Obstruction of the bile duct due to gallstones develops into biliary tract infection. Obstruction of Cystic duct (passage connecting the gallbladder neck and the common bile duct) may result in severe cholecystitis (painful inflammation of the gallbladder wall) and the obstruction of common bile duct can cause cholangitis (inflammation of the bile duct). One of the most common causes of death and illness in the entire world is biliary tract infections.
The biliary tract which is also known as biliary tree is named for the path through which bile is secreted by the liver and is transported to the duodenum which is also called, the first part of the small intestine. The biliary tract is a structure that is common with most of the members of the mammal family. It is referred as tree because it begins with many small branches that terminate at the common bile duct, which is also called as the trunk of the biliary tree. The bile secreted by the liver flows in the opposite direction as that of the blood of the other two channels. The other two channels of the duct are the hepatic -artery (short blood vessel that supplies oxygenated blood to the liver, duodenum and pancreas) and portal vein (blood vessel that carries blood from the spleen and gastrointestinal tract to the liver).
Biliary tract infection may cause pain in the bowel obstruction (obstruction of the intestine, preventing the normal transition of the products of digestion).
SYMPTOMS: Patients with gallstone typically show pain in the upper right quadrant of the abdomen which is often followed by vomiting and nausea feeling. The pain often may be very severe and last for several hours (biliary colic) or may turn to cholecystitis, with persisting fever and pain. On examination, there is a palpitation and pain in the upper right quadrant of the abdomen (also known as muphy’s sign).
CONSEQUENCES IF NOT TREATED: If biliary tract infections are left untreated, it may lead to cholecystitis, which may lead to severe pain in the upper right quadrant of the abdomen. It may also cause cholangitis which, if left untreated, may cause death. An obstruction in the biliary tract may also cause jaundice, which leads to the yellowing of the eyes and skin.
RECOMMENDATIONS: Therapy for severe cholangitis and cholecystitis can be achieved by the metabolic imbalance correction, anti-bacterial therapy, electrolyte and fluid replacement, of the patient. The factors that affect the anti-bacterial and pharmacokinetic properties of the common biliary tract like distribution of tissues and the concentration ratio in both serum and bile to the negligible concentration that is expected for micro-organism.
Patients having acute cholangitis and cholecystitis with moderate severity, treatment with piperacillin or mezlocillin is as effective as ampicillin plus aminoglycoside. Patients with severe illness, treatment with septicaemia (a combination of anti-bacterial medicine) is preferred. Treatment with an aminoglycoside, should not be exceeded for more than a few days as the risk of nephrotoxicity may increase in the case of cholestasis.
Long period of administration is necessary for recurrent cholangitis, oral sulfamethoxazole or trimethoprim is preferred as an agent.