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Cholecystitis: symptoms, treatment


Cholecystitis Cholecystitis is an inflammatory disease in which the gallbladder wall is affected and the biochemical and physical properties of bile change.

Surgeons (with an acute form of cholecystitis) and therapists (with chronic cholecystitis) often encounter this disease. In recent decades, medical statistics have noted a steady upward trend in the incidence of this disease.

Causes of cholecystitis

Inflammation in the gallbladder can occur for a variety of reasons. The main ones are:

  • the formation of stones that permanently damage the mucous membrane and can interfere with normal bile flow;
  • dietary (abuse of fatty, high-calorie and fried foods, strong drinks, random food);
  • psycho-emotional overstrain;
  • burdened heredity;
  • abnormal (often congenital) form of the gallbladder (different waistings, bends, partitions predispose to bile flow disorders);
  • hormonal imbalances and hormonal agents (including hormonal contraceptives, drugs used during IVF);
  • allergy (for example, food);
  • immune disorders;
  • drugs (tsiklosporin, clofibrate, octreotide contribute to stone formation);
  • drastic weight loss;
  • infectious agents (bacteria, parasites, viruses) that can penetrate into the gallbladder from the foci of dormant chronic infection already present in the body.

Infectious factors enter the gallbladder and ducts along with lymph (lymphogenous pathway), blood (hematogenous pathway) and from the duodenum (ascending pathway).

The inflammation that occurs in the gallbladder may not affect the functions of this organ, but may also disrupt both concentration and motor functions (up to a fully non-functioning or “disconnected” bladder).

Classification of cholecystitis

The course of cholecystitis is divided into:

  • acute;
  • chronic.

Both acute and chronic cholecystitis may be:

  • calculous (i.e., associated with the formation of stones in a bubble, its share reaches 80%);
  • stoneless (up to 20%).

In young patients, as a rule, cholecystitis without stones is found, but since the age of 30 years, the frequency of verification of calculous cholecystitis increases rapidly.

During chronic cholecystitis, the exacerbation stages alternate with the stages of remission (subsidence of both clinical and laboratory manifestations of activity).

Symptoms of cholecystitis

In a small proportion of patients, cholecystitis may be asymptomatic (its chronic variant), they lack clear complaints, so the diagnosis is often verified randomly during the examination.

Still, in most cases, the disease has vivid clinical manifestations. Often they manifest after some kind of dietary error (feast, eating fried foods, alcohol), psycho-emotional overstrain, jolting ride or excessive physical exertion.

All signs of cholecystitis can be combined into the following syndromes:

  • pain (dull or sharp pain, localized, usually in the right hypochondrium, but sometimes it occurs in the epigastric region, and in the left hypochondrium, can give to the right shoulder, neck, under the scapula);
  • dyspeptic (bloating, bitter taste in the mouth, nausea with vomiting, various stool disorders, feeling of heaviness in the upper right abdomen, intolerance of fat);
  • intoxication (weakness, fever, loss of appetite, muscle aches, etc.);
  • vegetative disturbances syndrome (headaches, sweating, premenstrual tension, etc.).

Patients may experience far from all the listed symptoms. Their severity varies from barely perceptible (with a sluggish chronic course) to almost unbearable (for example, in the case of biliary colic - a sudden attack of intense pain).

Complications of cholecystitis

The presence of any cholecystitis is always fraught with the possible development of complications. Some of them are very dangerous and require urgent surgical intervention. So, as a result of cholecystitis, patients may experience:

  • empyema of the gallbladder (purulent inflammation);
  • necrosis of the wall (necrosis) of the gallbladder due to inflammation and pressure on it with stones (stone);
  • perforation of the wall (the formation of holes in it) as a result of necrosis, as a result of its contents is in the abdominal cavity of the patient and leads to inflammation of the peritoneum (peritonitis);
  • the formation of a fistula between the bladder and intestine, the bladder and the renal pelvis, bladder and stomach (the result of necrotic changes of the gallbladder wall;
  • "Disabled" (broken) gallbladder;
  • pericholecystitis (transition of inflammation to nearby tissues and organs);
  • cholangitis (the spread of inflammation in the intra- and extrahepatic bile ducts of various sizes);
  • obstruction of the bile ducts;
  • "Porcelain" gallbladder (the result of the deposition of calcium salts in the bladder wall);
  • secondary biliary cirrhosis (a consequence of prolonged calculous cholecystitis);
  • gallbladder cancer.

