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Acute cholecystitis


Acute cholecystitis Cholecystitis refers to inflammation of the gallbladder, and any inflammation is nothing more than an attempt by the body to protect itself by removing damaged cells, irritating substances and disease-causing microbes from a diseased organ or tissue. Inflammation does not mean infection, even if it is present. Infection is caused by viruses, bacteria, fungi, etc., and inflammation is the body’s response to infection and an attempt to self-cure. Any inflammatory process is part of the immune response. At the onset of the disease, this helps a great deal to the body, but in the future such an effect as “inflammation caused by inflammation” may occur, that is, the inflammatory reaction replicates itself, and this should already cause concern.

The gallbladder is a small pear-shaped organ that is tightly attached to the liver. It is located on the right side of the abdomen. The cavity of the gallbladder is filled with bile, which it releases into the small intestine in order to help the intestines digest fats.

In 95 cases out of 100 acute cholecystitis is caused by the presence of gallstones.

Stones in the gallbladder - solid formations that form in the gallbladder or its ducts. Chemical analysis of the data of the formations shows that they consist of cholesterol, calcium and calcium carbonate. Stones can be many or few. Their sizes also vary.

People who have gallstones are prohibited from bobbing and taking choleretic drugs, since these procedures, together with the bile, can move the gallstone, and passing even a small gallstone through the bile duct is comparable to pushing a ping-pong ball into a straw. It is clear that such a condition causes unbearable pain.
Most people who have gallstones have no symptoms, and they live for years and even decades without even knowing about their problems. But sooner or later, a quiet life will end, because even immobilized gallstones inevitably lead to the emergence of acute cholecystitis.

Causes of Gallstones

Scientists physicians can not say for sure why a chemical imbalance occurred in the body of a person, which caused the formation of gallstones and the constant exacerbation of cholecystitis. However, the general characteristics by which it can be determined whether a person has a predisposition for gallstone disease are still available, and these are:

  • Excess weight (especially in women). It is noticed that the woman’s waist is thicker, the more chances she has for cholelithiasis and acute cholecystitis. Obese children are at risk and may occasionally suffer from exacerbation of cholecystitis, while children with normal weight almost never complain of pain in the right hypochondrium.
  • Pregnancy If a woman was at least once pregnant, she also falls into the risk group.
  • Diets Gallstones - a complication of rapid weight loss and the habits of constantly losing weight and getting better.
  • Pregnancy Protection . At risk of women taking oral contraceptives and undergoing estrogen therapy in high doses.
  • Heredity . Genetic predisposition to gallstone disease and as a result, to exacerbations of cholecystitis.
  • Improper nutrition . Fat food lovers often suffer from gallstones and acute cholecystitis.
  • Paul Women get sick more often than men.
  • Age. People over 60 are more likely than young people to suffer from gallbladder disease.
  • Increased sugar. Diabetics are prone to gallstones.
  • Taking some medication . Sometimes acute cholecystitis cause drugs that lower cholesterol in the blood.

Other causes of acute cholecystitis

In addition to gallstone disease, the cause of the development of acute cholecystitis may be:

  1. Abdominal trauma.
  2. Abdominal surgery.
  3. Tumor. Many people do not know that acute cholecystitis is caused by a tumor, a neoplasm that can be solid or filled with liquid. The word "tumor" does not mean cancer. Tumors are benign, precancerous, cancerous.

Benign tumors do not harm the health of "silence", but if they put pressure on nerves or blood vessels, other, very unpleasant changes in the body occur. Thus, even a benign tumor can stop the flow of bile from the gallbladder and thus cause an attack of acute cholecystitis.

Risk factors

A risk factor is a condition or situation in which the risk of developing a disease increases.

Crohn's disease

One of the main risk factors for the development of acute cholecystitis is Crohn's disease - a permanent condition in which the gastrointestinal tract is constantly inflamed. Crohn's disease can affect any part of the intestine, up to the anus. People suffering from this disease have constant fatigue, frequent diarrhea, discomfort, and abdominal pain.

