Gallbladder chronic cholecystitis. Penetrating into bile in fairly high concentrations

Chronic cholecystitis

With acalculous cholecystitis, the inflammatory process is most often localized in the neck of the bladder.

What provokes / Causes of Chronic cholecystitis:

Prevalence. According to L.M. Tuchin et al. (2001), the prevalence of cholecystitis among the adult population of Moscow in 1993-1998. increased by 40.8%. During the same period of time, there was also an increase in the incidence of cholecystitis by 66.2%.

Pathogenesis (what happens?) during Chronic cholecystitis:

In the development of chronic acalculous cholecystitis (CAC), three components are distinguished: stagnation of bile, changes in its physical chemical composition and the presence of infection. An important place in the development of the disease is given to physical inactivity, nutritional factors, psycho-emotional overload, and allergic reactions. Currently, there is an increase in incidence among men. CBC occurs more often in people with normal body weight Infectious agents penetrate into the gallbladder by hematogenous, lymphogenous and contact (from the intestine) route. Infection from the gastrointestinal tract can enter the bladder through the common bile and cystic ducts, and downward spread of infection from the intrahepatic bile ducts is also possible. At the same time, microflora in the gallbladder is detected only in 35% of cases, which can be explained by the detoxification function of the liver and the bacteriostatic properties of bile. Consequently, for the development of microbial inflammation in the gallbladder, prerequisites are necessary in the form of changes in the composition of bile (stagnation due to obstruction, dyskinesia), dystrophy of the mucous membrane of the gallbladder, impaired liver function, and depression of immune mechanisms. Infection of the gallbladder is promoted by chronic duodenal stasis, duodenitis, insufficiency of the sphincters of Oddi, and the development of duodenobiliary reflux. When infection occurs upward path E. coli and enterococci are more often found in jelly.

Classification of chronic cholecystitis

Depending on the specific course of the disease, latent (sluggish), recurrent and purulent ulcerative forms of chronic cholecystitis are distinguished.

Based on the presence of stones, they are distinguished:

chronic cholecystitis without cholelithiasis (calculous);
chronic calculous cholecystitis.

There are stages:

exacerbations;
remission.

According to the flow, mild, moderate and severe flow are distinguished. Mild course characterized by 12 exacerbations during the year, the presence of biliary colic no more than 4 times a year. Chronic cholecystitis of moderate severity is characterized by 3-4 exacerbations during the year. Biliary colic develops up to 5-6 times or more during the year. A severe course is characterized by exacerbations of the disease up to 5 times or more per year.

Symptoms of Chronic cholecystitis:

Features of clinical manifestations. The clinical picture of chronic cholecystitis includes pain, dyspeptic, cholestatic, asthenovegetative and intoxication syndromes caused by the inflammatory process and dysfunction of the bladder. Exacerbation of chronic hepatitis is characterized by pain in the right hypochondrium. The pain can be prolonged or paroxysmal, has a wide irradiation, often oriented to the right half of the chest, back, occurs after an error in diet, mental stress, changes in body position, physical overload. In some cases, pain syndrome occurs spontaneously, its development is accompanied by fever, symptoms of weakness, and cardialgia. Frequent but nonspecific complaints are dyspeptic disorders: severity in abdominal cavity, belching, nausea, bitterness in the mouth, flatulence, constipation.

Currently there are several clinical options chronic cholecystitis:

Cardiac variant, characterized by heart rhythm disturbances, electrocardiographic changes (T wave) with good tolerance to physical activity.
Arthritic variant, manifested by arthralgia.
Low-grade fever - prolonged low-grade fever (37-38 ° C) for about 2 weeks with periodic chills and symptoms of intoxication.
The neurasthenic variant is manifested by symptoms of neurasthenia and vegetative-vascular dystonia in the form of weakness, malaise, irritability, and insomnia. Intoxication may occur.
The hypothalamic (diencephalic) variant is accompanied by paroxysms of tremor, increased blood pressure, symptoms of angina pectoris, paroxysmal tachycardia, muscle weakness, and hyperhidrosis.

Physical examination may reveal varying degrees yellowness of the skin and mucous membranes, pain in the points of the bladder and liver area, muscle tension in the right hypochondrium, in some cases, enlargement of the liver and gall bladder.

