Cholangitis

Classification according to ICD-10
K83.0	Cholangitis
K80.3- K80.4	Cholangitis with choledocholithiasis
K74.3	Primary biliary cirrhosis. Chronic non-purulent destructive cholangitis
ICD-10 online (WHO version 2019)

Cholangitis , also known as cholangiitis , is inflammation of the bile ducts . This can be triggered by various causes, including blockages of the bile ducts from gallstones , stenoses , tumors or parasite infestation . A distinction is made between acute purulent cholangitis, non-purulent destructive cholangitis and chronic sclerosing cholangitis.

Acute purulent cholangitis

Acute cholangitis usually occurs as a result of an infection when colonized by bacteria , mostly Escherichia coli , Enterococcus or Klebsiella species, more rarely due to mobile, mesophilic aeromonads . As symptoms a unilateral pain occur of the right upper abdomen , fever with chills and jaundice ( jaundice on). The combination of these three symptoms is called Charcot's Trias II and is considered to be evidence (pathognomonic) for acute cholangitis. In the case of severe purulent cholangitis, there are also states of shock , disorders of the central nervous system and impaired renal function . Treatment includes endoscopic interventions in the biliary tract such as ERCP or PTCD , which restore the bile flow, and usually antibiotic treatment, a distinction being made between antibiotic therapy for acute cholangitis and that of secondary cholangitis.

Primary biliary cholangitis (PBC)

The primary biliary cholangitis is also called non-suppurative destructive cholangitis. 95% of those affected are women, with the frequency peak between the ages of 40 and 60. Diagnostically, antimitochondrial antibodies (AMA-M2) are found in the blood of most patients , which is why an autoimmunological genesis is assumed. Clinically, patients are characterized by itching , jaundice, and hypercholesterolemia . Standard therapy is carried out with ursodeoxycholic acid . Later on, patients can only be helped with liver transplants.

Primary Sclerosing Cholangitis (PSC)

Contrast medium representation of a primarily sclerosing cholangitis

The primary sclerosing cholangitis is a rare biliary tract disease. The cause is not clear. An association with the antigen HLA-B8 was found. The condition affects men twice as often as women. Laboratory diagnosis p- ANCA is found in up to 70% of cases . Often it is also associated with inflammatory bowel diseases such as B. associated with ulcerative colitis . The standard therapy is medicated with ursodeoxycholic acid and therapeutically with ERCP ( biliary stents ). As with destructive cholangitis, a liver transplant is necessary in the end-stage. There is an increased risk of cholangiocellular carcinoma and, in the presence of ulcerative colitis, colon cancer.

literature

J. Worthington, R. Chapman: Primary sclerosing cholangitis. In: Orphanet J Rare Dis. 2006 Oct 24; 1, p. 41. PMID 17062136 , PMC 1636629 (free full text).

Individual proof

^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 124-126.

[1] Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 124-126.