Bile duct stones complicated with cholangitis

　　The causes of bile duct stones with cholangitis are very complex, some of which are unchangeable factors, such as increasing age, female gender, race, genes, and family history; some are acquired factors, some of which are reversible.

　　Irreversible factors:

　　Age of onset: The incidence of bile duct stones with cholangitis increases with age. If the disease occurs in childhood, it is often related to hemolysis or congenital biliary tract disease. The peak age of onset is between 40 and 50 years.

　　Gender differences in disease onset: The results of ultrasound diagnosis show that the ratio of male to female onset is about 1:2, with cholesterol stones being more common in female bile duct stones with cholangitis. The high incidence of female cholesterol stones may be related to the fact that estrogen can increase the secretion of cholesterol in bile, reduce the total amount and activity of bile acids, and luteolin affects gallbladder contraction, causing bile stasis.

　　The incidence of bile duct stones with cholangitis varies significantly between races, suggesting that genetic factors are one of the pathogenic mechanisms of cholelithiasis.

　　Reversible factors:

　　The relationship between disease onset and pregnancy Pregnancy can promote the formation of bile duct stones with cholangitis, and the frequency of pregnancy is positively correlated with the incidence rate of bile duct stones with cholangitis. Due to the increase in estrogen during pregnancy, which changes the composition of bile, it can increase the saturation of cholesterol in bile; the slow emptying of the gallbladder during pregnancy; changes in body weight and dietary structure during pregnancy and postpartum also affect the composition of bile, changing the enterohepatic circulation of bile acids and promoting the formation of cholesterol crystals.

　　The relationship between disease onset and obesity Clinical and epidemiological studies have shown that obesity is an important risk factor for the onset of gallbladder cholesterol stones, with an incidence rate three times higher than that of normal weight individuals.

　　The complications of bile duct stones with cholangitis include: acute cholangitis or acute suppurative cholangitis, biliary pancreatitis, Mirizzi syndrome, and gallbladder gastrointestinal fistula.

　　Complications may include bile duct stones with cholangitis, obstructive jaundice, and biliary pancreatitis.

　　First, acute phase complications The acute phase complications of bile duct stones complicated with cholangitis are mainly biliary tract infections, including severe cholangitis, biliary liver abscess, and associated infectious complications. The causes of infection are related to the obstruction of stones and the inflammatory narrowing of the bile ducts. Acute phase complications not only have a high mortality rate but also seriously affect the surgical outcome.

　　Second, chronic complications

　　The chronic complications of bile duct stones complicated with cholangitis include systemic malnutrition, anemia, hypoproteinemia, chronic cholangitis, biliary liver abscess, multiple bile duct strictures, liver lobe fibrosis and atrophy, biliary cirrhosis, portal hypertension, hepatic dysfunction, and delayed biliary tract cancer related to long-term biliary tract infection and bile stasis. The chronic complications of bile duct stones complicated with cholangitis not only increase the difficulty of surgery but also affect the surgical outcome.

　　(1) Acute suppurative cholangitis. When biliary calculi with cholangitis are complicated by acute obstructive suppurative cholangitis, regardless of the location of the calculus obstruction, sepsis and infectious shock can occur, leading to multi-organ failure of the liver, kidney, lung, heart, and brain.

　　(2) Liver abscess and bronchopleural fistula. Based on recurrent episodes of acute obstructive empyema of the bile ducts, liver abscesses can form, with clinical symptoms similar to acute empyema of the bile ducts. When the abscess perforates into the lung, a bronchopleural fistula is formed, presenting with cough and expectoration of sputum, and the symptoms of severe infection may quickly subside at this point.

　　(3) Biliary hemorrhage. Biliary hemorrhage can occur when repeated inflammation erodes the bile ducts and adjacent blood vessels, causing clinical symptoms such as periodic gastrointestinal bleeding, abdominal pain, and fever.

　　(4) Biliary stricture. Biliary calculi with cholangitis often lead to repeated inflammatory injury and repair of the biliary wall, eventually resulting in fibrotic stricture of the bile duct.

