ADVERTISEMENT
The Sun Nigeria
  • Home
  • National
  • Columns
    • Broken Tongues
    • Capital Matters
    • Diabetes Corner
    • Duro Onabule
    • Femi Adesina
    • Frank Talk
    • Funke Egbemode
    • Insights
    • Kalu Leadership Series
    • Kunle Solaja
    • Offside Musings
    • PressClips
    • Public Sphere
    • Ralph Egbu
    • Shola Oshunkeye
    • Sideview
    • The Flipside – Eric Osagie
    • Tola Adeniyi
  • Business
  • Politics
  • Entertainment
  • The Sun TV
  • Sporting Sun
No Result
View All Result
  • Home
  • National
  • Columns
    • Broken Tongues
    • Capital Matters
    • Diabetes Corner
    • Duro Onabule
    • Femi Adesina
    • Frank Talk
    • Funke Egbemode
    • Insights
    • Kalu Leadership Series
    • Kunle Solaja
    • Offside Musings
    • PressClips
    • Public Sphere
    • Ralph Egbu
    • Shola Oshunkeye
    • Sideview
    • The Flipside – Eric Osagie
    • Tola Adeniyi
  • Business
  • Politics
  • Entertainment
  • The Sun TV
  • Sporting Sun
No Result
View All Result
The Sun Nigeria
No Result
View All Result
ADVERTISEMENT
Ley Your Dreams Come Alive – With FCMB Loans
Home Columns

Cholangitis: Gall bladder danger man

14th June 2018
in Columns, Health
0
KILL
0
SHARES
64
VIEWS
Share on FacebookShare on Twitter

In a previous outing on the lesions of the gall bladder, we had attempted to differentiate inflammation of the gall bladder known as Cholecystitis from gall stones or Cholelithiasis. We had briefly mentioned Cholangitis, which is the inflammation/infection of the bile ducts.

Having reviewed the situation, we came to the conclusion that Cholangitis deserves a treatise of its own because of its potentially lethal nature.

For a recap, the biliary ductile system includes the right and left hepatic ducts from the right and left lobes of the liver. The two join to form the common hepatic duct. The cystic duct from the gallbladder now joins the hepatic duct to form the common bile duct. This is finally joined by the pancreatic duct as the access the duodenum, which is the beginning of the small intestine. Bile is produced by liver cells and part of it is stored in the gall bladder because of the back pressure exerted by a muscular valvular ring at the entrance of the duct into the lumen of the duodenum known as the sphincter of Odi. Here it becomes concentrated following the absorption of water and salts dissolved in it.

Are you a Man 40 yrs and above? Do not miss the Vital Information, it goes off in 2 days! CLICH HERE to READ .

The main function of bile is to eliminate cholesterol and bilirubin from the body as well as emulsification of fats to make them more water soluble during digestion. It must be noted that all bile reach the duodenum through the common bile duct and ampulla of Vater and the flow is controlled by the sphincter of Odi together with pancreatic secretions. An important surgical reminder here is that the basic positioning of the gall bladder and the ductile system can vary from one individual to another. General surgeons know this too well.

Cholangitis is the inflammation of any portion of the bile duct. This inflammation is produced by bacteria infection and sometimes by other conditions like adverse auto immunes response in the body. Bile produced by the liver is sterile. This is due to its antibacterial action as a result of antibodies secreted into the bile and the action of bile acids that inhibit the growth of bacteria and mucus. The small numbers of bacteria that may be present in the ducts and gall bladder usually get there by moving backwards from the duodenum. The backflow could lead to a significant bacteria population but this is usually neutralised by the normal flow of bile out of the ducts into the lumen of the bowel.

However bacteria can reach the ducts from the blood stream and lymphatic vessels. When there is blockade of bile flow as its common in the presence of gall stones, stasis of bile would lead to increased multiplication of with compromised immune system and impairs the capability of the body to fight infection. This it does by impairing the functions of white blood cells and immune hormones or cytokines. This type of inflammation is often referred to as ascending Cholangitis.

Breaking!!! Earn up to N2 - N3 million monthly GUARANTEED (all paid in US Dollars). No training or refereal required. Do business with top USA companies like Amazon, Tesla, Facebook, IBM, Netflix, Zoom, etc. Learn more .

Apart from gall stones, other factors that can lead to ascending Cholangitis include narrowing of the lumen of the bile ducts from scarring, gall bladder cancer, cancer of the duodenum, pancreas, ampulla of Vater and certain bacteria that can thrive in oxygen depleted environment known as anaerobes like Clostridium and Bacteriodes. Intestinal worms like Ascaris lumbricoides; liver flukes etc. are also known culprits.

