Cholangiocystic dilatation

　　Cholangiocystic dilatation is related to chromosomal abnormalities. The etiology of cholangiocystic dilatation is the communicational cystic dilatation of intrahepatic bile ducts. The lesion can be diffuse or confined to a lobe or segment of the liver. The dilated cystic cavities contain bile or a mixture of bile and pus. Part of them may have concurrent cystic calculi.

　　Cholangiocystic dilatation is mainly manifested as severe upper right abdominal pain, fever, jaundice, and so on. Ultimately, it can lead to biliary cirrhosis, so it should be classified into the category of 'Rib Pain', 'Jaundice', and 'Mass Syndrome' in traditional Chinese medicine.

　　1. Liver and gallbladder damp-heat, irregular diet, or excessive alcohol consumption, which damages the spleen and stomach, leads to endogenous dampness and turbidity, transforms into heat, and steams the liver and gallbladder, or feels the pathogenic damp-heat, the cause of cholangiocystic dilatation is the failure of the liver and gallbladder to release, leading to pain in the ribs. 'Jin Gui Yao Lue' says: 'If the grain Qi does not digest, there is bitter turbidity in the stomach, the turbid Qi flows downward, and the urine and body turn yellow, it is called grain jaundice.'

　　2. Qi stagnation and blood stasis, emotional discomfort, liver and gallbladder qi stagnation, followed by the transformation of qi to blood, causing blood circulation to be unsmooth, meridians and collaterals to be不利, collaterals and meridians to be blocked, and coagulation into masses. As the 'Jisheng Fang · Treatment of Masses' said: 'Over-excitement, worry, joy, and anger can injure the five internal organs, and retention can lead to five masses.'

　　The above are the causes of cholangiocystic dilatation, which are very helpful for understanding the disease. Once diagnosed, active hospital treatment is required to avoid the condition from worsening and seriously affecting physical health.

　　Cholangiocystic dilatation was first reported by Caroli in 1958. It is a rare disease that usually forms many communicating cystic ears, often containing bile sludge, and stones may be present in the bile ducts and gallbladder. It may be accompanied by cholecystitis, cholangitis, and liver abscess. The bile duct obstruction or even blockage caused by the cystic dilatation of the lesion and the relative stenosis of the distal bile duct is the root cause of complications. So, what are the complications of cholangiocystic dilatation? The following introduces the complications of cholangiocystic dilatation.

　　1. Recurrent ascending cholangitis.

　　2. Biliary cirrhosis.

　　3. Bile duct perforation or rupture.

　　4. Recurrent pancreatitis.

　　5. Stone formation and wall cancerous changes.

　　The above are the complications of cholangiocystic dilatation. Once diagnosed, active treatment is required, and active prevention of complications should be carried out.

　　Cholangiocystic dilatation can occur at any age, mostly in children and young adults, and is manifested as recurrent cholangitis. Even liver abscesses can occur, and some patients may have intracystic stones. Due to the large difference in the range of lesions, there are also significant differences in clinical manifestations. Mild cases may be asymptomatic. The symptoms of cholangiocystic dilatation are mainly caused by intracystic stones, bile stasis, and secondary infection, manifested as severe pain in the upper right abdomen, fever, jaundice, and liver enlargement, with symptoms often recurring. Severe cases may present with clinical manifestations similar to acute liver abscess or acute suppurative cholecystitis. If congenital liver fibrosis is present at the same time, it can eventually lead to biliary cirrhosis.

　　The prevention of cholangiocystic dilatation is mainly the treatment of cholangitis, which requires long-term application of broad-spectrum antibiotics. That is, liver and bile duct diseases need to be treated actively, and the prevention of cholangiocystic dilatation should be carried out.

　　Cholangiocystic dilatation can occur at any location in the intrahepatic and extrahepatic bile ducts, so careful diagnosis is required. In addition to referring to the symptoms of abdominal pain, abdominal mass, and jaundice, auxiliary examination methods are also needed.

　　1. B-ultrasound imaging

　　It has the advantages of direct vision, tracking, and dynamic observation. For example, when the bile duct is obstructed and dilated, it can correctly locate the location and extent of the liquid content, the degree and length of bile duct dilation, and its diagnostic accuracy can reach more than 94%. It should be regarded as a routine examination method for diagnosis.

　　2. Biochemical examination

　　The determination of blood and urine amylase should be regarded as a routine examination during the onset of abdominal pain, which is helpful for diagnosis. It can suggest the possibility of accompanying pancreatitis or suggest the abnormal convergence of pancreatic and bile ducts, where high concentration of pancreatic amylase refluxing into the bile ducts enters the blood through the capillary bile ducts, causing hyperamylasemia. At the same time, the values of total bilirubin, nucleases, alkaline phosphatase, transaminases, etc., are all elevated, and they all return to normal in the remission period. In patients with a long course of the disease, there is liver cell damage, and in the examination of asymptomatic cases, it is normal.