　　(5) Biliary cirrhosis and portal hypertension. Diffuse intrahepatic bile duct calculi with cholangitis can gradually lead to biliary cirrhosis and further cause portal hypertension.

　　1. Biliary calculi with cholangitis usually do not have obvious symptoms in the early stage, and most are found during routine physical examinations. Sometimes, mild discomfort may be mistaken for gastrointestinal diseases, leading to delayed medical consultation.

　　2. Some solitary or multiple bile duct calculi with cholangitis exist freely within the gallbladder and are not prone to become lodged, rarely producing symptoms, and are known as asymptomatic bile duct calculi with cholangitis.

　　3. Small gallstones within the gallbladder can become lodged at the gallbladder neck, causing clinical symptoms, especially after eating greasy foods when the gallbladder contracts, or when symptoms are exacerbated due to changes in body position during sleep.

　　4. When gallstones become lodged in the gallbladder neck, they cause acute obstruction, leading to increased pressure within the gallbladder. Bile cannot pass through the gallbladder neck and cystic duct, causing clinical symptoms, usually characterized by biliary colic. This usually presents as persistent right upper quadrant pain that worsens intermittently, may radiate to the right shoulder and back, and is often accompanied by nausea and vomiting. Some patients may experience spontaneous resolution of symptoms a few hours later.

　　5. If biliary calculi with cholangitis persist and do not resolve, the gallbladder may continue to enlarge, possibly leading to infection and progression to acute cholecystitis. If not treated promptly, a small number of patients may progress to acute empyema of the gallbladder, and in severe cases, gallbladder perforation can occur, with serious clinical consequences.

　　6. Tenderness, or acute pain attacks, can be exacerbated by eating greasy foods, leading to increased upper abdominal pain. Fever and jaundice are rare, and abdominal signs are not prominent, often with only mild tenderness in the upper abdomen, and the gallbladder is not enlarged. Acute attacks may lead to abdominal pain, chills, high fever, and jaundice, known as the triad of Charcot's syndrome. In addition to the Charcot's triad (abdominal pain, chills, high fever, jaundice) of acute cholangitis, there are also signs of shock and suppression of the central nervous system, known as the Reynolds pentad.

　　7, Sudden severe and persistent pain under the sternum or in the upper right abdomen. Followed by chills and remittent fever, the body temperature can exceed 40℃. Often accompanied by nausea, vomiting, jaundice, but the depth of jaundice may not be consistent with the severity of the disease. About half of the patients may appear restlessness, disturbance of consciousness, drowsiness, and even coma, and central nervous system depression, accompanied by hypotension. Often indicates that the patient has developed sepsis and infectious shock, indicating that the condition is serious.

　　Traditional Chinese medicine in our country emphasizes 'treating diseases before they occur', that is, preventing the causes of diseases. Therefore, people with high-risk factors for bile duct stones with cholangitis should pay attention to:

　　1, Have a reasonable breakfast on time;

　　2, Have regular meals;

　　3, Eat more high-fiber foods, reduce the intake of high-calorie foods;

　　4, Avoid unreasonable rapid weight loss;

　　5, Increase physical activity appropriately.

　　Composition: 120 grams of walnuts, 30-60 grams of pure sesame oil.

　　Method: mix with 90 grams of rock sugar after frying and boiling, take three times a day.

　　Note: An elderly patient with bile duct stones and cholangitis for three years, spent thousands of yuan and was not completely cured. But after taking this medicine for 10 days

　　1. For bile duct stones with cholangitis, take 90-250 grams of Lysimachia christinae, decocted in water.

　　2. For bile duct stones with cholangitis, apply adhesive plaster with Semen Cuscutae to the corresponding ear acupoint of the digestive system. Once every other day, for 10 times as a course of treatment. And press once after each meal and before going to bed, for 15 minutes each time, so that the ear acupoint has a feeling of illness and swelling, and the auricle has a burning sensation.

　　3. For bile duct stones with cholangitis, take 50 grams of corn silk, decocted in water to drink, can be taken at any time without restriction on quantity.