Clinically, a person with Cholangitis may complain of right sided upper abdominal pains. There may be yellowish discolouration of the white portion of the eyes known as the sclera. This is also known as jaundice. The combination of these three symptoms is known as the Charcot’s triad. When added to these three symptoms the presence of septic shock and mental confusion, it becomes Reynolds’s pentad. This portends a grave clinical trend and a medical emergency.

100% Natural Herbs to Finally End Premature Ejaculation, Weak Erection and Small Manhood. >>>Click Here for Details<<< .
Premature Ejaculation & "Small Joystick" Resolved in 7Days... Click Here For Details .

The Diagnosis of Cholangitis will involve blood tests, imaging and endoscopy for obvious reasons. In practice an experienced caregiver can make a reasonably accurate clinical impression based on history and clinical signs as is so commonly practiced in our environment. However routine hematological and liver function tests may be necessary to have a holistic picture and severity of the condition. Blood and bile cultures may be done to ascertain the offending organism(s). The most common bacteria linked to ascending Cholangitis are gram-negative Escherichia coli, Klebsiella and Enterobacter.  This is why endotoxic or septic shock is common in acute infection that could be life threatening. Gram-positive Enterococcus also has a relatively high prevalence in Cholangitis.

Medical imaging is used to identify the site and nature of obstruction. For convenience Ultrasound is usually the first to be employed due to its easy availability. It can help to distinguish between Cholangitis and Cholecystitis but is relatively poor at identifying stones farther down the bile ducts. The gold standard test for biliary obstruction is the Endoscopic Retrograde Cholangiopancreatography (ERCP). This basically involves the passing of a tube through the mouth to the duodenum and X-rays taken after a radio opaque contrast medium has been injected. This procedure is also used to commonly unblock the duct. This may involve making a cut in the sphincter of Odi to ease flow of bile or the common bile duct opening dilated with a balloon. Stones can be removed by sucking or pushed into the duodenum.

When available, Magnetic Resonance Imaging (MRI) can be used. The procedure, Magnetic Resonance Cholangiopancreatography (MRCP) has comparable sensitivity to ERCP. The main drawback is that small stones can be missed.

In the presence of other lesions, like cancer, computed tomography (CT) scan and endoscopic ultrasound may be required to give additional information that would aid in the final diagnosis. Lately, endoscopic ultrasound is being employed in the removal of gall stones.
Ascending Cholangitis must be regarded as acute emergency that requires hospitalization.

Intravenous fluids with crystalloids if available must be administered especially in situations of low blood pressure with rapid radial pulse. Broad spectrum antibiotics with combinations of penicillin/Cephalosporins, amino glycosides and Metronidazole should be the caregiver’s first thought. If need be, Vassopressors may be added to this regimen and there should be no hesitation in the use of glucocorticoids.  Stabilising the patient should be the ultimate aim.

When this is achieved, other diagnostic and interventionist measures can be commenced. There are so many diagnostic imaging and curative procedures now available that are gradually reducing surgical interventions. The reality now is that the management of Cholangitis is gradually becoming the prerogative of physicians with surgeons being given the distance most advanced climes. This obviously calls for training in the handling of the equipment. But unfortunately in our environment due to resource constraints and limited equipment some surgeons still end up doing cholecystectomy.

Partner with me, let's get you making N500K to N500K a month! Skills open the doors to financial opportunities Click here to learn it .
Rapheal

Rapheal

Related Posts

pcn
Health

PCN seals 520 medicine shops, pharmacies in seven Kwara LGAs

26th May 2022
Monkeypox: Nigeria beefs up surveillance at entry points
Health

Monkeypox: Nigeria beefs up surveillance at entry points

26th May 2022
FG begins survey on impacts of COVID-19 palliatives, interventions
Health

FG begins survey on impacts of COVID-19 palliatives, interventions

26th May 2022
Next Post
North America healthwire

How women can avoid, survive urinary tract infections

Ways to get rid of body odour

Ways to get rid of body odour

Fayemi

Labour Party: We’ve no candidate for Ekiti guber

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

ADVERTISEMENT

Highlights

Ekiti panel on monarchs’ upgrade concludes hearing

2023: Buhari pledges commitment to fair, peaceful elections

Rivers APC: Why I boycotted governorship primaries – Abe

PDP elects Mohammed Abacha, Sadiq Wali as Governorship candidates in Kano

PCN seals 520 medicine shops, pharmacies in seven Kwara LGAs

Osun Guber: NATA endorses Oyetola for second term, promises 10,000 votes

Trending

No room for defectors from major parties - ZLP
Elections

No room for defectors from major parties – ZLP

26th May 2022
0

From Stanley Uzoaru, Owerri Ahead of its June 1 slated presidential primaries, Zenith Labour Party (ZLP) has...