Diagnosis of cholecystitis

Cholecystitis symptoms and diagnosis After listening to the patient's complaints described above, any doctor must examine him, paying attention to the color of the skin, the sclera, the frenulum of the tongue (they may turn out to be jaundiced). When probing the abdomen, a possible cholecystitis is indicated by soreness found in the right hypochondrium and in special gallbladder points and local muscle tension over this zone. In such patients, pain is often present when gently tapping along the right costal arch and along the right hypochondrium region.

For an accurate diagnosis, the patient is then usually sent to be examined. The following diagnostic methods help to identify cholecystitis:

  • hemogram (with disease activity signs of inflammation are detected: leukocytosis, thrombocytosis, accelerated ESR);
  • biochemical blood tests (cholestasis markers such as exacerbation of alkaline phosphatase, bilirubin, gamma-glutamyltranspeptidase can be detected during exacerbation, and acute phase inflammatory proteins, such as CRP, haptoglobin, etc., increase);
  • urinalysis (after an attack, bile pigments may be present in it);
  • ultrasonography (the study assesses the size of the gallbladder, the presence of deformities, stones, tumors, the uniformity of bile, the state of its walls and tissues around it, in acute cholecystitis the walls are stratified, their “double contour” appears, and in chronic thickening, sometimes to clarify the functional disorders this study complement the breakdown with choleretic breakfast);
  • MRI / CT (diagnostic capabilities of non-contrast review studies are similar to ultrasonography; MRI cholangiography is more informative, which analyzes the condition and patency of the ducts, excluding some of the complications of cholecystitis);
  • endoscopic ultrasonography (the method combines fibrogastroduodenoscopy and ultrasonography, since the diagnostic sensor is placed on the endoscope, it better visualizes the condition of the biliary ducts);
  • duodenal intubation (the results of the method indirectly indicate cholecystitis, if in the cystic portion the collected bile is cloudy with flakes, parasites are present);
  • seeding bile (detects pathogens, clarifies their appearance and sensitivity to different antibacterial drugs);
  • general abdominal radiography (a simple examination can confirm the perforation of the inflamed gallbladder, its calcification, detect some stones);
  • cholecystography is an x-ray contrast method, during which the contrast is introduced directly into the vein or through the mouth (it detects stones, the bubble is “turned off”, functional impairments, but after the widespread introduction of ultrasonography into the routine practice, it is extremely rare);
  • retrograde cholangiopancreatography (allows you to establish a complication - blockage of the ductal system, and even remove some stones);
  • cholescintigraphy with technetium (radioisotope technique is shown to verify acute cholecystitis and exclude the "disabled" bubble);
  • hepatocholecystography (radioisotope diagnostic procedure to clarify the type of functional disorders);
  • fecal microscopy for the detection of eggs or fragments of worms, lamblia cysts;
  • immunological (ELISA) and molecular genetic analyzes (PCR) for the detection of parasites.

Cholecystitis treatment

Medical tactics are determined by the form of cholecystitis, its stage and severity. Acute forms of the disease are treated exclusively in the hospital. In chronic cases, patients with mild and uncomplicated forms can do without hospitalization without an intense pain syndrome.

Therapeutic measures may be conservative and radical (surgical).

Conservative treatment

It is mainly used in cases of chronic illness. Possible non-invasive methods include:

  • diet;
  • drug therapy;
  • extracorporeal lithotripsy (shock wave).

Health food

Cholecystitis treatment Nutrition of patients in the acute phase of the process must necessarily be gentle and fractional. In especially serious cases, sometimes they even resort to a couple of “hungry” days, during which only liquids are allowed (weak warm tea, rosehip broth, diluted berry or fruit juices, etc.). Further, all products are boiled or cooked using a double boiler, and then wipe. Quenching and baking before remission is prohibited. All fatty foods and foods (dairy, pork, goose, lamb, duck, red fish, lard, pastry creams, etc.), smoked foods, canned food, hot spices, sweets, cocoa and caffeine-containing beverages, chocolate, egg yolks , baking. Mucus soups, grated porridges, vegetable, fish, meat or cereal souffles, puddings, dumplings, steam cutlets, kissels, mousses, protein omelets are welcome. Creamy (as a source of mucous membrane protector - vitamin A) and vegetable oils (soybean, corn, vegetable, cotton, olive, etc.) are permitted. All drinks and meals should be served warm to the patient, since cold can be the cause of a painful painful attack.

After the onset of the long-awaited remission, baking and stewing is allowed, the products are no longer wiped, and fresh berries, greens, vegetables, and fruits are included in the diet. To improve the composition of bile and reduce its ability to stone formation, dietary fiber is shown. It is rich in cereals (buckwheat, oats, barley, etc.), kelp, bran, vegetables, algae, fruits.

