Why does it occur
The main reason is an obstruction to the outflow of bile. Most often, this is a stone that has entered the common bile duct from the gallbladder. Less commonly, the ducts narrow after operations and injuries, become blocked by a tumor of the head of the pancreas or the ducts themselves, or become blocked due to parasitic diseases. A separate situation is a malfunction of a previously installed stent. In stagnant bile, intestinal bacteria multiply and enter the ducts through the ascending route. High blood pressure allows germs and their toxins to enter the bloodstream, which can cause the condition to worsen very quickly.
- Stone in the common bile duct
- Narrowing of the ducts after surgery
- Tumor of the ducts and pancreas
- Stent malfunction
- Parasitic diseases of the biliary tract
- Anomalies in the structure of the ducts
Symptoms
The classic combination is pain in the right hypochondrium, fever with chills and jaundice. It does not occur in everyone, so the absence of one of the signs does not exclude the diagnosis. Nausea, weakness, darkening of urine and lightening of stool, and itching are often associated. In older people, the picture is blurred: the temperature is low, the pain is moderate, and weakness, confusion and decreased blood pressure come to the fore. The appearance of lethargy and a drop in pressure means a severe course with a threat to life, and in this situation immediate hospitalization is required.
- Pain in the right hypochondrium
- High temperature with chills
- Yellowness of the skin and sclera
- Dark urine, light stool
- Itchy skin
- Confusion and drop in blood pressure in severe cases
Diagnostics
Blood tests reveal an increase in leukocytes and C-reactive protein, and in biochemistry - an increase in bilirubin, alkaline phosphatase and GGT, characteristic of a violation of the outflow of bile. Ultrasound is performed first: it shows dilation of the ducts, stones in the bladder and sometimes in the duct. A more accurate non-invasive method is magnetic resonance cholangiography, which clearly sees stones and narrowings. Computed tomography is prescribed if a tumor or complications are suspected. Blood cultures help select an antibiotic. Endoscopic retrograde cholangiography is today used primarily as a therapeutic procedure.
- Complete blood count and C-reactive protein
- Bilirubin, alkaline phosphatase, GGT, ALT and AST
- Ultrasound of the liver and bile ducts
- Magnetic resonance cholangiography
- Computed tomography for suspected tumor
- Blood culture
Treatment
Treatment begins immediately with intravenous fluids, pain relief, and broad-spectrum antibiotics, which are then adjusted based on culture results. The key stage is restoring the flow of bile. Most often it is performed endoscopically: an instrument is inserted through the mouth, the orifice of the duct is dissected, the stone is removed, or a drainage or stent is installed. If endoscopic access is not possible, percutaneous drainage under ultrasound or X-ray control is used. Open surgery is used less frequently. After the inflammation subsides, the issue of removing the gallbladder is decided if the cause was stones.
- Hospitalization and intravenous solutions
- Broad spectrum antibiotics
- Endoscopic stone removal and duct drainage
- Stenting for narrowings and tumors
- Percutaneous drainage if endoscopy is not possible
- Elective gallbladder removal after recovery
Prevention of recurrent episodes
The main measure is to eliminate the cause of bile stagnation. In case of cholelithiasis after suffering cholangitis, it is usually recommended to remove the gallbladder so that stones do not enter the duct again. In case of duct strictures, stenting may be required with planned replacement of the stent at the appointed time - they cannot be skipped, because a clogged stent itself provokes inflammation. It is important for people with installed drains to follow the rules of care. For any new fever with chills and jaundice, you should immediately seek help without waiting until the morning.
- Removal of the gallbladder for stones
- Timely replacement of the stent
- Proper drainage care
- Observation for duct strictures
- Immediate treatment for recurrent fever with jaundice
- Monitoring blood biochemistry at the appointed time