Diagnosis of Chronic cholecystitis:

Diagnostic features:

In a clinical blood test, leukocytosis with a neutrophilic shift to the left is observed, increase in ESR. In the presence of obstructive syndrome, a general urine test shows a positive reaction to bilirubin. In a biochemical blood test, an increase in the content of bilirubin, (X2 and globulins, sialic acids, C-reactive protein, fibrinogen, blood sugar, alkaline phosphatase activity, uglutamyl transpeptidase, aminotransferases is observed.

An important place in diagnosis is given to ultrasound and X-ray methods for examining the abdominal organs, esophagogastroduodenoscopy. The diagnosis of cholecystitis is considered proven if, during an ultrasound examination, a cholecystogram or cholecystoscintegram reveals deformation, thickening of the walls and a decrease in the contractile function of the bladder, and the presence of a peri-process.

When performing fractional duodenal intubation, a decrease in the amount of cystic bile, dysfunction of the sphincter of Oddi, and changes in biochemical composition bile, the presence of inflammatory components in it (reactive protein, sialic acids), bacterial contamination.

Treatment of Chronic cholecystitis:

Treatment of chronic cholecystitis without cholelithiasis (CC). The treatment program includes:

mode;
diet therapy;
drug therapy during exacerbation:
pain relief;
use of choleretic drugs;
antibacterial therapy;
normalization of the functions of the autonomic nervous system;
immunomodulatory therapy and increasing the overall reactivity of the body;
physiotherapy, hydrotherapy;
Spa treatment.

During a period of severe exacerbation of the disease, the patient must be hospitalized in a therapeutic hospital. In mild cases, treatment is usually carried out in outpatient setting. During the period of exacerbation, patients with chronic cholecystitis are recommended bed rest within 7-10 days.

Food should be mechanically and chemically gentle and not have a cholekinetic effect. During exacerbation of the disease therapeutic nutrition should help reduce inflammation in the gallbladder, prevent stagnation of bile, and ensure the prevention of the formation gallstones. In the phase of sharp exacerbation in the first 1-2 days, only drinking warm liquids (weak tea, juices from fruits and berries diluted with water, rosehip decoction) is prescribed in small portions up to 3-6 glasses per day. As the condition improves, pureed food is prescribed in limited quantities : slimy soups, porridges (semolina, oatmeal, rice), jelly, mousse, jelly. In the future, it is allowed low-fat varieties meat, fish, dairy products, sweet vegetables and fruits, butter And vegetable fats 30 g per day. Food is taken 46 times a day in small portions.

After eliminating signs of exacerbation of chronic cholecystitis, diet No. 5 is prescribed.

Drug therapy includes the use of drugs to relieve pain, normalize the function of the autonomic nervous system and the rational use of choleretic drugs described in the previous section. As an antispasmodic, it is advisable to prescribe duspatalin 200 mg (1 drop) 2 times a day.

To eliminate infection of bile, broad-spectrum antibacterial drugs are used that participate in the enterohepatic circulation and accumulate in therapeutic concentrations in the gallbladder. The drugs of choice are biseptol at a dose of 960 mg 2 times a day or doxycycline hydrochloride at a dose of 200 mg per day. In addition, ciprofloxacin 250-500 mg 4 times a day, ampicillin 500 mg 4 times a day, erythromycin 200-400 mg 4 times a day, furazolidone 100 mg 4 times a day, metronidazole 250 mg 4 times a day can be used. once a day. Antibacterial therapy is prescribed for 10-14 days. When choosing an antibacterial drug, it is necessary to take into account not only the sensitivity of microorganisms to the antibiotic, but also the ability of the antimicrobial agents to penetrate the bile.

To correct secondary immunodeficiency, preparations of the large thymus gland are used. cattle(thymalin, Taktivin, thymogen, timoptin), which are administered intramuscularly daily for 10 days. Decaris can be recommended as an immunomodulator (levamisole 50 mg once a day for the first 3 days of each week for 3 weeks, sodium nucleinate 0.2-0.3 g 3-4 times a day for a period of 2 weeks to 3 months).

