A high score asks about the treatment of cholangitis 140

Cholangitis is mostly caused by the reflux of bile, and intestinal bacteria invade! It's mostly g-bacteria!

I won't go into the details of why!

I suggest you still stay in the hospital for infusion** and you can go home!

The reason is very simple, oral drugs, the efficacy is relatively poor, can not form an effective drug concentration in the bile duct, if not as soon as possible and thoroughly, cause adhesions, secondary obstruction of the situation that can be troublesome, infusion ** with G bacteria drugs, the dosage is larger, is conducive to maintaining the concentration of drugs in the bile ducts, a large amount of liquid enters, can play a role in washing, take away bacteria!

** at home is mainly to eat small and frequent meals, soft food, and promote bile secretion and excretion! Secondly, intestinal medication can also be used to kill intestinal harmful bacteria (such as gentamisin oral) to avoid re-ascending infection!!

Don't be careless, this disease can be big or small, ** timely, infusion can be cured!

If it fails, complications such as obstruction may require surgery!!

**Regimen: Ceftetan and tinidazole for infusion, at least 7 days! If there is a high fever in the early stage, yellow bile (in the case of purulent cholangitis, azizyme is added).

Oral anti-inflammatory choleretic tablets, oral Qingda.

What are the best principles of acute obstructive purulent cholangitis.

Once acute obstructive purulent cholangitis occurs, active rescue measures should be taken to relieve the obstruction, drain bile and reduce bile pressure as soon as possible while fighting shock and infection.

1) First aid measures.

Anti-shock. Quickly correct the effective circulating blood volume, improve microcirculation, and replenish blood volume.

Correction of acidosis and water and electrolyte imbalances.

Anti-infective. Antibiotics that are effective against gram-negative bacilli are used, but aminoglycoside antibiotics should be avoided if possible, given that toxic shock and renal dysfunction are common in these patients. The second- and third-generation cephalosporins, which have been introduced in recent years, are broad-spectrum antibiotics and have less damage to kidney function, so they should be used.

In addition, attention should be paid to the control of anorexic co-infection, and metronidazole is the drug of choice.

The use of glucocorticoids can improve stress capacity, alleviate toxemia, and reduce endotoxin damage to vital organs.

Cardiodiuretic, protect heart, lung and kidney function.

Prevents bleeding tendencies and disseminated intravascular coagulation (DIC).

2) Relieve biliary obstruction and drain biliary tract The most fundamental principle of acute obstructive purulent cholangitis is to lose no time in carrying out effective biliary decompression and drainage as soon as possible, eliminate the spread of septic bile into the blood, and reduce the occurrence of serious complications. It is worth mentioning that antimicrobials and other first aid measures are not a substitute for biliary decompression drainage, but rather a supportive and complementary tool. At present, the methods of emergency biliary decompression and drainage can be divided into emergency surgical biliary drainage and emergency non-surgical biliary drainage.

Cholangitis medication principles.

Metronidazole can be used to fight infection. Cephalosporins in A or B can also be used, and anti-inflammatory choleretic tablets in B or choleretic stone decoction can be used for choleretic; Immunosuppressants prednisone and azathioprine. Liver protection is given hepatopamine, hepatamine, potassium and magnesium aspartate injection, etc.; Fluid rehydration, correction of water and electrolyte balance, appropriate blood transfusion, and supplementation of albumin, fat emulsion, etc. with "C" Chinese medicine to strengthen support**.

It's okay to get an injection, oral anti-inflammatory and choleretic tablets, and it's okay to hang a bottle for 7 days, specifically Aiyi 2 bottles for 1 day What else to rely on, I forgot

Real experience is not a random copy.

Obstructive cholangitis is not a clear definition and can be said to be cholangitis caused by obstruction. Most cholangitis is actually caused by biliary obstruction complicated by biliary tract infection.

Regardless of the cause of biliary obstruction, biliary obstruction must be addressed. If the biliary obstruction is caused by stones, the biliary obstruction can be relieved by surgical or endoscopic stone removal. If it is biliary obstruction caused by a tumor, it is necessary to actively ** the tumor.

