Holangit - the nonspecific inflammation of bilious channels arising owing to infringement of passableness zhelchevyvodjashchih of ways and infitsirovanija of bile. Most often at holangite from bile sow E coli. It is combined with holedoholitiazom, kistami the general bilious channel More often, a cancer bilious protokov.

V the majority of cases holangit arises at hit of activators of a bacterial infection in bilious channels from a gleam of a duodenal gut (an ascending infection), gematogennym (through system vorotnoj veins) or limfogennym (at diseases of a bilious bubble, a pancreas or a thick gut) putem.

Po to character of a current allocate sharp and chronic holangity. Sharp holangit depending on expressiveness of inflammatory changes of a wall of bilious channels can be kataralnym, purulent, difteriticheskim and nekroticheskim. Among forms chronic holangita allocate latent, retsidivirujushchy, the current is long current septic, abstsedirujushchy and sklerozirujushchij.

Simptomy. The clinical picture depends on presence or absence of the sharp destructive cholecystitis which often enough is becoming complicated holangitom. Disease usually begins with the painful attack reminding hepatic koliku (display holedoholitiaza) then the mechanical jaundice is quickly shown, rise in temperature, a skin itch. At survey ikterichnost integuments, on a skin traces raschesov, language damp, is imposed, the stomach is not blown up. At palpatsii a stomach some rigidnost muscles in right podrebere, morbidity, at deep palpatsii is defined increase in the sizes of a liver, its edge is rounded off. Temperature sometimes gekticheskogo type, a fever. In blood-lejkotsitoz with shift to the left. giperbilirubinemija basically at the expense of direct bilirubin, increase alkaline fosfatazy, moderate increase of hepatic enzymes (ALT, ACT) at the expense of toxic defeat hepatic parenhimy. holangita ultrasonic research of a liver can render the essential help in a diagnosis establishment and zhelchevyvodjashchih putej.

Pri absence of timely treatment the inflammation from a wall of bilious channels passes to surrounding fabrics and can call propityvanie a pechenochno-duodenal sheaf bile and a peritonitis, education of intrahepatic abscesses, development of sclerous changes in a fabric of a liver and secondary biliarnyj tsirroz.

Oslozhnenija. Formation of plural abscesses of a liver, sepsis, pechenochno-nephritic nedostatochnost.

Treatment holangita

Bolnoj with suspicion on holangit requires urgent hospitalisation, as treatment mainly operative. At a pre-medical stage appoint spazmoliticheskie and resolvents, antibiotics of a wide spectrum the actions which are not possessing gepatotoksicheskimi svojstvami.

Taktika of conducting of patients holangitom represents considerable difficulties, they are caused by presence of purulent process, a mechanical jaundice and a sharp destructive cholecystitis. Each of these moments demands the prompt permission, however patients with a mechanical jaundice do not transfer long and travmatichnyh operative interventions. Therefore it is expedient to provide first of all adequate outflow of bile, that simultaneously reduces clinical displays holangita, an intoxication. The second stage carry out the radical intervention directed on liquidation of the reason of occurrence holangita.

V a hospital spend dezintoksikatsionnuju and antibacterial therapy and prepare the patient for operative intervention. The greatest distribution at sharp holangite have received endoskopicheskie methods drenirovanija the bilious channels, providing normal outflow of bile. The forecast kataralnogo holangita at timely treatment the favorable. At purulent, difteriticheskom and nekroticheskom holangite the forecast more serious also depends on expressiveness morfol. Changes, the general status of the patient, and also from the factor which has called holangit. At it is long current chronic holangit which forecast adverse can develop biliarnyj a cirrhosis or abstsedirujushchy holangit. Preventive maintenance consists in timely revealing and treatment of diseases zhelchevyvodjashchih ways and area big duodenalnogo sosochka.

S the purpose dekompressii bilious ways spend endoskopicheskuju papillosfinkterotomiju after preliminary retrogradnoj holangiografii. At rezidualnyh stones holedoha after papillosfinkterotomii it is sometimes marked othozhdenie konkrementov from zhelchevyvodjashchih ways, the phenomena holangita are stopped also a question on necessity of repeated operation disappears. The forecast sereznyj.