For increase nonspecific resistance the body can use adaptogens: saparal 1 tablet. (0.05 g) 3 times a day for 1 month, Eleutherococcus extract, ginseng tincture, Chinese lemongrass, pantocrine 30-40 drops. 3 times a day for 12 months.

In the treatment of chronic cholecystitis, the use of enzyme preparations(digestal, festal, panzinorm, creon) for 3 weeks with meals, as well as antacid drugs (maalox, phosphalugel, remagel, protab), used 1.5-2 hours after meals.

For physiotherapeutic treatment of chronic cholecystitis, mud applications are used on the right hypochondrium area (10 procedures) and mud electrophoresis on the liver area (10 procedures). It must be remembered that mud therapy for inflammatory diseases of the biliary tract is used with great caution, only for those patients who do not have signs of active infection, it is better in combination with antibiotics.

Forecast. Depends on predisposing factors, timely treatment, and severity.

Which doctors should you contact if you have Chronic cholecystitis:

Gastroenterologist

Is something bothering you? Do you want to know more detailed information about Chronic cholecystitis, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can make an appointment with a doctor– clinic Eurolab always at your service! The best doctors will examine you, study external signs and help you identify the disease by symptoms, advise you and provide necessary help and make a diagnosis. you also can call a doctor at home. Clinic Eurolab open for you around the clock.

How to contact the clinic:
Phone number of our clinic in Kyiv: (+38 044) 206-20-00 (multi-channel). The clinic secretary will select a convenient day and time for you to visit the doctor. Our coordinates and directions are indicated. Look in more detail about all the clinic’s services on it.

(+38 044) 206-20-00

If you have previously performed any research, Be sure to take their results to a doctor for consultation. If the studies have not been performed, we will do everything necessary in our clinic or with our colleagues in other clinics.

You? It is necessary to take a very careful approach to your overall health. People don't pay enough attention symptoms of diseases and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific symptoms, characteristic external manifestations- so called symptoms of the disease. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to do it several times a year. be examined by a doctor to not only prevent terrible disease, but also support healthy mind in the body and the organism as a whole.

If you want to ask a doctor a question, use the online consultation section, perhaps you will find answers to your questions there and read self care tips. If you are interested in reviews about clinics and doctors, try to find the information you need in the section. Also register on medical portal Eurolab to stay up to date latest news and information updates on the website, which will be automatically sent to you by email.

Other diseases from the group Gastrointestinal tract diseases:

Grinding (abrasion) of teeth

Abdominal trauma

Abdominal surgical infection

Oral abscess

Edentia

Alcoholic liver disease

Alcoholic cirrhosis of the liver

Alveolitis

Angina Zhensula - Ludwig

Anesthetic management and intensive care

Ankylosis of teeth

Anomalies of the dentition

Anomalies of teeth position

Anomalies of the esophagus

Anomalies in tooth size and shape

Atresia

Autoimmune hepatitis

Achalasia cardia

Esophageal achalasia

Bezoars of the stomach

Budd-Chiari disease and syndrome

Veno-occlusive liver disease

Viral hepatitis in patients with chronic renal failure on chronic hemodialysis

Viral hepatitis G

Viral hepatitis TTV

Intraoral submucosal fibrosis (oral submucosal fibrosis)

Hairy leukoplakia

Gastroduodenal bleeding

Hemochromatosis

Geographic language

Hepatolenticular degeneration (Westphal-Wilson-Konovalov disease)

Hepatolienal syndrome (hepatosplenic syndrome)

Hepatorenal syndrome (functional renal failure)

Hepatocellular carcinoma (hcc)

Gingivitis

Hypersplenism

Gingival hypertrophy (gingival fibromatosis)

Hypercementosis (ossifying periodontitis)

Pharyngeal-esophageal diverticula

Hiatal hernia (HH)

Acquired esophageal diverticulum

Gastric diverticula

Diverticula of the lower third of the esophagus

Esophageal diverticula

Diverticula of the middle third of the esophagus

Esophageal dyskinesia

Dyskinesia (dysfunction) of the biliary tract

Liver dystrophy

Sphincter of Oddi dysfunction (postcholecystectomy syndrome)

