20:59,16,Oct,2005 | (1209/0/0) | Original

Acute Suppurative Cholangitis


1. Endoscopic biliary drainage for acute suppurative cholangitis nursing Chen Xiangying
Journal of Nursing Education Volume 14, 2010 25
Key words: Endoscopic biliary drainage; acute suppurative cholangitis; care;
Summary: May 2006 ~ May 2009 on 29 patients with acute suppurative cholangitis were treated with endoscopic biliary drainage, achieved good therapeutic effect, will now report as follows Nursing 2 .1 Materials and Methods. Percutaneous puncture treatment of elderly patients with acute biliary drainage analysis of 50 cases of purulent cholangitis Cambodia Luo Yuan
Minimally Invasive Medical Research 03 2010 05
Key words: acute suppurative cholangitis; elderly; puncture;
Abstract: Acute suppurative cholangitis (acute olostructive suppurative cholangitis, AOSC) is a severe disease of biliary tract infection, clinical . 3 more often. Endoscopic biliary drainage for acute suppurative cholangitis Quincy Nursing Wang Liqun
Chinese Medicine 2009, Volume 6, 35
Key words: Endoscopy; nasal biliary drainage; acute suppurative cholangitis;
Abstract: Objective: To evaluate the endoscopic biliary drainage (ENBD) in patients with acute suppurative cholangitis the efficacy and care. Methods: 42 cases caused by stones in patients with acute suppurative cholangitis nursing of endoscopic therapy to sum up . Results: The risk of . 4. 41 cases of acute suppurative cholangitis diagnosis and treatment of Wang Bingsong
Chinese People Medicine 21 02 2009
Key words: acute suppurative cholangitis;
Abstract: suppurative cholangitis is more common in clinical practice, mostly due to common bile duct obstruction caused by its rapid onset, the condition dangerous, complicated by septic shock and multiple organ failure, severe prone to cause death. In our hospital from 1990 to 2007 . 5.45 cases of acute suppurative cholangitis in surgical combined treatment of Bing-Cheng Gong
Chinese doctors in 2009 47, 19
Key words: acute suppurative cholangitis; surgical combined treatment;
Abstract: Objective acute surgical combined treatment of suppurative cholangitis. Methods 45 cases of acute suppurative cholangitis were reviewed and analyzed the clinical data. The results were seen in patients in different parts of biliary tract obstruction, postoperative pulmonary infection in 6 cases. Biliary tract , . 6. acute suppurative cholangitis with cardiovascular disease, evidence-based anesthesia has been quiet Liu Juying
Yunyang Medical College in 2009, 28 Volume 06
Key words: cardiovascular disease; acute suppurative cholangitis; elderly patients;
Abstract: Objective: With the evidence-based medicine approach for the case of acute suppurative cholangitis in elderly patients with cardiovascular disease, determine the anesthesia program. Square enamel: a full assessment of patient situation, the clinical issues raised, from the Cochrane Library (2009 .7. acute suppurative cholangitis clinical treatment of Feng Yingjie
Chinese
Journal of Practical Medicine 2009, Volume 4, 22
Key words: acute suppurative cholangitis; treatment;
Abstract: Objective To investigate the treatment of acute suppurative cholangitis. Methods A retrospective analysis from 2002 to 2007 were treated for acute suppurative cholangitis in 80 patients. Results postoperative bile leakage in 2 cases of wound dehiscence in 4 cases, multiple organ Failure 2 . 8. acute suppurative cholangitis complicated by septic shock patient care was what Lijuan
Modern Clinical Nursing 07, 2009 Volume 8
Key words: acute suppurative cholangitis; septic shock; care;
Abstract: Objective To summarize the acute suppurative cholangitis complicated by septic shock patient care. Methods Retrospective analysis of 9 cases of acute suppurative cholangitis patients with septic shock complicated by the clinical data and key nursing content. Results 1 patient in this group except for . 9. acute suppurative cholangitis patients with diabetes perioperative nursing Lufeng Jun
Modern Medicine 2009, Volume 01 of 20
Key words: acute suppurative cholangitis; diabetes; perioperative nursing;
Abstract: Objective diabetic patients with acute suppurative cholangitis (Acute obstructive suppurative cholangitis, AOSC) of perioperative nursing experience, improve . 10. Elderly patients with acute obstructive suppurative cholangitis PTCD Clinical observation and nursing Liu Jingniuaimin
Journal of Nursing Education 23, 2008 Volume 15
Key words: acute suppurative cholangitis; treatment; care;
