Chronic cholecystitis: causes, symptoms and treatment. Penetrating into bile in fairly high concentrations

Many patients suffering from liver and gallbladder diseases have a diagnosis of “chronic cholecystitis” in their medical records. What is it? What are they? Information about a common disease will be useful to many.

Causes, symptoms, types, features of the course chronic cholecystitis. How to prevent relapses? Effective methods treatment of inflammation in the gallbladder

Sluggish inflammatory process affects the gallbladder. Pathology during periods of remission does not particularly annoy the patient; the person often does not realize that the digestive organs are in serious danger.

Despite rare attacks, gallbladder damage is quite serious:

the outflow of bile is disrupted, the biochemical composition of the fluid changes;
cells cope poorly with the load, food digestion occurs more slowly than expected;
a sluggish inflammatory process causes degeneration of the walls of the gallbladder and inhibits immune mechanisms;
improper operation of an element of the digestive system worsens the general condition of the patient.

In the absence of competent therapy, untimely treatment for medical care damage to the inflamed walls of the gallbladder is so severe that the problem organ has to be removed.

Many people do not think about what kind of disease this is and do not know who is at risk.

Important! Reluctance to study the problem deeper is one of the factors that explains a late visit to the doctor with an advanced form of pathology. There is a lot of information about acute and chronic cholecystitis not only in print media, but also on the Internet. Most often, severe forms of pathologies develop due to the patient’s fault, due to inattention to the body’s signals.

Classification

According to the nature of the course, three forms of chronic cholecystitis are distinguished:

sluggish;
purulent-ulcerative;
recurrent.

By severity:

light. Exacerbations are recorded once or twice throughout the year, colic occurs up to four times during the same period;
average. Relapses were noted three to four times a year, five or six times within 12 months the patient suffered from biliary colic;
heavy. Pronounced symptoms with the development of biliary colic are recorded in the patient 6 or more times per year.

By the presence of stones in the bladder itself and bile ducts are distinguished:

calculous form chronic pathology;
without cholelithiasis or acalculous form of the disease.

Causes

Inflammation of the walls of the gallbladder develops under the influence of negative factors:

During the period of remission, the disease occurs with “blurred” signs; during exacerbation, the symptoms of the inflammatory process become brighter.

The slowly progressing disease negatively affects the digestion process, and the motor function of the gallbladder deteriorates.

Recognize chronic cholecystitispossible based on the following criteria:

mild aching sensations in the right side. After drinking alcohol, overeating, or carrying heavy objects, the pain intensifies;
dry mouth. The unpleasant sensation is strongest in the morning, after waking up;
poor digestion. With a lack of bile, incorrect biochemical composition liquids for breaking down food problems arise. The lack of a sufficient volume of bile in the duodenum provokes heaviness in the stomach, diarrhea or constipation, nausea, and bloating;
bitter taste in the mouth. A characteristic symptom of cholecystitis often occurs on an “empty” stomach. Often negative symptoms develops during meals or at the end of a meal;
deterioration general condition. A sluggish inflammatory process causes an increase in subfertile temperature, weakness appears against the background of weakened immunity, chronic fatigue. Often the appetite disappears, the feeling of a “stone” in the stomach worsens the mood, irritation and nervous tension increase.

How to treat

For diseases gastrointestinal tract, problems with the outflow of bile, the patient is registered with a gastroenterologist.

Regular visits to the doctor allow you to adjust the maintenance therapy regimen, quickly respond to signs of exacerbations, and prevent relapses.

At the first appointment, the gastroenterologist will talk about the course of cholecystitis and advise how to avoid frequent exacerbations.

The patient’s discipline regarding treatment issues and following the doctor’s recommendations are prerequisites for successful therapy chronic cholecystitis.

Basic principles of therapy:

Identification of negative factors that provoke relapses. If the patient knows for what reasons exacerbations most often occur, but does nothing to eliminate them, therapy will not bring noticeable results, and the condition of the gallbladder will worsen.
for a “softer” effect on the liver and gall bladder. The more accurately the patient follows the rules, the less the load on the weakened organ. The disease does not forgive deviations from dietary norms; the weakened organ reacts sensitively to smoked mackerel or pork ribs with mustard and garlic.
Refusal of high physical activity. It is important to remember: carrying loads, active training, and hard physical labor are harmful to a diseased liver and weakened gall bladder.
prescribed by the attending physician to stabilize the condition of the bile ducts. It is important to avoid uncontrolled use of medications.
Regular ultrasound examinations abdominal organs, blood test “for the liver complex” for timely detection serious deviations from the norm. Constant monitoring of the condition of diseased organs, clarification of questions regarding diet, work schedule, and medication intake from the attending physician.
Usage folk recipes: herbal decoctions, medicinal teas. The use of natural raw materials is carried out only on the recommendation of a gastroenterologist: some herbs have a negative effect on the liver and gall bladder if the components of the collection are dosed incorrectly.

Diet

Nutrition rules:

frequent meals (up to six times a day);
portions are small;
heat treatment of dishes: steaming, stewing, baking;
dishes are served only warm;
food should be soft, without large pieces;
Suitable mineral water is required (the name will be indicated by the doctor);
fasting and strict diets for weight loss are unacceptable;
more vegetables fermented milk products, plant food, dietary meat(chicken, turkey);
By-products, animal fats, fatty fish and meats, alcohol, baked goods, smoked foods, and excess salt are not recommended.

Information for patients! It is important to understand that such a difficult-to-treat disease can only be controlled by following the nutritional principles outlined by the gastroenterologist. Violation of the diet is fraught with complications and deterioration in well-being.

Drug treatment

Maintenance therapy for remission includes several groups of drugs:

choleretic drugs;
enzymes that improve food digestion;
non-steroidal anti-inflammatory compounds;
antibiotics, antiviral drugs(depending on the type of pathogen identified).

Folk recipes

Home remedies based on medicinal herbs will help reduce the likelihood of exacerbations and improve the process of breaking down food.

The attending physician will tell you which medicinal plants have a choleretic effect, and what tea to drink to relieve inflammation.