Omo-Agege

Delta guber: APC returns Omo-Agege as candidate

26th May 2022
PDP: PWDs seek slot in opposition party leadership

Road to 2023: NASS candidates strategic – PDP chieftains

26th May 2022
Ekiti panel on monarchs’ upgrade concludes hearing

Ekiti panel on monarchs’ upgrade concludes hearing

26th May 2022
Buhari hails Bello, Tallen at 63

2023: Buhari pledges commitment to fair, peaceful elections

26th May 2022

Follow us on social media:

Latest News

  • No room for defectors from major parties – ZLP
  • Delta guber: APC returns Omo-Agege as candidate
  • Road to 2023: NASS candidates strategic – PDP chieftains
  • Ekiti panel on monarchs’ upgrade concludes hearing
  • 2023: Buhari pledges commitment to fair, peaceful elections
  • Rivers APC: Why I boycotted governorship primaries – Abe
  • PDP elects Mohammed Abacha, Sadiq Wali as Governorship candidates in Kano
  • PCN seals 520 medicine shops, pharmacies in seven Kwara LGAs
  • Osun Guber: NATA endorses Oyetola for second term, promises 10,000 votes
  • Vandalism: AEDC workers risk life jail, dismissal
  • Operators demand nomenclature change for orphanage homes
  • Guber primaries: Prof Ibe threatens court action against Abia PDP
  • Sokoto: Guber Aspirants beg APC to adopt Direct Primaries
  • Delegates problem of Nigeria, says Raymond Edoh
  • Guber aspirant promises to build modular refineries in Abia
  • MTN, Dangote, others lead list of most admired brands in Nigeria
  • FG decries high rate of divorce, domestic violence, drug abuse
  • PDP presidential primaries: Diaspora group endorses Wike
  • Forex scarcity: NIMASA to entrench home-grown human capacity development
  • PDP primaries: Police deploy massively to prevent crisis

Categories

  • Abuja Metro
  • Anambra Watch
  • Arts
  • Broken Tongues
  • Business
  • Business Week
  • Cartoons
  • Citizen Joe
  • Columns
  • Cover
  • Culture
  • Duro Onabule
  • Editorial
  • Education Review
  • Effect
  • Elections
  • Entertainment
  • Events
  • Features
  • Femi Adesina
  • Food & Drinks
  • Frank Talk
  • Funke Egbemode
  • Gallery
  • Global Square by Kenneth Okonkwo
  • Health
  • Insights
  • Kalu Leadership Series
  • Kunle Solaja
  • Kunle Solaja
  • Letters
  • Lifeline
  • Lifestyle
  • Literary Review
  • Marketing Matters
  • Muiz Banire
  • National
  • News
  • Offside Musings
  • Opinion
  • oriental news
  • Politics
  • Press Release
  • PressClips
  • Public Sphere
  • Ralph Egbu
  • Shola Oshunkeye
  • Sideview
  • South-west Magazine
  • Sponsored Post
  • Sporting Sun
  • Sports
  • Sun Girl
  • Tea Time
  • The Flipside – Eric Osagie
  • The Sun Awards Live
  • The Sun TV
  • Thoughts & Talks
  • Time Out
  • Today's cover
  • Tola Adeniyi
  • Travel
  • Travel & Tourism
  • Trending
  • TSWeekend
  • Turf Game
  • Uncategorized
  • Updates
  • Views from Abroad
  • Voices
  • World
  • World News
  • Home
  • About Us
  • Paper Ad Rate
  • Online Ad Rate
  • The Team
  • Contact Us
  • Privacy Policy

© 2019 The Sun Nigeria - Managed by Netsera.

No Result
View All Result
  • Home
  • National
  • Columns
    • Broken Tongues
    • Capital Matters
    • Diabetes Corner
    • Duro Onabule
    • Femi Adesina
    • Frank Talk
    • Funke Egbemode
    • Insights
    • Kalu Leadership Series
    • Kunle Solaja
    • Offside Musings
    • PressClips
    • Public Sphere
    • Ralph Egbu
    • Shola Oshunkeye
    • Sideview
    • The Flipside – Eric Osagie
    • Tola Adeniyi
  • Business
  • Politics
  • Entertainment
  • The Sun TV
  • Sporting Sun

© 2019 The Sun Nigeria - Managed by Netsera.

Posting....