Abstract: Acute obstructive suppurative cholangitis (Acute Obstructive Suppurative Cholangivi, AOSC) is due to biliary obstruction, infection, biliary tract pressure . A total of 44 records 1 / 5 Page 93   [3 ]   4:
Acute Suppurative Cholangitis

Acute suppurative cholangitis, also known as acute obstructive suppurative cholangitis, refers to the obstruction caused by acute suppurative biliary tract infection, biliary tract surgery patient's death is the most important and most immediate cause, most secondary to bile duct stones and biliary ascariasis disease. The disease occurs in 40 to 60 years old, mortality 20% to 23%, the elderly, mortality was significantly higher than other age groups, the non-surgical cases can be as high as 70%. Abdominal pain is common, is the first symptom of the disease. Often repeated episodes of medical history. Pain in the xiphoid area under the general and (or) right upper quadrant, paroxysmal increase of persistent pain, may radiate to the right side of the upper body. Fever is the most common symptoms. Introduction to acute suppurative cholangitis (acutepurulentcholangitis, APC), also known as acute obstructive suppurative cholangitis (acuteobstructivesuppurativecholangitis, AOSC), refers to the obstruction caused by acute suppurative biliary tract infection, biliary tract surgery patient's death is the most important and most direct reason, most secondary to bile duct and bile duct ascariasis. China's acute biliary tract infection with severe acute cholangitis (acutecholangiti. Introduction to the pathophysiology of symptoms and signs of diagnostic tests causes treatment prognosis and prevention of complications See more information on Wikipedia
Introduction to acute suppurative cholangitis (acutepurulentcholangitis, APC), also known as acute obstructive suppurative cholangitis (acuteobstructivesuppurativecholangitis, AOSC), refers to the obstruction caused by acute purulent infection of biliary tract
Anatomy of acute suppurative cholangitis, biliary surgical patient's death is the most important and most immediate cause, most secondary to bile duct and bile duct ascariasis. China's acute biliary tract infection with severe acute cholangitis (acutecholangitisofseveretype, ACST) the term to describe its meaning especially acute suppurative serious type of biliary tract infection, which highlights the primary intrahepatic bile duct stones, bile duct stricture and pathologic clinical severity, but also stressed the biliary obstruction in the infection, the importance of the development, and the corresponding treatment requirements. Therefore, ACST, and APC, AOSC is not the same meaning, once established the diagnosis of ACST, which should have sufficient clinical knowledge and attention to help patients through timely and effective manner possible threats and reduce the risk of death is the bile duct The primary surgical clinical and research issues. Cause deaths is mainly due to sepsis, toxic shock, biliary liver abscess, biliary tract hemorrhage and multiple organ failure and so on. Pathological changes in these serious diseases caused by acute cholangitis has not or is no longer entirely the lesion itself, but the renewal of the result of disease or injury. Bile duct obstruction and infection of the interaction of these two factors can further increase the disease, if not effectively addressed or not timely, inappropriate, may lead to serious consequences mentioned above, therefore, early diagnosis and treatment is to reduce the clinical the key mortality, which involves multi-disciplinary, large-scale, and advanced research, need to continuously explore, accumulation and summarization, from theory to practice seek new breakthroughs. Usually rapid onset of symptoms and signs, under the sudden onset of xiphoid and (or) persistent right upper quadrant pain with nausea and vomiting, followed by chills and fever, more than half of the patients had jaundice. The typical patient had abdominal pain, chills and fever, jaundice and other charcot triad, nearly half of the patients conscious indifference, irritability, disturbance of consciousness, decreased blood pressure and other signs. Abdominal pain is common, is the first symptom of the disease. Often repeated episodes of medical history. Pain in the xiphoid area under the general and (or) right upper quadrant, paroxysmal increase of persistent pain, may radiate to the right side of the upper body. With varying degrees of severity of pain, due to the lower end of bile duct
