DIFFERENTIAL DIAGNOSIS OF cholangitis
CholecystitisIt
corresponds to an inflammation and infection of the gallbladder, the
pain is like a colic but it is very acute, almost always accompanied by a
defense of the right upper quadrant and especially fever, jaundice is
rare, biologically ,
disturbances are moderate liver, ultrasound allows the diagnosis by
showing wall thickening and gallbladder distention often associated with
pain in passing characteristic of the probe (ultrasonographic Murphy's
sign) and the absence of bile duct dilatation .
Mirizzi SYNDROMEMirizzi syndrome is a rare complication of gallstones in relation to an extrinsic compression of the bile duct by a calculus impacted in the infundibulum and the cystic duct.Ultrasonography may be misleading objectifying dilatation of the bile ducts inside and outside the liver with suspicion of common bile duct stones at the bottom.The diagnostic confirmation will be placed intraoperatively by finding a gallbladder lithiasis with sometimes large landlocked calculations in very dilated cystic compressing the common bile duct. This is free as will show the intra-operative cholangiography and cholédocoscopie.
THE BILIARY PANCREATITISIt is due to the isolation of a calculation at the ampulla of Vater, which will result in:
* An increase in pressure in the pancreatic duct (Wirsung The).
* Reflux of bile into the same channel.
* Activation of pancreatic enzymes.
* Inflammatory reaction.
It has the same clinical picture as cholangitis, the diagnosis is made by:The determination of amylase and amylase to be superior to 3 times normal.Ultrasound has no interest, visualization of the pancreas is difficult and may not be possible in 45-60% of cases, it will visualize especially gallstones (etiologic diagnosis).Chronic active hepatitis (ESP C)In cholestatic form, indeed, in some patients, chronic active hepatitis causes a marked cholestasis with jaundice more or less intense itching with increased PAL, sometimes permanent cholestasis is dominating the clinical picture that looks to quite near to primary biliary cirrhosis, cholestasis sometimes occurs in periods, accompanying the exacerbations of chronic active hepatitis. Serology confirmed the diagnosis.PERFORATION OR TORSION of the gallbladder
Mirizzi SYNDROMEMirizzi syndrome is a rare complication of gallstones in relation to an extrinsic compression of the bile duct by a calculus impacted in the infundibulum and the cystic duct.Ultrasonography may be misleading objectifying dilatation of the bile ducts inside and outside the liver with suspicion of common bile duct stones at the bottom.The diagnostic confirmation will be placed intraoperatively by finding a gallbladder lithiasis with sometimes large landlocked calculations in very dilated cystic compressing the common bile duct. This is free as will show the intra-operative cholangiography and cholédocoscopie.
THE BILIARY PANCREATITISIt is due to the isolation of a calculation at the ampulla of Vater, which will result in:
* An increase in pressure in the pancreatic duct (Wirsung The).
* Reflux of bile into the same channel.
* Activation of pancreatic enzymes.
* Inflammatory reaction.
It has the same clinical picture as cholangitis, the diagnosis is made by:The determination of amylase and amylase to be superior to 3 times normal.Ultrasound has no interest, visualization of the pancreas is difficult and may not be possible in 45-60% of cases, it will visualize especially gallstones (etiologic diagnosis).Chronic active hepatitis (ESP C)In cholestatic form, indeed, in some patients, chronic active hepatitis causes a marked cholestasis with jaundice more or less intense itching with increased PAL, sometimes permanent cholestasis is dominating the clinical picture that looks to quite near to primary biliary cirrhosis, cholestasis sometimes occurs in periods, accompanying the exacerbations of chronic active hepatitis. Serology confirmed the diagnosis.PERFORATION OR TORSION of the gallbladder
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