About one fifth of the patients have close relatives with such a disease. From this we can conclude that Crohn's disease can be inherited. In addition to genetic predisposition, Crohn's disease is caused by an inappropriate response of a person’s immune system to certain foods and especially medications, as well as this disease is triggered by a poor environment.

The symptoms of Crohn's disease depend on which part of the intestine is affected. With the defeat of the walls of the intestines is usually marked:

  • pain at the level of the right lower abdomen;
  • ulcers in the intestines, which sometimes bleed and it is the blood in the feces that the patient understands that something is wrong with his intestines;
  • mouth ulcers;
  • diarrhea - can be both mild and severe. Sometimes mucus, blood, pus are visible in the feces;
  • false urge to stool;
  • fatigue is a familiar feeling for patients with Crohn's disease;
  • loss of appetite;
  • weight loss due to poor appetite;
  • anemia (associated with anal fissures). Bleeding from the rectum and anal fissures are not so dangerous, as blood is usually not lost much, but the fissures themselves are very painful and bring many unpleasant hours to patients.


Another risk factor for acute cholecystitis is obesity. Despite the fact that everyone reads and writes about obesity and everything, most people do not even understand what it is and do not know what obesity is, which is not visually visible. To determine the presence or absence of excess weight, several factors should be correlated, such as age, muscle-fat ratio, height, sex, and bone density.

According to these indicators, it sometimes turns out that the ideal weight of two people of the same height can vary greatly.

However, one thing is undeniable, excess weight is dangerous to health.

Physical work during pregnancy

This risk factor is not as rare as one might think. Pregnant women are often forced to work physically. However, such loads damage the gallbladder, and acute cholecystitis may develop within a few weeks after delivery.

Symptoms of acute cholecystitis

  • Pain localized under the right lower edge of the ribs.
  • Aching that spreads through the lower back.
  • Can hurt the right shoulder.
  • The person becomes sick and sometimes vomits.
  • Increased sweating back.
  • Anxiety.

The patient's condition worsens if biliary colic is added to the inflammation of the gallbladder. This happens only in one case, when the gallstone falls into the bile duct, and through it into the duodenal ducts.

To provoke such a situation can receive fatty foods - the pain begins two hours after eating. It can be continuous, within 24 hours, or paroxysmal.
It happens that acute cholecystitis is accompanied by infection of gallstones. At the same time the patient is in a fever, and he constantly trembles. The vast majority of cases of acute cholecystitis, complicated by infection of gallstones, ends with an operation during which these stones are removed.

Diagnosis of acute cholecystitis

Very often, a preliminary diagnosis of acute cholecystitis is made by ambulance doctors. This is due to the fact that the disease begins suddenly and proceeds very rapidly. Usually, the relatives of the patient call an ambulance, and after taking anamnesis and palpation examinations, doctors understand the misfortune they are dealing with.

Then, regardless of whether the patient is sent to the hospital or stays at home (very rarely), a number of diagnostic procedures are prescribed.

Blood test

Through a general analysis, the number of leukocytes in the blood is determined. An increased white blood cell count indicates the presence of inflammation in the body, and if there is still a high level of bilirubin and alkaline phosphatase, this is clear evidence of a “benefit” for acute cholecystitis.

Computed tomography (CT) or ultrasound

This test allows the doctor to see how the gallbladder looks at the time of illness, and whether there are ulcers, tumors, etc. on its walls.

Hida scan  

This test allows you to examine the liver, gallbladder, biliary tract and small intestine. The doctor is able to track the production and flow of bile from the liver to the small intestine, as well as determine if there is a blockage, and if so, where it is.

Treatment of acute cholecystitis  

Immediately after the diagnosis, the patient will be advised for some time not to eat not only solid but also liquid food. The organism will be “fed” with intravenous drip infusions.

From medicines prescribed analgesics and antibiotics. There are never any problems with analgesics, the patient and his relatives understand that once a person has something to hurt, you must remove the pain by giving him an injection. Another thing when it comes to antibiotics.

Once, at the dawn of the "era of antibiotics," these dosage forms were prescribed and enthusiastically taken at the slightest manifestation of inflammation. In recent years, another trend has gone - people do not want to take antibiotics, rightly believing that this leads to a decrease in immunity and to other problems in the body. This opinion is partly correct, but there are times when these medicines, when used correctly, save lives.

