Biliary tract infection refers to bacterial infection of the biliary system, including acute and chronic cholecystitis, acute and chronic cholangitis, acute obstructive suppurative cholangitis, etc. It often coexists with cholelithiasis, and most of them are causal.The incidence of biliary tract infection is the second highest in acute abdomen, which is a common, multiple and refractory disease in surgery.
TCM disease name
Biliary tract infection
Visiting department
GI Medicine
Common causes
Obstruction, bacterial infection, etc
common symptom
Upper abdominal discomfort, dull pain, anorexia of greasy food, etc
infectivity
nothing
Science popularization in China
Committed to authoritative science communication
The certification expert of this term is
Li Binglu|Chief physician
Basic Surgery Department of Peking Union Medical College Hospitalto examine
Upper abdominal discomfort, dull pain, anorexia of greasy food, etc
infectivity
nothing
pathogeny
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1. Obstructive factors
Calculus, biliary parasites, inflammatory adhesion, etc. can cause biliary obstruction and cholestasis.High concentration of bile acid can cause damage to bile duct system cells and aggravate mucosal inflammatory edema.The common bile pancreatic channel is obstructed, the pancreatic juice flows into the biliary tract retroactively, and the activated pancreatic enzyme will also cause serious pathological changes in the biliary tract.
2. Bacterial infection
The pathogenic bacteria are mostly gram-negative bacilli, which can invade the biliary tract through various ways, such as intestinal ascending infection, systemic or local infection, biliary tract infection caused by blood circulation, and inflammatory diffusion of adjacent organs.
3. Other factors
In some patients with severe trauma, burns, shock and major surgery, the gallbladder contraction function is reduced, and the local blood circulation of the biliary system is blocked, leading to biliary tract infection.
clinical manifestation
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Biliary tract infection can only exist, but it often exists with cholelithiasis, which is mutually causal.Cholelithiasis can cause biliary obstruction, cholestasis, bacterial proliferation, and lead to biliary infection.Cholelithiasis may have no obvious symptoms and signs in the quiescent period, or only symptoms such as upper abdominal discomfort, dull pain, and aversion to greasy food;When gallstone movement, obstruction or bacterial infection occurs in a certain part of the biliary tract, symptoms such as colic, fever, jaundice, etc. may occur in the right upper abdomen.Severe infection can be complicated by gallbladder gangrene, perforation, biliary bleeding, liver abscess, toxic shock, etc.
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1. Physical examination
There may be tenderness in the gallbladder area of the right upper abdomen. When the inflammation spreads to the serosa, there may be abdominal muscle tension and rebound pain. Murphy's sign is positive.Some patients can touch the swollen gallbladder and have tenderness.
2. Blood routine
The white blood cell count increased and the percentage of neutrophils increased significantly.
3. B-ultrasonic inspection
Gallbladder enlargement and wall thickening can be shown. Gallstone images can also be seen in most patients.
4. Blood gas analysis
Metabolic acidosis may occur.
5. Abdominal puncture
It is helpful for the diagnosis of this disease.
diagnosis
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The diagnosis mainly depends on the medical history, clinical manifestations and auxiliary examinations.Biliary tract infection often has a history of repeated attacks. The prominent symptoms are abdominal pain and fever. The right upper abdomen has tenderness and abdominal muscle tension. Acute cholangitis is mostly characterized by jaundice.Biliary tract infection should also be differentiated from gastroduodenal perforation, acute pancreatitis, acute appendicitis, biliary ascariasis, etc.
treatment
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1. Non operative treatment
It is only suitable for acute biliary tract infection with mild clinical symptoms, without obvious symptoms of peritoneal irritation or shock and other serious complications.Treatment methods: ① fasting, infusion, nutritional support, vitamin supplementation, correction of water electrolyte and acid-base metabolism imbalance; ②Spasmolysis and pain relief: antispasmodic drugs can be used when biliary colic occurs, and tramadol, pethidine and other drugs can be selected as analgesics; ③Anti infection: select antibiotics that are effective against gram-negative bacteria and anaerobic bacteria, advocate combined and sufficient medication, and give sufficient broad-spectrum antibiotics for acute obstructive suppurative cholangitis for preoperative preparation; ④Percutaneous transhepatic gallbladder drainage (PTBD).
2. Surgical treatment
(1) Operation principle: relieve biliary obstruction, fully drain and reduce biliary pressure.Prepare well before operation, including blood transfusion, fluid replacement, intravenous antibiotics infusion, shock correction and other measures.
(2) Indications: ① Operation should be carried out as soon as possible after the diagnosis of biliary peritonitis; ②Hyperthermia, toxic shock, and no significant improvement or condition change after correction in a short time; ③Liver abscess, pancreatitis, gallbladder necrosis and perforation occurred during treatment; ④Bile duct stones.
(3) Operation method: ① Cholecystostomy: applicable to high-risk patients or cholecystitis patients with unclear local anatomical relationship. Stones should be removed during the operation. If the patient recovers, cholecystectomy can be performed 3 months later; ②Cholecystectomy: applicable to most patients with cholecystitis and cholecystolithiasis: ③ Common bile duct exploration and T-tube drainage: applicable to acute cholangitis and common bile duct stones, which can achieve the purpose of removing stones and draining bile. Generally, the gallbladder is removed at the same time, and only common bile duct exploration can be performed for those in critical condition.
