Etiological studies of Cholangitis
The infection of the biliary tract is never primitive. It
occurs when bile stasis secondary to an incomplete obstruction of the
bile ducts outside the liver, more rarely in the affections of the bile
ducts within the liver and in cases of reflux of duodenal fluid in the
biliary tract.
And despite the wide variety of conditions that can lead to cholangitis, the etiology is clearly dominated by the gallstones [4] [41].
BARRIERS incomplete bile duct
Cholelithiasis
It is conceivable that, for there to be precipitation calculations, it is necessary that there be an absence of the solubilizing agent, bile salts, an excess of the substance to dissolve cholesterol.
This imbalance may have a food-borne because, in fact, gallstones is much more common in Europe and the Far East. But it is certain that these dietary factors are not the only culprits. There are probably circumstances where the rate of bile salts is insufficient.
Endocrine factors could cause such a change: the stones are more common in women and appears to be particularly favored by the pregnancy.
But in some cases very different, the stones due to excess bilirubin, a consequence of hemolysis: these are pigment stones.
Cholelithiasis is the main etiology of cholangitis, it is due to a calculation single or multiple calculations, they will favor infection.
Cholelithiasis
It is the stones of the bile duct, due mostly to calculations (calculation of the low - or riprap choledochal bile) is a common complication of lithiasis of the gallbladder, it may nevertheless occur outside any vesicular disease.
It is characterized clinically by the triad of Charcot pain, fever, with a dominant symptom as obstructive jaundice. The general condition is good at first, then eventually deteriorate.
The cholelithiasis is complicated:
- Liver failure and its corollary biliary cirrhosis.
- The suppurative cholangitis: suppuration of any large bile duct, which can create a true sepsis with renal disease (cholangitis urémigène).
Inflammatory strictures of the bile duct
Most often due to surgical trauma, usually during a cholecystectomy. The wound during surgery is unknown in most cases.
This is usually short stenosis who sit at the junction cystic duct - common bile duct.
These strictures post traumatic cause cholangitis in 64% of cases, or in the immediate postoperative, after several months or one year after the intervention.
Tumor of the ampulla of Vater
Stenosing papillitis
Pédiculite
THE CONDITIONS intrahepatic bile ducts
They are rare but must be known because they cause stasis and biliary infection.
Caroli's disease
Dysgenesis is a congenital intrahepatic bile duct, head of multifocal cystic dilations, it is associated in most cases with liver fibrosis.
More rarely, absence of liver fibrosis, the disease is so often localized to one part of the liver and can be accompanied by other congenital malformations of the bile duct (choledochal cyst).
Acquired and not congenital disease. Clinically it may be asymptomatic and discovered incidentally, bulletin recurrent cholangitis start between 5 and 30.
Biliary papillomatosis
It is a condition characterized by a papillary hyperplasia in continuous sheets of the lining of the bile ducts. Malignant degeneration is common, it is considered rare cause of cholangitis.
The intrahepatic gallstones
Are often providers of cholangitis, besides the existence of the latter, in this case is discussed.
Reflux of duodenal fluid in the biliary tract
It can be spontaneous, in the absence of any apparent stasis be due to:
Bilio-digestive fistulas spontaneous
They are usually progressive complications of gallstones, duodenal fistulae cholécysto-are the most common, but often less complicated than cholangitis-colic fistula cholécysto. The risk of cholangitis appears to be related mainly to the gene flow of bile.
May be due to some surgical procedures
Such as sphincterotomy and cholédoco-duodenal anastomoses that are responsible for reflux into the bile duct and cholangitis.
PARASITIC
In general they are associated with cholelithiasis:
Some parasites "fluke Fasciola hepatica in", "Ascaris lumbricoides" intraductal create a barrier.
Other parasites that tells "alveolar echinococcosis" or hydatid cyst, are responsible for compression. Note the possibility of migration of vesicles, girls or membranous debris in the bile duct, evidence of cracking of the cyst.
Note the special case of cholangitis in the Far East mostly due to a fluke "clonochis sinensis" cholangitis in this case is due to inflammatory strictures of the bile ducts within the liver inflammation by parasite.
The prognosis of cholangitis is usually dark.
Cholangitis RECURRENT PRIMITIVE
It is a disease of unknown etiology, met in the Far East, generally associated with intrahepatic stones, more rarely, a parasitic "Clonorchis sinensis."
CAUSES CANCER:
It is a less common cause is mainly quotes: cancer of the pancreatic head, ampullôme vaterien, cancer of the bile duct, or common bile duct. The prognosis of this type is particularly acute cholangitis.
The sclerotic odditis-CHRONIC PANCREATITIS
Are rare causes of cholangitis.
Iatrogenic Cholangitis
They are rare, and they are the price of progress in the techniques of opacification of the bile ducts, as well as non-surgical methods of intervention in the common bile duct.
Cholangiography by KEHR drain: cholangitis is caused by venous reflux cholangiopancreatography favored by intraductal pressure greater than 25 cm of water.
Cholangiography transparietal:The cholangitis is caused by a dual mechanism:
- Increased intraductal pressure during injection of contrast.
- Sowing the seeds by direct blood bile during transhepatic puncture.
The endoscopic retrograde cholangiopancreatography:Two conditions seem necessary to cause cholangitis, following a ERCP:
- Development of a pressure previously infected bile.
- Existence of a prior biliary obstruction.