The word "antibiotic" can be deciphered as: "against bacteria." That is a medicine that destroys or slows the growth of bacteria. It is clear that this is a very powerful medical tool, and it should be administered when the body’s natural defenses are not enough to cope with the infection. Just such a disease is acute cholecystitis.  

How is antibiotic treatment prescribed for acute cholecystitis?

Patients with acute cholecystitis are prescribed antibiotics either orally (by mouth) or by injection. In most cases, the effect is visible within a few hours after the start of treatment. However, even with an improvement on the second day, the course of antibiotics should be completed. If this is not done, if anti-bacterial medication is needed in the future, it is highly likely that they will not act.

It is especially important to remember that these drugs should be taken exactly as prescribed by a doctor. If the doctor prescribes the drug one hour before meals or two hours after meals, this is how it should be done. Some antibiotics should not be taken with any food (for example, tetracycline and dairy products are incompatible) - these rules should not be ignored, otherwise cholecystitis will worsen even more.

Side effects of acute cholecystitis treatment with antibiotics:  

  1. Diarrhea. Improper use of antibiotics causes an increase in the sugar content in the intestines. Bacteria are fixed in the intestines and "thrive" on sugar. As a result, a person has persistent diarrhea.
  2. Fungal infection of the mouth, digestive tract and vagina. In the mouth, in the digestive tract and in the vagina, live “good” bacteria that a person needs, and during antibacterial treatment they also die, and fungus “comes” in their place.

Surgical treatment of cholecystitis

Once exacerbated, cholecystitis will worsen again and again. Therefore, sooner or later, doctors recommend surgical removal of the gallbladder. If acute cholecystitis is worsened by perforation of the gallbladder, then the operation is carried out urgently.

Usually, after the resection of the gallbladder, there is no deterioration in the quality of life, it is possible that episodes of diarrhea will sometimes occur (as without the gallbladder, bile from the liver immediately flows into the rectum), but no more. The main thing is that a person does not indulge in excesses in drinking and eating.

Diet for acute cholecystitis

In acute inflammation of the gallbladder, accompanied by intense pain in the right hypochondrium and other negative symptoms, the patient is given a fasting diet for the first 2 days, which allows to reduce the pronounced inflammatory symptoms. During this period warm drinks are allowed, in small portions, 2-3 cups a day (broth of hips, weak sweet tea, sweet fruit and berry juices diluted with water).

In the next two days, ground food (mucous rice, semolina or oat soups and porridge, mousses, jellies, skim milk and compotes) is introduced into the diet. All products can be consumed in small portions, 6 times a day. To enhance the flow of bile, the patient is given plenty of drink (2-2.5 liters of fluid each).

After 3-4 days, the patient is transferred to the diet number 5-in (ground food without salt). It includes cottage cheese, steamed fish and meat of low-fat varieties, wheat crackers, mashed potatoes and carrots, steam omelette, low-fat kefir.

After 5-10 days, diet No. 5-a is prescribed, and after relief of pain, diet No. 5.

Possible complications of acute cholecystitis

If untreated, acute cholecystitis can lead to:

  • fistula (pathological channels between the gallbladder and duodenum);
  • biliary peritonitis (the flow of bile into the abdominal cavity);
  • perforation of the gallbladder (rupture of the walls of the gallbladder);
  • gangrene of the gallbladder (impaired blood circulation in the walls of the gallbladder, and as a result of this, the dying off of the wall sections);
  • abscess of the gallbladder (boil on the wall of the gallbladder).

Prevention of cholecystitis

Acute cholecystitis will never develop if:

  1. Eat regularly, three times a day, at the same time.
  2. Lead an active lifestyle, and thus hinder the development of gallstones. It does not have to be a sport, you can do simple exercises five times a week for 30 minutes.
  3. Never lose weight fast. Rapid weight loss is harmful to the gallbladder and provokes the formation of gallstones. You should lose weight slowly!
  4. Maintain normal body weight. The closer the weight to the ideal, the less the risk of developing acute cholecystitis.

| 5 December 2014 | | 3,078 | Diseases of the digestive tract