Angiography in acute suppurative cholangitis caused by stones and biliary ascariasis is very severe abdominal pain, and more than hilar bile duct stones and bile duct obstruction caused by secondary infection of the tumor caused by APC, in general no severe abdominal pain, only a sense of the upper abdomen or right upper quadrant pain, dull pain, or pain, usually tolerable. Is the most common symptoms of fever, in addition to a small number of patients due to critical condition, infection, toxic shock, body temperature can not rise, in general, APC patients had fever, body temperature above 40 ℃ can be as high, sustained fever. Some patients have signs of shivering is bacteremia, positive blood culture at this time to do high rate, the bacterial species and the same bacteria in the bile. Liver - bile duct stones in leaves is often the only APC-induced fever, and abdominal pain and jaundice can be very light, or even does not appear. APC jaundice is another common symptom, with an incidence of about 80%. Presence or absence of jaundice and the degree of jaundice, biliary obstruction depends on the location and the duration of obstruction. In general, the longer the biliary obstruction, biliary higher the pressure, the more complete obstruction, jaundice deeper. Hepatic duct bile duct obstruction following prone to jaundice. A team of intrahepatic bile duct obstruction, recurrent cholangitis attacks can cause atrophy of the lobe of the liver fibrosis, but no obvious jaundice may not even appear. Nausea and vomiting are common outside of Charcot triad of concomitant symptoms. Physical examination can be found: sclera and yellowish discoloration of skin, skin scratches, 80% of patients under the xiphoid and right upper quadrant tenderness and rebound tenderness, muscle tension is often not obvious. Without removal of the gallbladder and gallbladder in patients without atrophy, palpable enlargement of the gallbladder. Acute inflammation in the gallbladder at the same time, the right upper quadrant appeared tenderness, rebound tenderness and muscle tension, Murphy sign was positive in patients with inflammatory exudate, the right lower abdomen with signs of peritonitis, should be differentiated from acute appendicitis, but this right upper quadrant tenderness was still sick, it is not difficult to identify. Patients with hepatic abscess, can occur right hypochondrium skin edema, tenderness and liver area percussion pain positive. Cause of APC caused by many reasons, however, biliary obstruction and bacterial infections are two basic requirements, common causes are the following. 1. Bile duct stone caused by bile duct stone is the most common cause of APC, accounting for more than 80%. It is divided into primary and secondary bile duct stones in bile duct stones. Primary bile duct stones are the "bilirubin calcium" stones, more common in rural areas in China, especially
Angiography in acute suppurative cholangitis and Sichuan, its incidence is high. Intrahepatic and extrahepatic bile duct can occur both in the common bile duct surgery and autopsy to the stones accompanied by bile duct stricture. Mostly of secondary bile duct stones of cholesterol, mainly from gallstones, due to various causes gallbladder, the small stones into the bile duct. Bile duct causing biliary obstruction, secondary bacterial infection of acute suppurative cholangitis. Cholangitis symptoms and the severity of bile duct stones out of proportion to the number and size of stones, but the extent of biliary obstruction and bacterial virulence are closely related, clinically often see significant expansion of bile duct, bile duct contain a number of large blocks stones, cholangitis patients and no serious performance, on the contrary, some patients only a piece of impacted stones in the common bile duct, the patient developed severe abdominal pain and severe symptoms of poisoning. Gallstones generally do not cause cholangitis, and only in the gallbladder neck and cystic duct stone impaction, oppression hepatic duct, and (or) common bile duct, Mirizzi syndrome is caused when cholangitis. 2. Biliary tract caused by parasitic biliary parasites are another common cause of APC, a common parasite biliary ascariasis, clonorchiasis and other biliary tract, which is the most common bile duct ascariasis, it is the complications of intestinal ascariasis . In China, particularly in rural areas of intestinal roundworm infections as high as 50% to 90%. When gastrointestinal disorders, hunger, lack of insecticide treated properly or in patients with gastric acid, worms easily penetrate into the bile duct; In addition, the worms like the alkaline environment, and habits of drilling, so it is easy to enter biliary intestinal worms, causing incomplete bile duct obstruction, while stimulating the sphincter Oddi, sphincter spasm caused further increase the biliary obstruction, clinically severe abdominal pain. Worms into the biliary tract, while the bacteria into the biliary tract in biliary obstruction, cholestasis of the situation, a lot of growth and reproduction of bacteria, it causes acute suppurative cholangitis. 