　　3. Gastrointestinal barium meal examination

　　For those with large cystic dilatation, it can show the displacement of the duodenum to the left anterior, expansion of the duodenal ring, and a curved indentation. Its diagnostic value has been replaced by ultrasound examination.

　　4. Intraoperative cholangiography

　　During surgery, contrast medium is directly injected into the common bile duct, which can show the entire image of the intrahepatic and extrahepatic bile duct system and the pancreatic duct, understand the extent of intrahepatic bile duct dilation and the reflux of the pancreatic and bile ducts, and help in choosing the surgical method and postoperative treatment.

　　5. Percutaneous liver puncture cholangiography

　　It is more likely to be successful in cases of cholangiocystadenoma and can clearly show the intrahepatic bile ducts and their directions, clearly indicating whether there is bile duct dilation and the extent of dilation. It is applied to cases of jaundice to differentiate the cause or site of obstruction, and can observe the pathological changes of the bile duct wall and its interior, and differentiate the cause of obstruction according to the characteristics of the image.

　　6. Endoscopic retrograde cholangiopancreatography

　　With the help of duodenoscopy, contrast medium can be directly injected into the bile duct and pancreatic duct through the papilla opening, to determine the extent of bile duct dilation and the site of obstruction, and can also show the length and abnormalities of the common channel between the pancreatic and bile ducts.

　　The above are the examination items for cholangiocystadenoma. Through these examinations and clinical symptoms, the disease can be diagnosed. Once diagnosed, active treatment is needed to avoid the progression of the disease.

　　Cholangiocystadenoma was first reported by Caroli in 1958. It is a rare disease that usually forms many communicating cystic ears, often containing bile sludge, and gallstones may be present in the bile ducts and gallbladder. It may be accompanied by cholecystitis, cholangitis, and liver abscess. Cholangiocystadenoma has a familial tendency and may be accompanied by choledochal cyst. Gallstones, the disease caused by the formation of gallstones in the bile duct or gallbladder, can cause severe abdominal pain, jaundice, fever, and other symptoms. So, what are the dietary principles for this disease? The following introduces the dietary health care for patients with cholangiocystadenoma.

　　1. Increase the intake of high-fiber foods, such as vegetables and fruits.

　　2. Limit the intake of cholesterol, and absolutely do not eat foods rich in cholesterol such as internal organs and egg yolks.

　　3. Increase the intake of vitamin K, such as: spinach flowers, broccoli, etc., which are rich in content.

　　4. Avoid foods that are prone to produce gas, such as: potatoes, sweet potatoes, legumes, onions, radishes, carbonated beverages, and acidic juices, coffee, cocoa, and the like.

　　5. Milk is limited to skim milk for drinking.

　　6. Eat more yellow and green vegetables rich in vitamin A.

　　7. Reduce the use of frying, frying, and more boiling, stewing, and steaming methods.

　　8. Avoid high-fat soups and mayonnaise.

　　9. Keep the taste as light as possible, and control the seasoning.

　　10. Avoid eating processed foods and foods high in sugar.

　　Caroli first reported the liver intrahepatic bile duct cystic dilatation in 1958. It is a rare disease, which usually forms many communicating cystic ear canals, often containing bile sludge, and bile ducts and gallbladders may contain stones, and may be accompanied by cholecystitis, cholangitis, and liver abscess. If the symptoms of bile duct dilatation are not relieved by using antispasmodics and antibiotics, surgical treatment should be adopted. The main treatment methods include:

　　1. External drainage

　　Applied to individual severe cases, such as severe obstructive jaundice with liver cirrhosis, severe biliary tract infection, spontaneous bile duct perforation, and secondary treatment after the condition is improved.

　　2. Cyst and intestinal internal drainage surgery

　　For example, the cystic duodenal anastomosis, due to many complications, such as recurrent biliary inflammation, stenosis of the anastomosis, stone formation, etc., later turned to cystic jejunal Roux-en-Y anastomosis, and various anti-reflux operations were designed on the intestinal loop, but there was still a problem of pancreas and bile reflux, so bile duct inflammation or pancreatitis symptoms still occurred after surgery, and even reoperation was needed, and there were frequent reports of postoperative cyst wall cancer. Therefore, it is rarely used now.

　　3. Bile duct dilatation resection and bile duct reconstruction

　　In recent years, the method of radical resection of the dilated bile duct and bile duct reconstruction has been advocated to achieve the purpose of removing the focus and分流 of pancreas and bile. Physiological bile duct reconstruction surgery can be adopted, placing the jejunum between the bile duct and duodenum, or adding a anti-reflux valve, or adopting Roux-en-Y anastomosis of bile duct and jejunum, or bile duct and duodenum anastomosis, etc., all can achieve good results. The most important thing is that the anastomosis must be large enough to ensure the full drainage of bile.

　　Feihua Health Network warm reminder:Patients with bile duct dilatation should be treated scientifically under the guidance of a doctor according to their own symptoms, should not reject surgery, and should not take medicine blindly. This will only worsen the symptoms, thereby increasing the difficulty of cure.