Medicinal plants for chronic cholecystitis:

. For 500 ml hot water you will need 2 tbsp. l. dry fruits. Boil for 5 minutes, leave for half an hour, drink three times before meals (15 minutes);
tansy flowers. You will need a glass of boiling water + 1 tsp. vegetable raw materials + thermos. After 45 minutes, the infusion is ready. Accept healing agent a third of an hour before meals, take a tablespoon;
choleretic collection. St. John's wort - 10 g, immortelle - 15 g, half a liter of boiling water. Simmer over low heat for 5 minutes, strain the infused product after 15 minutes, drink a quarter glass a third of an hour before breakfast, lunch and dinner;
mint leaves. For 200 ml of boiling water - a teaspoon of aromatic plant material. In a thermos, the infusion is ready in 30 minutes. The optimal volume for one dose is half a glass, frequency is twice a day.

Important! Do-it-yourself when selecting teas and infusions for chronic cholecystitis is unacceptable: one incorrect component in the collection - and instead of a positive effect, the patient will get diarrhea or bloating.

It is easy to understand that this disease significantly worsens the patient’s general condition.

Refusal of an abundance of fatty and fried foods, control health conditions, treatment of bacterial and viral infections– mandatory measures to prevent inflammatory processes in the gallbladder.

Chronic cholecystitis is characterized by a long course, and it can develop after several cases acute form diseases, and independently.

Proper and timely treatment allows you to achieve stable remission, and its absence over time contributes to the complete loss of the gallbladder’s functions. I will discuss in detail below what chronic cholecystitis is, its symptoms and treatment.

Chronic cholecystitis - what is it?

gallbladder photo

Chronic cholecystitis is an inflammatory process in the walls of the gallbladder. This organ is located near the liver and is a reservoir for bile, which then passes into the small intestine to digest food. Normally, its outflow occurs regularly and unhindered, but if this process is disrupted, then its accumulation provokes thickening and inflammation of the walls of the bladder.

The main causes of chronic cholecystitis are infection and bile stagnation. These factors are interrelated and the first impetus for the formation of pathology can be any of them. The accumulation of bile secretion increases the risk of infection, and infection and inflammation, in turn, contribute to the narrowing of the excretory duct and slower release of bile into the intestine.

The following factors can provoke inflammation:

overweight and obesity, when the cholesterol content in bile is increased, and this is one of the reasons for the development of cholelithiasis;
starvation;
hereditary predisposition;
pregnancy;
acceptance of funds hormonal contraception, antibiotics, for example, Ceftriaxone, and other drugs (Octreotide, Clofibrate);
rare meals (1-2 times a day).

The risk of cholecystitis is increased in the elderly, senile age and when infected with helminths living in the gallbladder and its duct (roundworms, lamblia). In women, the disease is diagnosed more often than in men, since female sex hormones affect the active production of cholesterol.

Chronic calculous cholecystitis is a pathology in which inflammation of the gallbladder and cholelithiasis are combined, that is, stones are formed in it and its duct. The pathology is also called cholelithiasis.

Symptoms are constant pain of varying intensity and periods of increased body temperature, followed by short-term normalization.

If the symptoms of chronic calculous cholecystitis do not appear, or biliary colic that occurs once does not recur, then conservative treatment with medications and physiotherapy is prescribed. Its goal is to reduce inflammation, restore bile flow, treat existing pathologies and improve metabolism.

With strong changes in the walls and ducts, the presence of long-formed stones and involvement in pathological process Surgical intervention is prescribed for the nearest organs.

The operation involves removing the gallbladder along with the stones and is performed under general anesthesia.

Symptoms of chronic cholecystitis

The main symptom of chronic cholecystitis is pain in the right hypochondrium; they are characterized by the following features:

Occur and increase after eating fatty or fried foods;
Most often aching, dull and lasting from 2-3 hours to 4-7 weeks or longer;
May radiate up to the shoulder or neck;
The appearance of acute short-term or long-term pain is typical for the stages of exacerbation.

Other symptoms that occur during illness:

vomiting resulting from eating fatty foods;
bitter or metallic taste in the mouth;
deterioration and loss of appetite;
long-term nausea;
stool disorders - diarrhea or constipation;
bloating.

The last two symptoms of chronic cholecystitis are common and indicate concomitant pathologies, for example, pancreatitis or gastritis (impaired functioning of the pancreas or stomach). Long-developing cholecystitis is also manifested by weakness, nervousness, fatigue, decreased immunity and, as a result, frequent colds.

During an exacerbation of chronic cholecystitis, the first symptom that appears is an attack of pain. Appearing suddenly in the area of the right hypochondrium, it can maintain its intensity for a long time.

Increased pain is provoked by sudden movements and pressure on the right side, so during an attack a person tries to take a position that reduces any impact on the painful side.

Following the pain, digestive disorders develop - nausea, vomiting, diarrhea. If there is an acute infectious-inflammatory process in the gallbladder, then these symptoms are accompanied by chills and a significant increase in body temperature - up to 39-40°.

To overcome an exacerbation, bed rest and plenty of fluids into the body are required. In order to reduce pain, it is recommended to take antispasmodics, for example, 1 tablet of No-shpa, Analgin or Ketorol three times a day. While in the hospital, injections of Promedol, Papaverine, Platiphylline or Atropine are used.

In addition to diet and painkillers, the following are used in the treatment of exacerbation of chronic cholecystitis:

Antibiotics wide range actions to combat the infection that caused the inflammation - Erythromycin, Ampicillin or other drugs prescribed by a doctor;
Choleretic medications – Cholenzym, Allohol, Flamin;
Ursosan, which has an immunomodulatory and hepatoprotective effect, is indicated in severe cases when the liver is involved in the inflammatory process.

The duration of therapy is 1 month, while eliminating pain syndrome succeeds within 7-10 days. If drug treatment exacerbation does not have an effect, then it is indicated surgical removal gallbladder.

Diagnostic methods

In a conversation with the patient and when studying the medical history, the doctor draws attention to the reasons that could lead to the development of chronic cholecystitis - pancreatitis and other pathologies. When palpating the right side under the ribs, painful sensations occur.

One of the characteristic ones is the Mussi symptom, or the phrenicus symptom, which is the appearance of pain when pressing on the sternocleidomastoid muscles above both collarbones (see figure).

Laboratory tests reveal:

In the blood - increased erythrocyte sedimentation rate, high activity liver enzymes - alkaline phosphatase, GGTP, AlT and AsT;
In the bile, if there are no stones, there is a low level of bile acids and an increase in the content of lithocholic acid, cholesterol crystals, an increase in bilirubin, protein and free amino acids. Bacteria that cause inflammation are also found in the bile.

