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Chronic cholecystitis


Chronic cholecystitis

Chronic cholecystitis

Chronic cholecystitis is a very common disease of the gallbladder, characterized by inflammation of its walls. The most common cause of this disease is the formation in the lumen of the bile duct stones and infection.

The gallbladder is a hollow organ located near the lower surface of the liver. The main function of the bladder is the accumulation of bile produced by the liver. In the process of digestion, this secret plays a very important role:

  • destroys the pathogenic bacteria that enter the intestine with food;
  • stimulates intestinal peristalsis;
  • promotes fat splitting;
  • participates in the removal of excess cholesterol and toxic substances.

As a result of stone formation, infection and inflammation of the gallbladder wall are gradually destroyed, its ability to accumulate bile decreases more and more. This, of course, always affects the quality of assimilation and processing of food. The entire digestive system of the sick person’s body suffers. According to the data, chronic cholecystitis currently affects up to 20% of the world's population.

Causes of Chronic Cholecystitis

Directly involved in the development of the disease is an infection of a parasitic, viral or bacterial nature. Most often, this is a conditionally pathogenic microflora - that is, microorganisms that are constantly present in the intestines of a healthy person and are involved in digestion: streptococcus, staphylococcus, enterococcus, escherichia, Pseudomonas bacillus and others. this factor is malnutrition.

Less commonly, chronic cholecystitis is caused by pathogenic bacteria - microorganisms that are not in the body of a healthy person and that which enter it from the outside: yeast cells, shigella, typhoid bacillus, paratyphoid bacillus, etc.

In some cases, the cause of cholecystitis are anatomical anomalies of the ducts and gallbladder (compression, bends), as well as a violation of the tone of the biliary tract and their motor functions in the background:

  • endocrine disorders;
  • chronic inflammatory processes in the digestive tract;
  • emotional stress.

The change and composition of bile (dyscholium) is also one of the significant factors in the occurrence of chronic cholecystitis. It occurs because of an excess of cholesterol in food, impaired metabolic processes in the body and dyskinesia (decreased motor function) of the biliary tract and gall bladder. Contribute to the development of these violations:

  • sedentary lifestyle;
  • obesity;
  • unbalanced, high-calorie food;
  • taking certain medications, a side effect of which is the thickening of bile;
  • in women, hormonal changes during pregnancy, oral contraceptives;
  • gallbladder injury;
  • reduced immunity;
  • atherosclerosis of the arteries that supply blood to the gallbladder;
  • the presence of foci of chronic infection in the body;
  • parasitic diseases.

In some cases, inflammation of the gallbladder walls may occur without the participation of pathogenic microflora. This is possible with autoimmune diseases, allergies and atopic dermatitis and is caused by the body's response to allergens of various origins. It has also been observed that chronic cholecystitis affects women more often.

Types of chronic cholecystitis

The disease is characterized by a chronic course and a tendency to alternate exacerbations and remissions. Given their number throughout the year, experts determine the nature of the disease: mild, moderate or severe.

There are 2 main types of chronic cholecystitis:

  • non-calculous (stoneless) - (inflammation of the walls of the gallbladder without the formation of stones);
  • calculous (with the formation of hard stones - stones).

Depending on the course of the disease, 3 forms of the disease are distinguished - sluggish, recurrent and suppurative.

Boneless cholecystitis

Causes of boneless cholecystitis are the stagnation of bile and the change in its composition, as well as the presence of infection. Both of these factors mutually reinforce each other. Stagnation of bile contributes to the penetration of the infection into the gallbladder, and the resulting inflammation of the excretory duct and its walls, in turn, further reinforces this phenomenon. The surface of the walls is gradually destroyed.

However, due to the bacteriostatic properties of bile, pathogenic microflora in the human gallbladder can lead to the development of the disease only if there are factors that weaken the body:

  • mucosal dystrophy;
  • changes in the composition of bile;
  • reduced immunity;
  • abnormal liver function;
  • inflammatory diseases of the duodenum.

The surface of the walls of the gallbladder with a stoneless chronic cholecystitis is gradually destroyed. This process may be accompanied by a violation of the gallbladder tone, and in severe cases by the presence of such comorbidities as pancreatitis , pericholecystitis, reactive hepatitis.

Chronic cholecystitis

Despite the fact that chronic cholecystitis without stones is much more common than gallstone disease, stagnation of bile in any case leads to the appearance of calculus - it is only a matter of time. Contribute to this process changes in the composition of bile and the presence of inflammation.

Bile is made up of bile acids, lipids, pigments and minerals. When the ratio of these components changes, cholesterol entering the body with food precipitates and crystallizes - solid concrements are formed. The reasons for such changes are constant errors in nutrition and some states:

  • excess in food fat, cholesterol, vitamin deficiency;
  • overweight;
  • diabetes;
  • infectious diseases.

The size of the stones can be different - from 1-2 mm to the size of a chicken egg, their number can vary from units to tens and even hundreds. Very varied and the shape of stones.

There are several types of calculous cholecystitis: typical, atypical, esophagalgic, cardialgic and intestinal. The disease can have acute and chronic forms, often accompanied by dysfunction of the gallbladder and the appearance of severe complications, including:

  • violation of the patency of the ducts of the gallbladder;
  • dropsy;
  • hardening;
  • chronic abscess;
  • chronic cholangitis;
  • biliary cirrhosis ;
  • hepatitis;
  • gallbladder cancer.

There are four stages in the development of calculous cholecystitis. The first, pre-stone stage is characterized by thickening of bile and the presence of microliths in the gallbladder. At subsequent stages, the formation of calculus (stage 2), the transition of the disease to chronic (stage 3) and the emergence of complications (stage 4).

