Inflammation of the bile ducts – classification, causes, diagnosis. How to cure cholangitis?

Proven content

Inflammation of the bile ducts is a condition characterized by a build-up of bile in the ducts inside the liver. The disease is caused by microorganisms that colonize the duodenum and enter the bile ducts. These are mainly: dysentery amoebiasis, pneumoniae, intestinal bacteria, sometimes yeasts.

Definition and classification of cholangitis

Inflammation of the bile ducts is a condition that causes bile to accumulate in the ducts inside the liver. This can damage the liver cells. The ailment comes in two forms:

1. primary biliary cholangitis – is not conditioned by any other disease, nor is it a consequence of any other ailment, unlike secondary cholangitis.
2. secondary cholangitis – occurs as a consequence of another problem with the liver or bile ducts.

The structure of the biliary tract

We divide the biliary tract into:

1. intrahepatic – made up of bile ducts that form the hepatic bile ducts. Their task is to lead bile out of the liver. After leaving the liver, they form one large common hepatic duct that gives rise to the extrahepatic bile ducts;
2. extrahepatic.

The common hepatic duct after connection with the gallbladder and from the connection area is called common bile duct.

Gallbladder – is located under the liver, and bile collects inside it. When we eat food, the follicle begins to contract, which means that bile is automatically secreted into the gastrointestinal tract and then it flows into the duodenum. Thus, inflammation develops when bile flow is obstructed or inhibited from the bile ducts.

The characteristic symptoms of inflammation of the gallbladder and biliary tract include:

1. fever,
2. chills
3. jaundice,
4. pain in the right hypochondrium.

PRIMARY Biliary tract Inflammation (Hardening)

Primary cholangitis can affect both the intrahepatic and extrahepatic pathways and is a rare condition. This disease is also called sclerosing disease, because scarring occurs in the area of ​​the bile ducts, which therefore loses their elasticity. The presence of scar tissue causes the bile ducts to narrow, which in turn leads to bile retention in the ducts inside the liver. Treatment and prevention vary, and so do the prognosis.

Residual bile destroys liver cells, and as they stretch along the conductors of the liver, they cause cirrhosis and liver failure. The disease of cirrhosis is progressive and may be asymptomatic at first, which is why it is so often diagnosed at an advanced stage. In primary cholangitis, liver function gradually deteriorates leading to serious health effects.

The reasons

The causes of this ailment are not fully known. There is talk of the family history of the disease, i.e. genetic factors. More than half of the patients are diagnosed with:

1. ulcerative colitis;
2. inflammatory bowel disease;
3. sometimes Crohn’s disease.

However, diseases that may increase the risk of primary cholangitis include diabetes mellitus and pancreatitis.

symptoms

Primary cholangitis occurs in patients of all ages, but most often these are people over 40 years of age. In most patients, the ailment does not give any symptoms, and if it does appear, it takes several weeks or even months. Among the symptoms we can distinguish:

1. weight loss
2. general feeling of being unwell
3. constantly tired,
4. unbearable itching of the skin,
5. jaundice (this occurs when the patient is in a very bad condition).

Complications of primary cholangitis

Complications in this disease can be vitamin A, D, E and K deficiencies. Usually the body digests them with fats, but when there is no bile digesting fats from food, the absorption of vitamins from the gastrointestinal tract is blocked.

Bile that remains in the bile ducts can become infected. Then the patient develops a high temperature, chills and abdominal pain. The disease can lead to cirrhosis of the liver, the only effective treatment for which is transplantation. In addition, some may develop liver failure and ten percent of patients may develop liver cancer, with a very poor prognosis.

Diagnosis

Primary cholangitis is quite often detected by accident during check-up, because it usually does not give any symptoms at the beginning. The most important diagnostic test is a blood test to help assess the levels of liver enzymes. In patients with primary cholangitis, the AST, ALP, ALT, and GGTP enzymes are significantly elevated, as are bilirubin levels. ERCP (retrograde cholangiopancreatography) is considered a test that unambiguously helps to diagnose the disease. This is an imaging examination in which the doctor inserts a tube through the mouth, then through the esophagus and into the stomach. Then the tube is directed towards the duodenum, where there is a papilla with an opening into which the bile and pancreatic ducts exit. The doctor gives a contrast to the bile ducts through the nipple in order to be able to better visualize the bile ducts. Then (after administration of the contrast agent), an X-ray examination is performed, which perfectly illustrates all the narrowing or dilatation.

Important! In the case of contraindications to the administration of contrast, the doctor orders another imaging test using magnetic resonance imaging.

If cirrhosis is suspected, a liver biopsy is performed.

Treatment of primary cholangitis

Therapy in primary cholangitis is mainly based on the widening of the strictures in the bile ducts. An endoscopic technique is used for this, using ERCP. Liver transplant is the only effective treatment for some patients, especially if the inflammation keeps coming back and treatment is not providing the expected benefit. Unfortunately, even after the transplant, the inflammation may attack again. Attention! To be able to perform a transplant, the patient must meet certain conditions!

In addition, treatment may be symptomatic. In addition to relieving itching, the patient also takes painkillers.

SECONDARY Biliary tract Inflammation

Secondary cholangitis occurs as a result of biliary diseases or other liver ailments. Narrowing of the bile ducts obstructs the outflow of bile. The bile accumulating above the narrowing becomes infected (most often with Coli, Klebsiella or Escherichia bacteria) and, consequently, inflammation of the bile ducts occurs.

How do we get infected?

Bacteria enter the digestive system when we eat contaminated food, and then through the bile duct, they enter the liver. In addition, infection may occur due to the presence of parasites in the liver, in the form of human roundworm or liver fluke (these are usually rare cases of infection). Some parasites cause constriction of the bile ducts and, at the same time, stagnation of bile. Other causes of problems with the outflow of bile are:

1. narrowing of the bile ducts due to inflammation in the liver or bile ducts,
2. narrowing of the bile ducts due to surgeries carried out in the area of ​​the liver,
3. cholelithiasis,
4. the use of certain medications (in psychiatry) – can also damage the bile ducts.

How is secondary cholangitis manifested?

Patients with secondary cholangitis may experience:

1. fever,
2. chills,
3. pain in the upper abdomen (right or middle),
4. weakness.

Inflammation of the bile ducts can be very dangerous as in some cases it can lead to life-threatening septic shock. In patients with bacterial inflammation, many toxins produced by foreign bodies multiply in the body. Sepsis not only causes life-threatening complications, but also significantly impairs the functioning of vital organs. Any untreated septic shock will lead to death!

Diagnosis

Doctors prescribe blood tests and imaging tests to diagnose secondary cholangitis. The first of them reveals an increased concentration of liver enzymes, such as ALP, AST, ALT or GGTP, an increase in bilirubin and white blood cells, which have the body’s protective properties against infection by viruses and bacteria. In turn, the imaging test performed in diagnostics is ERCP (endoscopic retrograde cholangiopancreatography), which combines the endoscopic and X-ray methods.

How to heal?

Treatment is based primarily on maintaining a proper diet. Patients hospitalized for secondary cholangitis are rehydrated with drip irrigation. In addition, they are given an antibiotic. Surgical treatment with ERCP with dilatation of the bile ducts may be necessary in some patients.