Instrumental and hardware methods diagnosis of chronic cholecystitis:

cholegraphy;
scintigraphy;
duodenal intubation;
arteriography;
cholecystography.

Treatment tactics for chronic cholecystitis

Calculous chronic cholecystitis of the gallbladder and non-calculous (acalculous) cholecystitis are treated surgically. severe forms. In other cases it is shown conservative therapy, including:

Antibacterial drugs for the sanitation of inflammation;
Enzyme products - Panzinorm, Mezim, Creon - to normalize digestion;
NSAIDs and antispasmodics to eliminate pain and relieve inflammation;
Drugs that enhance the flow of bile (choleretics) – Lyobil, Allohol, Holosas, corn silk;
Droppers with sodium chloride, glucose to detoxify the body.

In the remission stage of cholecystitis without complications after removing the main symptoms, you can take decoctions of chamomile, peppermint, tansy, dandelion, yarrow, and calendula.

Physiotherapeutic methods include electrophoresis, SMT therapy, reflexology, applications with therapeutic mud, and balneological procedures.

Since calculous chronic cholecystitis is associated with the formation of gallstones, its treatment is carried out through surgery.

If surgery is contraindicated, an alternative method is extracorporeal shock wave lithotripsy, used to crush stones. However, after this procedure, over time it is possible re-education stones.

Diet for chronic cholecystitis

The nature of the diet for chronic cholecystitis provides for a number of restrictions. During the period of remission it is indicated, in the acute stage - and the general principles of nutrition are as follows:

frequent meals in small portions at the same time;
reduce simple carbohydrates to a minimum - sweets, honey, baked goods;
refusal of carbonated drinks, alcohol and coffee in favor of weak tea, compotes, natural juices, herbal infusions, mineral water;
vegetable oils, lean meat, low-fat dairy products, oatmeal and buckwheat porridge, vegetables and fruits are allowed;
Fatty meats and broths, nuts, fried foods, egg yolks, sour cream, cottage cheese and milk with a high percentage of fat, sausage, ice cream;
Acceptable methods of cooking are steaming, boiling and baking.

Which doctors should you contact if you have any suspicions?

If any symptoms similar to cholecystitis appear, especially with acute pain in the right side, you should consult a gastroenterologist as soon as possible.

Otherwise, exacerbation or prolonged course of the chronic form of the disease can lead to serious complications– peritonitis, inflammation of neighboring organs, rupture of the gallbladder, disability and even death.

Timely diagnosis and treatment selected by a specialist allows you to avoid negative consequences.

Today it is considered the most common disease. Chronic cholecystitis occurs in all age groups, but it mainly affects middle-aged people (40-60 years old).

Symptoms of the development of chronic cholecystitis

This is a disease bacterial origin which is accompanied by an inflammatory process. The course of chronic cholecystitis is long and alternates with periods of exacerbation and remission. An exacerbation of the disease occurs when the diet is disrupted. Deterioration of the condition occurs only during the period of exacerbation of the disease.

The main symptoms of the disease: dull pain in the right hypochondrium, bloating in the upper part, itching. A dull aching pain is usually observed after eating (rich, spicy, fried), sometimes reminiscent of biliary colic. Additional dyspeptic and neurological symptoms chronic cholecystitis:

bitterness in the mouth,

belching air,

flatulence,

insomnia,

irritability.

Diagnosis symptoms of chronic cholecystitis

To treat the disease it is necessary to take laboratory tests: feces, urine, blood, ultrasound and x-ray examination. The examination reveals the following symptoms of cholecystitis:

sensitivity or pain in the right hypochondrium, sometimes local protective muscle tension;

specific symptoms cholecystitis arising from diseases of the liver or gall bladder: Ortner, Obraztsova, Kera, Murphy, Mussi and others;

there may be an enlarged liver;

V general analysis blood may be neutrophilic leukocytosis, accelerated ESR;

at ultrasound examination abdominal organs: deformation and/or change in the size of the gallbladder, thickening and/or compaction of its walls, the presence of suspension and/or stones in the bladder cavity;

during duodenal intubation, it may not be possible to take a portion B of gallbladder bile (due to a violation of the gallbladder reflex and the concentration ability of the gallbladder) or this portion will be dark and cloudy;

in the duodenal contents with symptoms of cholecystitis: a lot of mucus, desquamated epithelial cells, leukocytes (especially in the B portion of bile), the pathogen can be identified;

cholecystography: changes in the shape of the gallbladder, possible detection of stones.

By clinical picture Chronic cholecystitis is distinguished by the more well-known in medical practice: dyspeptic, pain, cholestatic, intoxication and asthenovegetative syndromes, which are determined by gallbladder dysfunction and the inflammatory process. With exacerbation of the disease, pain in the right hypochondrium is characteristic. The pain can be paroxysmal and long-lasting, has a wide irradiation that occurs after a diet, psychological stress, physical overload. A physical examination may reveal yellowness of the skin and tenderness in the liver and bladder.

arise the following complications for chronic cholecystitis: hepatitis, pancreatitis, chronic cholangitis. It is not uncommon that the inflammatory process gives rise to the formation of stones in the gallbladder.

Chronic cholecystitis and its manifestations

There are several forms of the disease:

recurrent,

latent,

purulent-ulcerative.

Today there is an alternative classification of the disease:

cardinal type of chronic cholecystitis, which is characterized by a violation heart rate;

arthric, which is expressed by arthralgia;

neurasthenic – manifested by symptoms of neurasthenia;

hypothalamic - it is expressed by paroxysms of tremor, increased blood pressure, pronounced symptoms of tachycardia.

Symptoms of acalculous chronic cholecystitis

Chronic acalculous cholecystitis is an inflammation of the gallbladder mucosa. The disease manifests itself as disturbances of digestive function, pain, and general manifestations of inflammatory processes in the body. The acalculous type of chronic form is classified as a disease of the digestive tract. Women are more likely to suffer from this disease than men.

Chronic acalculous cholecystitis is characterized by severe pain under the right rib, everything is clear at once, but chronic cholecystitis is a rather insidious disease, since the patient can carry a delayed-action mine within himself for many years. Serious problems in the functioning of the stomach, liver and intestines are a consequence of constant inflammation in the body.

