Holangit – nonspecific inflammatory defeat of bilious channels of a sharp or chronic current. At a holangita pain in the right podreberye, fever from oznoba, dispepsichesky frustration, jaundice is noted. Diagnostics of a holangit includes the analysis of biochemical indicators of blood, carrying out fractional duodenal sounding with a bakissledovaniye of bile, ultrasonography, a chreskozhny chrespechenochny holangiografiya, RHPG. In treatment of a holangit antibiotic treatment, dezintoksikatsionny therapy, purpose of enzymes, FTL (mud cure, hloridno-sodium bathtubs, parafino-and an ozokeritoterapiya, UVCh, a diathermy), sometimes – a surgical decompression of bilious ways is used.
At a holangita can be surprised inside - or extra hepatic bilious channels. The disease arises at women at the age of 50 — 60 years more often. In gastroenterology holangit, as a rule, it is diagnosed together with gastroduodenity, cholecystitis, hepatitis, cholelithiasis, pancreatitis.
Classification of a holangit
The current of a holangit can be sharp and chronic. Depending on patomorfologichesky changes sharp holangit can accept a catarrhal, purulent, difteritichesky or necrotic form. Catarrhal holangit it is characterized by hyperaemia and hypostasis mucous bilious channels, leykotsitarny infiltration of their walls, an epithelium deskvamation. At a purulent holangit there is a fusion of walls of the bilious courses and formation of multiple abscesses. The heavy current is noted at formation of fibrinozny films on walls of the bilious courses (difteriticheskiya holangit) and emergence of the centers of a necrosis (necrotic holangit).
Most often chronic meets holangit which can develop as an outcome of an acute inflammation or from the very beginning to get a long current. Allocate latent, recidivous, it is long current septic, abstsediruyushchy and skleroziruyushchy forms of a chronic holangit. At a skleroziruyushchy holangit in walls of the bilious courses connecting fabric expands that causes striktura of bilious channels and still their big deformation.
On localization of an inflammation distinguish holedokhit (an inflammation of a holedokh – the general bilious channel), angiokholit (an inflammation of the intra hepatic and extra hepatic bilious courses), papillit (an inflammation of a faterov of a nipple). On etiologichesky factors distinguish holangita of the bacterial, aseptic and parasitic nature.
Reasons of a holangit
The most part of holangit is caused by hit to bilious canals of bacterial activators (more often - colibacillus, the protea, stafilokokk, enterokokk, a neklostridialny anaerobic infection, is more rare — mikobakteriya of tuberculosis, a bryushnotifozny stick, a pale spirokheta). Microorganisms get into the bilious courses in mainly ascending way from a gleam of a 12-perstny gut, hematogenic – through a vorotny vein, limfogenny – at cholecystitis, pancreatitis, enteritis. Small intra hepatic bilious channels, as a rule, inflame at viral hepatitis. Parasitic holangita most often develop at the accompanying opistorkhoz, an askaridoza, a lyamblioza, a strongiloidoza, a klonorkhoza, a fastsioleza.
Aseptic enzymatic holangit can develop as a result of irritation of walls of the bilious courses the activated pancreatic juice taking place at a pankreatobiliarny reflux. In this case in the beginning there is an aseptic inflammation, and accession of an infection happens again, in later period.
On aseptic type also proceeds skleroziruyushchiya holangit, caused by an autoimmune inflammation of bilious channels. At the same time, along with a skleroziruyushchy holangit, nonspecific ulcer colitis, a disease Krone are often noted, vaskulit, rheumatoid arthritis, tireoidit etc.
Serves as prerequisites for development of a holangit , meeting at dyskinesia of biliary tract, anomalies of the bilious courses, a cyst of a holedokh, cancer of bilious ways, a holedokholitiaza, a stenosis of a faterov of a nipple etc. Yatrogenny damages of walls of channels at endoscopic manipulations (a retrograde pankreatokholangiografiya, installation of stent, a sfinkterotomiya), surgeries on the bilious ways can precede the beginning of a holangit.
Symptoms of a holangit
The clinic of a sharp holangit develops suddenly and is characterized by Sharko's triad: high temperature of a body, pains in the right podreberye and jaundice.
