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.
Ahaladze, G.G., 2009. Patogeneticheskie aspekty gnojnogo holangita, pochemu net sistemnoj vospalitel'noj reakcii pri mehanicheskoj zheltuhe? [Pathogenetic aspects of suppurative cholangitis. Why not systemic inflammatory response with obstructive jaundice?] Annaly Hirurgicheskoj Gepatologii 14(2), 9–15 (in Russian).
Chacko, V.V., Shatalov, A.D., Vojtjuk, V.N., Fominov, C.M., Matvienko, V.A., 2013. Ostryj holangit i biliarnyj sepsis [Acute cholangitis and biliary sepsis]. Ukrainskij Zhurnal Hirurgii 2, 152–157 (in Russian).
Dacenko, B.M., 2010. Obturacionnaja zheltuha: Patogeneticheskaja osnova razvitija gnojnogo holangita i biliarnogo sepsisa [Obstructive jaundice: Pathogenetic basis for the development of suppurative cholangitis and biliary sepsis]. Annaly Vinnyc'kogo Nacional'nogo Medychnogo Universytentu 14(1), 15–19 (in Russian).
Daсenko, B.M., Borisenko, V.B., 2013. Mehanicheskaja zheltuha, ostryj holangit, biliarnyj sepsis: Ih patogeneticheskaja vzaimosvjaz' i principy differencial'noj diagnostiki [Jaundice, acute cholangitis, biliary sepsis: Their pathogenetic relationship and principles of differential diagnosis]. Novosti Hirurgii 5, 31–39 (in Russian).
Eliseev, S.M., Kornilov, N.G., Chikotilov, S.P., Gumerov, R.R., 2010. Obosnovanie hirurgicheskoj taktiki pri mehanicheskoj zheltuhe [Justification of surgical tactics in obstructive jaundice]. Bjul. VSNC SO RAMN 5(75), 233–239 (in Russian).
Fialkina, S.V., Bekbauov, S.A., Maznitsa, D.A., 2012. Intestine microbiocenosis in mechanical jaundice caused by obturation of biliary ducts. Zh. Mikrobiol. (Moscow) 3, P. 61–64.
Gal'perin, E.I., Ahaladze, G.G., Kotovskij, K.G., Glebov, A.J., Chevokin, O.N., Momunova, O.N., 2009. Patogenez i lechenie ostrogo gnojnogo holangita [Pathogenesis and treatment of acute suppurative cholangitis]. Annaly Hirurgicheskoj Gepatologii 14(4), 13–21 (in Russian).
Gubinа-Vakulуk, I.G., Sorokina, I.V., Markovs’kyi, V.D., 2009. Sposib kil'kisnogo vyznachennja vmistu antygenu v biologichnyh tkanynah [The method of quantitative determination of antigen content in biological tissues]. Patent 46489 Ukraine, G 01N 33/00. Nu200906730; zajavl. 26.06.09; оpubl. 25.12.09. Bjul. N 4. (in Ukrainian).
Horwood, J., Akbar, F., Davis, K., Morgan, R., 2010. Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones. Ann. R. Coll. Surg. Engl. 92(3), 206–210. >>doi: 10.1308/003588410X12628812458293
Khan, A.B, Khan, A.B., Salati, S.A., Bhat, N.A., Parihar, B.K., 2010. Association between intraoperative bactibilia and postoperative septic complications in biliary tract. Surg. East Centr. African. J. Surg. 15(2), 113–121.
Kloek, J.J., van der Gaag, N.A., Aziz, Y., Rauws, E.A., van Delden, O.M., Lameris, J.S., Busch, O.R., Gouma, D.J., van Gulik, T.M., 2010. Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J. Gastrointest. Surg. 14(1), 119–125. >>doi: 10.1007/s11605-009-1009-1
Korol'kov, A.J., 2009. Holangit i biliarnyj sepsis: Problema i puti reshenija [Cholangitis and biliary sepsis: Problems and solutions]. Vestn. Hirurgii im. I.I. Grekova 187(3), 17–20 (in Russian).
Kozhemyakin, Y.M., Khromov, A.S., Filonenko, M.A., Saifutdinova, G.A., 2002. Metodychni rekomendacii' po utrymannju laboratornyh tvaryn ta roboti z nymy [Guidelines for the maintenance of laboratory animals and working with them]. Avicena, Kyiv (in Ukrainian).
Kucukav, F., Okten, R.S., Cumhur, T., 2011. Percutaneous biliary intervention for primary sclerosing cholangitis in a patient with situs inversus totalis. Turk. J. Gastroenterol. 22(6), 636–640.
Mosler, P., 2011. Management of acute cholangitis. Gastroenterol. Hepatol. 7(2), 121–123.
Stolin, A.V., Prudkov, M.I., Nishnevich, E.V., 2009. The choice of treatment in patients with suppurative cholangitis. The Annals of the Russian Academy of Medical Sciences 3, 126–129.
Suda, K., Ohtsuka, М., Ambiru, S., Kimura, F., Shimizu, H., Yoshidome, H., Miyazaki, M., 2009. Risk factors of liver dysfunction after extended hepatic resection in biliary tract malignancies. Am. J. Surg. 197, 752–758. >>doi: 10.1016/j.amjsurg.2008.05.007
Wang, Q., Gurusamy, K.S., Lin, H., Xie, X., Wang Wang, C., 2012. Pre-operative biliary drainage for obstructive jaundice. Cochrane Database Syst. Rev. 12, 9.
Xu, E.J., Zheng, R.Q., Su, Z.Z., Li, K., Ren, J., Guo, H.Y., 2012. Intra-biliary contrast-enhanced ultrasound for evaluating biliary obstruction during percutaneous transhepatic biliary drainage: A preliminary study. Eur. J. Radiol. 81(12), 3846–3850. >>doi: 10.1016/j.ejrad.2012.06.025
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons «Attribution» 4.0 License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.