The first symptom of the disease is dull aching pain under the right thigh, which usually appear a few hours after a feast that included harmful fried foods, and also, fatty foods and, especially, alcohol. Signs of cholecystitis may also appear the day after a heavy meal. There are several signs that indicate possible problems with the gallbladder, these are: bitterness and metallic taste in the mouth, morning sickness, belching, flatulence, various stool disorders, irritability, insomnia, yellowness of the skin, whites of the eyes, white coating on the tongue.

In chronic acalculous cholecystitis, the mucous membrane of the gallbladder is usually damaged, and microbial flora adheres to the process, as a result of which the outflow of bile is disrupted. According to the severity of the disease, chronic cholecystitis is divided into mild, moderate and severe, and according to the stages of the disease into the stages of exacerbation and remission.

Signs of calculous chronic cholecystitis

This is an inflammation of the gallbladder due to the presence of stones in it. Very often, exacerbation of chronic calculous cholecystitis is observed in women after 40 years of age.

Here are the main symptoms of the disease:

after eating fatty, fried, smoked foods, pain appears in the right hypochondrium. An attack can be triggered after physical exertion, jogging, driving on a bad road (shaking on the road can dislodge a stone in the bile duct);

acute pain may be accompanied by fever, weakness, bitterness in the mouth, vomiting, nausea;

If treatment is not carried out, complications may follow.

How to treat chronic cholecystitis using traditional methods

Treatment of the disease involves:

diet therapy,

drug therapy,

relief of pain syndrome,

antibacterial therapy,

immunomodulatory therapy,

physiotherapy,

hydrotherapy (sanatorium treatment)

Treatment of the disease is carried out under the supervision of a gastroenterologist.

Principles of therapy for chronic cholecystitis:

course of antibiotic treatment;

treatment with antispasmodics;

herbal medicine and traditional methods for the treatment of illness;

compliance with diet and treatment regimen. At severe pain take 1-2 tablets of No-shpa, a tablet of Glycesset or Nitroglycerin under the tongue, in rare cases you can take a tablet of Baralgin.

If the disease is detected bacterial infection, then antibiotics are prescribed: Erythromycin, Rifapicin, Ampicillin. The duration of treatment for chronic cholecystitis is 10-14 days.

The main choleretic agents that can dilute bile: Digestal, Festal, Allochol, Hologon, Nikodin, Tsikvalon.

In case of chronic cholecystitis, it is necessary to adhere to the treatment regimen: cancel all physical activity, stay in bed, and rest. Follow the diet strictly.

If ineffective conservative treatment Chronic cholecystitis, which is complicated by an abdominal abscess and the development of peritonitis, requires emergency surgery. Surgical intervention takes place in the removal of the gallbladder (cholecystectomy), - this is drainage of the bile ducts and abdominal cavity. In the case of chronic cholecystitis caused by gallstones, there is only one treatment option - surgery.

How to treat cholecystitis of this form with myotropic antispasmodics?

If there are contraindications to the use of anticholinergics, and according to some authors, myotropic antispasmodics (prostate adenoma, glaucoma), in order to reduce the hypertonicity of the sphincter of Oddi, you can resort to Eufillina:

24% solution 1-2 ml intramuscularly or 2.4% solution 5-10 ml intravenously [Zimmerman Ya. S., 1987]. For less severe pain syndrome, you can limit yourself to prescribing Theophylline or Eufillina orally 0.15-0.3 g 3 times a day.

However, we must not forget that these drugs can irritate the gastric mucosa and provoke dyspeptic symptoms. If an exacerbation of the disease occurs, short, repeated (5-7 days) courses should be carried out broad spectrum antibiotics or nitrofuran derivatives - Furagin, Furadonin(0.05-0.1 r 3-4 times a day). Drugs of the last group for the prevention of frequently occurring dyspeptic disorders (most often nausea) are best prescribed after or during meals.

The same applies to Gramurin(0.5 g 2 tablets 3 times a day) and Nevigramon(0.5-1 g, 1-2 capsules 3-4 times a day). The course of these drugs in the treatment of chronic cholecystitis is approximately 1.5-2 weeks.

Choleretic drugs in the treatment of chronic cholecystitis

Favorite treatments are choleretic substances and compositions. Despite even the overly widespread use of these remedies, scientific evidence of their medicinal benefits turns out to be more than modest. Sometimes they do more harm than good. Among the routinely used drugs in the treatment of chronic cholecystitis, we name Allohol, Holenzym, Liobil, Flamin, Holagol, Holagon, Holosas.

There is conflicting information in the literature about the methodology for their use. So, according to M.D. Mashkovsky (1983), Allohol, Cholenzym are taken after meals, Liobil - at the end of it, and Oxafenamide, Flamin, Kholagol - Before meals. The theoretical basis for these practical recommendations does not seem obvious. According to Ya. S. Zimmerman (1987), choleretics are divided into 3 groups:

first - drugs for the treatment of chronic cholecystitis containing bile and bile acids (Liobil, Allohol, Cholenzym),

second - synthetic drugs, endowed not only with choleretic, but also with some cholekinetic, bacteriostatic and anti-inflammatory effects (Oxaphranomide),

third - combined formulations (Flamin, liquid extract corn silk, Holosas).

In addition, there are 3 complex drugs for the treatment of chronic cholecystitis: Olimethine, Cholagol, Rosanol, to which, in addition to choleretic, anti-inflammatory and antispasmodic activity is attributed.

Without denying the validity of the above division of choleretic agents, we note the lack of rigorous evidence of their therapeutic effectiveness. The desire to increase the secretion of bile by the liver does not even seem theoretically justified. In fact, the action of these drugs does not affect the inflamed gallbladder, from which it would be desirable to remove the infection and inflammatory products. Cholangitis is mostly associated with impaired patency of the main bile ducts, and in such conditions the use of choleretics is contraindicated. Drawing some parallel with cystitis and pyelitis, we note that diuretics do not occupy a prominent place in their therapy. Noteworthy literature on addiction positive action a number of choleretics from the ability to relieve constipation, which often accompanies biliary pathology.

How to treat chronic cholecystitis with mineral waters?