Benign nonepithelial tumors

Benign neoplasms of the gallbladder

Benign liver tumors

Benign tumors of the esophagus

Benign epithelial tumors

Cholelithiasis

Fatty hepatosis (steatosis) of the liver

Malignant neoplasms of the gallbladder

Malignant tumors of the bile ducts

Foreign bodies of the stomach

Candidal stomatitis (thrush)

Caries

Carcinoid

Cysts and aberrant tissue in the esophagus

Mottled teeth

Upper gastrointestinal bleeding

Xanthogranulomatous cholecystitis

Leukoplakia of the oral mucosa

Drug-induced liver damage

Medicinal ulcers

Cystic fibrosis

Salivary gland mucocele

Malocclusion

Impaired development and eruption of teeth

Tooth formation disorders

Hereditary coproporphyria

Hereditary disorder of the structure of enamel and dentin (Stanton-Capdepont syndrome)

Non-alcoholic steatohepatitis

Liver necrosis

Pulp necrosis

Emergency conditions in gastoenterology

Esophageal obstruction

Osteogenesis imperfecta of teeth

Examination of patients in emergency surgery

Acute delta superinfection in hepatitis B virus carriers

Acute intestinal obstruction

Acute intermittent (intermittent) porphyria

Acute disturbance of mesenteric circulation

Acute gynecological diseases in the practice of a surgeon

Acute bleeding from the digestive tract

Acute esophagitis

Acute alcoholic hepatitis

Acute appendicitis

Acute apical periodontitis

Acute acalculous cholecystitis

Acute viral hepatitis A (AVHA)

Acute viral hepatitis B (AVHB)

Acute viral hepatitis B with delta agent

Acute viral hepatitis E (AVHE)

Acute viral hepatitis C

Acute gastritis

Acute gingivitis

Acute stomach

Acute pericoronitis

Certain types of intestinal obstruction

Edema-ascitic syndrome

Periodontal disease

Pathological tooth resorption

Peptic ulcer of unspecified localization

Peptic ulcers of the esophagus

Peptic esophagitis

Primary biliary cirrhosis of the liver

Primary sclerosing cholangitis

Chronic cholecystitis

With acalculous cholecystitis, the inflammatory process is most often localized in the neck of the bladder.

What provokes / Causes of Chronic cholecystitis:

Pathogenesis (what happens?) during Chronic cholecystitis:

There are three components in the development of chronic acalculous cholecystitis (CAC): stagnation of bile, changes in its physicochemical composition and the presence of infection. An important place in the development of the disease is given to physical inactivity, nutritional factors, psycho-emotional overload, and allergic reactions. Currently, there is an increase in incidence among men. CBC occurs more often in people with normal body weight. Infectious pathogens penetrate the gallbladder by hematogenous, lymphogenous and contact (from the intestine) route. Infection from the gastrointestinal tract can enter the bladder through the common bile and cystic ducts, and downward spread of infection from the intrahepatic bile ducts is also possible. At the same time, microflora in the gallbladder is detected only in 35% of cases, which can be explained by the detoxification function of the liver and the bacteriostatic properties of bile. Consequently, for the development of microbial inflammation in the gallbladder, prerequisites are necessary in the form of changes in the composition of bile (stagnation due to obstruction, dyskinesia), dystrophy of the mucous membrane of the gallbladder, impaired liver function, and depression of immune mechanisms. Infection of the gallbladder is promoted by chronic duodenal stasis, duodenitis, insufficiency of the sphincters of Oddi, and the development of duodenobiliary reflux. When infection penetrates through the ascending route, E. coli and enterococci are more often found in the jellies.

Classification of chronic cholecystitis

Depending on the specific course of the disease, latent (sluggish), recurrent and purulent ulcerative forms of chronic cholecystitis are distinguished.

Based on the presence of stones, they are distinguished:

chronic cholecystitis without cholelithiasis (calculous);
chronic calculous cholecystitis.

There are stages:

exacerbations;
remission.

According to the flow, mild, moderate and severe flow are distinguished. A mild course is characterized by 12 exacerbations during the year, the presence of biliary colic no more than 4 times a year. Chronic cholecystitis of moderate severity is characterized by 3-4 exacerbations during the year. Biliary colic develops up to 5-6 times or more during the year. A severe course is characterized by exacerbations of the disease up to 5 times or more per year.

