Chronic noncalculous cholecystitis treatment. Noncalculous cholecystitis - what is it?

Chronic noncalculous (calculous) cholecystitis- represents chronic inflammation gallbladder, usually combined with motor-tonic disorders of the biliary system, but not accompanied by the formation of gallstones.

In foreign literature, noncalculous (acute) cholecystitis is usually understood as severe inflammatory disease gallbladder resulting from sepsis, major surgery, severe trauma, sickle cell anemia, diabetes, prolonged fasting, or parenteral nutrition, which leads to stagnation of bile, various vasculitis (SLE, polyarteritis nodosa). Sometimes infectious agents such as salmonella or CMV (in immunocompromised patients) can be detected.

The causes of chronic non-calculous cholecystitis may be opportunistic microbial flora (Escherichia, streptococci, staphylococci, less commonly Proteus, Pseudomonas aeruginosa, enterococci).

The disease manifests itself as pain, disturbances digestive function And general manifestations inflammatory reaction body.

Epidemiology of chronic acalculous cholecystitis
The incidence of chronic acalculous cholecystitis is 6-7 cases per 1000 population. Chronic acalculous cholecystitis occurs much less frequently than is diagnosed, especially in outpatient settings.

According to foreign epidemiological data, chronic acalculous cholecystitis accounts for 5 to 10% of all cases of acute cholecystitis and has a higher mortality rate than calculous cholecystitis.

Women get sick 3-4 times more often than men.

ICD-10 code
K81.8. Other forms of cholecystitis.

Diagnostics

The diagnosis of cholecystitis can be suspected if the patient complains of pain in the right hypochondrium, especially occurring after consuming fatty foods.

Diagnostic methods
- History taking
  When collecting anamnesis special attention attention should be paid to the localization of pain and its connection with the intake of fatty foods. It is also necessary, if possible, to identify the presence of predisposing factors (factors causing bile stagnation, gallbladder dyskinesia).
- Physical examination
  In general, physical examination for chronic non-calculous cholecystitis does not have specific features and does not allow one to confidently differentiate calculous and acalculous lesions of the gallbladder without special methods research.
  - Inspection.
    A characteristic feature of chronic cholecystitis is the presence of a coated, scalloped (with teeth imprints) tongue in patients, which is a reflection of stagnation in the gallbladder.
  - Palpation.
    When palpating the abdomen, there is pain in the projection of the gallbladder (the intersection of the outer edge of the right rectus abdominis muscle with the costal arch), which intensifies with inspiration (Kehr's symptom), as well as when tapping the edge of the palm along the right costal arch (Ortner's symptom). However, these symptoms are not always detected.
    
    With cervical localization of cholecystitis, sometimes with a deep breath it is possible to palpate the bottom of the enlarged gallbladder.
    
    Additional palpation symptoms, sometimes identified in chronic non-calculous cholecystitis:
    - Murphy's symptom - careful, gentle insertion of the hand into the gallbladder area and, with a deep breath, the palpating hand causes sharp pain.
    - Mussi's symptom is pain when pressing on the phrenic nerve between the legs of the sternocleidomastoid muscle on the right.
    - McKenzie's symptom is hyperesthesia of the abdominal skin in the right hypochondrium with the most severe pain in the area of the projection of the gallbladder.
    - Shoffard's symptom - during ventrodorsal bimanual palpation, pain occurs in the projection area of the head of the pancreas and gallbladder (a symptom characteristic of cholecystopancreatitis). The same symptom was described by Zakharyin.
    - Lyakhovitsky's symptom - pain occurs with slight pressure on the right half xiphoid process or when retracting it upward.
    - Kharitonov's symptom is pain on palpation to the right of the spinous process of the IV thoracic vertebra.
    - Jonash's symptom is pain when pressing at the insertion of the right trapezius muscle in the occipital region (in the area of projection of the occipital nerve).

Noncalculous cholecystitis is a pathological condition manifested by impaired motility of the gallbladder and its pathways. May leak into acute form or chronic (with alternating exacerbations and remissions).

The symptoms of this disease significantly worsen the quality of life of patients and cause various complications. This is why mandatory treatment is required.

For this purpose it is used drug therapy, surgery, and alternative treatments. The manifestations of the disease can be reduced by following proper nutrition.

What kind of illness is this

This is a pathology of the gallbladder, in which the organ becomes inflamed and its motor-tonic functions are impaired.

The difference is that with this pathology, stones do not form in the gallbladder. That is why this condition has another name - acalculous cholecystitis.

Experts identify several types of pathology:

Chronic form. In this case, periods of exacerbations and remissions alternate.
Spicy. Characterized by severe symptoms.

Engaged in diagnosis and treatment this state gastroenterologist

Main reasons

Most often, pathology develops if an infection enters the organ. This usually happens if there is an inflammatory process in the intestines. Then infection of the gallbladder occurs through lymph or blood.

These diseases cause pathogenic microorganisms, such as staphylococci, Proteus, Escherichia coli, enterococci, streptococci.

The disease in adults can occur against the background of other digestive ailments, such as:

pancreatitis;
duodenitis;
bile duct dyskinesia;
gastritis;
peptic ulcer;
hepatitis.

There are other reasons for the development of the pathological condition, due to which bile stagnates in the organ and ducts.

These include:

wall deformations;
organ prolapse;
decreased tone;
impaired outflow of bile.

If the patient has an acute form of the disease, then if there is inflammation in the organs digestive system chronic non-calculous cholecystitis begins to develop.

The following factors are identified that provoke the occurrence of a pathological condition:

Diabetes mellitus can provoke the development of pathology. Install exact reason An experienced gastroenterologist will help.

Symptoms of pathology

The main symptom is pain in the right hypochondrium, usually aching in nature. Most often, this syndrome occurs if the day before you consumed fatty or fried food, after experiencing stress or heavy physical activity.

Symptoms that accompany the pathology may be the following:

frequent belching;
periodic nausea;
a feeling of bitterness in the mouth;
bloating;
heartburn.

If the patient has an exacerbation of the disease or the dietary rules have been violated, vomiting with bile may develop. This condition is also characterized by an increase in temperature, general weakness, sleep disorder, headache.