3. Tumors caused by APC tumor is important mainly because of biliary tract and ampullary tumors, mostly malignant tumors. Biliary obstruction caused by tumor growth, poor bile excretion, deposition of secondary bacterial infection caused by bile APC. It is noteworthy that, in the cause of biliary obstruction is unclear, in order to confirm the diagnosis, implementation of biliary invasive procedures such as ERCP very easy to check bacteria into the biliary tract, the patient in the examination after the end of abdominal pain, fever and a series of acute biliary symptoms of inflammation. The emergence of APC tumors caused great difficulties, increasing the risk of surgery, and even radical resection of the patients the opportunity to miss. Therefore, in patients with obstructive jaundice, suspected biliary or periampullary tumors when, ERCP invasive procedures such as biliary tract should be particularly careful, as must be, which can drain into the nasal duct to prevent the occurrence of APC. The duodenal papilla cancer, can be observed under microscope and cut duodenal biopsy for pathological examination, do not do ERCP. 4. Bile duct stenosis is usually surgical and autopsy can be seen in the presence of APC in patients with bile duct stricture, common are: common bile duct stenosis, liver and bile duct and intrahepatic bile duct stenosis, stenosis can be a place, there can be multiple narrow , varying degrees of severity of stenosis in the upper section of the narrow duct dilatation, there is more associated with stones. Also found in iatrogenic bile duct stricture of bile duct injury, biliary-enteric anastomosis stricture and congenital cystic dilatation of bile duct psychosis. Bile duct stricture caused by poor drainage, easy to be stricken with acute bacterial infection caused suppurative cholangitis. Biliary tract infection bacteria to aerobic gram-negative bacteria the highest detection rate, of which Escherichia coli, Proteus, Pseudomonas aeruginosa and Klebsiella most Gram-positive cocci in fecal streptococci and staphylococci more. Bile in the anaerobic bacterial infections, especially attention, in which the fragile bacilli, bacterial culture positive rate was reported 40% to 82%, and the differences with the culture and isolation methods, culture-related. After high-dose antibiotics purulent bile can no bacterial growth. The main sources of bacteria in bile is ascending infection by intestinal bacteria that enter the duodenum, bile duct; trail can also be infected, mainly through the portal vein, seen enteritis, gangrenous appendicitis and other diseases; other parts of the body purulent foci blood circulation can also cause liver abscess and biliary tract infection. Gram-negative bacteria in bile cracking release a lipopolysaccharide, a strong toxic effects, known as endotoxin, which liver cells by capillary bile duct or bile duct venous reflux barrier into the blood, causing endotoxemia. LPS directly damage cells, causing blood cells and platelet aggregation, thrombosis, damage to capillary endothelial cells to increase permeability, such microvascular damage can be the vital organs throughout the body, causing toxic shock and multiple organ dysfunction syndrome. Pathophysiology of the normal biliary tree-like structure was, by all levels of the liver bile duct confluence to the common bile duct, and finally through the sphincter of Oddi into the duodenum. Liver bile secretion pressure 2.8 ~ 3.6kPa (29 ~ 37cmH2O), the average secretion of pressure 3.1kPa (32cmH2O), normal bile duct wall by the large number of elastic fibers in the biliary obstruction, the obstruction of the bile duct above the expansion, enlargement of the gallbladder