　　4. For bile duct stones with cholangitis, take 30 grams of Chinese foxglove, decocted with equal parts of rice wine and water, take one dose per day, for 3-4 weeks, until all the stones are excreted.

　　5. For bile duct stones with cholangitis, take 60 grams of Chinese foxglove, twice a day, decocted in water for internal use.

　　3, Eat more pumpkin regularly

　　Eat pumpkin steamed, fried, or made into soup or congee, three times a day, for 40 consecutive days.

　　4, Drink loach soup

　　There is also an experience formula in folk: take 1-2 fresh loaches each time, cook in a low flame, add a little table salt for seasoning, cook until the meat is soft and the soup is thick, eat the meat and drink the soup, mainly drinking the soup. Once a day, for 15 days as a course of treatment, the symptoms of bile duct stones with cholangitis can be significantly alleviated.

　　Auxiliary examination

　　Imaging examination is currently the main means for diagnosing bile duct stones with cholangitis, with ultrasound examination being the first choice.

　　For a functional gallbladder, ultrasound diagnosis can accurately detect the condition of gallstones inside the gallbladder, whether the gallbladder wall is thickened and uniform, and whether the gallbladder function is abnormal. The results are often accurate and reliable. However, for bile duct stones with cholangitis, due to the lack of contrast from liquid bile, the reliability of ultrasound diagnosis is somewhat insufficient, and more advanced examination methods are needed when necessary, such as CT scan.

　　Disease diagnosis

　　The diagnosis of bile duct stones complicated with cholangitis mainly relies on medical history and ultrasound examination, which is usually easy to diagnose. However, due to the atypical nature of its symptoms, it is often difficult to distinguish from other upper abdominal diseases.

　　Differential diagnosis

　　Bile duct stones complicated with cholangitis need to be distinguished from the following diseases:

　　Acute or chronic gastritis Can manifest as various atypical symptoms of discomfort or pain in the upper abdomen from mild to severe. Many pains caused by bile duct stones complicated with cholangitis are no longer in the upper right abdomen, but in the middle of the upper abdomen, so they are easily misdiagnosed as gastritis.

　　Peptic ulcer If there is a history of peptic ulcer, the pain in the upper abdomen is related to dietary regularity. Bile duct stones complicated with cholangitis and bile duct stones complicated with cholangitis often occur after meals, or with bloating, especially after eating greasy food.

　　Chronic hepatitis When hepatitis leads to abnormal liver function, there may be symptoms such as dull pain or discomfort in the upper right abdomen, loss of appetite, etc. It can be distinguished by routine ultrasound diagnosis and liver function tests.

　　Fatty liver A considerable number of patients with bile duct stones complicated with cholangitis also have fatty liver. The symptoms of discomfort in the upper right abdomen are difficult to distinguish whether they come from a gallbladder with stones or from fatty liver with liver damage. It requires the help of a specialist doctor to distinguish.

　　1. Filled bile duct stones complicated with cholangitis

　　2. Porcelain gallbladder

　　3. Associated with diabetes

　　4. Bile duct stones complicated with cholangitis greater than 2.5 cm

　　5. Atrophic gallbladder

　　6. Family history of biliary tract diseases

　　7. Associated with gallbladder polyps

　　For patients with symptomatic bile duct stones complicated with cholangitis, it is recommended to visit the outpatient department and decide under the guidance of a doctor whether surgical treatment is needed.

　　Drinking water soaked with climbing pumpkin vines: Take 100 grams of climbing pumpkin vines (double for fresh), wash and chop them, put them in a thermos bottle, soak them with boiling water, and drink them as tea. Method of administration: soak one thermos bottle a day, which can be drunk at any time during the day and while eating. Only one bottle is drunk a day, and the medicine needs to be changed and soaked again every day. Drink for 3-4 days, and stones will start to pass, usually in a cloudy urine state, sometimes with small stone particles. When a silk-like liquid appears in the urine, it means that all the stones have been expelled, and the medicine does not need to be taken anymore. Avoid spicy, alcohol, especially lard.

　　1. For patients with bile duct stones complicated with cholangitis, the food they eat should not be too greasy, and they should not eat and drink excessively, or be under too much stress. They should not drink too much alcohol.