Symptoms of Chronic cholecystitis:

Features of clinical manifestations. The clinical picture of chronic cholecystitis includes pain, dyspeptic, cholestatic, asthenovegetative and intoxication syndromes caused by the inflammatory process and dysfunction of the bladder. Exacerbation of chronic hepatitis is characterized by pain in the right hypochondrium. The pain can be prolonged or paroxysmal, has a wide irradiation, often oriented to the right half of the chest, back, and occurs after an error in diet, mental stress, change in body position, or physical overload. In some cases, pain syndrome occurs spontaneously, its development is accompanied by fever, symptoms of weakness, and cardialgia. Frequent but nonspecific complaints are dyspeptic disorders: heaviness in the abdominal cavity, belching, nausea, bitterness in the mouth, flatulence, constipation.

Currently, there are several clinical variants of chronic cholecystitis:

Cardiac variant, characterized by heart rhythm disturbances, electrocardiographic changes (T wave) with good tolerance to physical activity.
Arthritic variant, manifested by arthralgia.
Low-grade fever - prolonged low-grade fever (37-38 ° C) for about 2 weeks with periodic chills and symptoms of intoxication.
The neurasthenic variant is manifested by symptoms of neurasthenia and vegetative-vascular dystonia in the form of weakness, malaise, irritability, and insomnia. Intoxication may occur.
The hypothalamic (diencephalic) variant is accompanied by paroxysms of tremor, increased blood pressure, symptoms of angina pectoris, paroxysmal tachycardia, muscle weakness, and hyperhidrosis.

During a physical examination, one can detect varying degrees of yellowness of the skin and mucous membranes, pain in the points of the bladder and liver area, muscle tension in the right hypochondrium, and in some cases, enlargement of the liver and gall bladder.

Diagnosis of Chronic cholecystitis:

Diagnostic features:

In a clinical blood test, leukocytosis with a neutrophilic shift to the left and an increase in ESR are observed. In the presence of obstructive syndrome, a general urine test shows a positive reaction to bilirubin. In a biochemical blood test, an increase in the content of bilirubin, (X2 and globulins, sialic acids, C-reactive protein, fibrinogen, blood sugar, alkaline phosphatase activity, uglutamyl transpeptidase, aminotransferases is observed.

When performing fractional duodenal intubation, a decrease in the amount of cystic bile, dysfunction of the sphincter of Oddi, changes in the biochemical composition of bile, the presence of inflammatory components (Reactive protein, sialic acids), and bacterial contamination are noted.

Treatment of Chronic cholecystitis:

Treatment of chronic cholecystitis without cholelithiasis (CC). The treatment program includes:

mode;
diet therapy;
drug therapy during exacerbation:
pain relief;
use of choleretic drugs;
antibacterial therapy;
normalization of the functions of the autonomic nervous system;
immunomodulatory therapy and increasing the overall reactivity of the body;
physiotherapy, hydrotherapy;
Spa treatment.

During a period of severe exacerbation of the disease, the patient must be hospitalized in a therapeutic hospital. In mild cases, treatment is usually carried out on an outpatient basis. During the period of exacerbation, patients with chronic cholecystitis are recommended to rest in bed for 7-10 days.

Food should be mechanically and chemically gentle and not have a cholekinetic effect. During exacerbation of the disease, therapeutic nutrition should help reduce inflammation in the gallbladder, prevent stagnation of bile, and ensure the prevention of the formation of gallstones. In the phase of sharp exacerbation in the first 1-2 days, only drinking warm liquids (weak tea, juices from fruits and berries diluted with water, rosehip decoction) is prescribed in small portions up to 3-6 glasses per day. As the condition improves, pureed food is prescribed in limited quantities : slimy soups, porridges (semolina, oatmeal, rice), jelly, mousse, jelly. In the future, lean varieties of meat, fish, dairy products, sweet vegetables and fruits, butter and vegetable fats of 30 g per day are allowed. Food is taken 46 times a day in small portions.

After eliminating signs of exacerbation of chronic cholecystitis, diet No. 5 is prescribed.