With regard to cleansing the gallbladder from infection and associated pathological products, there are more reasons to positively evaluate drugs with cholekinetic activity. Some of the beneficial effects can be attributed to this mineral waters at famous drinking resorts. The same applies to the use of Carlsbad salt, barbara, and magnesium sulfate solutions in the treatment of chronic cholecystitis. These drugs can be prescribed systematically several times a day. So, Carlsbad salt is taken 30-45 minutes before meals at the rate of 1 teaspoon per 1 glass warm water. In addition, they are used in the form of probeless tubes, for which highly mineralized mineral waters or 10-20 g (1-1.5 tablespoons) of magnesium sulfate, or Carlsbad salt, diluted in 1-2 glasses of water are used.

At the same time, we once again emphasize that even if cholelithiasis is suspected, the use of cholekinetic drugs is contraindicated. They should not be prescribed when obvious signs exacerbation of the process.

Treatment of chronic calculous cholecystitis

The general principles of therapy for both acalculous and calculous chronic cholecystitis largely coincide. The regimen of patients depends on the severity of exacerbation phenomena. Diet should correspond to table No. 5. For calculous chronic cholecystitis, occurring with hypomotor dyskinesia of the gallbladder, it is advisable to increase food fats to 120 g per day, with half allocated to their plant representatives. In case of calculous cholecystitis, their content in food, on the contrary, is advisable to somewhat limit. The task of diluting bile is achieved by drinking at least 1.5 liters of liquid per day.

We are skeptical about the effectiveness of such proposals, as well as the ability choleretic drugs significantly affect the inflammatory process. During the period of its pronounced exacerbation, their use is rather contraindicated, and when it subsides, then assess the degree of their beneficial effects the course of cholecystitis is not so simple. In any case, the formulaic recommendation of such interventions should not be the focus of therapeutic efforts.

Treatment of chronic calculous cholecystitis largely depends on the absence or presence of stones in the bladder and ducts. In case of choledocholithiasis, the use of all choleretic drugs is generally contraindicated, and in case of cholecysulignase, their cholekinetic representatives should not be prescribed, as they can provoke the migration of stones and aggravate the manifestations of exacerbation of the disease. Unfortunately, in practice these principles are often violated, which is not at all indifferent to the fate of patients.

In case of sufficiently severe pain syndrome, which shows dependence on hyperkinetic disorders, it is appropriate to prescribe peripheral anticholinergics and myotropic antispasmodics, as well as a combination of both.

The treatment period is quite long. Strict adherence to the diet is necessary when the disease is in remission, spicy and fried foods are excluded from the diet, and alcohol consumption is completely eliminated. During the period of exacerbation of the disease, it is necessary to undergo treatment in a hospital under the supervision of a specialist and prescribe antispasmodic and painkillers, completely exclude food intake and prescribe deintoxication therapy. When this treatment fails positive results, apply surgical treatment by removing the gallbladder and stones. This surgery relieves the patient from the disease.

Causes of chronic cholecystitis

Many people have the misconception that the gallbladder is the source of bile, but this is not the correct opinion. The gallbladder is a kind of reservoir for storing bile, and the bile itself is formed in the liver. Main function bile is the process of digesting fats. Throughout the day, the liver produces one liter of bile, which is stored in the gallbladder and dispersed as needed.

Chronic cholecystitis is characterized by systematic inflammation of the walls of the gallbladder, in which the outflow of bile is disrupted. Women often suffer from the disease, 3-4 times more often than men. It should also be borne in mind that people of asthenic physique are more prone to symptoms of the disease.

It is believed that the main factor in the development of chronic cholecystitis is a violation of the outflow of bile and its stagnation; the disease develops against the background of cholelithiasis. The inflammatory process is often accompanied by impaired motor-evacuation function and contributes to the formation of stones.

Causes of acalculous chronic cholecystitis

The question of the comparative frequency of calculous and acalculous forms of the disease remains controversial. Even 20 years ago, Z. Marzhatka (1967) wrote that “inflammation of the gallbladder develops only as an exception in the absence of stones. There is a lot of talk about non-calculous chronic cholecystitis, but it seems that we are more likely talking about an erroneous interpretation of radiological findings or about a diagnosis made only so that the patient does not remain without a diagnosis. At the same time, some domestic authors even today classify chronic acalculous chronic cholecystitis as a fairly common disease, accounting for 25-30% of all protracted outpatient and clinical cases of cholecystopathy. Our experience contradicts such ideas and allows us to join the opinion of 3. Marzhatka (1967).

Among the causes of chronic cholecystitis of this form, some developmental anomalies are indicated: elongated and tortuous cystic duct, as well as papillitis (odditis) with duodenitis or duodenal ulcer. There is an opinion that the inflammatory process begins from the neck of the bladder (cervical cholecystitis), and then spreads to the entire organ.

For a long time, the idea of giardiasis etiology of a number of acalculous cholecystitis persisted. It has now been established that the main habitat of Giardia is small intestine, and the existence of these protozoa in the biliary tract remains unproven. Hence, the diagnosis of giardia cholecystitis cannot be considered legitimate.

Stagnation of bile in the gallbladder during cholecystitis is influenced by anatomical pathologies in the development of the gallbladder:

duct pathology;

compression of the bile ducts;

kinks of the bile ducts and bladder;

contraction of the gallbladder.

The following factors can be attributed to bile stagnation in chronic acalculous cholecystitis: endocrine disorders, decreased tone of the biliary tract, emotional stress, the effect of the inflammatory process on the organs of the digestive tract.

The outflow of bile is influenced by the following factors: prolapse of the abdominal organs, pregnancy, irregular food intake, sedentary lifestyle.

Causes of calculous chronic cholecystitis

The disease has a more common name – cholelithiasis. The name itself gives reason to think that calculous cholecystitis is the formation of stones in the gall bladder. Statistics on gallstone disease state that overweight women are most often affected. In men, this disease is much less common.

The formation of gallstones is influenced by two main factors of the disease: stagnation of bile and high concentration of salts that disrupt metabolism. These two factors contribute to:

increased hormonal levels,

pregnancy,

pancreatic disease,

obesity,

biliary dyskinesia,

irregular food intake.

These main causes of the disease contribute to the loss of cholesterol crystals in the gallbladder, then the crystals increase in size due to bilirubin and calcium salts. The presence of stones leads to dysfunction of the bladder and ducts, which leads to an inflammatory process. First, the inflammation enters the gallbladder, and then moves to the stomach and duodenum.

Long lasting gallbladder inflammation is called chronic cholecystitis, symptoms and treatment, diet, folk remedies will be discussed in our article.