Drug treatment of cholecystitis

During the exacerbation of any cholecystitis patients are recommended:

  • antibiotics that penetrate into the bile in concentrations sufficient to kill the infection (doxycycline, ciprofloxacin, erythromycin, oxacillin, rifampicin, zinnat, lincomycin, etc.);
  • antibacterial agents (Biseptol, Nevigramon, furazolidone, nitroxoline, etc.);
  • antiparasitic drugs (depending on the nature of the parasite, it is prescribed - macmorrho, metronidazole, tiberal, nemozol, biltricid, vermoxum, etc.);
  • detoxification agents (ringer's solutions, glucose, reamberin, etc .;
  • non-narcotic analgesics (baralgin, spazgan, trigan D, took, etc.);
  • antispasmodics (papaverine, halidor, mebeverin, no-spa, buscopan, etc.).
  • perirenal novocainic blockade (with unbearable pains, if they are not removed by other medicines);
  • means for stabilization of the autonomic nervous system (Elenium, motherwort, Eglonil, Melipramine, benzogeksony, etc.);
  • antiemetic drugs (domperidone, metoclopramide, etc.);
  • immunomodulators (imunofan, polyoxidonium, sodium nucleinate, licopid, timoptin, etc.).

After relief of inflammation in the case of calculous cholecystitis, some patients try to dissolve the stones with the help of medicines. For this, doctors prescribe them with ursodeoxycholic or chenodeoxycholic acid (ursofalk, henofalk, urdox, ursosan, etc.). It is better not to take these drugs on their own, as they can be effective in only 20% of patients. There are certain clear indications for their reception which can be determined only by a qualified specialist. For each patient, the optimal dose of medication is set individually. They should be taken long enough (about a year) and regularly. The treatment is carried out under medical and laboratory control (periodically it is necessary to determine the biochemical parameters of the blood, perform an ultrasound). Self-treatment is fraught with the development of pancreatitis (inflammation of the pancreas), blockage of the biliary tract, intense pain, severe diarrhea.

In the remission phase of cholecystitis without stones, patients can begin a course of choleretic drugs. But for this it is advisable to have information about the type of functional disorders. The arsenal of modern cholagogue is extremely rich. Patients are recommended Hofitol, Odeston, Oxafenamide, Pumpkin, Cholensim, Nicodean, Hepatophilic, Milk Thistle, Tansy, Smoke, Barberry, Tissue Mortar, Salt, Magnesium, Xylitol, etc. If you have proven stones, bonsthene, holgogum, magnesium salts, xylitol, etc. gallbladder) choleretic dangerous.

Extracorporeal lithotripsy (shock-wave)

Stones are destroyed by shock waves generated from special installations. The technique is possible only with cholesterol composition of stones and preserved contractility of the bladder. Often it is combined with medicinal litholytic (preparations of xeno- and ursodeoxycholic acid) therapy, which is needed to eliminate fragments of stones formed as a result of extracorporeal lithotripsy. In the Russian Federation, this technique is used quite rarely.

Surgical treatment of cholecystitis

With the ineffectiveness of these conservative methods, non-functioning bladder, serious acute illness, constant exacerbations, frequent biliary colic, the appearance of complications, treatment can only be operative. Surgeons perform removal of the gallbladder affected by inflammation (cholecystectomy). Depending on the access and method of cholecystectomy is:

  • traditional with a section of the abdominal wall and wide open access (preferable for complicated course, but more traumatic, after it patients recover longer, more postoperative problems compared with the following two types);
  • laparoscopic (considered to be the primary option, access to the bladder is provided by several punctures, the necessary equipment and video camera are inserted through them, it is easier to carry, patients are better rehabilitated and are previously discharged from the clinic);

minicolecystectomy (it differs by a mini-access, whose length is not more than 5 centimeters, is an intermediate method, as there are elements of the "open" technique).

| September 30, 2014 | | 38 957 | Diseases in men
Leave your feedback

Being Beautiful: Can surgery be done during acute cholecystitits due to gallstone stuck at neck? Our doctor advised to wait for 4 to 5 weeks after 5 days of antibiotics?

Jwala jj: Thank you very much. A very informative and inspiring vedio. It makes learning easier and interesting. I have a similiar method of learning with diagrams.your work is just awesome

Nancy Jacobs: This is the best video I have ever seen showing the details of the actual laparoscopic procedure. Unfortunately you stopped right where my problem began. The explain as briefly as I can the clip on the duct came off almost directly after the procedure. It was not detected for seven days nor was it dealt with in hospital for close to two weeks. Bile was basically pouring into my body all this time. What effect did this have on my body? Doctors don’t want to talk about it with me

Raphaëlle Lalonde-Fortin: Armando, you're the man! Thank you for what you do, you give my medical studies another dimension. (From Montreal, Canada) :)