Nonspecific signs may also appear. These include increased heart rate, development of arrhythmia, intestinal colic, constipation and diarrhea.

If you have the symptoms described above, it is important to seek help from a doctor.

Diagnostic methods

A specialist begins identifying a disease by collecting an anamnesis. It is also important to examine the patient, which is based on the Murphy, Shoffard, and Mussi tests. IN mandatory the patient should undergo laboratory tests, namely, donate urine and blood for analysis.

You can find out an accurate diagnosis using the following methods:

scintigraphy;
laparoscopy;
celiacography;
X-ray;
cholegraphy;
duodenal examination.

Experts believe that the most reliable method is ultrasound diagnostics. When interpreting the results, echo signs such as organ size, wall thickness, and motor function are taken into account.

Drug treatment

The choice of treatment regimen depends entirely on the form and course of the disease. If the patient is at the stage of exacerbation of the pathology, then drug therapy is used.

Antibiotics are mandatory to eliminate inflammation and infection in the gallbladder. The following drugs in this group can be used:

Cefazolin;
Clarithrosin;
Ampiox;
Amoxiclav;
Ampicillin.

Drug treatment also includes the use of drugs from the following pharmacological groups:

IN complex treatment also include taking vitamins B and C.

Other measures

Physiotherapeutic procedures are considered auxiliary methods of therapy. They are best carried out during remission. Spa treatment is also effective.

An additional method is also probing using potassium permanganate, sorbitol and mineral water. If organ motility is reduced, tubes with magnesium are used.

In acute and severe forms of the disease, surgical intervention is possible.

Proper nutrition

The diet for acute pathology should be based on the consumption of the following dishes:

egg white omelette;
porridge;
low-fat cottage cheese;
bran;
baked and stewed vegetables;
compote;
jelly.

During remission, the list of dishes expands slightly. The consumption of lean meats and fish is allowed. It is recommended to eat pumpkin, watermelon, sweet pepper, dried fruits, beets, carrots.

The patient needs to remove the following foods from the diet:

smoked meats;
marinades;
pickles;
carbonated drinks;
coffee;
fresh fruits and vegetables;
egg yolks;
confectionery;
fast food;
semi-finished products;
baked goods;
spices and seasonings;
nuts;
alcoholic drinks.

Fatty foods, high-calorie fish and certain types of meat, lard, and oil are also prohibited.

The patient should eat dishes prepared by steaming, stewing and baking. They must be eaten warm.

It is important to keep your meals divided: it is recommended to eat up to six times a day, but in small portions. Overeating or undereating is contraindicated.

Folk remedies

As a supporting and adjuvant therapy at pathological condition folk remedies are used.

To improve the process of bile secretion and relieve inflammatory processes in the organ, it is recommended to take decoctions of such medicinal plants, How:

buckthorn;
licorice;
tansy;
immortelle;
corn silk;
chamomile;
marshmallow;
calendula;
sage.

They can be drunk separately, but are best in collections. During exacerbations, you can take infusions peppermint, valerian, calendula, chamomile and dandelion.

It is important to remember that the use of alternative medicines must be approved by a specialist.

Prevention rules

Disease prevention measures include:

Maintaining proper nutrition.
Moderate physical activity.
Passing preventive examinations.
Rules of personal hygiene.
Refusal to drink alcohol.
Establishing a drinking regime.
Reception medicines only as prescribed by a doctor.

If a person has a history of diseases of the digestive system, then he must adhere to all the instructions of the treating specialist.

Possible complications and prognosis

The outlook for the disease is mostly favorable. However, if the disease is advanced and treatment is ignored, complications such as:

hepatitis;
cholelithiasis;
cholangitis in chronic form;
empyema.

Also, with frequent exacerbations, a bag filled with pus may form in the bladder. In the future, it can break through the wall of the organ (there will be a perforation), which will lead to more dangerous complications.

There are many causes of non-calculous cholecystitis. Treatment depends on the form of the disease and the severity. Proper nutrition in this case, it is both an obligatory part of therapy and a measure to prevent pathology.

Every seventh person per 1000 cases suffers from non-calculous cholecystitis or acalculous cholecystitis. The frequency of diseases in the female half of the population is 4 times higher than the recorded cases in men. The disease affects adults and young people. Presumably, chronic noncalculous cholecystitis is a prerequisite for cholesterol calculosis with the formation of stones.

Description of the disease

Non-calculous cholecystitis develops in the gallbladder in the form of inflammation with changes in the structure and tissues of the organ, in which the following occurs:

compaction and deformation of walls;
thinning of the mucous membrane, which becomes like a mesh;
increase in muscle fibers;
scarring.

If the inflammation goes deeper, adhesions form at the border with neighboring tissues and organs. Other gastrointestinal diseases begin to develop.

There are 3 stages of cholecystitis:

light;
average;
severe.

The disease is characterized by phases:

Exacerbations.
Subsidence of the acute phase.
Persistent or unstable remission.

According to the nature of the flow:

monotone;
recurrent;
variable.

According to the form of the disease, they are distinguished:

typical;
atypical esophageal, intestinal, cardiac form.

Chronic acalculous cholecystitis is diagnosed more often than it occurs. A diagnosis can only be made in an outpatient clinic. According to statistics, the disease accounts for 5-10% of the total number of cases of acute cholecystitis. The chronic acalculous form has a higher mortality rate compared to calculous disease.

Etiology with pathogenesis

The first indicator of the onset of the disease is pain syndrome after eating on the right under the ribs. Feeling dull, constantly aching pain are given to the cervical spine, right shoulder with a spatula. The condition is characterized by nausea with vomiting, a bitter taste in the mouth, which is caused by the outflow of bile into the esophagus and stomach.

The chronic form of acalculous cholecystitis is characterized by stages of exacerbations and remissions, which replace each other.

Before making a diagnosis, the doctor will review the patient's medical history.

The disease is diagnosed based on the patient's medical history, heredity, complaints, examination, and the results of laboratory tests with ultrasound. When palpating the abdominal muscles, the patient feels pain on the right and in the navel area. Yellowness of the integument is not visualized.

