Infection des voies biliaires n’est jamais primitive. Elle se rencontre en cas de stase biliaire secondaire à un obstacle incomplet des voies biliaires extra hépatiques, plus rarement dans les affections des voies biliaires intra hépatiques et en cas de reflux du liquide duodénal dans les voies biliaires.
Et malgré la grande diversité des affections pouvant conduire à une angiocholite, l’étiologie est dominée incontestablement par la lithiase biliaire [4][41].
LES OBSTACLES INCOMPLETS DE LA VOIE BILIAIRE PRINCIPALE
Gallstones
Conceivably, for there to be precipitation, it was necessary that there be a fault with the solubilizer, bile salts, or an excess of the substance to dissolve cholesterol.
This imbalance could have a foodborne because, in fact, cholelithiasis is much more common in Europe and the Far East. But it is certain that these dietary factors are not the only ones involved. There are probably circumstances where the rate of salt Bile is insufficient.
endocrine factors could cause such an alteration, the stone is more common in women and appears to be particularly favored by pregnancies.
But in some cases, although different, the stone is due to an excess of bilirubin, resulting from hemolysis: these are pigment stones.
Gallstones represents the main etiology of cholangitis, it is due to a single calculation or multiple stones, they will promote infection.
cholelithiasis
It lithiasis of the bile duct, most commonly due to calculations (calculation of the low - choledochal choledochal or ballast) is a frequent complication ; quente of lithiasis of the gallbladder, it can still occur without any vesicular disease.
It is clinically characterized by Charcot's triad: pain, fever, with such a prominent symptom obstructive jaundice . The general condition is good at first, then eventually deteriorate. The
cholelithiasis is complicated:
- Liver failure and the resulting biliary cirrhosis.
- The suppurative cholangitis: big suppuration of the entire biliary tree, which can create a true septicemia with renal disease (cholangitis urémigène).
inflammatory strictures of the bile duct Main
mostly due to surgical trauma, usually during a cholecystectomy. The wound during surgery is unknown in most cases.
These are usually short strictures who sit at the junction of cystic duct - common hepatic duct. These strictures
post traumatic cause cholangitis in 64% of cases, either in the immediate postoperative period or after several months or one year of intervention.
Tumor of the ampulla of Vater
Papillitis stenosing
Pédiculite
DISORDERS OF BILIARY LIVER INTRA
They are rare but must ê ; be known because they cause stasis and biliary infection.
Caroli Disease
dysgenesis is a congenital intrahepatic bile duct, head of multifocal cystic dilatation, it is associated in most cases with hepatic fibrosis.
More rarely, absence of hepatic fibrosis, the disease is so often localized to a portion of the liver and may be accompanied by other congenital malformations of the bile duct (choledochal cyst ).
disease acquired and not congenital. Clinically it may be asymptomatic and discovered incidentally, bulletin recurrent cholangitis start between 5 and 30 years.
biliary papillomatosis
It is a condition characterized by papillary hyperplasia in continuous sheets of the mucosa of the bile ducts. Cancerous degeneration is common, it is considered rare cause of cholangitis.
The intrahepatic gallstones are seldom
purveyors of cholangitis, besides the existence of the latter, in this case is discussed.
reflux of duodenal fluid in the biliary
It can be spontaneous, without any apparent stasis and be due to:
fistula Spontaneous bilio-digestive
They are usually progressive complications of lithiasis biliary-duodenal fistula cholecysto are most frequent, but often less complicated than cholangitis cholecysto-colic fistula. The risk of cholangitis appears to be related mainly to the gene flow of bile.
Can be due to some surgical
Such as sphincterotomy and choledocho-duodenal anastomoses that are responsible for reflux into the bile ducts and cholangitis.
PARASITIC
In general they are associated with cholelithiasis:
Some parasites " fluke Fasciola hepatica in ", " Ascaris " create a barrier intraductal.
Other parasites that tells "the alveolar echinococcosis " or hydatid cyst, are responsible for compression. Note the possible migration of vesicles, girls or membranous debris in the bile duct, evidence of a cracking of the cyst.
Note the special case of cholangitis Far East mostly due to a fluke in " clonochis sinensis " cholangitis in this case is due to inflammatory stricture of intrahepatic bile ducts with inflammation of the parasite.
The prognosis is usually bleak cholangitis.
RECURRENT PRIMARY
Cholangitis is a disease of unknown etiology, met in the Far East, usually associated with intrahepatic lithiasis, more rarely a parasitic " Clonorchis sinensis .
CAUSES CANCER: It
a less common cause is mainly cites: cancer of the pancreatic head, ampulla of Vater, cancer of the bile duct or common hepatic duct. The prognosis of this type is particularly acute cholangitis.
The odditis sclerosus-CHRONIC PANCREATITIS
constitute rare causes of cholangitis.
Cholangitis IATROGENIC
They are rare, and they are the price of progress in the techniques of opacification of bile ducts, as well as in non-surgical methods intervention on the bile duct.
The T-tube cholangiography: cholangitis is caused by venous reflux cholangio promoted by intracanal pressures greater than 25 cm of water.
cholangiography transparietal: The
cholangitis is caused by a dual mechanism:
- Increased intraductal pressure during injection of contrast.
- Sowing the seeds by direct blood bile during transhepatic puncture.
The endoscopic retrograde cholangiopancreatography:
Two conditions seem necessary to cause cholangitis, following an ERCP
- Getting overpressure bile previously infected.
- Existence of a prior biliary obstruction.
The Mirizzi syndrome
Mirizzi syndrome is a rare complication of cholelithiasis in connection with an extrinsic compression of the bile duct by a stone impacted in the infundibulum or in the cystic duct [36].
OTHER CAUSES
They may be foreign, including foodborne, which are sometimes responsible for cholangitis.
