Pathogenesis (disease development)
At the forefront of pathogenesis is the obstruction of bile flow. Even partial (partial) obstruction, in the majority of cases caused by a stone in the context of cholelithisais (gallstone disease), favors the colonization of bacteria in the bile ducts. The bacteria originate from the duodenum (small intestine), rarely entering the bile ducts hematogenously (via the bloodstream) from the portal circulation or lymphogenically (through the lymph/lymphatic vessels). The farther the stenosis (narrowing) or obstruction of the bile ducts is from the duodenum, the lower the risk for infection.
Etiology (causes)
Disease-related causes
- Cholelithiasis (gallstones) – most common cause.
- Diverticulosis (protrusions in the area of the intestinal wall).
- Biliary strictures (narrowing of the bile ducts), for example, after surgery.
- Parasite infestation
- Primary sclerosing cholangitis (PSC) – chronic inflammation of the extrahepatic and intrahepatic (located outside and inside the liver) bile ducts.
- Tumors in the bile ducts
Other causes
- Germs carried by diagnostic and therapeutic interventions (procedures) on the biliary system:
- Endoscopic retrograde cholangiopancreaticography (ERCP) – radiographic imaging of the biliary system and pancreatic duct (pancreatic duct) during an endoscopic examination.
- Percutaneous transhepatic cholangiodrainage (PTCD) – insertion of a drainage catheter into the bile ducts (biliary drainage), through which accumulated bile is drained to the outside.
