Novosti
Khirurgii

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Year 2021 Vol. 29 No 1

GENERAL & SPECIAL SURGERY

V.V. BOYKO 1, A.V. MALOSHTAN 1, R.M. SMACHYLO 1, A.M. TYSHCHENKO 1, A.A. NEKLIUDOV 1, V.A. VOVK 2, M.A. KLOSOVA 1, O.V. VOLCHENKO 1

PHYSICAL AND CHEMICAL PROPERTIES OF BILE DURING THE ONSET AND MANIFESTATION OF CHOLANGITIS. ACUTE CHOLANGITIS: POSSIBLE TRIGGERING MECHANISMS

V. T. Zaytsev Institute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine 1,
Regional Clinical Hospital 2, Kiev,
Ukraine

Objective. To determine the possible triggering mechanism for the development and manifestation of acute suppurative cholangitis based on the study of the rheological, physical and chemical properties of bile.
Methods. The bile of choledoch was studied in patients (n=41) with calculous obstruction of the biliary tract, 25 of them had clinical picture of cholangitis. For comparison, 32 patients with asymptomatic choledocholithiasis were examined. Bile sampling was performed in each patient twice: the first bile intake was obtained during duodenoscopy and cannulation of the major papilla of the duodenum and endoscopic papillosphincterotomy and the second portion – during a follow-up examination three days after the endoscopic papillotomy. The biliary pH, viscosity, the amount of solids in it, the concentration of primary bile acids, microbial contamination and the intraductal pressure were studied.
Results. For the first time, it has been hypothesized that a reduced concentration of bile acids in the bile causes a subsequent chain of triggering and manifestation of acute cholangitis. In the first bile intake the concentration of bile acids is three fold decreased in patients with acute cholangitis in comparison with the patients of control group, and in the second case it reliable increased but was lower than in the control group. It was a small amount of bile acids caused sedimentation of a colloidal bile solution, increased its viscosity and amount of dry sediment, caused precipitation and sludge. This chain process caused the instantaneous inclusion of concretion in sludge and acute obstruction of the choledoch. As a result of bacterial contamination, the microbial dissemination of bile increases by 103-104 times, the choledoch becomes like an abscess. Endoscopic papillosphincterotomy breaks this chain and surgical management is the definitive mode of treatment for decompression and biliary track sanitation.
Conclusion. A decrease of bile acids in the content of the bile causes a chain process of sedimentation, the formation of sludge and a complete block of the choledoch, which is the primary trigger for cholangitis.

Keywords: choledocholithiasis, acute cholangitis, primary bile acids, pathogenesis, endoscopic papillosphincterotomy
p. 20-27 of the original issue
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Address for correspondence:
61103, Ukraine, Kharkov,
Balakirev Str., 1
V. T. Zaytsev Institute of General and Urgent Surgery of the National Academy of Medical Sciences
of Ukraine, the Department
of the Liver and Bile Ducts Surgery,
tel. +380 57349-41-20,
e-mail: andrey.aleksandrovich@googlemail.com
Nekliudov Andrey A.
Information about the authors:
Boyko Valeriy V., MD, Professor, Corresponding Member of the National Academy of Medical Sciences of Ukraine, Director of V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0003-4771-9699
Maloshtan Aleksandr V., MD, Chief Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-5205-8480
Smachylo Rostyslav M., MD, Professor, Head of the Department of the Liver and Bile Ducts Surgery, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0003-1237-0255
Nekliudov Andrey A., PhD, Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-5567-2419
Tishchenko Alexand M., MD, Professor, Chief Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0002-9151-778X
Vovk Valerii A., MD, Surgeon, Regional Clinical Hospital, Kharkov, Ukraine
https://orcid.org/0000-0003-0888-1837
Klosova Maria A., PhD, Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-6048-4084
Volchenko Oleg V., Junior Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-7818-2359
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