In most cases cholangitis is the result of a complete or incomplete obstruction on serving the CBD, but in some cases much more rare it occurs comparison of patients with CBD free [16].
cholangitis WITH OBSTRUCTION OF THE CBD
Three elements are involved in their development:
- A complete or incomplete obstruction of the bile duct.
- The penetration of pathogens into the CBD.
- factors promoting the spread of the root canal infection.
Injury of the CBD
is complete or incomplete obstruction of pathogens is essential. Stasis and dilatation of the CBD are the consequence of obstruction and contribute to the development of infection.
penetration of germs in the CBD
The multiplicity of channels offered reflects their possible interaction and ignorance of the exact mechanism.
ductal upward track:
remains the most commonly accepted, but it was discussed. It is reflux of enteric and stasis upstream allows them to multiply.
Thus the origin of intestinal bacteria isolated is a compelling argument in favor of this hypothesis. But the relative sterility of the duodenum is an objection to this theory.
hematogenously:
It has been suggested that the portal route involves the passage of intestinal bacteria in portal blood and their return to the hepatic bile after treatment, but this mode of penetration of germs seems very questionable.
the direct route:
This mode of infection of the bile duct is present, less often involved.
It is the result of a traumatic biliary tract infections, mainly instrumental endoscopic maneuvers, and any surgery on the hepatobiliary sphere.
Dissemination of infection
Is done in two ways:
Local Propagation: From
infection directly responsible for biliary abscess formation at the walls of the bile ducts or hepatic parenchyma.
Broadcast:
Infectious process is done through blood, this blood-borne hypertension is facilitated by the CBD in relation to prevailing the existence of the obstacle.
Thus several studies have demonstrated the existence of reflux cholangioveineux bacteria on an obstructed bile duct under pressure just higher than that of the hepatobiliary secretion.
Moreover, whatever the mode of spread of infectious process, terrain plays a facilitating role. Thus, cholangitis develops in a more severe in immunocompromised patients (treatment with corticosteroids and immunosuppressants), and elderly patients or carriers of multiple defects.
cholangitis TRACK FREE BILE
gastrointestinal reflux in VB
It seems that the reflux isolé ne puisse entraîner qu'exceptionnellement des angiocholites. Il s'observe dans la plus part des cas opérés après anastomose bilio-digestive, le plus souvent cholédoco-duodénale.
De plus l'exploration chirurgicale ou endoscopique des anastomoses bilio-digestives cholédoco-duodénales à permis de constater la relative fréquence des débris alimentaires stagnants dans la VBP.
Les angiocholites au cours d'une infection siégeant en dehors de la VBP, il s'agit d'un problème encore mal élucidé.
However, in cases of suppurative cholecystitis, intrahepatic abscess or primary or working in the context of a sepsis, intraoperative bilicultures can show pre ; presence of an infection of the bile duct with normal bile duct. The hypothesis of Oddi spasm associated reaction could be considered.
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