In order to correct secondary immunodeficiency, preparations of the thymus gland of cattle (thymalin, Taktivin, thymogen, timoptin) are used, which are administered intramuscularly daily for 10 days. Decaris can be recommended as an immunomodulator (levamisole 50 mg once a day for the first 3 days of each week for 3 weeks, sodium nucleinate 0.2-0.3 g 3-4 times a day for a period of 2 weeks to 3 months).

To increase the body's nonspecific resistance, adaptogens can be used: saparal, 1 tablet. (0.05 g) 3 times a day for 1 month, Eleutherococcus extract, tincture of ginseng, Chinese lemongrass, pantocrine 30-40 drops. 3 times a day for 12 months.

In the treatment of chronic cholecystitis, the use of enzyme preparations (digestal, festal, panzinorm, creon) for 3 weeks during meals, as well as antacid preparations (maalox, phosphalugel, remagel, protab), used 1.5-2 hours after meals, is indicated.

Forecast. Depends on predisposing factors, timely treatment, and severity.

Which doctors should you contact if you have Chronic cholecystitis:

Gastroenterologist

Is something bothering you? Do you want to know more detailed information about Chronic cholecystitis, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can make an appointment with a doctor– clinic Eurolab always at your service! The best doctors will examine you, study external signs and help you identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolab open for you around the clock.

(+38 044) 206-20-00

You? It is necessary to take a very careful approach to your overall health. People don't pay enough attention symptoms of diseases and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called symptoms of the disease. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to do it several times a year. be examined by a doctor, in order not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the organism as a whole.

If you want to ask a doctor a question, use the online consultation section, perhaps you will find answers to your questions there and read self care tips. If you are interested in reviews about clinics and doctors, try to find the information you need in the section. Also register on the medical portal Eurolab to keep abreast of the latest news and information updates on the site, which will be automatically sent to you by email.

Other diseases from the group Gastrointestinal tract diseases:

Grinding (abrasion) of teeth

Abdominal trauma

Abdominal surgical infection

Oral abscess

Edentia

Alcoholic liver disease

Alcoholic cirrhosis of the liver

Alveolitis

Angina Zhensula - Ludwig

Anesthetic management and intensive care

Ankylosis of teeth

Anomalies of the dentition

Anomalies of teeth position

Anomalies of the esophagus

Anomalies in tooth size and shape

Atresia

Autoimmune hepatitis

Achalasia cardia

Esophageal achalasia

Bezoars of the stomach

Budd-Chiari disease and syndrome

Veno-occlusive liver disease

Viral hepatitis in patients with chronic renal failure on chronic hemodialysis

Viral hepatitis G

Viral hepatitis TTV

Intraoral submucosal fibrosis (oral submucosal fibrosis)

Hairy leukoplakia

Gastroduodenal bleeding

Hemochromatosis

Geographic language

Hepatolenticular degeneration (Westphal-Wilson-Konovalov disease)

Hepatolienal syndrome (hepatosplenic syndrome)

Hepatorenal syndrome (functional renal failure)

Hepatocellular carcinoma (hcc)

Gingivitis

Hypersplenism

Gingival hypertrophy (gingival fibromatosis)

Hypercementosis (ossifying periodontitis)

Pharyngeal-esophageal diverticula

Hiatal hernia (HH)

Acquired esophageal diverticulum

Gastric diverticula

Diverticula of the lower third of the esophagus

Esophageal diverticula

Diverticula of the middle third of the esophagus

Esophageal dyskinesia

Dyskinesia (dysfunction) of the biliary tract

Liver dystrophy

Sphincter of Oddi dysfunction (postcholecystectomy syndrome)

Benign nonepithelial tumors

Benign neoplasms of the gallbladder

Benign liver tumors

Benign tumors of the esophagus

Benign epithelial tumors

Cholelithiasis

Fatty hepatosis (steatosis) of the liver

Malignant neoplasms of the gallbladder

Malignant tumors of the bile ducts

Foreign bodies of the stomach

Candidal stomatitis (thrush)

