OVERVIEW
Biliary tract infection refers to bacterial infections of the biliary system, including acute and chronic cholecystitis, acute and chronic cholangitis, acute obstructive septic cholangitis, etc. It often coexists with cholelithiasis, and the two are mostly causally related to each other. The incidence of biliary tract infection accounts for the 2nd place of acute abdomen, and it is a common, frequent and intractable disease in surgery.
Causes
1. Obstructive factors
Stones, biliary parasites, inflammatory adhesions can cause biliary obstruction and bile stagnation. High concentration of bile acids can cause bile duct system cell damage, aggravate mucosal inflammation and edema. Biliary-pancreatic common channel obstruction, pancreatic reflux into the biliary tract, the activated pancreatic enzymes can also make the biliary tract serious lesions.
2. Bacterial infection
The pathogenic bacteria are mostly gram-negative bacilli, which can invade the biliary tract by various ways, such as intestinal upstream infection, systemic or local infection caused by biliary tract infection through the bloodstream and the spread of inflammation in neighboring organs.
3.Other factors
Some patients with severe trauma, burns, shock and after major surgery, the contractile function of gallbladder is reduced, and the local blood transportation of biliary system is impaired, which leads to biliary tract infection.
Symptoms
Biliary tract infection may exist alone, but it mostly exists simultaneously with cholelithiasis and is mutually causative. Cholelithiasis can cause biliary obstruction, bile stagnation and bacterial colonization, leading to biliary tract infection. Cholelithiasis may have no obvious symptoms and signs in the resting period, or only symptoms such as epigastric discomfort, vague pain, and anorexia of greasy food; when gallstone movement, obstruction, or bacterial infection occurs in a certain part of the biliary tract, symptoms such as right upper abdominal colic, fever, and jaundice may appear. Severe infection can be complicated with gangrenous perforation of gallbladder, biliary hemorrhage, liver abscess, toxic shock, etc.
Examination
1. Physical examination
There may be pressure pain in the right upper abdomen gallbladder area, and when the inflammation spreads to the plasma membrane, there may be abdominal muscle tension and rebound pain, and Murphy’s sign (Murphy’s sign) is positive. In some patients, the enlarged gallbladder may be palpable and tender.
2. Blood test
The white blood cell count is increased and the percentage of neutrophils is obviously elevated.
3. Ultrasound
The gallbladder may be enlarged with thickening of the wall, and gallbladder stones may be visualized in most patients.
4. Blood gas analysis
Metabolic acidosis may occur.
5. Abdominal puncture
Helps in the diagnosis of the disease.
Diagnosis
Diagnosis is mainly based on history, clinical manifestations and ancillary investigations. Biliary tract infections often have a history of recurrent episodes, and the prominent symptoms are abdominal pain, fever, pressure and abdominal muscle tension in the right upper abdomen, and acute cholangitis is often characterized by jaundice. Biliary tract infection should also be differentiated from gastroduodenal perforation, acute pancreatitis, acute appendicitis, and biliary ascariasis.
Treatment
1. Non-surgical treatment
It is only suitable for acute stage biliary tract infection with mild clinical symptoms, without obvious peritoneal irritation or serious complications such as shock. Treatment: ① fasting, infusion, nutritional support, vitamin supplementation, correction of water electrolyte and acid-base metabolism imbalance; ② antispasmodic and analgesic: biliary colic attacks can be used to antispasmodic drugs, analgesic drugs such as tramadol, pethidine, etc.; ③ anti-infective: selection of gram-negative bacteria and anaerobic bacteria antibiotics, advocating the combination of full dosage of medication, acute obstructive pyogenic biliary cholangitis should be given a sufficient amount of broad-spectrum antibiotics Do preoperative preparation; ④ percutaneous hepatic puncture gallbladder drainage (PTBD).
2. Surgical treatment
(1) Surgical principles: relieve biliary obstruction and reduce biliary pressure by adequate drainage. Make preoperative preparations, including blood transfusion, rehydration, intravenous antibiotics and correction of shock and other measures.
(2) Indications: ① biliary peritonitis should strive for early surgery after diagnosis; ② high fever, toxic shock, correction in a short period of time without significant improvement or change in condition; ③ in the process of treatment complicating liver abscess, pancreatitis, gallbladder necrosis and perforation; ④ bile duct stones; ⑤ patients whose condition has progressed after conservative treatment.