General Plan gall to temporarily buffer the high-pressure duct. However, the bile duct wall of the elastic fibers in a certain limit, so the expansion of bile duct and the buffering capacity has certain limits, if not relieved of bile duct obstruction, bile duct pressure continues to rise, the secretion of pressure over the liver, the liver stops secreting bile duct cholestasis, suppurative bacterial infection, causing bile duct wall, near the major body organs and organ damage. APC, the patients with liver and (or) extrahepatic bile duct congestion and edema, thickening; bile duct mucosal hyperemia, edema, erosion, hemorrhage, and scattered small ulcers, some ulcers on darker, incarcerated in a small stone , bile duct to form many small abscess, a small number of patients developed focal necrosis, or even worn out. Because bile duct obstruction, bile duct pressure increased, when the pressure exceeds 3.43kPa (36cmH2O), the intrahepatic bile duct epithelial cells, capillary necrosis, bile capillary rupture, venous reflux of bile into the bile duct through the blood, resulting in hyperbilirubinemia. Clinical examination of serum total bilirubin and direct bilirubin were increased, urine bilirubin and urobilinogen positive. Capillary bile duct epithelial necrosis of the liver, bile capillary rupture, bile can reflux via lymphatic sinus or into the blood, which bacteria enter the blood circulation, causing bacteremia and sepsis. Clinical manifestations of chills and fever. The bacteria enter the blood circulation volume and proportional to the amount of bacteria in bile, most of which bacteria still remain in the liver, causing liver abscess, known as biliary liver abscess. Abscess can be multiple, involving mainly located in the lobe of the cholangitis, multiple liver abscesses can be integrated into a larger abscess. Recurrent episodes of cholangitis and liver abscesses scattered long treatment, and finally the formation of biliary cirrhosis, focal liver atrophy, the left lateral lobe of liver is most common. APC caused when the bile duct and liver damage in addition, the inflammation can also wave and the surrounding tissue and organs, surgery and autopsy can be seen in the vicinity of biliary pyogenic liver abscess, infection, subphrenic abscess, localized peritonitis. Sometimes can spread to the chest caused by inflammation of the right lower right acute suppurative pleurisy and pneumonia. APC can also cause acute interstitial pneumonia, acute interstitial nephritis, glomerulonephritis and focal suppurative cystitis, acute inflammation and acute splenic purulent meningitis and other major organ damage, and can occur diffuse intravascular coagulation (DIC) and systemic bleeding and other serious damage. Diagnosis of acute cholangitis diagnosed diagnostic criteria, each which have not been unified. The rapid onset, prognosis and ferocious, and sometimes in the absence of jaundice before the patient has a change of consciousness, accompanied by chills, fever, hypotension, such as performance, it caused great difficulties to the diagnosis. Severe acute cholangitis have a deepening understanding of the development process. Some scholars believe that the diagnosis in the Charcot triad basis, together with the two major symptoms of shock and unconsciousness can be diagnosed. Held in Chongqing in 1983, bile duct stone disease symposium, Chinese scholars to work out a "diagnostic criteria for severe acute cholangitis." Rapid-onset, severe, and more in need of emergency relief
Treatment of acute suppurative cholangitis drainage; obstruction in the extrahepatic bile duct, left or right hepatic duct, shock, systolic blood pressure <70mmHg, or two or more of the following symptoms to diagnosis: 1. Psychological symptoms. 2. Pulse of more than 120 times / min. 3. White blood cell count over 20 × 109 / L. 4. Temperature higher than 39 ℃ or lower than 36 ℃. 5. Purulent bile, while bile duct incision significantly increased internal pressure. 6. Blood bacterial culture was positive. The diagnostic criteria have been tried for nearly 20 years, it has practical clinical significance, helps to avoid blindness, in a timely manner to a patient, reduce mortality. Distinguish between severe acute cholangitis cholangitis and general boundaries and their different meanings, the medical treatment referred to a new level of work, a new level. Laboratory 1. White blood cell count 80% of cases was significantly higher white blood cell count, neutrophils increased with a left shift. However, in severe cases or secondary to biliary sepsis, the white blood cell count may be lower than normal or only a left shift and toxic particles. 2. Bilirubin serum total bilirubin, direct bilirubin measurement and urobilinogen, urine bilirubin tests showed the characteristics of obstructive jaundice. 3. Serum enzyme serum alkaline phosphatase increased significantly, mildly elevated serum transaminases. Such as bile duct obstruction a long time, prothrombin time prolonged. 