Caries

Carcinoid

Cysts and aberrant tissue in the esophagus

Mottled teeth

Upper gastrointestinal bleeding

Xanthogranulomatous cholecystitis

Leukoplakia of the oral mucosa

Drug-induced liver damage

Medicinal ulcers

Cystic fibrosis

Salivary gland mucocele

Malocclusion

Impaired development and eruption of teeth

Tooth formation disorders

Hereditary coproporphyria

Hereditary disorder of the structure of enamel and dentin (Stanton-Capdepont syndrome)

Non-alcoholic steatohepatitis

Liver necrosis

Pulp necrosis

Emergency conditions in gastoenterology

Esophageal obstruction

Osteogenesis imperfecta of teeth

Examination of patients in emergency surgery

Acute delta superinfection in hepatitis B virus carriers

Acute intestinal obstruction

Acute intermittent (intermittent) porphyria

Acute disturbance of mesenteric circulation

Acute gynecological diseases in the practice of a surgeon

Acute bleeding from the digestive tract

Acute esophagitis

Acute alcoholic hepatitis

Acute appendicitis

Acute apical periodontitis

Acute acalculous cholecystitis

Acute viral hepatitis A (AVHA)

Acute viral hepatitis B (AVHB)

Acute viral hepatitis B with delta agent

Acute viral hepatitis E (AVHE)

Acute viral hepatitis C

Acute gastritis

Acute gingivitis

Acute stomach

Acute pericoronitis

Certain types of intestinal obstruction

Edema-ascitic syndrome

Periodontal disease

Pathological tooth resorption

Peptic ulcer of unspecified localization

Peptic ulcers of the esophagus

Peptic esophagitis

Primary biliary cirrhosis of the liver

Primary sclerosing cholangitis

The human body is a reasonable and fairly balanced mechanism.

Among all infectious diseases known to science, infectious mononucleosis has a special place...

The world has known about the disease, which official medicine calls “angina pectoris,” for quite a long time.

Pig ( scientific name – parotitis) is called an infectious disease...

Hepatic colic is typical manifestation gallstone disease.

Brain edema - consequences excessive loads body.

There are no people in the world who have never had ARVI (acute respiratory viral diseases)...

A healthy human body is able to absorb so many salts obtained from water and food...

Knee bursitis is a widespread disease among athletes...

Signs of chronic cholecystitis ultrasound

Chronic cholecystitis: what it is, treatment, symptoms, signs, causes

Chronic cholecystitis is an inflammation of the gallbladder, in which the disease occurs with exacerbations and remissions. Chronic cholecystitis almost always occurs in the context of gallstones and previous episodes acute cholecystitis(even moderate severity). The nature of the damage varies from moderate chronic infiltration inflammatory cells to fibrotic changes, which leads to shrinkage of the gallbladder. Severe calcification of fibrous walls is called porcelain gallbladder.

Causes of chronic cholecystitis

The development of chronic cholecystitis is based on the same processes as during the formation of acute cholecystitis.

Pathogenesis. With significant stagnation of bile, microliths can form, gradually growing to stones, forming cholelithiasis. When the gallbladder is blocked by a stone, the infection process often intensifies.

Symptoms and signs of chronic cholecystitis

The disease can occur in different ways. In some cases, during the period of remission the patient has no complaints at all, but during exacerbations a classic attack of acute cholecystitis develops. However, this option is not the most common. Usually, even without an exacerbation, the patient is bothered by heaviness in the right hypochondrium after eating, bitterness in the mouth in the morning, and periodic nausea. At the same time, the body temperature remains normal.

Stones cause intermittent obstruction cystic duct, which is clinically manifested by recurrent biliary colic. Such attacks of pain are not necessarily accompanied by severe inflammation of the gallbladder; the degree of inflammation does not correlate with the intensity and frequency of biliary colic. On examination, muscle tension may be detected in the upper right quadrant of the abdomen; the temperature usually does not rise. Fever suggests the presence of acute cholecystitis. Once biliary colic occurs, it is prone to relapse.

With hypomotor dyskinesia, the pain is dull, aching, accompanied by dyspeptic symptoms.

Hypermotor dyskinesia is accompanied by acute intense pain. May be provoked by psycho-emotional stress. This pain is called “hepatic colic.”

Complications of chronic cholecystitis

Among the complications, exacerbation of cholecystitis is possible first of all. In addition, the disease can lead to pancreatitis in the patient.

