Correlation of Biliary Pressure, Bile Duct Diamter and Biochemical Test in Cholangitis

Choi, Eun Chang; Han, Ho Seong; Kim, Young Woo; Choi, Yong Man

Abstract

BACKGROUND: The development of cholangitis requires two conditions: first, the patient must have infected bile, and second, there must be an increase in bile duct pressure. Clinical symptoms of this disease (e.g., fever and chills, jaundice, abdiminal pain) are correlated with bactbilia, increased biliary pressure.
METHODS
This study was planned to investigate two important factors in patients with cholangitis who have clinical manifestation like high fever, chills, and right upper guadrant (RUQ) pain at records of 50 patients who had been admitted to the Department of Surgery at DongDaeMoon Ewha Womans University Hospital between September 1994 and December 1997 and have been operated with the diagnosis of hepatobiliary disease were reviewed. The cases had been who had using abdominal computed tomography, ultrasonography, or endoscopic retrograde cholangiopancreatography. Under general anesthesia, the diameter of the Common bile duct (CBD) and intrabiliary ductal pressure were measured. the direct bilirubin, Alkaline phosphatase (ALP), body temperature and the peripheral white blood cell count were also measured. We analyzed the correlation of the measured parameters.
RESULTS
Fortyfive of the 50 patients had biliary tract stones, and 5 had a cancer located in the periampullary area. Their average age was 54. There were no statistical significance among the location of the biliary duct stone, the causative organism, and the intrabiliary ductal pressure. The measured CBD diameter was 17.2+/-3.7 mm. The measured intraductal pressure was 18.5+/-6.5 cmH2O. There were no statistical correlation between the CBD diameter and the intraductal pressure. The direct bilirubin was 1.86+/-1.96 mm, higher than the normal value, and a statistically significant correlation with the CBD diameter. The serum ALP was 338 IU/L, and it was higher than normal value. Though the ALP had no statistically significant correlation with the CBD diameter, it had a significant correlation with the CBD pressure. The peripheral WBC count was 11,000+/-4433/mm3, higher than the normal value, but it had no statistical corrlation with the CBD diameter and the intraductal pressure. The CBD pressure of the patients who had elevated body temperature above 37.5oC was higher than the CBD pressure of the patients whose body temperarure was below 37.5degrees C.
CONCLUSION
This study suggests that an elevated intrabiliary ductal pressure plays an important role in aggravated symptoms of cholangitis. The serum ALP represents the elevated biliary ductal pressure of the acute phases, while an increased biliary duct diameter and direct bilirubin represent the chronic phase, also, the change of WBC count does not correlate with the intrabiliary ductal pressure and the CBD diameter, and the patients with elevated body temperatures have increased biliary ductal pressure.