Biliary tract inflammation, mainly bile duct inflammation, is called cholangitis. This disease often occurs at the same time as cholecystitis. The more common cause is mainly bacterial infection of the bile duct secondary to cholestasis. Depending on the severity of the condition, patients may develop fever, abdominal pain, jaundice (yellowing of the skin and whites of the eyes), and in severe cases, septic shock; it can be divided into acute and chronic types according to the severity of the condition.

What are the dangers of acute cholangitis?

Acute cholangitis causes bile duct infection, and the bile duct mucosa is congested with water, aggravating the bile duct obstruction. The bile gradually changes from clear to purulent, the pressure in the bile duct continues to increase, and the bile duct proximal to the obstruction gradually expands.

Bile ducts can also become infected and suppurate, causing ulcers and biliary bleeding. Even if the obstruction is eliminated by surgery and bile duct hypertension is relieved, the damage will still be left in the liver parenchyma and bile ducts, which is why the disease is serious.

What are the symptoms of acute cholangitis?

There is a medical term called Charcot’s triad (abdominal pain, chills, high fever, and jaundice), which are typical symptoms. In addition, patients with acute suppurative obstructive cholangitis also suffer from shock (significant drop in blood pressure) and depression of the central nervous system (confusion or coma), collectively known as Reynolds’ pentad.

What is the main cause of acute cholangitis?

Acute cholangitis occurs when obstruction and cholestasis caused by various causes of bile ducts become complete obstruction or bacterial infection worsens.

Most are secondary to bile duct stones and biliary ascariasis. In addition, they are also caused by bile duct strictures, bile duct tumors, and other lesions. Severe acute cholangitis is a disease with high mortality in surgical acute abdomen.

What is the cause of chronic cholangitis?

The main causes are chronic non-specific infections.

Intestinal bacteria invade the biliary system from the portal vein, causing chronic inflammation, hyperplasia of fibrous tissue in the bile duct wall, and narrowing of the bile duct wall. Autoimmune diseases are also an important cause. If accompanied by segmental enteritis, chronic fibrous thyroiditis, retroperitoneal fibroinflammatory sclerosis, etc., and the immune complexes in the serum are often higher than normal, chronic disease should be actively considered.

The disease may also be related to congenital factors, Strongyloides infection, alcoholism, lithocholic acid, and other factors.

What are the surgical methods for acute cholangitis?

Since the principle of surgery is to relieve the obstruction that causes cholangitis, doctors generally strive for simple and effective surgical methods, mainly bile duct incision, exploration, and drainage.

The method is to incise the common bile duct and expose the obstruction of the common bile duct. If there are stones or foreign bodies, they can be removed surgically. If it is a tumor, it can be removed. The common bile duct is then inserted into a T-tube, allowing the bile to drain out of the body through the T-tube. Generally, the operation time should be shortened as much as possible, and the condition will recover naturally after the obstruction is relieved.

Currently, in clinical practice, percutaneous bile duct drainage can be used to relieve bile duct obstruction in patients with obvious bile duct dilation. After the condition is stabilized, symptoms are relieved, and liver function improves, elective surgery can be performed. This can shorten perioperative risks.

What should patients with cholangitis pay attention to in their daily lives?

• Try to reduce the consumption of fat, especially animal fat, and replace animal oil with vegetable oil as much as possible.
• A considerable part of the formation of cholecystitis and cholelithiasis is related to excessive cholesterol content in the body and metabolic disorders. Therefore, it is necessary to limit fish roe, yolks of various eggs, and various liver, kidney, heart, brain, and other foods with high cholesterol content.
• It is better to steam, boil, stew, and braise food, and eat less fried, fried, roasted, grilled, smoked, and pickled foods.
• Increase the consumption of foods rich in high-quality protein and carbohydrates such as fish, lean meat, soy products, fresh vegetables, and fruits to protect the liver.
• Eat more foods rich in vitamin A such as tomatoes, corn, carrots, etc. to keep the gallbladder epithelial cells healthy.
• You can usually drink more fresh vegetables or melon juice, such as watermelon juice, orange juice, carrot juice, etc., and increase the frequency and quantity of drinking water and meals to increase the secretion and excretion of bile and reduce inflammation and cholestasis.
• Eat less fiber-rich foods such as celery to avoid difficulty digesting and increasing gastrointestinal motility, which may cause biliary colic.
• Stop smoking and drinking, and eat less spicy food and strong condiments to avoid irritating the gastrointestinal tract and inducing or aggravating the condition.
• When you are weak or have poor digestive function, you should eat a liquid or semi-liquid diet that is light, easy to digest, has less residue, has a suitable temperature, is non-irritating, and is low in fat.

How to prevent cholangitis?

Pay attention to dietary hygiene to prevent infection; when inflammation occurs, apply antibiotics promptly; prepare a reasonable diet and avoid excessive consumption of animal fat-containing foods; the most important thing is to have regular physical examinations and early detection and early treatment.