Symptoms of chronic cholecystitis

The main symptom of chronic cholecystitis is pain in the right hypochondrium - prolonged or episodic, radiating to the scapula and right shoulder. It can spread to a fairly wide area of ​​the chest and back. Sometimes pain is accompanied by weakness, cardialgia, fever and other symptoms:

  • stomach ache;
  • nausea, vomiting;
  • flatulence, heaviness in the abdominal cavity;
  • chronic constipation or diarrhea (diarrhea);
  • metallic, bitter taste in the mouth.

Outside of exacerbations, the patient from time to time experience a dull pain in the epigastric region and in the right hypochondrium. During exacerbations, the symptoms of chronic cholecystitis are similar to the symptoms of the acute form of the disease, therefore relapse is treated and treated accordingly.

Course of the disease

Chronic cholecystitis most often appears as an independent disease (primary), especially if there are factors contributing to its development. It also happens that it occurs after the manifestations of acute cholecystitis - inflammation of the walls of the gallbladder (secondary). The reason for it are:

  • infection,
  • blockage of the duct stone.

After episodes of acute inflammation, the normal functioning of the gallbladder deteriorates - it becomes dense, compressed and loses its ability to preserve bile, which ultimately leads to a chronic course of the disease.

Chronic cholecystitis occurs for a long time, for many years. If adequate treatment was prescribed in time, a long-term remission of the disease can be achieved, otherwise it leads to wrinkling of the gallbladder and, accordingly, the loss of its functions.

Clinical options

Experts identify several different clinical variants of the disease, characterized by the course and symptoms:

  • cardiac - characterized by a violation of heart rhythm;
  • low-grade - prolonged rise in body temperature to 37-38 degrees, chills, signs of intoxication;
  • arthritic pain in the joints;
  • hypothalamic - increased blood pressure, tachycardia , weakness, angina pectoris , hyperhidrosis;
  • neurasthenic - vegetative dystonia, malaise, insomnia, irritability.

In some cases, there may be some yellowness of the mucous membranes and skin of the patient, muscle tension in the right hypochondrium, pain in the liver, gallbladder, their increase.

Diagnosis of chronic cholecystitis

In the diagnosis of the disease, the main role is played by duodenal sounding and ultrasound. Probing allows to obtain bile, intestinal and pancreatic juice for cytological and bacterial studies. Ultrasonography also makes it possible to determine the size of the gallbladder, the condition of its walls, to reveal the presence of stones and other structures.

After examination and examination by a gastroenterologist and a surgeon, mandatory laboratory tests are also carried out:

  • general urine analysis;
  • blood test (total, bilirubin, liver fragments, cholesterol, protein content);
  • feces analysis.

If necessary, additional studies are conducted, such as tomography, X-ray and radioisotope studies.

Treatment of stoneless chronic cholecystitis

Treatment of chronic cholecystitis complex. It includes:

  • antibiotic therapy;
  • diet;
  • choleretic and antispasmodic drugs;
  • physiotherapy;
  • herbal medicine.

On an outpatient basis, the treatment of chronic cholecystitis is possible in the case of a mild course of the disease, but during the period of pronounced exacerbations the patient must be in the hospital. The first goal is to arrest the pain and relieve the inflammatory process. After achieving the desired effect to normalize the functions of education, the secretion of bile and its promotion along the bile ducts, the doctor prescribes biliary and spasmolytic agents.

Medicinal plants - herbal medicine - are also widely used in the treatment of chronic cholecystitis. Their use in the form of decoctions and infusions of choleretic charges allows you to enhance and prolong the effect of drugs taken by the patient.

Treatment of calculous cholecystitis

In the treatment of calculous cholecystitis, conservative therapy is ineffective. Therefore, the main method of treatment in this case is the removal of the gallbladder along with concrements surgically - cholystectomy. Currently, this is increasingly used laparoscopy - an operation performed using video equipment and special tools inserted into the abdominal cavity through small holes (up to 1 cm). This method has important advantages: the absence of traces on the skin, a short postoperative period (3-4 days) and, accordingly, a quick return to normal life. In the vast majority of cases, cholectectomy can get rid of the disease.

Diet for chronic cholecystitis

In chronic cholecystitis, fractional diet is indicated (4-5 times a day), in small portions. For improved secretion, food intake should take place at about the same time. Daily drinking ration is 2-2.5 liters of liquid. Food temperature should not exceed 60 ° C, and not be less than 15 ° C. The daily salt intake rate is not more than 8-10 grams.

The diet of a patient suffering from chronic pancreatitis should include flour products (stale wheat bread, biscuits, white crackers), cottage cheese and cereal casseroles. Low-fat meats (boiled or baked), vegetable, dairy and cereal soups, marmalade, non-chocolates, low-fat and spicy cheeses, eggs (no more than 1 per day), dairy products, fresh fruits and vegetables are allowed.

Products prohibited in cholecystitis

  • Sweet, puff pastry, fresh and rye bread;
  • Fatty meats;
  • Broths (mushroom, meat, fish);
  • Fatty fish, fish roe and canned fish;
  • Offal;
  • Pasta, beans, millet, crumbly porridge;
  • Spicy, salty and fatty cheese;
  • High fat dairy products;
  • Marinated, salted and pickled vegetables;
  • Radish, radish, cabbage, spinach, mushrooms, garlic, onions, sorrel;
  • Spices;
  • Smoked meat;
  • Fried foods;
  • Cold and carbonated drinks;
  • Coffee, cocoa;
  • Ice cream, cream products;
  • Chocolate;
  • Sour fruit.

| 20 December 2014 | | 9 745 | Diseases of the digestive tract