4. Bacterial culture in the chills and fever when the blood for bacterial culture, often has positive. Types of bacteria and bile in the line, the most common bacteria Escherichia coli, Klebsiella, Pseudomonas, Enterococcus and Proteus and so on. In about 15% of bile samples can be seen in the anaerobic bacteria, such as Bacteroides fragilis or Clostridium perfringens. Other auxiliary examination 1. Cholangiography PTC patients to use more, with the dual role of diagnosis and treatment. Expansion of the bile duct and can be found in the site of obstruction, causes, but serious shock patients are not generally suitable for the check immediately. 2.CT and MRI examination when highly suspected extrahepatic biliary obstruction and B ultrasound examination failed to establish the diagnosis, possible CT or MRI. CT or MRI for the specific site of obstruction, causing obstruction of the reasons is better than B-ultrasound, the accuracy rate of up to 90%. 3. B-ultrasound examination has become the preferred screening method. Detect gallbladder stones, common bile duct stones and intrahepatic bile duct stone diagnostic accuracy were 90%, 70% to 80% and 80% to 90%. Can be found in parts of calculus of bile duct obstruction, and (or) intrahepatic bile duct dilatation, and to understand the size of the gallbladder, liver size and the availability of liver abscess formation. Differential diagnosis of typical cases generally easier to make a diagnosis, but should be differentiated from these diseases. 1. A history of peptic ulcer perforation patients, the abdominal muscles were stiff plate, the liver dullness shrink or disappear, there is free gas below the diaphragm can be diagnosed. 2. Subphrenic abscess B ultrasonic examination can be found in the location and size of abscess, CT examination can reliably locate, and can see the relationship between the abscess and surrounding organs. 3. Acute pancreatitis blood, urine or serum amylase, lipase increased. B ultrasonic examination can be found in the pancreas was localized or diffuse increase can identify with them, if necessary, to further determine the possible CT examination and extent of the lesion. 4. B-liver abscess, CT and other imaging examinations and easy identification of acute suppurative cholangitis. 5. The lower right of bacterial pneumonia by the typical symptoms, signs and chest X-ray diagnosis. Therapy treatment of acute suppurative cholangitis relieve bile duct obstruction surgical principle to reduce the pressure and drainage of the bile duct. Treatment should be based on the patient's admission the case may be. Most scholars believe that the disease should be in a serious shock or multiple organ failure did not occur in time before operative treatment. However, surgery must be combined with effective non-surgical therapy, the ideal efficiency can be achieved
Pathological picture of acute suppurative cholangitis fruit. 1. Non-surgical treatment of non-surgical treatment early in the disease, especially acute simple cholangitis, the condition is not serious, can be the first non-surgical methods. 75% of the patients, access to and control of infection in a stable condition, while the other 25% of patients on non-surgical treatment fails, by the simple cholangitis developed into acute obstructive suppurative cholangitis, surgical treatment should be timely use. Non-surgical treatment of spasm and pain and gallbladder, including the application of drugs, of which 50% magnesium sulfate solution often good results, the dosage is taken every 30 ~ 50ml or 10ml, 3 times / d, gastrointestinal decompression also regular applications; high-dose combination of broad-spectrum antibiotics is important, though in the bile duct obstruction in the treatment of antibiotic concentration can not reach the required concentration, but it can effectively treat bacteremia and sepsis, commonly used antibiotic gentamicin , chloramphenicol, ampicillin (ampicillin) and other 3rd generation cephalosporins, and ultimately have to bacterial culture under the blood or bile, and drug sensitivity test, and then adjust the appropriate antibiotics. If there is shock, should be actively anti-shock therapy; such as non-surgical treatment of 12 ~ 24h after the condition was not improved, shall proceed to surgery; even if the shock is not easy to correct, we should also strive for surgical drainage, because only the bile duct obstruction removed, the shock can be corrected. (1) General treatment: decompression can reduce bloating, reduce vomiting, and stimulation of bile secretion. May be given after diagnosis antispasmodic analgesic drugs, such as intramuscular injection of atropine, scopolamine