胆管炎（cholangitis）.docVIP

胆管炎（cholangitis） [typing] Acute calculous cholecystitis (95%) Acute non calculous cholecystitis (5%) Acute Calculous Cholecystitis [pathogeny] Cystic duct obstruction, bacterial infection, more women [performance] Colic on the right upper quadrant, radiating right shoulder back [image examination] B ultrasound, WBC- [treatment] Final treatment - surgery [timing of operation] Within 48-72h Nonoperative treatment was ineffective and worsened Severe complication [method of operation] cholecystectomy, gall bladder stoma Acute non calculous cholecystitis [etiology] a variety of factors, unknown, ischemia, more men [manifestations] critically ill patients, after severe trauma, long-term TPN [treatment] operation chronic cholecystitis 70%-95% complicated with gallstone Atypical symptoms of dyspepsia Ultrasound showed wall thickening, emptying - calculus. Surgical removal of gallstone People who have no gallstone should be treated with caution and conservative treatment Acute obstructive suppurative cholangitis (AOSC) Acute cholangitis of severe type (ACST) [pathogeny] Bile duct stone (76-88.5%) biliary ascariasis Biliary stricture Bile duct and ampullary tumor [pathology] Complete obstruction of bile duct + pyogenic infection Bile pressure - bile canaliculi rupture, purulent bile reflux, a large number of bacteria, toxins entering the hepatic veins, systemic circulation, systemic purulent infection, and multiple organ dysfunction Performance: pentalogy of Reynolds Abdominal pain, chills, high fever, jaundice, shock, and central nervous system inhibition [diagnosis] pentalogy of ultrasound and blood Or T39 ~ C, P120 / min, WBC20 109/L [treatment] Principle: emergency operation relieves biliary obstruction, unobstructed drainage and early and effective reduction of intrahepatic bile duct pressure [preoperative preparation] Broad-spectrum antibiotics Correct the disorder of water and electrolyte Restore blood volume to ensure good blood perfusion and oxygen supply Cooling, su