Causes of development of chronic cholecystitis

Chronic cholecystitis is a form of the disease characterized by periods of remission and exacerbation. The cause of the disease is damage to the walls of the gallbladder, caused by disturbances in the outflow of bile.

The chronic form of cholecystitis happens:

calculous. Stones and sand can block the lumens of the bile ducts, which prevents the outflow of bile. In addition, they injure the mucous membrane of the organ;
non-calculous. In this case, the cause of the disease may be disturbances in the structure of the gallbladder and ducts: kinks, tumors, narrowing, etc. Often the cause of the chronic form of the pathology is irritation of the organ by enzymes coming from the pancreas.

Chronic inflammation can be caused by various microorganisms. Especially often are revealed:

streptococci;
staphylococci;
enterococci;
proteas;
Pseudomonas aeruginosa;
Escheria.

Infection occurs in three ways:

contact;
hematogenous;
lymphogenous.

General The causes of the development of chronic cholecystitis are:

congenital defects of organ structure;
deviations in gallbladder motility, accompanied by bile retention;
gallstone pathology;
helminthic infestation;
errors in nutrition;
alcohol abuse.

Symptoms of chronic cholecystitis

Chronic cholecystitis becomes one of the complex disorders of the gallbladder; the symptoms and treatment of the disease differ from its acute form.

You need to understand that the disease develops gradually, over several months and even years. It is characterized by periods of exacerbation, accompanied by certain symptoms, and remissions that occur after therapy. The more accurately it is observed diet prescribed for the patient, the longer the asymptomatic (remission) period lasts.

Main symptom chronic inflammation of the gallbladder – dull pain felt in the right hypochondrium. The feeling of pain can last for weeks, radiating to right shoulder or the right side of the lumbar region.

The feeling of pain will intensify:

in violation of the diet (eating spicy, fatty foods, drinking carbonated drinks, alcohol);
with hypothermia;
in stressful situations.

Sometimes an exacerbation of the disease can develop as part of premenstrual syndrome.

Symptoms of the chronic form of cholecystitis are:

indigestion;
dyspeptic symptoms – nausea, vomiting;
dull tenderness in the right hypochondrium;
bitterness in the mouth;
long-lasting low-grade fever;
the development of obstructive jaundice is possible.

In some cases, symptoms atypical for the disease may develop. The person may experience pain in the heart area or have trouble swallowing food.

Diagnosis of chronic cholecystitis

The methods used in diagnosing pathology make it possible to identify the factors that provoke its development. For example, bile stagnation, organ defects, etc.

During palpation, the doctor determines positive symptoms characteristic of chronic cholecystitis:

Murphy. Increased pain when pressing on the gallbladder against the background of a deep sigh;
Georgievsky-Mussi. When pressing with a finger on the area (right) between the sternal and clavicular processes, the patient experiences sharp pain in the area of the gallbladder;
Shoffara. Pain in the choledon-pancreatic region.

The patient is prescribed the following laboratory tests:

general blood test. Shows increase in ESR, shift in leukocentral formula;
blood biochemistry. During the study, an increase in the level of liver enzymes is revealed.

Among the instrumental techniques the most effective are:

Ultrasound examination;
cholegraphy;
scintigraphy;
cholecystography;
duodenal sounding.

In some cases, arteriography may be prescribed. The study reveals pathological thickening of the walls of the organ, as well as the proliferation of blood vessels in the adjacent parts of the liver.

Traditional treatment of chronic cholecystitis

Surgical intervention is practiced for the calculous form of the disease, as well as severe non-calculous chronic cholecystitis.

drugs from the antibiotic category. They are necessary for the rehabilitation of the existing source of inflammation;
enzymes necessary to restore the disturbed digestion process - Mezim, Creon and others;
products from the category of antispasmodics and NSAIDs. Used to relieve pain and inflammation;
drugs from the group of choleretics that improve the discharge of bile - Allohol, Lyubiol and others.

Drip administration of sodium chloride and glucose is also prescribed to detoxify the body.

Additionally, the following physiotherapy procedures may be prescribed:

electrophoresis;
therapeutic mud (in the form of applications);
reflexology;
treatment with mineral waters.

Calculous cholecystitis is accompanied by the formation of stones of various sizes in the cavity of the gallbladder. Treatment of this form of pathology is performed only surgically. If there are contraindications to surgery, an alternative procedure is prescribed - shock wave lithortipsy. Method of non-surgical crushing of stones. After removal pathological symptoms Prophylactic treatment with folk remedies is allowed.

Treatment of chronic cholecystitis with folk remedies

Not only acute, but also chronic cholecystitis, the symptoms and treatment of which with classical drugs have already been discussed, lends itself well to unconventional treatment with decoctions and infusions of herbs. Let's Let's get acquainted with traditional methods.

Task traditional medicine– speed up the process of bile formation, make bile less viscous and stimulate its movement.

Prevention of chronic cholecystitis

Prevention of chronic cholecystitis in adults is:

following a diet that limits fried and fatty foods/foods;
treatment of gastrointestinal diseases;
preventing the development of constipation;

Among numerous diseases, chronic cholecystitis is of particular danger; symptoms and treatment, diet, folk remedies - all these are important points that allow you not to miss the disease itself and improve your life, making periods of remission as long as possible.

Cholecystitis is an inflammatory disease of the gallbladder. It is the most common disease of the abdominal organs. Currently, 10-20% of the adult population suffers from cholecystitis, and this disease tends to further increase. This is due to a sedentary lifestyle and diet ( excessive consumption foods rich in animal fats - fatty meat, eggs, butter), height endocrine disorders(obesity, diabetes). Women get sick 4 times more often than men, this is due to taking oral contraceptives, pregnancy.

Among the numerous diseases of the biliary tract, functional disorders (dyskinesia), inflammatory (cholecystitis), and metabolic disorders (cholelithiasis) are distinguished. These conditions are phases of one pathological process: first, a violation of the motility of the gallbladder occurs - dyskinesia, then an inflammatory process joins - acalculous cholecystitis is formed, which over time transforms into cholelithiasis (cholelithiasis).

Causes of cholecystitis: main and additional.

The main reasons include the infectious factor. The infection enters the gallbladder through the blood, lymph and upward path from the intestines.

