to remove the biliary obstruction factors and ensure the smooth flow of bile ducts. If there is an acute attack, control it first and then perform surgery after the condition stabilizes. Open the bile duct to remove stones or worms and perform T-shaped tube drainage.

　　① Biliary Duct Dilatation and Support Drainage Surgery:For patients with long-segment biliary duct stenosis that cannot be resected, it is possible to use internal biliary duct stent support or U-shaped tube drainage. If the main problem is diffuse biliary duct stenosis outside the liver, after the common bile duct is incised during surgery, the Bakes biliary dilator is gradually expanded in both upward and downward directions along the biliary duct (including the expansion of the Oddi sphincter, which should be done gradually and slowly without excessive force to prevent bile duct rupture and bleeding from accompanying blood vessels), and then a T-shaped tube is placed for support and drainage. If there are changes in the intralobular bile ducts, gradual expansion is performed until a U-shaped tube can be placed on the liver surface for drainage. Initially, the external diameter of the liver drainage should not be too large, as it is difficult to place and may lead to intralobular bile duct rupture and bleeding due to over-expansion. A finer catheter should be placed first, and the catheter should be changed every 3 months, gradually increasing the diameter of the catheter. The catheter should be placed for at least 1 to 2 years, or even for life.

　　② Bile-enteric anastomosis support and drainage surgery:According to the location of the lesion and the degree of stenosis, various forms of bile-enteric anastomosis are selected, and internal supports are placed through the anastomosis or through the hepatic drainage tube.

　　③ Bile duct stenosis resection:Bile duct end-to-end anastomosis or narrowing section incision and shaping, repair surgery with vascular pedicle of gallbladder flap, round ligament, or jejunal flap. It is suitable for patients with segmental stenosis of extrahepatic bile duct and mild intrahepatic bile duct lesions above the stenosis.

　　④ Bile duct intima stripping:In order to increase the diameter of the bile duct, but it is technically difficult.

　　⑤ In-situ liver transplantation:For those with persistent jaundice and biliary cirrhosis, or who belong to diffuse primary biliary cirrhosis, and cannot be corrected by the aforementioned surgical methods, liver transplantation may offer a long-term cure hope. Between 1981 and 1990, the University of Pittsburgh and Mayo Clinic performed liver transplantation surgery on 216 adult patients with primary biliary cirrhosis, with a postoperative observation period of 34±25 months. To evaluate the results of liver transplantation, it was compared with the natural course mathematical model of primary biliary cirrhosis (MayoModel——a model obtained from the serum bilirubin, splenomegaly, and histological changes of liver tissue of 426 patients with primary biliary cirrhosis as variables). The results showed that the Kaplan-Meier survival probability after liver transplantation was already higher than the predicted value of MayoModel six months after surgery, and it was even more obvious at 5 years, and the difference was more significant in patients with severe conditions.

　　⑥ Portosystemic venous shunt surgery:Patients with portal hypertension should use portosystemic shunt surgery appropriately. Because during portal hypertension, the portal vein vascular network at the hepatic hilum is dilated and the pressure is high, a large amount of bleeding often occurs during surgery, making it difficult to proceed, so a staged surgical method can be adopted. If the patient's condition is good, a portosystemic shunt surgery and extrahepatic bile duct drainage surgery can be performed in one stage to reduce portal vein pressure and alleviate jaundice, followed by a thorough bile duct surgery at the hepatic hilum 3 to 6 months later. If the condition is severe, a bile duct decompression surgery can be performed first to alleviate liver function damage and reduce jaundice, followed by a portosystemic shunt surgery 6 months later, and then a bile duct surgery at the hepatic hilum 3 months later.