Pathogenic aspects of acute cholangitis
AbstractThe research is aimed at the study of dynamic pathomorphological changes of choledoch and acute cholangitis development factors determined during the experiment. 36 rats of Wistar line were under trial. The main group consisted of 30 animals undergoing the open laparotomy, choledoch ligation and puncture modeling of acute cholangitis by E. coli culture in 1 х 108 CFU/ml concentration under general anesthesia. 6 healthy rats were included in the control group. Samples of general biliary duct under autopsy for pathomorphological study were taken on the 3rd, 7th, 14th, 21st and 30th day. In panoramic samples colored by hematoxilin and eozin the degree of dystrophic, necrobiotic, hemodynamic, inflammatory and atrophic manifestations’ changes were studied. Average depth of choledoch wall and height of its epithelial lining were morphometrically estimated. Collagen of the IV type as well as expressing receptors to CD34 were defined with the help of monoclonal antibodies in choledoch epithelial cells of basal membranes and choledoch vessels endotheliocytes. In choledoch, enhancement of edema and inflammatory infiltration by lymphoplasmocytic elements with the admixture of neutrofils with granulation tissue was detected from the 3rd up to the 30th day of the experiment. From the 14th day formation of bile clots of blood was detected in choledoch clearance, part of which was locked to its de-epitheliolized internal surface. According to morphometrical study data, choledoch wall depth increased from 261.1 ± 3.13 µm on the 3rd day to 572.5 ± 3.42 µm on the 30th day of the experiment. Mucosa membrane has lost its folding on the 14th day, epitheliocytes flattening was replaced by their destruction with fragments rejection into the duct lumen by the 30th day of the experiment. The epithelium height index decreased from 14.8 ± 0.09 µm on the 3rd day to 11.7 ± 0.15 µm on the 30 day of the experiment. Collagen of the IV type fluorescence intensity of vessel basal membranes from the 3rd day closely matched the control, its enhancement was detected by the 30th day. Choledoch epitheliocytes fluorescence, expressing the receptors to CD34 reliably decreased by the 30th day of the study. In its turn, content of collagen of the IV tyre, as well as vessels endothelium expression in preparations treated by PQA to CD34 reliably increased by the 30th day of the experiment. Thus, in pathogenesis of acute cholangitis apart from well-known factors such as cholestasis and infection the third factor was detected, in the way of biliary ducts mucosa membrane lesion. In morphogenesis of choledoch mucosa membrane lesion the decrease in role of epitheliocytes adhesive properties was stated as well as deficit of collagen of the IV type in the structure of epithelial basal membranes. During observations where epithelial covering consistency was preserved, inflammatory changes in choledoch were insignificant, which is proved by sufficient resistance of biliary ducts epithelium to infection in the presence of cholestasis and bacteriocholia, but in cases when mucosa membrane de-epitheliolization took place the development of severe purulent-destructive cholangitis and pericholangitis was detected.
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