Cholangitis PATHOPHYSIOLOGY
In
most cases cholangitis is the result of a complete or incomplete
obstacle sitting on the CBD, but in some cases it occurs much more
expensive rare patients with CBD free [16].CHOLANGITIS WITH THE OBSTACLE OF CBDThree elements are involved in their development:- A complete or incomplete obstruction of the bile duct.- The penetration of pathogens in the CBD.- Factors promoting the spread of infection root canal.Damage to the VBPThis is the complete or incomplete obstruction of pathogens is critical. Stasis and dilation of the CBD are the result of obstruction and contribute to the development of infection.Penetration of germs in the CBDThe multiplicity of channels offered reflects their entanglement possible and ignorance of the exact mechanism.the way root canal bottom:Remains the most commonly accepted, but it is discussed. It is done by reflux of enteric bacteria and upstream stasis favors their multiplication.Thus the origin of intestinal bacteria isolated is a compelling argument in favor of this hypothesis. But the relative sterility of the duodenum is an objection to this theory.
hematogenously:It was suggested that the portal route involves the passage of intestinal bacteria in portal blood and bile back into the liver after treatment, but this mode of penetration of germs seems very questionable.the direct route:This mode of infection of the bile duct is now less often involved.It is the result of trauma infecting the bile ducts, mainly instrumental endoscopic maneuvers, and all surgery on the sphere hepatobiliary.Spread of infectionIs done in two ways:Local spread:Infection of the bladder directly responsible for the formation of abscesses in the walls of the bile ducts and liver parenchyma.Broadcast:Infectious process is done through blood, this blood-borne hypertension is facilitated by prevailing in VBP related to the existence of the obstacle.And several studies have demonstrated the existence of a reflux cholangioveineux bacteria on a blocked bile duct under pressure just above that of the hepatobiliary secretion.Moreover, whatever the mode of spread of infectious processes, terrain plays a supporting. Thus, cholangitis develops in a more severe in immunocompromised patients (treatment with corticosteroids and immunosuppressants), and elderly or carrying multiple defects.
Cholangitis with free Biliary Duct
Reflux in the digestive B.DIt seems that the isolated reflux can lead to exceptionally cholangitis. It occurs in most cases operated after bilio-digestive anastomosis, usually cholédoco ulcer.More surgical exploration or endoscopic biliary-digestive anastomoses cholédoco-duodenal found the relative frequency of food debris in stagnant CBD.Cholangitis during the infection sitting outside the CBD, this is a problem not well understood.However, in cases of suppurative cholecystitis or liver abscess in primitive or operating within the framework of a sepsis, bilicultures intraoperative, may show the presence of an infection of the bile duct with bile bile normal. The hypothesis of spasm associated oddien reaction could be considered.
hematogenously:It was suggested that the portal route involves the passage of intestinal bacteria in portal blood and bile back into the liver after treatment, but this mode of penetration of germs seems very questionable.the direct route:This mode of infection of the bile duct is now less often involved.It is the result of trauma infecting the bile ducts, mainly instrumental endoscopic maneuvers, and all surgery on the sphere hepatobiliary.Spread of infectionIs done in two ways:Local spread:Infection of the bladder directly responsible for the formation of abscesses in the walls of the bile ducts and liver parenchyma.Broadcast:Infectious process is done through blood, this blood-borne hypertension is facilitated by prevailing in VBP related to the existence of the obstacle.And several studies have demonstrated the existence of a reflux cholangioveineux bacteria on a blocked bile duct under pressure just above that of the hepatobiliary secretion.Moreover, whatever the mode of spread of infectious processes, terrain plays a supporting. Thus, cholangitis develops in a more severe in immunocompromised patients (treatment with corticosteroids and immunosuppressants), and elderly or carrying multiple defects.
Cholangitis with free Biliary Duct
Reflux in the digestive B.DIt seems that the isolated reflux can lead to exceptionally cholangitis. It occurs in most cases operated after bilio-digestive anastomosis, usually cholédoco ulcer.More surgical exploration or endoscopic biliary-digestive anastomoses cholédoco-duodenal found the relative frequency of food debris in stagnant CBD.Cholangitis during the infection sitting outside the CBD, this is a problem not well understood.However, in cases of suppurative cholecystitis or liver abscess in primitive or operating within the framework of a sepsis, bilicultures intraoperative, may show the presence of an infection of the bile duct with bile bile normal. The hypothesis of spasm associated oddien reaction could be considered.
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