It is possible that the temperature may rise to subfebrile levels (37-37.5°C), which persist for a stable period of time. Blood test shows signs inflammatory process: leukocytosis, high ESR, change percentage different types of leukocytes. Ultrasound shows an enlarged gallbladder with thickened walls, its bending, dyskinesia (dysfunction) of the bile ducts with stagnation of bile.

The cause of the pathology is an infection, the causative agents of which are E. coli, staphylococci, enterococci, Proteus or mixed pathogenic flora. The infection enters the organ via the reverse route - from the intestines during dysbacteriosis, enteritis, colitis, chronic pancreatitis and other gastrointestinal pathologies. It is possible that the gallbladder may become infected through the bloodstream or lymph due to inflammation of the appendix, uterine appendages, lungs, gums, or chronic tonsillitis.

The main predisposing factor is bile stasis, which occurs due to dysfunction of the gallbladder and ducts due to:

developmental anomalies (constrictions, kinks, compression);
decreased peristalsis;
endocrine dysfunction;
psycho-emotional stress;
existing inflammatory processes;
prolapse of the peritoneal organs;
sedentary work with prolonged immobility;
rare and plentiful food;
pregnancy.

Symptoms

Nausea and vomiting are characteristic symptoms of the disease.

The disease lasts a long time with attacks and improvements. TO characteristic symptoms include:

aching pain on the right under the ribs, which intensifies after eating eggs, cold, hot, fried, fatty, smoked, carbonated, alcoholic;
nausea with vomiting;
bitter taste with frequent belching.

Atypical symptoms are characterized by:

long, dull painful attack in the area of the projection of the heart after eating;
severe heartburn;
swallowing dysfunction;
bloating in the intestines;
constipation

Attacks may recur with heavy physical activity and severe stress. You may also experience:

arrhythmia with increased heart rate;
painful attacks with diarrhea.

Diagnostics

There are several ways to diagnose a non-calculous disease:

Clinical studies with blood biochemistry, general analysis blood and urine.
Examination of the patient with analysis of the patient's complaints. When examining the oral cavity, a scalloped plaque is detected, which indicates stagnation of bile.
Palpation with assessment of the patient's pain.
Ultrasound examination of the gallbladder.
HIDA scintigraphy on a gamma tomograph using radiopharmaceuticals.
Duodenal examination of the contents of the duodenum, consisting of bile with intestinal, gastric and pancreatic juice.
X-ray examination of the bladder after oral administration contrast agent.
X-ray examination of the bladder after intravenous infusion of contrast.
Classic X-ray examination.

Treatment

In case of severe pain, gross changes in the structure of the gallbladder, a significant reduction in peristalsis, especially if exacerbations occur frequently, it is recommended to treat cholecystitis in a hospital for 10-14 days. Therapeutic objectives:

elimination and prevention of exacerbations;
prevention of inflammation of other organs arising from pathology;
treatment of complications;
pain relief;
stabilization of the functions of the bile and the motility of its canaliculi;
suppression of infection and inflammation in the bladder;
restoration of normal digestive function, impaired biliary system.

Diet is one of the methods of treating the disease.

Treatment methods:

Diet with nutrition optimization. To do this, foods that irritate digestion are excluded, fractional and frequent use food in small portions. This will allow the gall bladder to regularly release bile. Dishes need to be boiled and steamed. It is better to bake vegetables and fruits in the oven. The diet must be followed for a long time.
Drug therapy is based on taking medications: antispasmodics, antibiotics, detoxifiers, enzyme preparations, choleretics, cholecystokinetic agents.

At the stage of remission, which occurs against the background of hypokinesia of the gallbladder, treatment is supplemented by other methods:

The use of blind tubes or gentle lavage of the liver and bile ducts. To do this, prepare a solution of xylitol, sorbitol in a 30% MgSO4 solution or mineral water. Do 6 to 8 tubes every 7 days.
Phytotherapy based on intake herbal decoctions yarrow, marshmallow, tansy, buckthorn, licorice.
Sanatorium-resort treatment in health resort cities.

Acute cholecystitis is a disease that develops in approximately 18% of patients with acute surgical diseases abdominal organs. Moreover, statistics indicate that women suffer from acute cholecystitis 3 times more often than men.

The reasons for the development of acute cholecystitis can be attributed to many factors. These are, in particular, biliary tract hypertension, cholelithiasis, infectious factors in the biliary tract, dietary disorders, decreased immunity, stomach diseases, etc.

According to statistics, in 80% of cases, acute cholecystitis is a complication of cholelithiasis. In this case, stones that have been in the lumen of the gallbladder for a long time lead to disruption of the mucous membrane and contractile function of the gallbladder. Often they clog the mouth of the bladder duct, which causes an inflammatory process to develop.

In 100% of cases, the main factor that begins the development of acute cholecystitis is food. Excessive use fatty and spicy foods lead to intensive education bile. Spasm of the sphincter of Oddi provokes hypertension in the ductal system. Food allergens can also affect the sensitized membrane, which also causes spasm to develop.

There are a number of stomach diseases that can provoke the development of acute cholecystitis. In particular, this chronic gastritis(hypoacid and anacid), which is accompanied by a strong decrease in the amount gastric juice, including hydrochloric acid. Acute cholecystitis also develops against the background of local ischemia of the mucous membrane of the gallbladder and disturbances in the rheological qualities of the blood. The presence of pathogenic microflora is enough for acute destructive cholecystitis to begin to develop.

Chronic cholecystitis is an inflammation of the gallbladder, initially caused by an infectious factor. The disease occurs with alternating periods of remission and exacerbations, in most cases it has a complication in the form of cholelithiasis. Also often in the background chronic cholecystitis pancreatitis develops.

In medicine, calculous and non-calculous forms of cholecystitis are distinguished. The causes of the occurrence and exacerbation of chronic cholecystitis can be varied, but the basis will always be infectious, as well as stagnation of bile with a further change in its physical and chemical properties.

The main factor in the development of chronic cholecystitis is bacterial infection. Microbes get into gallbladder along the bile duct from the duodenum. They can also enter the bloodstream from an inflamed intestine or through the lymphatic tract. Thus, streptococci, staphylococci, and E. coli can become foci of infection in the gallbladder.