Sharp holangit demonstrates from fever: sharp rise in the body temperature to 38-40 °C, oznob expressed to perspiration. At the same time there are intensive pains in the right podreberye reminding bilious colic with irradiation in the right shoulder and a shovel, a neck. At a sharp holangit intoxication quickly accrues, weakness progresses, appetite worsens, the headache, nausea with vomiting, a diarrhea disturbs. A little later at a sharp holangit there is jaundice – visible yellowing of skin and a skler. Against the background of jaundice the skin itch, as a rule, the normal sleep amplifying at night and interrupting develops. As a result of the expressed itch on the patient's body with holangity skin raschesa are defined.
In hard cases violations of consciousness and the phenomenon of shock can join Sharko's triad – in this case the simptomokompleks called by Reynolds's pentade develops.
Clinical manifestations of a chronic holangit carry the erased, but progressing character. The disease is characterized by dull aches in the right side of weak intensity, feeling of discomfort and a raspiraniye in an epigastriya. Jaundice at a chronic holangit develops late and demonstrates far come changes. The general violations at a chronic holangit include subfebrilitt, fatigue, weakness.
Diagnostics of a holangit
To suspect holangit, as a rule, it is possible on the basis of a characteristic triad of Sharko; the specifying diagnostics is performed on the basis of laboratory and tool researches.
Biochemical tests indirectly testify to a holestaza; at a holangita increase in level of bilirubin, alkaline phosphatase, , alpha-amylases is noted. For identification of activators of a holangit fractional duodenal sounding with bacteriological crops of bile is carried out. In 60% of cases at a holangita the mixed bacterial flora takes place. For the purpose of an exception of a parasitic invasion the research a calla on eggs of helminths and protozoa is shown.
Ultrasonography of an abdominal cavity and liver, an ultrasonografiya of bilious ways, KT belong to the visualizing methods of diagnostics of a holangit. With their help it is possible to receive the image of bilious channels, to reveal their expansion, to define existence of structural and focal changes in a liver.
Among tool methods of diagnostics of a holangit the leading role is assigned to an endoscopic retrograde pankreatokholangiografiya, a magnetic and resonant pankreatokholangiografiya (MRPHG), a chreskozhny chrespechyonochny holangiografiya. On the received roentgenograms and tomograms the structure of biliary tract is well visualized that allows to establish the reason of their obstruction.
Treatment of a holangit
The major tasks at a holangita are knocking over of an inflammation, desintoxication and a decompression of bilious ways. Depending on the reasons and existence of complications treatment of a holangit can be carried out by conservative or surgical methods. Conservative maintaining the patient with holangity consists in ensuring functional rest (a bed rest, hunger), purpose of spazmolitichesky, anti-inflammatory, antibacterial, antiparasitic means, infusional therapy, gepatoprotektor.
Etiotropny treatment of a holangit is carried out taking into account the found activators: at bacterial flora tsefalosporina in a combination with aminoglikazida and metronidazole are usually applied; at identification a worm or protozoa - antiparasitic means. At the expressed intoxication carrying out a plasma exchange is shown. During remission of a holangit physiotherapeutic treatment is widely used: induktotermiya, UVCh, microwave therapy, , diathermy, mud applications, ozokeritoterapiya, parafinoterapiya, hloridno-sodium bathtubs.
As treatment of a holangit is impossible without normalization of function of a zhelcheotvedeniye, quite often it is necessary to resort to different surgical interventions. For the purpose of a decompression of bilious channels the zndoskopichesky papilosfinkterotomiya, extraction of concrements of bilious channels, endoscopic stenting of a holedokh, chreskozhny transhepatic drainage of bilious channels, external drainage of bilious channels, etc. interventions can be carried out. As the most effective method of treatment of a skleroziruyushchy holangit serves transplantation of a liver.
Forecast and prevention of a holangit
At the holangit complicated by an abstsedirovaniye, cirrhosis, a hepatorenal failure, generalized septic process, the forecast unsatisfactory. Timely therapy of a catarrhal holangit allows to achieve treatment; at a purulent, difteritichesky and necrotic form - the forecast more serious. The long current of a chronic holangit can lead to a resistant invalidization.
Prevention of a holangit dictates need of timely treatment of a gastroduodenit, beskamenny cholecystitis, ZhKB, pancreatitis, helminthic and protozoan invasions; observations at the gastroenterologist after the postponed surgical interventions on the bilious ways.