Primary sources of infection may be:

Additional factors:

1. Biliary dyskinesia. These are functional disorders of the tone and motility of the biliary system (gallbladder and bile ducts). Occurs in any case of chronic cholecystitis, leading to impaired outflow and stagnation of bile.
2. Congenital anomalies development of the gallbladder.
3. Pancreatic reflux. Rejection of duodenal contents into biliary tract. Pancreatic juice with active enzymes causes enzymatic damage to the walls of the gallbladder. Occurs in diseases of the pancreas and duodenum.
4. Impaired blood supply to the gallbladder. Occurs against the background of atherosclerosis, hypertension, diabetes mellitus, lead to a narrowing of the lumen of blood vessels.
5. Violation normal composition bile (discholia). A change in the composition of gallbladder bile and the ratio of its components leads to damage to the wall of the gallbladder. This is facilitated by eating monotonous, fat-rich foods.
6. Allergic and immunological reactions cause inflammatory changes in the wall of the gallbladder.
7. Hereditary factor.
8. Endocrine changes (pregnancy, taking oral contraceptives, obesity, menstrual irregularities).

Additional factors create conditions for the development of inflammation and prepare favorable soil for the introduction of microbial flora.

Symptoms of cholecystitis.

Cholecystitis can be acute or chronic.

Acute cholecystitis

Acute acalculous cholecystitis It is rare, usually proceeds without complications and ends with recovery, sometimes it can become chronic. The disease most often develops in the presence of gallstones and is a complication of cholelithiasis. At the onset of the disease, intense paroxysmal pain in the right hypochondrium, nausea, vomiting, body temperature rises to 38-39 degrees. There may be chills, yellowing of the sclera and skin, stool and gas retention.

For acute calculous cholecystitis typical severe course with the spread of the inflammatory process to surrounding organs and tissues.

Cholecystitis is complicated by liver abscess, local or diffuse peritonitis (inflammation of the bile ducts). In this condition, you should immediately consult a doctor - surgeon, therapist to resolve the issue of hospitalization in a surgical hospital.

Chronic cholecystitis

The disease begins gradually, often in adolescence. Complaints arise under the influence of poor diet and psycho-emotional stress.

The main manifestation of the disease is pain in the right hypochondrium. It can be displaced to the left hypochondrium, the upper half of the abdomen. Non-calculous cholecystitis is accompanied by one or another form of secondary dyskinesia, this often determines the nature of the pain. With concomitant hypomotor dyskinesia, the pain is constant, aching, and not intense. Often the equivalent of pain is a feeling of heaviness or burning in the right hypochondrium. In cases of hyperkinetic dyskinesia, the pain is intense, short-term, and has a paroxysmal nature. The pain radiates to the supraclavicular fossa, to lumbar region, in the subscapular region, the region of the heart.

Cholecystocardial syndrome - includes pain in the heart, palpitations, cardiac arrhythmias, this is associated with an infectious and toxic effect on the heart muscle.

At long term diseases may be involved in the pathological process solar plexus, solar syndrome occurs. Its main symptom is burning, intense pain in the navel area, radiating to the back.

The occurrence and intensification of pain is associated with errors in diet, physical activity, vibration, hypothermia, emotional overload, alcohol consumption.

Nausea and vomiting occur in 30-50% of cases; it is reflexive in nature and is associated with impaired tone of the gallbladder or is caused by concomitant gastroduodenitis or pancreatitis. An admixture of bile is detected in the vomit. Vomiting, like pain, is provoked by alcohol intake and dietary errors.

A feeling of bitterness in the mouth, “bitter” belching - these complaints are most common with inflammation of the gallbladder.

Skin itching, its appearance is associated with impaired bile secretion and is the result of irritation of skin receptors by bile acids accumulated in the blood. Violation of the outflow of bile leads to the short-term appearance of jaundice.

Chills and increased temperature are observed with exacerbation of the inflammatory process in the gallbladder.

Patients often suffer from severe vegetative-vascular dystonia. Painful attacks they are accompanied neurotic syndromes such as weakness, sweating, palpitations, headache, emotional lability(mood instability), sleep disturbance.

For patients suffering from allergies, exacerbation of chronic cholecystitis can cause allergic reactions(urticaria, Quincke's edema).

Women may develop premenstrual tension syndrome. 2-10 days before menstruation, headaches, pastiness of the face, hands, legs, and mood instability appear. During the same period, symptoms of exacerbation of chronic cholecystitis are also observed.

Video about the causes, symptoms and treatment of chronic cholecystitis:

Manifestations of chronic cholecystitis are diverse, they consist of various signs, establish accurate diagnosis and a general practitioner or gastroenterologist can prescribe the necessary set of examinations.

Diagnosis of cholecystitis

Laboratory research:

Mineral waters also have the same effect. Depending on their composition, they can have a stimulating effect on the contractile function of the gallbladder. Mineral waters without gas are taken as prescribed by a doctor 3 times a day, 1 glass 30 minutes - 1.5 hours before meals (depending on the state of stomach secretion) warm or hot (40 - 50 degrees);

Blind probing - tubing, 1 time per week, 3-5 times.

It is carried out in the morning on an empty stomach. Slowly (in small sips) you should drink 150-200 ml of warm (40-45 degrees) mineral water with the addition of 20-25 g of sorbitol or xylitol. Lie on your right side, on your back for an hour. Placed under the right side warm heating pad. After bowel movements, it is recommended to take a shower and rest for 20 minutes. The first meal is 1-1.5 hours after the end of the procedure. This is a glass of tea with honey, cottage cheese.

In the presence of microlites in bile, hypotension of the gallbladder, cholestatic syndrome, bile acid preparations (ursodeoxycholic acid) are used for 1-3 months, under medical supervision.

In order to normalize the biliary function of the liver, hepatoprotectors with choleretic properties are prescribed. Chofitol – hepatoprotector plant origin containing dry aqueous extract from the juice of field artichoke leaves. Take 2 tablets 3 times a day 20 minutes before meals for a month. Gepabene – combination drug of plant origin, containing fumaria extract and dry extract of milk thistle fruits. Take 1 capsule 3 times a day after meals.

Regime and therapeutic nutrition.

During the period of severe exacerbation of cholecystitis, patients are recommended to undergo treatment in a hospital - therapeutic or gastroenterological, adherence to bed rest, and a state of psycho-emotional rest. After liquidation pronounced signs exacerbation, the patient’s regimen is expanded to general.