If it is an early-stage tumor, tumor resection and biliary-intestinal anastomosis can be done. If the tumor is advanced, a stent can be placed to unblock the bile duct so that the infection can be controlled and cholangitis can be cured.

Cholangitis is a positive primary disease that needs to be addressed for biliary obstruction.

1.Chronic cholangitis.

Surgical methods are used to remove obstructive factors and ensure smooth biliary drainage. In acute attacks, the infection is controlled first and surgery is performed only after the condition is stabilized. The bile duct is cut to remove stones or roundworms, and a T-tube is drained.

If there is Odysdic sphincter stenosis, sphincteroplasty can be done, and if there is lower common bile duct obstruction, biliary enteral drainage such as common bile duct duodenal anastomosis or biliary oval roux-y anastomosis can be performed. To relieve the lesion of infection, the gallbladder should be removed. In patients with intrahepatic bile duct stenosis, it is necessary to thoroughly understand the pathological changes and relieve the cause of obstruction.

For example, the intrahepatic bile duct stricture segment is incised, and the intrahepatic stones are removed, and then the ROUX-Y bile duct jejunostomy is performed. Reflux cholangitis is predisposed to occur after Odysschaplasty and cholangioduodenal anastomosis.

2.Acute cholangitis.

Surgery removes bile duct obstruction, reduces bile duct pressure, and drains smoothly. However, in the early stages of the disease, when acute simple cholangitis is less severe, nonsurgical methods may be used first.

It is ineffective to non-operative** and progresses from simple cholangitis to acute obstructive purulent cholangitis, and surgery should be used promptly**. Non-surgical** includes the use of antispasmodic, analgesic, and choleretic drugs, of which 50% magnesium sulfate solution often has a good effect, and the dosage is 30 50 ml once or 10 ml 3 times a day; Gastrointestinal decompression is also commonly used; The combination of high-dose broad-spectrum antibiotics is very important, although the concentration of antibiotics in the bile can not reach the required concentration in the bile duct obstruction, but it can be effective in bacteremia and sepsis, commonly used antibiotics are gentamicin, chloramphenicol, pioneer mycin and ammonicillin. Appropriate antibiotics should be adjusted based on blood or bile culture and susceptibility testing.

If shock is present, it should be actively anti-shock**. If there is no significant improvement within 12 24 hours after non-surgery**, surgery should be performed immediately. Even if shock is not easily corrected, surgical drainage should be sought.

For cases where the disease is severe at the beginning, especially if the jaundice is deep, surgery should be performed promptly. The surgical mortality rate is still as high as 25-30%. Surgical methods should be simple and effective, mainly cholangiotomy and drainage.

It should be noted that the drain must be placed proximal to the bile duct obstruction, as drainage distal to the obstruction is ineffective and does not remission. It can also be excised if the condition allows.

1.**Choose (1) diffuse, bile duct lumen 4 mm Regardless of whether the jaundice is severe or not, it is advisable to use non-surgical** methods. When appropriate conditions are available, liver transplantation should be performed to avoid ineffective surgical treatment.

2) Local, segmental, extrahepatic bile duct 4 mm, severe jaundice can be operated**. (3) Complete occlusion of the bile duct or long-term obstructive jaundice, resulting in poor liver function and ascites and edema, can be non-surgical**, and surgical exploration can be carried out when the effect is not significant, but the prognosis is poor. 2.

Drugs**(1) Immunosuppressive drugs Corticosteroids have been widely used in primary sclerosing cholangitis**, such as prednisone (prednisone), and the effect is obvious after taking it for several weeks to months. Corticosteroids can not only inhibit inflammation and reduce bile duct wall fibrosis, but also have the effect of direct choleretic and jaundice. (2) Antibiotics When patients have cholangitis, abdominal pain, fever, etc., antibiotics should be added**, but long-term use is not recommended.

3) Penicillamine plays a leading role in promoting the excretion of copper in the urine (some studies have found that the intrahepatic copper level is increased in patients with primary sclerosing cholangitis), but its exact efficacy still needs to be further confirmed. (4) Anti-fibrotic drugs Colchicine has the effect of anti-fibrinogenesis, inhibition of collagen synthesis, and has a good effect on liver cirrhosis, so some people try to use it for primary sclerosing cholangitis. However, cases are still small and it is difficult to draw conclusions.

