Bile duct stones and cholangitis

　　The main causes of biliary calculus are:
　　1. Biliary infection causes biliary inflammation, and the action of bacteria creates conditions for the formation of gallstones.
　　2. The remnants of biliary ascaris can become the core of gallstones, and most of the gallstones can be composed of the worm body.
　　3. Bile stasis can cause the precipitation and accumulation of bile components, which is conducive to the formation of gallstones.

　　Cholangitis is an acute suppurative infection of the bile duct caused by bile stasis due to biliary obstruction (the most common being biliary calculus obstruction), leading to a rapid increase in intraductal pressure. The main pathogenic bacteria are Gram-negative bacilli, among which Escherichia coli is the most common.

　　The complications of biliary calculus and cholangitis include sepsis and infectious shock, multiple organ dysfunction syndrome (MODS) of liver, kidney, lung, heart, and brain, biliary stricture and biliary cirrhosis, and portal hypertension.

　　The typical clinical manifestation of biliary calculus is biliary colic, fever, chills, and jaundice, known as the Charcot triad, but many patients lack complete triad manifestation. Most patients have sudden, sharp pain under the xiphoid process on the right side, which can radiate to the right shoulder and back, but a few people may be completely painless, only feeling discomfort and distension in the upper abdomen.
　　Due to the frequent occurrence of cholangitis with biliary calculus, about 2/3 of the patients develop chills and high fever after acute abdominal pain. Generally, jaundice begins to appear 12 to 24 hours after abdominal pain, at which time the pain usually subsides, and jaundice is generally not very deep, with fluctuating characteristics. Sometimes, jaundice can also be the only clinical manifestation of a few patients with common bile duct calculi. During jaundice, the urine becomes darker, the feces become lighter, and there may be skin itching. During physical examination, tenderness and muscle tension are found in the upper abdomen and the right upper quadrant. The gallbladder is often not palpable. In patients with a longer course of the disease, palpable enlarged liver and spleen are found, and the liver texture is relatively hard.

　　Biliary calculus and cholangitis are interdependent and causally related; the vast majority of cholangitis cases are accompanied by gallstones. There is a close relationship between biliary calculus and biliary ascaris; the eggs or remnants of ascaris can settle in the bile duct to form the core of the calculus, so preventing and treating biliary ascaris syndrome is of great importance. Therefore, attention should be paid to dietary hygiene to prevent 'illness from the mouth'; timely deworming should be done for patients with enterobiasis. For bile duct calculi less than 1.0 cm in size, a combination of traditional Chinese and Western medicine can be tried for bile promotion and stone expulsion; some patients may expel gallstones. If the calculus causes biliary obstruction and cholangitis, hospital treatment should be sought.

　　The main examination methods for cholangitis and cholangitis are:
　　1. In blood routine examination, leukocyte count is elevated, left shift, indicating inflammation; serum bilirubin determination suggests obstructive jaundice.
　　2. Ultrasound examination shows stones in the bile duct.
　　3. CT examination shows bile duct dilation or the presence of stones.
　　4. Oral cholecystography often shows no gallbladder shadowing, and percutaneous liver puncture cholangiography shows intraportal bile duct dilation, bile duct obstruction, etc.

　　The following are the dietary注意事项 for cholangitis and cholangitis:
　　1. Dietary control:Develop good eating habits such as regular meals, small meals, and not overeating. Reduce fat intake.
　　2. Avoid eating gas-producing foods:Such as sweet potatoes, potatoes, celery, onions, radishes, chives, soybeans, bamboo shoots, and garlic, carbonated beverages, and acidic fruit juices, coffee, cocoa, etc., which are prone to cause bloating, do not eat or eat less.
　　3. Increase fiber intake:Eat more soluble fiber foods such as vegetables, fruits, and coarse grains such as oats and barley.

　　Cholangitis is mainly treated by surgery, such as exploration or incision and extraction of stones from the common bile duct, using T-tube drainage of the common bile duct, and routinely performing intraoperative cholangiography through the T-tube, which can reduce the occurrence of residual cholangitis stones. After surgical exploration of the bile duct, cholangioscopy can also be used to determine whether there are residual stones in the bile duct. Cholangioscopy can locate and remove residual cholangitis stones. After surgery, T-tube drainage for 10 to 14 days, until the patient's jaundice is basically resolved, systemic and local cholangitis infections are also basically controlled, and cholangiography confirms that the bile duct to the duodenum is unobstructed without residual stones, the T-tube can be removed.

　　Currently, endoscopic papillotomy (EPT) is the main method for treating common bile duct stones, with nearly 80% of patients receiving endoscopic papillotomy treatment. In recent years, some large hospitals and specialized hospitals in China have also adopted endoscopic papillotomy or domestic papillotomy techniques combined with endoscopic lithotripsy as an important non-surgical method for treating common bile duct stones, and it is increasingly popular and widely promoted.