Biliary hypertension: a description, causes, symptoms and treatment

According to the publicly available data, at present the number of diseases of the bile duct system has increased. This is explained by the conduct of unhealthy lifestyle, malnutrition, and hereditary predisposition of man. Every year there is an increase in diseases accompanied by the development of biliary hypertension. This serious pathology will be discussed in our article.

Features of the disease

Biliary hypertension is the most common manifestation of a malignant neoplasm that occurs in the liver and gall bladder. Very often this pathology is accompanied by mechanical jaundice. The tumor that appeared on the head of the pancreas starts to press on the bile ducts, and the stones or polyps located there promote the appearance of pressure, which does not allow the bile to flow normally. Such hypertension is treated if it is benign in nature, with the help of surgical endoscopic intervention.

Causes of development

Biliary hypertension is able to develop under the following pathological conditions:

• Benign and malignant tumors arising in one of the biliary ducts, leading to a violation of outflow. In addition, the emergence of such pathology leads to the squeezing of one of the ducts that developed in the nearby organ neoplasm.
• Gallstone disease and calculous cholecystitis. Such diseases are characterized by the formation of insoluble stones in various parts of the hepatobiliary system and the occurrence of mechanical jaundice.
• The presence in the ducts of parasites - helminths.

Also, this ailment can develop due to congenital malformations of the bile ducts, which have an altered shape and diameter of the lumen. In this case, signs of the disease appear already in childhood.

Symptoms

The signs of biliary hypertension do not manifest themselves in any way at the initial stage of their development, which is why many patients start this disease. However, one should be alert for the following symptoms:

• weakness;
• flatulence;
• diarrhea;
• Pain in the right hypochondrium.

The main symptom, clearly indicating the syndrome of biliary hypertension, is an increase in the volume of the spleen associated with pressure in the portal system. At a later stage, anemia, thrombocytopenia, and leukopenia occur.

This causes jaundice as a result of mechanical pressure on the gallbladder. In the abdominal cavity fluid (ascites) can accumulate, the feature of which is its resistance to the therapy. To get rid of it, it usually takes a long time. The patient begins to increase the volume of the abdomen, swollen legs, on the abdominal wall, the anterior vein widens.

The most severe manifestation of the disease is a hemorrhage into the stomach, rectum or esophagus. All this is accompanied by blood vomiting. And if bleeding occurs in the esophagus, then in the feces will be the admixture of blood.

Diagnostics

Instrumental methods of research are conducted in the following cases:

• To confirm the presence of biliary hypertension;
• In order to establish the disease that caused the emergence of such a pathology.

The following methods are considered the most informative.

Ultrasound

One of the important points in choosing a plan for treatment of biliary hypertension is the level of the bile ducts. In this case, the main non-invasive method is ultrasound examination of the abdominal cavity and retroperitoneal space. Due to such diagnostics, the expansion of extra- and intrahepatic bile ducts is revealed, which is a symptom of such a pathology.

Biliary hypertension with a distal level of the block is characterized by an expansion of hepaticocholedoch, and after a while the intrahepatic ducts expand, and an increase in the size of the gallbladder occurs. The duct with a diameter of more than 10 mm happens in the case of a neoplasm. With a high block, the presence of a sleeping gallbladder and the expansion of the intrahepatic ducts are revealed. The tumor is observed in 51.3% of cases.

CT scan

CT of abdominal cavity organs and retroperitoneal space helps visualize the features of the structure of many organs. Such a study makes it possible to obtain sufficiently accurate results with respect to formations of large size and assesses how much their germination occurred in adjacent structures.

Radiocontrast study methods

If there is a suspicion of a pathology such as biliary hypertension, then experts often perform endoscopic retrocholangiopancreatography or cholangiography. Introduction of radiopaque substances with such methods is carried out in different ways, but has a similar result. Thanks to such a substance on the X-ray, it is possible to estimate the degree of patency of the duct system.

Biopsy

Such a study is considered an invasive method, and resorted to it only in a complex case, namely, when a malignant tumor is suspected. Usually they perform targeted trepanobiopsy of the liver under the supervision of ultrasound. Take a small amount of tissue from the focus of the pathology, which is subjected to pathohistological examination. The result obtained makes it possible to judge the nature of the neoplasm.

Diagnostic laparoscopy

If the above diagnostic methods could not determine the cause of biliary hypertension, then the operation is performed. It can be performed laparoscopically or laparotomically, and it becomes possible at one time to perform both diagnostic and therapeutic surgical manipulations. With the help of diagnostics, direct visualization and intraoperative biopsy are performed. Surgical manipulations are performed depending on the nature of the detected pathology.

Treatment

If biliary hypertension was diagnosed, the treatment is performed in a conservative or surgical manner.

Conservative treatment is usually performed with functional disorders, the elimination of which is performed by such drugs as "Atenolol", "Nitroglycerin", "Monopril", "Anaprilin", "Nitrosorbide", "Sulodexide", "Ednit."

Surgical treatment is carried out only if the listed medicines have not brought any result. The operation is performed when ascites, intestinal bleeding, stomach and esophagus are detected, as well as with the development of hypersplenic syndrome. Modern methods of surgical intervention involve the use of laparoscopy, which is a low-trauma sparing operation with the introduction through thin incisions of thin tubes with a camera, micromanipulators and lighting. An image appears on the monitor, focusing on which the doctor removes the obstacle.

In no case can you do self-medication and take medications, as well as chemicals to remove the tumor, reduce the volume of the stomach and remove the stones without prescribing a doctor. In addition, if biliary hypertension of the liver and gall bladder is detected, the following therapeutic actions are performed:

• Put a dropper to maintain an optimal level of fluid and electrolytes;
• Use medicines that improve the blood supply and nutrition of liver cells;
• Carry out antibacterial therapy;
• Decompress the bile duct.

Conclusion

Thus, biliary hypertension is considered a very serious pathology. Basically, the diseases that lead to this ailment are treated surgically. But do not be afraid of this, because a timely call to the doctor can eliminate the root cause of such hypertension and the pathology itself.