Exacerbation of chronic cholecystitis occurs due to stagnation of bile caused by: frequent severe stress, eating disorders, Not sufficient quantity fiber entering the body, physical inactivity, pregnancy, obesity, improper development gallbladder. A large amount of spicy, fried and fatty foods in the diet, allergies, improper metabolism, chronic dehydration - additional reasons exacerbations in chronic cholecystitis.

Causes of cholecystitis

The cause of cholecystitis is an infection that enters the gallbladder most often from the intestines through bile ducts, or can come from other places through the flow of blood and lymph. Some factors can serve as a trigger for the onset of cholecystitis: overweight, fat and junk food, low acidity gastric juice, disruption of the biliary tract, intestinal dysbiosis and constipation.

The most common cause of cholecystitis is cholelithiasis. Gallstones damage the wall of the gallbladder or may obstruct the flow of bile. In more than 60% of patients, an infection is detected in the bile: coli, streptococci, salmonella and others.

The causes of acute cholecystitis may be a blockage of the gallbladder duct, through which bile flows from the bladder. gallstone or exposure to an infectious agent. If drainage function If bile is normal and flows normally, then an infection that has entered the gallbladder does not cause an inflammatory process. Otherwise, inflammation occurs.

Risk factors for cholecystitis may include previous complex operations, acute illnesses, pregnancy, stress, physical activity and overwork.

Symptoms and types of cholecystitis

Nausea, bitterness in the mouth and heaviness in the right hypochondrium are signs of a disease not of the liver, but of the gallbladder. Among the main symptoms of cholecystitis are:

The main symptom of cholecystitis is pain, which can be short-term and intense, occurring with poor diet and stress, if there is a spasm of the biliary tract. Often radiates to the collarbone. The pain can be dull, aching and constant, intensifying with active movements or sports if a person has low blood pressure. In the most severe stages of cholecystitis, pain can immobilize a person.
There is frequent bitterness in the mouth, bitter belching. The patient feels sick, vomits with an admixture of bile, due to unhealthy and unhealthy diet. Patients often complain of sweating, fatigue, insomnia, nervous disorders and irritability.
The patient develops jaundice: the skin and whites of the eyes turn yellow.
In some forms of cholecystitis, stool may be colorless, urine becomes dark in color.
A high temperature rises, a person becomes feverish, and the level of leukocytes in the blood increases as the disease worsens.
The tongue becomes dry, with a yellowish-brown coating, the liver becomes enlarged, and pain occurs in the area of the gallbladder when palpating the abdomen.

Acalculous (non-calculous) cholecystitis

The basis for the development of acalculous cholecystitis is an infection penetrating into the bladder area. The infectious pathogen enters the organ through the blood or lymph flow, descending pathways and other means from organs and systems of the body affected by infections. Cholecystitis almost never occurs as a separate autonomous disease: most often this diagnosis accompanies hepatitis, pancreatitis and other diseases. This explains the fact that most often acalculous cholecystitis takes on a chronic form, and is very rare in the “pure” acute form.

Chronic acalculous cholecystitis can develop as a result of biliary dyskinesia and reflux (reverse reflux) from the biliary tract due to stagnation or thickening of bile. Also, the chronic form of the disease develops after the formation of inflammation of the bladder wall after pancreatic enzymes from the bile duct enter it. This is especially common in liver cirrhosis or cystic pancreatitis. For elderly patients, chronic acalculous cholecystitis is the result of impaired circulation in the wall of the gallbladder due to damage to the vessels supplying it.

Most often, the primary diagnosis can be determined by the following characteristic features:

attacks of dull pain in the right hypochondrium;
pain that occurs 1-2 hours after eating - especially if the patient has eaten fried or fatty foods;
pain attacks that begin after lifting heavy objects, loads, stress;
attacks of nausea, vomiting, heartburn, belching, bitter taste;
vomiting, which brings relief, with overeating or in acute stages.

Atypical forms of acalculous cholecystitis: cardialgic (imitation of pain in the heart, arrhythmia. Occurs after eating while lying down); esophagic (belching, heartburn, chest pain, feeling that food is “stuck” in the esophagus); intestinal (abdominal pain, bloating, diarrhea alternating with constipation).

Acute calculous cholecystitis

Acute calculous cholecystitis is a form of inflammatory disease of the gallbladder, which is characterized by the presence of stones in the organ. One of the types of cholelithiasis. This diagnosis is made in approximately 10% of adult patients, most often over the age threshold of 40 years. At the same time, women get sick more often than men. Sometimes the disease develops in childhood.

Risk group:

women, mainly during pregnancy;
obese patients;
people who have suddenly lost weight;
older and older people.

Acute calculous cholecystitis means a pronounced inflammatory process. It develops due to penetration into the gallbladder infectious agent against the background of disturbances in the natural outflow of bile (due to blockage by stones). Microbial flora can enter the organ through ascending and descending paths(from the duodenum, from the liver), through blood and lymph.

Acute calculous cholecystitis is of three types: catarrhal, phlegmonous, gangrenous. Regardless of the form, the inflammation process is accompanied by pericholecystitis with local or widespread adhesive process, limiting the area of infection only to the right hypochondrium.

Symptoms of calculous cholecystitis in acute form begin with sudden attack biliary colic. This manifests itself in the form acute pain in the area of the right hypochondrium. The pain may radiate to the shoulder or shoulder blade (also on the right). Provoking factors for pain syndrome can be alcohol consumption, poor nutrition, stress. Against the background of an attack of pain, the patient feels nausea. Repeated vomiting begins, bringing no relief. Bile impurities are noticeable in the vomit.

Body temperature may also increase - up to 38-40 degrees Celsius. This is especially true for gangrenous acute calculous cholecystitis. Blood pressure may fall sharply, the patient feels sweetness, breaks out in a cold sweat. In some cases, symptoms of jaundice begin: color changes skin, stool discoloration, etc.

At catarrhal form cholecystitis, pain increases with any sudden movement and any physical activity. Symptoms develop quite rapidly. Upon examination, the doctor may identify the following confirming symptoms of acute calculous cholecystitis: dry tongue, mild bloating, soreness and muscle tension in the area where the gallbladder is projected.