or pethidine Hill (meperidine). Patients in acute suppurative cholangitis with dehydration, should be appropriate to add the liquid, intravenous vitamin C and vitamin K. (2) anti-shock therapy: the first as quickly as possible additional blood volume that can be used intravenous fluids, blood transfusions. If blood pressure remains low, the choice of dopamine boost drug treatment, oliguria is particularly necessary when applying this medication. Once deactivated boost small number of patients after treatment, blood pressure and decreasing trends in such cases until the blood pressure rises, the drug concentration gradually reduced until the blood pressure is stable after the disabled, and sometimes need to maintain the medication 2 to 3 days. Some patients had metabolic acidosis, the infusion to correct acidosis can be corrected after shock, and sometimes appropriate application of basic drugs needed to correct. (3) anti-infection: use of antibiotics in biliary tract infection is based on the principles of antimicrobial spectrum, toxicity, drug concentrations in the blood and excreted in bile and choose how much, in theory, the choice of antibiotics should be based on the sensitivity of blood culture results. In the bacterial culture is not the result, the choice of antibiotics based mainly on clinical experience and the most common bacterial bile situation and take combination therapy methods, including aerobic and anaerobic resistance to the drug. Escherichia coli is mainly aerobic, the choice of gentamicin, tobramycin, broad-spectrum penicillin or a second or third generation cephalosporin (eg ceftriaxone, cefoperazone, etc.). In addition, quinolones and carbapenems (eg imipenem - cilastatin, imipenem trade name) is more sensitive. Metronidazole on anaerobic bacteria has a strong bactericidal effect, a broad spectrum antibiotic, high concentrations of bile. In recent years, new formulations of tinidazole has been used clinically and found no significant gastrointestinal side effects. (4), glucocorticoid: large doses of adrenal cortex hormones can improve capillary permeability and reduce fluid leakage sites of inflammation and cell aggregation, contribute to inflammation subsided, reducing bacterial toxins on damage to vital organs , the lifting of vasospasm improve microcirculation, increase blood on the step-up response to drugs, which most scholars advocate for patients with acute suppurative cholangitis application of adrenal corticosteroid therapy for toxic shock, commonly used dose of hydrocortisone 200 ~ 300mg / d or dexamethasone 15 ~ 20mg / d, with intravenous fluids. (5) Prevention of renal failure: step-up, antibiotics of choice, should be avoided to reduce blood volume or renal toxicity of drugs associated with renal dysfunction in patients with diuretic mannitol can promote the toxic discharge. Such as renal failure has been to consider the application of kidney dialysis treatment as soon as possible. 2. Surgical treatment of surgical treatment of the disease more serious, especially in cases of deep jaundice, should be early surgical treatment. Mortality can be as high as 25% to 30%. Surgical approach should be simple and effective, mainly bile duct exploration and drainage. It should be noted that the drainage tube must be placed on the proximal bile duct obstruction in the distal obstruction of the drainage is not valid, the condition can not be eased. If conditions permit condition, inflammation of the gallbladder can be removed until the patient through the dangerous period, and then solve the bile duct lesions. (1) Surgical treatment: Surgical treatment is mainly used: â‘  The non-surgical treatment of 12 ~ 24h after the disease still no improvements. â‘¡ there early and rapid development of shock, it is difficult to correct those. â‘¢ start more serious condition, the body weight and symptoms associated with deep jaundice. (2) endoscopic treatment: For unknown etiology cholangitis; non-surgical treatment of 24 ~ 36h invalid or sicker persons; older, with incidence more or weight, anesthesia risk is greater; a history of repeated biliary surgery who could Emergency endoscopic biliary decompression and drainage lines, including the duodenal sphincterotomy and stone extraction, or by nasogastric tube or endoscopic catheters (nasal duct) biliary drainage. Studies have shown that endoscopic treatment is indeed effective and can reduce mortality. Acute cholangitis and emergent endoscopic stone extraction EST indications as follows: â‘  distal common bile duct stone impaction or stone, if not removed can