Colangitis mai tasowa

Colangitis mai tasowa
Description (en)
Iri	non-neoplastic bile duct disorder (en) , inflammatory disease (en) bile duct disease (en)
Field of study (en)	gastroenterology (en)
Symptoms and signs (en)	Shawara, zazzaɓi, Ciwon ciki chills (en)
Medical treatment (en)
Magani	obeticholic acid (en)
Identifier (en)
ICD-10-CM	K83.0
ICD-9-CM	576.1
DiseasesDB	2514
MedlinePlus	000290
eMedicine	000290
MeSH	D002761
Disease Ontology ID	DOID:9446

Ascending Cholangitis, wanda aka fi sani da acute cholangitis ko kawai cholangitis), kumburi ne na bututun bile, yawanci ya haifar da ƙwayoyin cuta da ke hawa daga mahaɗarta tare da duodenum (bangare na farko na ƙananan hanji). Yana faruwa ne idan bututun bile ya riga ya rufe shi da wani ɓangare ta hanyar gallstones.

Alamomi da alamomi

Ƙungiyoyin Charcot

Mutumin da ke fama da cholangitis na iya gunaguni game da Ciwon ciki (musamman a saman dama na ciki), zazzabi, rigors (rashin ƙarfi) da jin tsoro (Rashin lafiya). Wasu na iya bayar da rahoton jaundice (launin launin rawaya na fata da fari na idanu).

Binciken jarrabawar jiki yawanci sun haɗa da jaundice da tausayi na sama na dama. Triad na Charcot shine saiti na binciken da aka saba da shi guda uku a cikin cholangitis: ciwon ciki, jaundice, da zazzabi. An ɗauka a baya ya kasance a cikin 50-70% na shari'o'in, kodayake kwanan nan an bayar da rahoton mitar a matsayin 15-20%. Reynolds' pentad ya haɗa da binciken triad na Charcot tare da kasancewar damuwa da rikicewar hankali. Wannan haɗuwa da alamun yana nuna mummunar yanayin da ci gaban sepsis, kuma ana ganin shi ba a saba gani ba.

A cikin tsofaffi, gabatarwar na iya zama ba ta dace ba; suna iya rushewa kai tsaye saboda sepsis ba tare da nuna fasalulluka na al'ada ba. Wadanda ke da indwelling stent a cikin bututun bile (duba ƙasa) bazai haifar da jaundice ba.

Dalilan da suka haifar

Rashin ƙuƙwalwar ƙuƙwalwa, wanda yawanci yana cikin ƙuƙwasawa mai tsanani, yawanci saboda gallstones ne. 10-30% na shari'o'in, duk da haka, saboda wasu dalilai ne kamar su tsauraran matakai (ƙuntatawar bututun bile ba tare da wani ciwon daji ba), lalacewar bayan tiyata ko canza tsarin bututun bile kamar ƙuntatawa a shafin anastomosis (haɗin tiyata), kumburi daban-daban (kansar da bututun bile, ciwon daji na gallbladder, ciwon lafiya na Ambula na Vater, ciwon kansa na pancreatic, ciwon zuciya na duodenum), anaerobic kwayoyin kamar Clostridium da Bacteroides (musamman a cikin tsofaffi).[1]

Kwayoyin da zasu iya kamuwa da hanta da bututun bile na iya haifar da cholangitis; waɗannan sun haɗa da ƙwayoyin Ascaris lumbricoides da ƙwayoyen hanta Clonorchis sinensis, Opisthorchis viverrini da Opisthorchis felineus . [1] A cikin mutanen da ke fama da Cutar kanjamau, an san yawancin kwayoyin da ke haifar da cutar kansar AIDS cholangiopathy, amma haɗarin ya ragu da sauri tun lokacin da aka gabatar da ingantaccen maganin cutar kanjamawa.[2][3] Cholangitis na iya rikitar da hanyoyin kiwon lafiya da suka shafi bututun bile, musamman ERCP. Don hana wannan, ana ba da shawarar cewa waɗanda ke fama da ERCP don kowane nuni su sami maganin rigakafi (mai hanawa). [4][5]

Kasancewar stent na dindindin na biliary (misali a cikin ciwon daji na pancreatic) dan kadan yana ƙara haɗarin cholangitis, amma ana buƙatar stents na wannan nau'in sau da yawa don ci gaba da patent na bile a ƙarƙashin matsin lamba na waje.

Halitta

Diagram da ke nuna hanta da sassan da suka danganci tsarin narkewa

Bile yana samar da hanta, kuma yana aiki don kawar da cholesterol da Bilirubin daga jiki, da kuma emulsifying na mai don sa su zama masu narkewa a cikin ruwa da taimakawa wajen narkewar su. Bile an kafa shi a cikin hanta ta hanyar hepatocytes (kwayoyin hanta) kuma an fitar da shi cikin bututun hanta na yau da kullun. Ana adana wani ɓangare na bile a cikin hanji saboda matsin lamba na baya (wanda sphincter na Oddi ke yi), kuma ana iya sakin shi a lokacin narkewa. Har ila yau, gall bladder yana mai da hankali kan bile ta hanyar shan ruwa da gishiri da aka narke daga gare ta. Dukkanin bile ya kai duodenum (bangare na farko na ƙananan hanji) ta hanyar bututun bile na yau da kullun da Ambula na Vater. Sphincter na Oddi, wanda yake a mahaɗar ampulla na Vater da duodenum, tsoka ce ta zagaye wacce ke sarrafa sakin duka bile da ɓoyayyun pancreatic a cikin hanyar narkewa.

Itacen biliary yawanci ba shi da ƙwayoyin cuta saboda wasu hanyoyin kariya. Sphincter na Oddi yana aiki azaman shingen inji. Tsarin biliary yawanci yana da matsin lamba (8 zuwa 12 cmH2O) kuma yana ba da damar bile ya gudana kyauta ta hanyar. Ci gaba da gudana na bile a cikin bututun yana fitar da ƙwayoyin cuta, idan akwai, cikin duodenum, kuma baya ba da izinin kafa kamuwa da cuta. Tsarin tsarin bile - gishirin bile da immunoglobulin wanda epithelium na bututun bile ya ɓoye yana da rawar kariya.

Cutar ƙwayoyin cuta kadai ba tare da toshewa ba yawanci yakan haifar da cholangitis. Koyaya karuwar matsin lamba a cikin tsarin biliary (sama da 20 cmH2O) wanda ya haifar da toshewa a cikin bututun bile yana fadada sarari tsakanin sel da ke kewaye da bututun, yana kawo gurbataccen bile a cikin hulɗa da jini. Har ila yau, yana shafar aikin sel na Kupffer, waɗanda ƙwayoyin macrophage ne na musamman waɗanda ke taimakawa wajen hana ƙwayoyin cuta shIgA cikin tsarin biliary. A ƙarshe, karuwar matsin lamba yana rage samar da IgA immunoglobulins a cikin bile. Wannan yana haifar da bacteremia (bacteria a cikin jini) kuma yana haifar da ciwon amsawar kumburi (SIRS) wanda ya ƙunshi zazzabi (sau da yawa tare da rigors), tachycardia, karuwar numfashi da karuwar ƙididdigar fararen jini; SIRS a gaban wanda ake zargi ko tabbatar da kamuwa da cuta ana kiranta sepsis . Tsayar da biliary kanta yana lalata Tsarin rigakafi kuma yana lalata ikonsa na yaki da kamuwa da cuta, ta hanyar lalata aikin wasu ƙwayoyin rigakafi (neutrophil granulocytes) da kuma canza matakan hormones na rigakafi.