Phlegmonous cholecystitis develops in the presence of a purulent inflammatory process. It is characterized by severe pain, which increases several times when changing body position, breathing, or coughing. General condition worsens, pulse increases, temperature rises, nausea and vomiting begin. Abdominal bloating occurs. Lack of timely treatment will lead to transition to the gangrenous form, which carries the risk of rapid death.

The gangrenous form of acute calculous cholecystitis is associated with partial or complete damage to the gallbladder wall. The form develops on the 3-4th day of acute cholecystitis, left without adequate treatment. The integrity of the organ wall is compromised, and bile can penetrate into the abdominal cavity. This form develops especially often in older people.

Characteristic symptoms - sharp increase body temperature, deterioration of health. The pain in the right hypochondrium may subside, but the discomfort will spread to the entire abdominal area. Without treatment, acute gangrenous calculous cholecystitis leads to painful death.

Chronic calculous cholecystitis

Chronic calculous cholecystitis is an inflammatory disease of the gallbladder. The second name is cholelithiasis (GSD). It is worth considering in more detail the causes of the disease.

All substances that are present in bile are in chemical equilibrium. Any change in composition, provoked by an increase in the concentration of one substance, can lead to the formation of stones: some of the dissolved salts will precipitate and gradually begin to crystallize. Over time, the stones grow. Moving with the flow of bile, they lead to damage to the wall of the gallbladder. The patient feels pain.

The stones may be different sizes, present in the gallbladder in varying quantities, have a smooth or sharp surface. According to statistics, 10% of the adult population of the planet has stones in the gallbladder (and in most cases, women). This problem is very rare in children. If the stones are located in the main duct, this leads to a mechanical blockage of the bile flow. The gallbladder stretches and enlarges slightly. The wall becomes thin, which can cause it to rupture and allow bile to enter the abdominal cavity. This will happen if timely treatment of chronic calculous cholecystitis is not provided.

Calculous cholecystitis in general can occur in both acute and chronic forms. However, the acute form is rarely diagnosed, since it is caused by the presence of a strong infectious factor against the background of asymptomatic calculous cholecystitis.

The chronic form develops over several years. Therefore, the central damaging factor in this form is not infection, but blockage of the duct and a chemical change in the composition of bile. Precursors of the disease:

biliary dyskinesia;
chronic gastritis, viral hepatitis, peptic ulcer, chronic pancreatitis, liver cirrhosis;
obesity, diabetes mellitus;
pregnancy, menopause;
diet violations in chronic cholecystitis;
pathologies of the biliary tract;
work requiring extreme physical exertion;
hereditary factors.

Cholecystitis in pregnant women

In most cases, the reason for the development of cholecystitis in pregnant women is a decrease in contractile functions muscles that control the tone of the bile ducts. This is due to the influence of the leader female hormone progesterone on smooth muscle. As a result, bile is excreted less intensively, and stagnation processes begin in the gallbladder. Against their background, the infection penetrates the walls of the gallbladder and provokes the onset of the inflammatory process.

An important fact: if cholecystitis was diagnosed in a woman before pregnancy (or it is present in a chronic form), doctors give an almost 100% chance of exacerbations occurring while expecting a child.

The main manifestation of cholecystitis in women during pregnancy is pain in the right hypochondrium. Painful sensation may vary in intensity, but in most cases patients complain of a feeling of heaviness or a dull aching pain. However, the pregnancy factor does not allow us to pay attention to this factor in time: a woman can explain the pain for a long time by the movements of the fetus and not think about other causes of the sensations. It is worth noting that fetal movements only increase pain in the right hypochondrium.

The reason for visiting a doctor in most cases is acute, cramping pain that cannot be tolerated. Such pain syndrome indicates that the disease is progressing and there is big risk the development of complications (for example, pancreatitis) that will threaten the life of the fetus and mother. Therefore, it is better to pay attention to all types of pain during pregnancy.

It is important to note that with cholecystitis in pregnant women, pain in the right hypochondrium will intensify after eating fried, fatty, salty or spicy foods.

Characteristic symptoms of gallbladder inflammation in women:

a feeling of bitterness in the mouth;
frequent belching;
nausea and vomiting;
heartburn;
bloating;
prolonged toxicosis (up to the 30th week instead of the 12th).

As you can see, the symptoms of cholecystitis are very similar to the symptoms of the usual condition of a pregnant woman. This similarity negatively affects the timeliness of diagnosis. The disease drags on and brings more undesirable consequences.

Cholecystitis in children

Cholecystitis in children is not a very common disease, so it is important to diagnose it promptly and correctly, providing quality treatment. Abdominal pain in a child is enough common occurrence, which is why many parents do not always give them great value. However, intense pain is one of the symptoms of cholecystitis.

The disease in children can manifest itself in acute or chronic forms. According to statistics collected over a long period of time, one can see that at the age of up to 8 years, boys are more often diagnosed with the disease; up to 14 years, the incidence rate is equal among both boys and girls; after 14 years, girls are more likely to get sick (about 3-4 times) .

Causes of cholecystitis in children:

the presence of infection in the gastrointestinal tract;
biliary dyskinesia;
Not proper diet, including a large amount of fat;
improper diet;
gastrointestinal motility disorders;
deformation of the bile ducts;
heredity;
psycho-emotional factors.

Acute cholecystitis in children is rarely diagnosed - most often we're talking about about chronic cholecystitis in catarrhal form. Gallstones also form quite rarely.

Cholecystitis in children can manifest itself in the form of several specific symptoms and general factors indicating the presence of an inflammatory process in the body. In the youngest, the disease begins with symptoms of general intoxication. It is important for parents to notice the first manifestations. This is possible if you carefully monitor the child’s condition. You should consult a doctor if your baby has: alternating diarrhea and constipation, tongue yellow plaque, periodically there is no appetite, there are complaints of heaviness or pain in the right hypochondrium. These are standard manifestations of cholecystitis in chronic form.

Acute cholecystitis is characterized by a sudden onset, without previous symptoms. The child complains about paroxysmal pain and heaviness in the right hypochondrium. Nausea, belching occurs, and vomiting is possible after fatty foods. Abdominal bloating begins, body temperature rises to 39 degrees, accompanied by chills and paleness.

