42 year old female came with history of recurrent attacks of abdominal pain, fever, and jaundice. MRCP coronal HASTE image of upper abdomen shows dilatation of intrahepatic biliary radicles and CBD with multiple calculi within the hepatic ducts (L>R) and CBD (arrows). No calculi in the gall bladder. Thick slab MRCP image (left) better shows the IHBR and CBD dilatation with hepaticolithiasis and choledocholithiasis. Incidentally note the right retrocaval ureter.
Recurrent pyogenic cholangitis (RPC) or Oriental cholangiohepatitis is a recurrent and chronic and biliary tract infectious process typically seen in the Asian population, particularly Chinese. The disease involves recurrent episodes of infectious cholangitis with fever, abdominal pain, and jaundice. The causative infectious agents are typically bacterial such as E. coli and other coliforms. However biliary tract parasites such as Ascaris lumbricoides and Clonorchis sinensis are common coexistent pathogens, and it is not clear which infectious agents are the primary cause or representative of secondary superinfection.
The recurrent infections lead to bile duct dilatation, strictures, obstruction, and calculi. The bile duct dilatation may be pronounced and involves both the intrahepatic and extrahepatic ducts. There is a predilection for ductal involvement in the left lobe of the liver but diffuse intrahepatic disease can be seen. The extrahepatic bile duct can be quite dilated up to as much as 3-4cm in diameter. The dilatation of the extrahepatic duct may be secondary to loss of elasticity of the duct wall due to chronic infection or it may be due to ampullary narrowing.
The calculi are typically bile pigment stones with varying amounts of calcium. The stones have a mud or paste-like consistency. The stones presumably form due to bacterial enzymes causing deconjugation of bilirubin which then precipitates as calcium bilirubinate. In addition it has been postulated that a low protein diet as is seen in some Asian populations may play a role in formation of intraductal stones. MRCP is gold standard non invasive investigation for diagnosis of oriental cholangitis.
1 comment:
Most prostate cancers are adenocarcinomas, cancers that arise in glandular cells of the prostate’s epithelial tissue. Prostate cancers usually progress slowly and produce no symptoms in the initial stages. Eventually, the tumor may enlarge like mine too, the prostate gland, pressing on the urethra and causing painful or frequent urination and blood in the urine. So I was so uncomfortable with this prostate cancer diseases then I decided to do online search on how to cure cancer because I well have read a lot about herbal medicine, I came across a lot of testimony how Dr Itua cure HIV/herpes then Cancer was listed below the comment.with courage I contacted Dr Itua and he sent me his herbal medicine through Courier service then I was asked to pick it up at my post office which i quickly did. I contacted Dr Itua that I have received my herbal medicine so he instructed me on how to drink it for three weeks and that is how Dr Itua Herbal Medicine cures my prostate Cancer, The treatment takes three weeks and I was cured completely. Dr Itua is a god sent and I thank him every day of my life. Contact him now On: Email:drituaherbalcenter@gmail.com/ Whatsapp:+2348149277967.
He listed that he can as well cure the following diseases below.... Cerebral Amides. Lung Cancer,Brain cancer,Esophageal cancer,Gallbladder cancer,Gestational trophoblastic disease,Head and neck cancer,Hodgkin lymphoma Intestinal cancer,Kidney cancer,Leukemia,Liver cancer,Melanoma,Mesothelioma,Multiple myeloma,Neuroendocrine tumors,Hodgkin lymphoma,Oral cancer,Ovarian cancer,Sinus cancer,Soft tissue sarcoma,Spinal cancer,Stomach cancer,Meniere's disease , Testicular cancer,Throat cancer,Thyroid Cancer,Uterine cancer,Vaginal cancer,Vulvar cancer. Alzheimer's disease,Autism,measles, tetanus, whooping cough, tuberculosis, polio and diphtheria Adrenocortical carcinoma. Alma, Uterine Cancer, Breast Cancer, Allergic diseases. Kidney cancer, Love Spell, Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Generalized dermatitis,Alzheimer's disease,Brain Tumor,Lupus,Endometrial Cancer, cerebrovascular diseases
Dementia.Colo rectal cancer, Lottery Spell, Bladder Cancer, Skin Cancer,Ovarian Cancer,Pancreatic Cancer, HIV /Aids,Brain Tumor, Herpes, Non-Hodgkin lymphoma, Inflammatory bowel disease, Copd, Diabetes, Hepatitis
Post a Comment