3.Surgery**(1) Internal drainage is suitable for patients with local stenosis, the stenosis segment of the common bile duct is resected, and the common bile duct jejunostomy is performed. (2) External drainage is suitable for patients with diffuse stenosis of the bile duct, a thinner catheter should be placed first, and then the catheter should be replaced every 3 months, and the diameter of the catheter should be gradually increased, and the catheter should be placed for at least 1 2 years, or even for life.

3) Orthotopic liver transplantation Patients with persistent jaundice combined with biliary cirrhosis, or diffuse primary sclerosing cholangitis, which cannot be corrected by the above surgical methods, may have a long-term hope for liver transplantation.

**Folk remedies for chronic cholecystitis.

1. Cinnamon heart and antler cream**Chronic cholecystitis.

Aunt Yu is 65 years old this year, and a few days ago, she suddenly felt severe pain in her upper right abdomen. Moreover, the whites of the eyes are yellowish and the appetite is lacking. Later, she was diagnosed with chronic cholecystitis by the hospital, and at first she took some conventional medications, but with little effect.

Later, after a friend's introduction, I went to find an old Chinese medicine doctor, and the doctor said that she was an acute attack of chronic cholecystitis, because she had jaundice, chronic nephritis, and high blood pressure plus her age, the doctor recommended the use of the first method of warming the spleen and kidneys, and draining the liver and gallbladder.

2. Chronic cholecystitis.

Mr. Zhang suffers from gastritis and often has anorexia, originally he didn't care, thinking that it is normal for patients with stomach problems to be anorexic, but recently, he suddenly felt that his right upper abdomen was connected to the back with a feeling of swelling and pain, and he was inexplicably nauseous, often hiccuping, stomach distention, and couldn't eat greasy things. After going to the hospital for examination, it was found that the gallbladder wall was thickened, the gallbladder was slightly reduced, and several 0s could be seen in the gallbladder2 cm size strongly echoic light spots.

Diagnosed with chronic cholecystitis.

The doctor prescribed him a traditional Chinese medicine prescription: 30 grams of whole melon, bupleurum, and white peony, 10 grams of citrus aurantium, Fabanxia, tangerine peel, and acacia flower, 6 grams of Zhuru and Coptis chinensis, and wine rhubarb (lower back), decoction and 6 doses in a row, and the condition was basically relieved, and then, the doctor prescribed 1 dose of medicine, 1 5 grams of Bupleurum chinensis, 30 grams of white peony, and 30 grams of whole melon, and after two and a half months, the size of the gallbladder was normal for B ultrasound, and other laboratory indices were also within the normal range.

Prescription: 2 grams of cinnamon heart, 9 grams of deer horn cream tablets, 9 grams of perilla stem, ginger half xiake, Guangchen Pike, Yun Poria cocos, fried six (Shenqu) song, 12 grams of desmodium, fried Sichuan Coptis l gram, l dose every other day, after taking 7 doses, it can have a good effect.

Please confirm the above answers with Chinese medicine practitioners before confirming whether they are feasible!

Extrahepatic bile duct stones are still mainly surgical**.

The principles of surgery** are:1

Take as many stones as possible during the operation.

2. Relieve biliary tract stricture and obstruction, and remove the infection focus.

3. Maintain bile drainage after surgery to prevent gallstone regeneration.

Common surgical methods are as follows:

1. Choledochiotomy and stone removal + T tube drainage.

2. Biliary-intestinal anastomosis.

3Oddi sphincteroplasty.

4. Endoscopic sphincterotomy and stone removal. At present, I have not heard of any special drugs that can relieve bile duct stones, and the risk of concurrent biliary pancreatitis and cholangitis is high! The further development of these 2 diseases is terrible!

It's inconvenient to tell you too much!

Another point is to make a clear diagnosis, where are the stones, the size of the stones, whether there is obstruction of the common bile duct, whether there are symptoms of yellow staining of the mucosa throughout the body, and whether there is any impaired liver function? Only by understanding the specific condition can we make a targeted plan.