　　Herba Sarcandrae Scopulariae

　　2. High-fat foods should be avoided, and high-cholesterol foods such as (the brains, liver, kidneys) of pigs, cows, and chickens, fish eggs, egg yolks, etc. should be avoided during the illness.

　　3. At the same time, smoking and drinking should be avoided, and meat should be eaten less, and avoid eating salty and greasy foods.

　　4. Avoid eating pork, pork liver, beef, pork kidney, animal brains, duck meat, sardines, crabs, etc.

　　5. Avoid eating spinach, green peas, lima beans, and other legumes, as well as cauliflower and asparagus.

　　6. If it is calcium phosphate and magnesium ammonium phosphate stones, avoid the intake of calcium and phosphorus, such as milk, tofu, shrimp skin, kelp, fatty meat, egg yolks, etc.

　　7. If it is calcium oxalate stones, avoid radishes, spinach, chocolate, celery, potatoes, and soy products. Especially spinach.

　　8. Limit the intake of sugar; avoid spicy and刺激性 foods such as scallions, ginger, chives, garlic, chili, etc.

　　According to traditional Chinese medicine, apples are slightly warm in nature and sweet and sour in taste, with the effects of moistening the lungs, quenching thirst, dispelling summer heat and relieving restlessness, and promoting appetite and bowel movements. Medical research has found that apples contain a variety of substances that can reduce blood lipids, limit platelet aggregation, reduce the tendency of vascular thrombosis, and prevent atherosclerosis, which can soften blood vessels and promote blood circulation. A simple apple recipe can also achieve the effects of preventing and treating bile duct stones with cholecystitis.

　　1. Use surgical methods to remove obstructive factors and ensure unobstructed bile duct drainage. In acute attacks, control the infection first, and then perform surgery after the condition stabilizes. Incise the bile duct to remove stones or worms, and perform T-tube drainage. If there is a narrowing of the Oddi's sphincter, sphincteroplasty can be performed, and if there is lower end obstruction of the common bile duct, bile duct duodenal anastomosis or bile duct jejunum Roux-y anastomosis, etc., can be performed for biliary-enteric internal drainage. To relieve the infection focus, the gallbladder should be removed. For patients with intrahepatic bile duct stenosis, it is necessary to thoroughly understand their pathological changes and relieve their obstructive causes. If the stenotic segment of the intrahepatic bile duct is incised, and the intrahepatic stones are cleared, then Roux-y bile duct jejunum anastomosis should be performed.

　　2. Surgical removal of bile duct obstruction to reduce bile duct pressure and ensure unobstructed bile duct drainage. However, in the early stage of the disease, for acute simple cholecystitis with mild symptoms, non-surgical methods can be used first.

　　For patients with ineffective non-surgical treatment and progression from simple cholecystitis to acute obstructive suppurative cholangitis, surgical treatment should be adopted in a timely manner. Non-surgical treatment includes antispasmodic, analgesic, and choleretic drug applications, among which 50% magnesium sulfate solution is often effective, with a dose of 30~50ml taken once or 10ml taken three times a day; gastroenteric decompression is also commonly used; the combined use of high-dose broad-spectrum antibiotics is very important.

　　3. Oddi's sphincteroplasty: Indications are the same as biliary-enteric anastomosis, especially for those with mild choledochal dilatation who are not suitable for biliary-enteric anastomosis.

　　4. Minimally Invasive Cholecystolithotomy: Indications: ① Applicable to solitary bile duct stones with cholecystitis; ② Multiple bile duct stones with cholecystitis; ③ Bile duct stones with or without symptoms accompanied by cholecystitis; ④ Bile duct stones with recurrent biliary colic attacks accompanied by cholecystitis; ⑤ No stone impaction; ⑥ Non-acute inflammatory stage; ⑦ Good sonographic visibility of bile; ⑧ Gallbladder wall thickness of 0.3~0.5cm; ⑨ Gallbladder contraction function ≥30% after lipid meal; ⑩ Patients voluntarily request cholecystopreservation treatment.