(3) Surgical methods: ① cholecystostomy: for high-risk patients or patients with cholecystitis whose local anatomical relationship is not clear, the stone should be removed in stoma, and cholecystectomy can be performed after 3 months if the patient’s condition recovers; ② cholecystectomy: for most cholecystitis and cholecystolithiasis patients; ③ choledochotomy and T-tube drainage: for acute cholecystitis and choledochotomy, which can achieve the goal of removing the stone and draining bile; ④ cholelithiasis and choledochotomy. The purpose of removing stones and draining bile can be achieved by removing the gallbladder at the same time, and only the common bile duct can be explored for those in critical condition.
Questions you may be concerned about
How to treat bile duct infection with chills
Biliary tract infection with chills indicates that the patient is in the stage of high fever, and chills appear due to high body temperature, suggesting that the symptoms of biliary tract infection are aggravated. Generally, it is mostly gallbladder stones, bile duct stones, etc. It may also be gallbladder cancer, which can be handled by choosing medication such as levofloxacin and ibuprofen, and surgical treatment.
1. Gallbladder stones: caused by heredity, bacterial infection and other factors, when the stones block the gallbladder duct causing bile duct obstruction, local inflammation attack, resulting in biliary tract infection, high fever, chills, jaundice and other symptoms. It is recommended to choose antibiotic treatment such as cefuroxime and levofloxacin, and take ibuprofen to reduce fever at the same time. After the disease is under control, the stones should be removed through surgery.
2. Bile duct stones: mainly due to bacterial infection, biliary stasis and other factors, can be caused by stone obstruction induced bacteria in the bile duct to reproduce in large quantities induced biliary tract infection, high fever, chills, abdominal pain and other symptoms. You can choose ceftazidime and other drugs to fight infection. After the condition is stabilized, symptomatic treatment can be carried out for bile duct stones.
3. Gallbladder cancer: gallbladder cancer affects the normal discharge of bile, makes bile stagnation and destroys the internal environment of bile duct, which leads to biliary tract infection, chills, high fever, right upper abdominal pain, and gallbladder perforation in serious cases. It is necessary to actively carry out anti-infection treatment, choose ampicillin and other drugs. If necessary, consider removing the gallbladder, and choose radiotherapy after surgery according to the specific situation.
Biliary tract infection chills may also have other causes, it is recommended to go to the hospital in time, improve the examination to clarify the cause of the disease, give targeted treatment or treatment. All of the above medications should be used under the guidance of a doctor, avoid self-medication.
Can Moxifloxacin be used for biliary tract infections?
Moxifloxacin can be used for biliary tract infections, and can be combined with other antibacterial drugs if necessary.
Moxifloxacin belongs to the quinolone class of antibacterial drugs. Its mechanism of destroying bacteria is mainly through the inhibition of bacterial DNA synthesis.
The drug is effective in sterilizing some common gram-positive, gram-negative and anaerobic bacteria. Gram-negative bacteria are common in biliary tract infections, so Moxifloxacin can be used for biliary tract infections.
It can also be combined with other types of antibiotics, such as ceftriaxone and cefuroxime, if necessary. The most common adverse reactions to moxifloxacin include tendonitis, tendon rupture, and peripheral neuropathy.
The drug is contraindicated in patients who are allergic to the drug, breastfeeding, pregnant women, hepatic insufficiency, under 18 years of age, hypokalemia, congenital or acquired prolongation of the QT interval.
The above mentioned drugs are recommended to be used under the supervision of a doctor.
What to do if biliary tract infection occurs after liver cancer ablation?
Biliary tract infection after liver cancer ablation can be treated with general treatment, medication and surgery according to the degree of disease.
1. If the degree of biliary tract infection after liver cancer ablation is mild and not accompanied by other complications, fasting and water, nutritional supportive treatment, antispasmodic and analgesic drugs (e.g. atropine, pethidine), anti-infective drugs (e.g. moxifloxacin, cefroxazole), choleretic drugs (e.g. arbutin), etc. can be used.
2. If the biliary tract infection is serious, anti-infective treatment and systemic supportive therapy should be carried out as soon as possible. After relief, the doctor should assess the condition and perform cholecystectomy if the patient can tolerate surgical treatment. If conservative treatment is ineffective, cholecystic drainage is feasible and cholecystectomy should be chosen after the condition is stabilized.
When biliary tract infection occurs after liver cancer ablation, it should be standardized under doctor’s guidance according to specific conditions. In addition, the above drugs should also be used under the guidance of doctors.