Pancreatitis, appendicitis, peritonitis, and volvulus have the same symptoms. In any case, you should immediately call emergency assistance For correct diagnosis and prescription of treatment (mainly inpatient).

When examining the child, the doctor will be guided by the following symptoms to make a diagnosis of cholecystitis:

tension and bloating of the abdominal wall;
rumbling in the stomach;
pain when pressing in the area of the gallbladder, etc.

It is important to note that if the above signs appear, you should never give your child painkillers - this will lead to lubrication. clinical symptoms and misdiagnosis.

Treatment of cholecystitis

How to treat cholecystitis? Since cholecystitis occurs from an infection, if there are signs of its exacerbation, the patient must take antibiotics, which are prescribed by a doctor after undergoing a bile test. To relieve pain, the patient is prescribed antispasmodics. These include no-spa, papaverine in tablets and suppositories, duspatalin and others. In the treatment of cholecystitis, choleretic agents are used, which are selected depending on the functioning of the biliary tract. If there is stagnation of bile, you need to take medications from the cholekinetic group: berberine, sorbitol, xylitol and magnesia.

For cholecystitis, the tubage method can help. Using this method, the bile ducts are washed and the secretion of bile from the gallbladder is stimulated. In the morning, drink a glass of mineral water on an empty stomach. still water room temperature, to which you can add one tablespoon of xylitol, sorbitol or magnesia. Then the patient should lie on his right side, placing a warm heating pad, and remain in this position for one and a half or two hours. The procedure can be done once every 3 days; 10 procedures are enough for a course.

It is strictly forbidden to perform tubing on patients with cholelithiasis, as it can cause strong movement bile and stones that will block the passage of the bile duct, and urgent surgery will be required. The most life-threatening stones are those with a diameter of one centimeter, since small ones can pass through, while large ones will get stuck in the gallbladder ducts.

Treatment of cholecystitis includes drinking mineral waters with high mineralization. You need to drink them half an hour before meals, the water should be at room temperature. If there are no stones, it is recommended to drink choleretic decoctions of immortelle herbs, corn silk, and St. John's wort. Decoctions can be prepared and drunk for a long period in autumn or winter, including herbs to increase immunity and strengthen the gallbladder: lemongrass, rhodiola, eleutherococcus, ginseng and others.

Medicines for cholecystitis

Treatment of cholecystitis with medications is the basis of therapy for this disease. Physiotherapy and herbal medicine are methods that are used only after the symptoms and causes of exacerbation have been removed. Before this, it is important to take medications selected by your doctor, including:

After stopping the inflammatory process, treatment of cholecystitis and pancreatitis with medications may require dissolving the stones with the help of medications. Doctors use chenodeoxycholic or ursodeoxycholic acid for this purpose. Their effectiveness affects only about 20% of patients, so prescribing drugs requires clear diagnostic indications.

The dosage of medications for each patient is determined individually. A number of medications must be taken for a long period of time (about 12 months), periodically monitoring biochemical blood parameters and performing ultrasound diagnostics. Self-medication with medications can lead to inflammation of the pancreas (pancreatitis) and blockage of the bile ducts.

In the remission phase, patients are prescribed choleretic drugs(if diagnosis indicates the absence of confirmed stones). The choice of drugs is very wide: milk thistle, nicodine, fume, tansy, hofitol and many others.

Treatment of cholecystitis with folk remedies: the most effective

Air. 1 teaspoon of crushed rhizomes per 1 cup of boiling water. Leave for 20 minutes, strain and consume 0.5 cups 4 times a day.

Volodushka. Pour 5-10 g of roots into 1 glass of water and boil until half of the original volume of water has evaporated. Then cool and strain. Drink 0.5 cups 3 times a day. In case of inflammation of the gallbladder, you can pour 5 g of herb, add 1 glass of boiling water, leave until it cools down and strain. Drink 0.5 cups 3 times a day before meals.

Bird's knotweed. 1 tbsp. pour a spoonful of herbs into 1 glass of water and boil for half an hour in a water bath. Leave for 15 minutes and then strain. Take 3-4 times a day, 1 tbsp. spoon.

Oregano. Pour 1 teaspoon of herb into 1 glass of boiling water. Leave for 2 hours. Drink ¼ cup 3 times a day.

Corn silk. 1 tbsp. pour 1 cup of boiling water over a spoonful of corn columns with stigmas, leave for 60 minutes, strain. Use the infusion 1 tbsp. spoon every 3 hours.

Vegetable oil with laurel. Mix 200 g of sunflower, corn, cottonseed oil with 30 crushed laurel leaves. Infuse the mixture for 3-6 days, strain at the end. Use 10-15 drops, mixed with tea, 2-3 times a day. Recommended for chronic cholecystitis and cholelithiasis.

Honey, olive oil, lemon. Mix 1 kg of high-quality honey, 1 glass of olive oil, 4 lemons minced (peel 2 of them). Mix everything well and place in a sealed container. Keep refrigerated. Stir before each use. Use 1 tbsp. spoon 3 times a day half an hour before meals. 3-4 courses are recommended over 1 year.

The plantain is big. 1 tbsp. Pour 1 cup of boiling water over a spoonful of herbs and leave for 10 minutes, then strain. Daily norm- 1 glass (drink in small sips throughout the day).

Yarrow. Brew 2 teaspoons in 1 glass of boiling water, leave for 60 minutes, then strain. Drink ¼ cup 4 times a day before meals.

Salvia officinalis. Brew 2 teaspoons of leaves in 2 cups of boiling water, leave for half an hour, strain. Use the infusion 1 tbsp. spoon every 2 hours.

How to relieve an attack of cholecystitis at home?

The wisest decision is to call emergency services immediately. It is prohibited to relieve pain on your own. It is not recommended to apply a heating pad to the sore spot. The listed measures will temporarily alleviate the condition, but will not allow the doctor to make a correct diagnosis due to a distortion of the clinical picture.

