Due to the lack of bile in the intestine or the reduction of bile volume, vitamin K is not absorbed enough, which affects the formation of coagulation factors in the human body, which will lead to bleeding tendency.
After obstruction of biliary system, bile excretion is obstructed and bilirubin flows back to blood, which is called obstructive jaundice.
The location of obstruction may be inside or outside the liver, with complete obstruction and incomplete obstruction.
2. Causes of biliary obstruction biliary obstruction is a disease with high mortality in surgical acute abdomen, most of which are secondary to bile duct stones and biliary ascariasis.
However, bile duct stricture and bile duct tumor can sometimes be secondary to this disease.
These diseases cause bile duct obstruction, cholestasis and secondary bacterial infection.
Almost all of the pathogenic bacteria come from the intestine, and retrograde into the biliary tract through the ampulla of Vater or through the channel of choledochojejunostomy.
Bacteria can also enter the bile duct or blood passage.
The main pathogenic bacteria were Escherichia coli, Klebsiella, Streptococcus faecalis and some anaerobic bacteria.
3. The differential diagnosis of obstructive jaundice can be divided into two categories: benign disease and malignant disease.
Bile duct stones are the most common benign diseases, followed by inflammatory stricture of biliary tract (such as duodenal papillary stenosis, acute and chronic cholangitis, etc.), and benign tumor of biliary tract (such as choledochal cyst).
The prominent accompanying symptoms of jaundice in these benign lesions are dull upper abdominal pain, chills and fever. The nature of abdominal pain is generally distending pain, strangling pain is the main symptom, sometimes strangling pain is a significant symptom. There has been a history of recurrent attacks in the past, which generally presents acute and subacute symptoms.
Malignant diseases include various primary and metastatic cancers occurring in the common bile duct, including cholangiocarcinoma, pancreatic head cancer, duodenal papillary carcinoma, etc.
Malignant tumor lesions are generally chronic process, for painless jaundice, do not cause the attention of patients, often see a doctor very late, mostly in 1 ~ 2 months or so, accompanying symptoms are generally not typical, pancreatic head cancer often with right upper abdominal pain as the prominent symptom.
How to prevent biliary obstruction and pay attention to the changes of liver function: AFC often causes serious damage to liver function. At present, monitoring methods can not detect liver failure early. Diagnosis is usually made after mental symptoms and hepatic encephalopathy. Therefore, we must attach great importance to various clinical characteristics and accurately record the changes of bile volume, color and concentration every day.
In AFC, the secretion and reabsorption of bile are affected due to the damage of hepatocytes and bile capillaries. Sometimes the amount of bile is large, up to 4000-7000ml per day. The color is light, which can cause a lot of water and electrolyte loss and further aggravate the liver burden.
The use of somatostatin can significantly reduce the amount of bile secretion.
After bile duct drainage, bile salt in the intestinal tract decreased significantly, which could not effectively inhibit bacterial reproduction and endotoxin. However, a large amount of endotoxin into the liver via portal vein could further aggravate liver damage. Oral bile salt could significantly reduce intestinal bacteria and endotoxin.
It is also very important to strengthen intestinal sterilization and cleaning. Kanamycin can inhibit intestinal bacteria and significantly reduce the amount of endotoxin in liver.
TCM treatment of biliary obstruction: it is suitable for shock stage.
Shengmai Powder, compound Danshen injection and Shenfu Decoction can be used in combination with various anti shock measures of Western medicine.
Clearing heat and detoxification, cooling blood and dispersing blood: it is used to resist infection and reduce various toxic blood symptoms and bleeding tendency, and it is often used in combination with antibiotics and hormones of Western medicine; Tongli attack, cholagogue expelling stone: mainly using cathartic and cholagogue Chinese medicine, Qingdan Decoction and bile duct Paishi Decoction can be selected.
According to the principle of syndrome differentiation of traditional Chinese medicine, it is necessary to strengthen the body's vital energy and eliminate pathogenic factors, clear away heat and toxin, relieve liver and gallbladder, activate blood circulation and remove blood stasis, strengthen stomach and spleen, regulate and improve organ function, enhance immunity and remove endotoxin, prevent and treat complications and improve cure rate.
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