During an exacerbation, in the first two days, only warm liquids are prescribed (weak sweet tea, fruit and vegetable juices diluted with water, still mineral water) in small portions up to 1.5 liters per day and several crackers. As the pain subsides and the general condition improves, the diet table. Recommend:

Puree soups from vegetables and cereals,
- porridge (oatmeal, rice, semolina, buckwheat),
- jelly, mousse, jelly, low-fat cottage cheese,
- low-fat boiled fish,
- pureed and boiled meat, steamed cutlets (veal, chicken, turkey, rabbit),
- white crackers.

Food is taken in fractional portions 5-6 times a day.

During the period of exacerbation it is recommended to carry out fasting days 1 day a week:
- curd - kefir day. 900g kefir for 6 doses, 300g low-fat cottage cheese for 3 doses and 100g sugar;
- rice-compote. 1.5 liters of compote, prepared from 1.5 kg of fresh or 240 g of dry fruit for 6 servings, rice porridge, cooked in water from 50g of rice - for 3 servings.

After stopping the exacerbation of cholecystitis, a diet is prescribed, table No. 5, which is the main one for this disease.

Patients are recommended:
- milk soups, fruit soups, vegetable soups with cereals, noodles;
- boiled meat, steamed cutlets, meatballs (beef, rabbit, chicken, turkey);
- low-fat varieties sea or river fish, boiled or baked, without crust;
- eggs, up to 1-2 per day – soft-boiled, in the form of steam omelettes;
- dairy products: low-fat milk, cottage cheese, kefir, yogurt, yogurt, butter (limited);
- vegetables boiled, baked, partially raw. Potatoes, beets, carrots, tomatoes, cucumbers, pumpkin, sweet pepper, eggplants, cauliflower, zucchini;
- fruits and berries. Pears, melons, bananas, peaches, apricots, watermelons, sour apples;
- porridge – buckwheat, oatmeal, rice, semolina, with the addition of milk, if tolerated;
- sweet dishes – marshmallows, marmalade, honey, jams, preserves, jelly;
- flour products – wheat and rye bread, yesterday's, white bread crackers, dry, unpalatable cookies.

You need to eat food in small portions, slowly 5-6 times a day. Not recommended long breaks between meals, fasting. Breakfast is required, dinner 2-3 hours before bedtime, not much. The amount of liquid is not limited. Copious amount food, taken once, disrupts the rhythm of bile secretion, causes spasm of the gallbladder and provokes pain.

In case of chronic cholecystitis, it is necessary to increase the consumption of foods that improve the flow of bile and reduce cholesterol levels:

Rich dietary fiber(bran, vegetables, fruits, berries). The bran is pre-steamed and added to dishes, 1-1.5 tablespoons 3 times a day;
- rich in magnesium salts (buckwheat and oatmeal, dried fruits, bran);
- containing essential polyunsaturated fatty acids, phospholipids, vitamin E (corn, olive, sunflower and other oils);
- containing lactic acid bacteria (fermented milk drinks, cottage cheese).

WITH high content fats of animal origin (fried foods, fatty fish, pork, lamb, duck, sausages, smoked meats, mayonnaise, creams, cakes, pastries);
- raw onions, garlic, radishes, sorrel, spinach, mushrooms, bean dishes (peas, beans);
- cold and carbonated drinks, concentrated juices, coffee, cocoa, alcoholic drinks.

Rehabilitation.

Physiotherapy and spa treatment is an important component of comprehensive rehabilitation of patients. Inductothermy and a UHF electric field are used as thermal procedures to correct hypertonicity of the gallbladder and have anti-inflammatory and analgesic effects. The course of treatment is 12-15 procedures, daily. In order to stimulate the emptying of the gallbladder, it is prescribed impulse current low frequency. To reduce dyskinetic phenomena, electrophoresis of 5% novocaine, 2% papaverine is recommended. For normalization functional state nervous system a galvanic collar according to Shcherbakov and electrophoresis with bromine are used. For the same purpose, coniferous, oxygen and carbon dioxide baths are prescribed. Spa treatment indicated no earlier than 2-4 months after an exacerbation of cholecystitis. Patients are sent to balneo-mud resorts: Essentuki, Zheleznovodsk, Truskavets, Morshin.

Complications of cholecystitis.

Complications include: pericholecystitis, pancreatitis, cholangitis, reactive hepatitis, duodenitis.

Pericholecystitis occurs when all walls of the gallbladder are involved in the pathological process and serous membrane(peritoneum). In this condition, the pain syndrome is constant and intense, spreads to the right side, and intensifies when turning and bending the torso.

Cholangitis is an inflammatory process in bile ducts. The main symptom is an increase in temperature to 40 degrees with stunning repeated chills, nausea, vomiting, cramping pain in the right hypochondrium.

If not calculous cholecystitis often other organs are involved in the pathological process digestive system: if along with pain in the right hypochondrium appear painful sensations“girdling” character, loose stools – possible involvement of the pancreas in the pathological process. If the pain spreads to the entire area of the liver and is accompanied by its enlargement - accession reactive hepatitis, the occurrence of late, hungry pains in upper half abdomen indicates the presence of duodenitis.

Complications not only cause loss of ability to work, but also pose a threat to the patient’s life, therefore, when the first symptoms of the disease appear, you should immediately consult a doctor - a therapist or gastroenterologist.

Prevention of cholecystitis.

You should adhere to a long-term diet with limited fatty, fried foods, frequent fractional meals, exclusion of alcoholic and carbonated drinks. Gradual normalization of body weight.

Sanitation of outbreaks chronic infection oral cavity and nasopharynx.

Annual medical examination by a doctor with an ultrasound of the hepatobiliary system.

Consultation with a doctor on cholecystitis

Question: Is it possible to relieve an attack of biliary colic during calculous cholecystitis on your own using folk remedies or medications?
Answer: No, you need to urgently consult a surgeon. At untimely treatment life-threatening complications may develop.

Question: What are the contraindications for blind probing?
Answer: Blind probing is contraindicated in case of cholelithiasis, acute infectious diseases, active hepatitis and cirrhosis of the liver, serious illnesses cardiovascular system. The procedure is not recommended for women during menstruation or pregnancy.

Vostrenkova Irina Nikolaevna, therapist of the highest category