It is better to seek medical help at the very beginning of an attack of cholecystitis. Timely medical care (in most cases in a hospital setting) will remove acute inflammation in 3 days, eliminate symptoms completely in 10 days. In the future, to avoid repeated attacks, the development of pancreatitis and the need surgical removal gallbladder, it is recommended to adhere to a diet and maintain healthy image life with a daily routine.

Diet for cholecystitis

Exacerbation of cholecystitis is the result of stagnation of bile caused by in a sedentary manner life, frequent stressful situations, alcoholism, unhealthy diet (eating fatty foods, irregular meals). The patient’s condition during the exacerbation period is severe: if we are talking about acute calculous cholecystitis, then even mild movements cause not only discomfort, but even hepatic colic.

The diet for exacerbation of cholecystitis is based primarily on eating exclusively pureed foods. You will have to be patient during this period, carefully following the dietary requirements: after the exacerbation ends, you can not adhere to this rule, grinding only meat with veins. During an exacerbation, you should limit your salt intake and exclude fried, fatty and spicy foods from your diet.

A balanced diet for cholecystitis is correct ratio plant and animal proteins, this is to provide the body with a sufficient amount of vitamins, minerals, fiber plant origin. During periods of exacerbation, you should avoid eating eggs in any form - they can increase pain and attack hepatic colic. If for some reason you want to eat an egg, this is allowed only in the form of a steam omelet.

One of the most important points Therapy for acute and chronic cholecystitis is strict nutrition. In the acute form of cholecystitis, it is better not to eat anything for two days; you can drink weak tea, fruit drinks, juices diluted with water one to one, or mineral water without gas. Then you can include puree soups and porridges, low-fat cottage cheese, boiled meat and steamed fish in your diet. After a week you can go on a diet, excluding harmful products. Meals should be frequent, in small portions 5-6 times a day. The food should be warm, not very hot or cold, so as not to provoke a second attack.

The diet for cholecystitis allows you to eat vegetable, fruit, milk, cereal soups, borscht and cabbage soup without meat, in simple broth. Dairy products include milk with a low fat content, fermented milk products, kefir, yogurt, acidophilus, low-fat cottage cheese. You can use yesterday's bread or slightly dried bread.

It is strictly forbidden to include in the diet for cholecystitis such products as: puff pastry, fresh pastries and bread, pastries, cakes and other sweets with cream, fried pies, meat and strong broths, sour cabbage soup, fatty meats (lamb and pork), game, fried meat, smoked meats, sausages, canned food, fatty fish, caviar, salted and smoked fish, butter and lard, mustard and spicy seasonings, eggs in any form, green onions, mushrooms, radishes, garlic, horseradish, salted and pickled vegetables, chocolate, cocoa, ice cream, black coffee, carbonated cold drinks. Alcohol in any doses is strictly prohibited.

Diet for acute cholecystitis: therapeutic nutrition

Diet 5c is gentle, without mechanical and chemical irritants. This means eating only pureed food. Chemical composition of this diet: 50 g protein, 40 g fat, 250 g carbohydrates per day. Daily calorie content - 1600 Kcal. Diet No. 5c, in particular, includes wheat crackers, pureed low-fat cottage cheese, pureed meat and steamed fish.

Approximate 1-day diet menu No. 5c with acute cholecystitis:

daily intake of sugar - 40 g, dried bread (white) - 200 g;
first breakfast: oatmeal pureed, steamed egg white omelette, tea;
second breakfast: carrot puree, rosehip decoction;
lunch: half a serving of mashed potato soup, steamed meat soufflé, baked apple;
afternoon snack: pureed fruit compote;
dinner: curd pudding, tea;
at night: a glass of low-fat kefir or rosehip decoction.

After 5-10 days of following such a diet, provided that the exacerbation stage is stopped, you can switch to diet No. 5.

Diet for chronic cholecystitis

A diet for chronic cholecystitis allows you to include the following products in your diet: bread from wheat flour 1st and 2nd grades, rye from peeled and sifted flour. The main requirement for bread is that it must be yesterday's bread. You can eat dry biscuits and crackers. Lean meat and fish, cottage cheese, and apples are allowed as fillers for savory pies.

The menu can include vermicelli, small pasta, dumplings, and cheesecakes. Soups: vegetable and cereal soups with vegetable broth, milk soups with noodles, vegetarian or fruit borscht, beetroot soups. Flour and vegetables for dressing should not be fried, but dried. For chronic cholecystitis, you can eat lean meat and low-fat meat products based on beef, young lamb, pork, veal, rabbit meat. As for poultry, you can eat chicken and turkey meat without skin, boiled, as well as baked (but after boiling).

Low-fat fish (cod, pike perch, bream, navaga, perch, silver hake), steamed, boiled, and in the form of meatballs is allowed. Milk and products can be consumed in in kind or as additives to dishes (porridge, sauces). Use sour cream as a seasoning for salads. Allowed types of cheeses: Russian, Yaroslavl. Recommended cereals are oatmeal, rice and buckwheat. Among fats, it is better to give preference to vegetable ones.

Vegetables can be consumed raw, baked or boiled. Allowed spices: dill and parsley, ground red sweet pepper, cinnamon, bay leaf, vanillin, cloves (all in limited quantities).

Adequate nutrition for chronic cholecystitis is described in detail in the requirements for diet No. 5 - the officially approved diet for this type of disease. If you stick to it constantly, you can reduce the number of exacerbations to a minimum and not feel discomfort. It is better to pre-coordinate any diet with your doctor.

Honey for cholecystitis

Honey for cholecystitis is allowed and recommended due to a number of benefits. In particular, the product has a choleretic effect, is able to alleviate pain and provide prevention against bile stagnation (relevant for chronic cholecystitis).

It is recommended to take the product as follows: Dissolve 1 tablespoon in a glass warm water and drink on an empty stomach in the morning. After taking it, lie on your right side. The course of treatment is from 5 to 7 days. For calculous cholecystitis, it is recommended to take corn cobs with honey - this is one of the means for dissolving stones. Naturally, any such therapy must be agreed upon with the attending physician.

Honey therapy is not an alternative to drug and diet therapy. Honey is recommended to be used in combination general treatment- only in such situations it beneficial properties will be appropriate.