Mirizzi SYNDROME
Mirizzi 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 [36].
OTHER CAUSES
They may be foreign, including foodborne, which are sometimes responsible for cholangitis.
And despite the wide variety of conditions that can lead to cholangitis, the etiology is clearly dominated by the gallstones [4] [41].
BARRIERS incomplete bile duct
Cholelithiasis
It is conceivable that, for there to be precipitation calculations, it is necessary that there be an absence of the solubilizing agent, bile salts, an excess of the substance to dissolve cholesterol.
This imbalance may have a food-borne because, in fact, gallstones is much more common in Europe and the Far East. But it is certain that these dietary factors are not the only culprits. There are probably circumstances where the rate of bile salts is insufficient.
Endocrine factors could cause such a change: the stones are more common in women and appears to be particularly favored by the pregnancy.
But in some cases very different, the stones due to excess bilirubin, a consequence of hemolysis: these are pigment stones.
Cholelithiasis is the main etiology of cholangitis, it is due to a calculation single or multiple calculations, they will favor infection.
Cholelithiasis
It is the stones of the bile duct, due mostly to calculations (calculation of the low - or riprap choledochal bile) is a common complication of lithiasis of the gallbladder, it may nevertheless occur outside any vesicular disease.
It is characterized clinically by the triad of Charcot pain, fever, with a dominant symptom as obstructive jaundice. The general condition is good at first, then eventually deteriorate.
The cholelithiasis is complicated:
- Liver failure and its corollary biliary cirrhosis.
- The suppurative cholangitis: suppuration of any large bile duct, which can create a true sepsis with renal disease (cholangitis urémigène).
Inflammatory strictures of the bile duct
Most often due to surgical trauma, usually during a cholecystectomy. The wound during surgery is unknown in most cases.
This is usually short stenosis who sit at the junction cystic duct - common bile duct.
These strictures post traumatic cause cholangitis in 64% of cases, or in the immediate postoperative, after several months or one year after the intervention.
Tumor of the ampulla of Vater
Stenosing papillitis
Pédiculite
THE CONDITIONS intrahepatic bile ducts
They are rare but must be known because they cause stasis and biliary infection.
Caroli's disease
Dysgenesis is a congenital intrahepatic bile duct, head of multifocal cystic dilations, it is associated in most cases with liver fibrosis.
More rarely, absence of liver fibrosis, the disease is so often localized to one part of the liver and can be accompanied by other congenital malformations of the bile duct (choledochal cyst).
Acquired and not congenital disease. Clinically it may be asymptomatic and discovered incidentally, bulletin recurrent cholangitis start between 5 and 30.
Biliary papillomatosis
It is a condition characterized by a papillary hyperplasia in continuous sheets of the lining of the bile ducts. Malignant degeneration is common, it is considered rare cause of cholangitis.
The intrahepatic gallstones
Are often providers of cholangitis, besides the existence of the latter, in this case is discussed.
Reflux of duodenal fluid in the biliary tract
It can be spontaneous, in the absence of any apparent stasis be due to:
Bilio-digestive fistulas spontaneous
They are usually progressive complications of gallstones, duodenal fistulae cholécysto-are the most common, but often less complicated than cholangitis-colic fistula cholécysto. The risk of cholangitis appears to be related mainly to the gene flow of bile.
May be due to some surgical procedures
Such as sphincterotomy and cholédoco-duodenal anastomoses that are responsible for reflux into the bile duct and cholangitis.
PARASITIC
In general they are associated with cholelithiasis:
Some parasites "fluke Fasciola hepatica in", "Ascaris lumbricoides" intraductal create a barrier.
Other parasites that tells "alveolar echinococcosis" or hydatid cyst, are responsible for compression. Note the possibility of migration of vesicles, girls or membranous debris in the bile duct, evidence of cracking of the cyst.
Note the special case of cholangitis in the Far East mostly due to a fluke "clonochis sinensis" cholangitis in this case is due to inflammatory strictures of the bile ducts within the liver inflammation by parasite.
The prognosis of cholangitis is usually dark.
Cholangitis RECURRENT PRIMITIVE
It is a disease of unknown etiology, met in the Far East, generally associated with intrahepatic stones, more rarely, a parasitic "Clonorchis sinensis."
CAUSES CANCER:
It is a less common cause is mainly quotes: cancer of the pancreatic head, ampullôme vaterien, cancer of the bile duct, or common bile duct. The prognosis of this type is particularly acute cholangitis.
The sclerotic odditis-CHRONIC PANCREATITIS
Are rare causes of cholangitis.
Iatrogenic Cholangitis
They are rare, and they are the price of progress in the techniques of opacification of the bile ducts, as well as non-surgical methods of intervention in the common bile duct.
Cholangiography by KEHR drain: cholangitis is caused by venous reflux cholangiopancreatography favored by intraductal pressure greater than 25 cm of water.
Cholangiography transparietal:The cholangitis is caused by a dual mechanism:
- Increased intraductal pressure during injection of contrast.
- Sowing the seeds by direct blood bile during transhepatic puncture.
The endoscopic retrograde cholangiopancreatography:Two conditions seem necessary to cause cholangitis, following a ERCP:
- Development of a pressure previously infected bile.
- Existence of a prior biliary obstruction.
Mirizzi SYNDROME
Mirizzi 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 [36].
OTHER CAUSES
They may be foreign, including foodborne, which are sometimes responsible for cholangitis.
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