not be effectively placed ENBD decompression. â‘¡ were generally adequate, no abnormal hemodynamics and blood coagulation. â‘¢ small stones, small, 1 to 3, less than 1.0cm, estimated easily removed. Emergency endoscopic stone extraction should be routinely placed after ENBD. For the EST in the emergency endoscopic biliary drainage and stone conducive removed and discharged, but also conducive to the drainage of pancreatic juice and reduce the pancreatic duct pressure to reduce the incidence of pancreatitis. As effective drainage can be effective in preventing recurrence of stone recurrence and biliary tract infection. However, in emergency cases, the treatment principles for effective biliary decompression and drainage should be based, should not blindly pursue completely cured. (3) percutaneous transhepatic biliary drainage (PTCD): Act on the high or low bile duct obstruction are applicable, and the better effect, the puncture should be guided in the B-or under X ray, but also by the drainage and catheter flushing perfusion effective antibiotic treatment. Prognosis and prevention of prognosis: the higher living standards, health conditions improved, a variety of diagnostic and therapeutic technology, the mortality of this disease has decreased significantly. Excellent treatment of mild acute cholangitis, and its death and underlying disease or surgical complications. Mortality of severe acute cholangitis is still high, according to China recently reported total mortality was 12.3% ~ 34%, which combined toxic shock AOSC The mortality of 22.4% to 40%, the combined mortality of biliary liver abscesses were 40% to 53.3%, there were multiple organ failure with poor prognosis, mortality as high as 60% to 70%. Obviously acute suppurative cholangitis is biliary surgery remains the most serious diseases. In order to improve the therapeutic effect, further reducing the mortality, but also needs to seriously study the etiology and pathogenesis, to improve food hygiene practices, strengthen their own health awareness, so that early diagnosis and effective treatment, prevention hemobilia, biliary liver abscesses, Severe acute pancreatitis and other complications and the incidence of multiple organ failure, can effectively reduce the disease's mortality rate, improve the therapeutic effect. Prevention: Acute suppurative cholangitis is bile duct stones, bile duct ascariasis of serious complications, so the disease is mainly for primary prevention of bile duct stones and the prevention and treatment of biliary ascariasis. Prevention of hepatolithiasis â‘ , the prevention of hepatolithiasis key is to prevent and eliminate pathogenic factors. Just diagnosed with bile duct stones in patients, should alert the occurrence of this disease, especially in complicated biliary tract infection prevention and control should be more active. Sensitive to the early stage of high dose antibiotic resistant infections, attention to water, electrolyte and acid-base balance, strengthen the control of systemic support for the treatment of biliary tract infection. In the case of the body as soon as conditions permit surgery to remove stones, unobstructed drainage, to achieve the prevention of the occurrence of AOST. â‘¡ Control bile duct ascariasis. Worms into the biliary tract after different degrees of obstruction caused by biliary tract, so that bile duct pressure increased, when the concurrent bacterial infection, can induce AOST. In addition, the bile duct ascariasis bile duct stones is an important factor in the formation.
Therefore, prevention is the prevention of bile duct ascariasis AOST extremely important aspect. Mainly pay attention to water, food hygiene, prevention of intestinal ascariasis. Once confirmed that the line piperazine citrate treatment, such as the disease has been diagnosed with biliary ascariasis should be treated as soon as possible. Given analgesic, antispasmodic, infection control, to promote their own worms from the biliary exit. In addition, duodenal endoscopy can be used with a snare some of the worms into the mouth of the trap out of the common bile duct in vitro. Treatment fails to consider the time of surgery. Complications 1. Bacteremia in some patients, there may be fever, chills, bacteremia signs. 2. Jaundice incidence rate of about 80%. Presence or absence of jaundice and the degree of jaundice, biliary obstruction depends on the location and the duration of obstruction. 3. Peritonitis in patients with inflammatory exudate, there may be signs of right lower peritonitis.
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