After the attending physician determines the recommended daily dose honey, do not consume the entire amount at once. It is better to start using 0.5 teaspoon and see how the body reacts. If missing side effects in the form skin rash, dysbacteriosis - you can consume honey in the recommended dosage. There are several methods for using the product:

morning and evening, drink 100 ml of the diluted product;
Eat 1 tbsp 3 times a day. spoon;
each of these methods is designed to consume honey for 1-2 months with further breaks;
for frequent constipation, you can eat 1 tbsp. spoon of honey with 1 tbsp. spoon of aloe juice for 30 minutes. Before meals;
You can sweeten tea, compote, fruit drink, kefir with honey;
Casserole with honey and other dishes are acceptable.

Prevention of cholecystitis

Prevention of cholecystitis is aimed at reducing the likelihood of gallstones forming. First of all, it is necessary to monitor the quality and mode of food consumption. You can't skip meals. It is recommended to have breakfast, lunch and dinner at the same time. People with chronic cholecystitis are advised to adhere to fractional meals, divide your meals into small portions and eat five times a day. It will be easier for the body to cope with food and you will prevent a repeat crisis.

Prevention of cholecystitis includes healthy diet, excluding saturated and animal fats, salt and hot seasonings. Fatty foods contribute to the formation of stones and excess weight gain. The diet should include lungs and healthy products. You can eat light fermented milk products, dishes from vegetables, fruits, and cereals. Smoked foods, processed foods, and fatty desserts should be excluded from your diet. It is better to avoid alcoholic drinks forever.

Exercise and active image life are included in measures to prevent cholecystitis. Sedentary image life leads to excess weight gain and stagnation in the body, which can lead to the formation of gallstones. Office work should include hourly breaks with a short warm-up of all parts of the body. It is best for your health to do gymnastics, Pilates, swimming or regular walking. If you can’t go to the gym, walk more often, go for walks fresh air in any weather. Avoid stressful and excessive physical activity, as they can lead to relapse of cholecystitis.

One of the main reasons for the development of cholecystitis is excess weight. The higher it is, the more risk the occurrence of gallstones. Therefore, it is necessary to monitor your diet, physical activity, and when overweight you definitely need to lose weight. When losing weight, be careful not to go on diets that promise to lose ten kilograms in a week. Quick loss weight weakens the body and increases the risk of gallstones. It is better to contact a nutritionist who will create the right diet and weight loss program. You can lose 1.5 kilograms per week.

Chronic noncalculous cholecystitis is a long-term inflammatory process in the gallbladder, characterized by impaired motility and fibrous changes in the walls, but not accompanied by the formation of stones. The causes of this form of inflammation are most often poor nutrition and infection. Acalculous cholecystitis can also occur in acute form as a result of diabetes mellitus, prolonged fasting, extensive surgical interventions and other conditions leading to stagnation of bile.

The disease occurs with a frequency of about 7 cases per 1000 people, women are affected approximately 3-4 times more often than the male population. It should be noted that chronic non-calculous cholecystitis is quite common among children.

Clinical picture

The clinical picture of the disease is characterized by a long, relapsing and progressive course, in which periods of remission and exacerbation are distinguished. For chronic noncalculous cholecystitis typical symptom is aching, dull ache under the right rib, sometimes in the epigastric region. Painful sensations can last for quite a long time - from several hours to weeks. The occurrence or intensification of pain is most often associated with errors in nutrition. Thus, an exacerbation of the disease may develop after consuming large quantities fatty foods, alcohol intake, carbonated and cold drinks, spicy dishes, eggs.

Sometimes inflammation affects the tissue around the organ, and pericholecystitis develops. In this case, the pain syndrome becomes constant and more intense, the symptoms intensify with changes in body position and bending forward. Irradiation of pain to the right subscapular region is characteristic, right side neck, shoulder, lumbar region. Reflex pain in the heart often occurs.

Murphy's symptom: when you press on the gallbladder while inhaling, a sharp pain occurs

Also, symptoms of dyspepsia are characteristic of cholecystitis of the non-calculous form. These include:

feeling of nausea,
bitter belching and
heartburn,
bitterness, dryness, ;
change in the nature of stool (diarrhea is replaced by constipation).

During the period of exacerbation of acalculous cholecystitis, symptoms of intoxication are possible. Patients are worried about chills, weakness, malaise, headache, sleep disorders. The temperature rarely rises above 38 degrees. If the fever reaches higher numbers, this may indicate complications (empyema of the gallbladder, cholangitis).

Important: if you have signs of chronic cholecystitis, you should contact a gastroenterologist.

Treatment of the disease

In case of severe exacerbation of non-calculous cholecystitis, treatment is carried out in a hospital. The goal of therapy is to relieve exacerbations, prevent and treat complications. Conservative therapy is usually sufficient. Surgical interventions are performed in cases of frequent and severe exacerbations, severe deformation of the gallbladder and ineffective use of medications.

Diet food

Medicines

Drug treatment of chronic acalculous cholecystitis is aimed at solving the following problems:

elimination of pain syndrome;
restoration of motility and tone of the biliary tract;
suppression of the inflammatory and infectious process in the gallbladder;
normalization of impaired digestion.

Usually used for non-calculous cholecystitis antispasmodics, antibiotics, agents that normalize the motility of the gallbladder and intestines. In case of severe intoxication, carry out infusion therapy. If cholelithiasis is excluded during the examination, it is possible to use choleretic drugs based on ursodeoxycholic acid.

To normalize the digestion process enzyme preparations. For exacerbations of acalculous cholecystitis, treatment takes about 2 weeks, but with the development of complications it can be longer. After acute symptoms have been eliminated, the doctor may prescribe physiotherapy that will improve contractile activity gallbladder.

To maintain remission of chronic non-calculous cholecystitis, treatment with herbal remedies is useful.

Pharmacies sell ready-made choleretic preparations, which are very convenient to use.

To improve bile secretion and reduce the inflammatory process, decoctions of tansy, yarrow, licorice, buckthorn and other medicinal plants are used.

Important: before using any of the presented treatment methods, you should consult your doctor.

Several recipes traditional medicine for the treatment of acalculous cholecystitis.