Examination of chronic cholecystitis

In case of chronic cholecystitis, duodenal intubation can be performed. At the same time, in the portion of bile that is extracted from the bladder, a large number of leukocytes are found, which sometimes even gather in clusters.

In addition, the bile itself looks opaque and contains a large number of flakes. In many cases, it is mixed with mucus and contains many epithelial cells, which should not normally be present. Change her physicochemical characteristics: when the gallbladder is inflamed, the pH decreases, i.e. bile becomes more acidic and its specific density decreases.

When conducting a bacteriological examination (bile culture) and studying it under a microscope, it is revealed harmful microorganisms.

An important diagnostic procedure is ultrasound. Among the ultrasound signs of chronic cholecystitis is an increase in the thickness and density of the walls of the gallbladder, as well as their deformation. When the properties of bile change, a “precipitate” consisting of crystalline elements may be noticeable in the bladder.

If the patient has already formed stones, they are also clearly visible. With the long-term existence of the disease, the appearance of adhesions is possible - strands consisting of connective tissue. They form in the lumen of the bladder, as well as outside it, between the bladder and neighboring organs.

Very useful in diagnosing chronic cholecystitis x-ray examination. On overview photo In the abdominal cavity, stones may not be visible, provided they consist predominantly of cholesterol and its compounds. For this reason, the study is carried out with contrast. The patient either drinks it (oral cholecystocholangiography) or receives it intravenously (intravenous cholecystocholangiography). The substance is excreted by the liver into the bile, staining the bladder and ducts from the inside. Therefore, the images show the stones, their size and location, as well as changes in the structure of the gallbladder.

Cholecystitis can be diagnosed using thermography. Areas of the body with elevated temperatures emit infrared rays, which are recorded by the device. With this disease, the temperature of the gallbladder increases by an average of 0.5-2 degrees.

If necessary, radioisotope testing can be performed. In this case, labeled technetium is injected into the patient’s body, which is excreted in the bile and allows one to see the contours of the organs of the biliary system during scanning.

By doing general analysis blood, the result depends on how severe the inflammatory process is at one time or another. When it increases, it is expressed by an increase in the level of leukocytes and an increase in ESR. In biochemical analysis, during an exacerbation there is an increase in the content of fibrin and sialic acids.

Diagnosis of chronic cholecystitis is based on typical clinical symptoms, signs of inflammation based on the results of clinical and biochemical blood tests, duodenal intubation data, bile culture with bacterial isolation, ultrasound data, etc.

Acute cholangitis is characterized by pain in the right hypochondrium, fever, jaundice, increased ALT, AST.

Diagnosis of chronic cholecystitis

Chronic cholecystitis is suspected in patients with recurrent biliary colic and the presence of gallstones. An ultrasound or other imaging test usually confirms the presence of gallstones, and in rare cases allows you to detect a wrinkled, fibrous gallbladder. The diagnosis is made on the basis of recurrent biliary colic and ultrasound data, which reveals stones in the gallbladder. Cholescintigraphy may indicate a “disabled” gallbladder, but this study is less accurate.

Care and treatment of chronic cholecystitis

In the treatment of chronic cholecystitis, choleretic drugs are widely used to reduce congestion in the gallbladder. Modern drugs (gepabene, odeston) have choleretic, cholecystokinetic and antispasmodic effects on the sphincter of Oddi.

Acalculous cholecystitis is treated on an outpatient basis or, in case of exacerbations, in a therapeutic hospital. In case of severe exacerbation, the patient is prescribed bed rest for 2-3 days. All patients are advised to follow a diet.

Among medicines apply antibacterial agents, usually combine beta-lactams (ceftriaxone, amoxiclav, etc.) with metronidazole. A course of antibiotics is carried out for 7-10 days.

In parallel with them, B vitamins and antispasmodics are prescribed to reduce pain (no-spa, baralgin).

Calculous cholecystitis is usually treated surgically.

Among the physiotherapeutic techniques, UHF therapy and electrophoresis have an anti-inflammatory effect. For acalculous cholecystitis, you can also prescribe electrical stimulation of the gallbladder, with the help of which its contractility and bile production are activated. When the exacerbation subsides, it is recommended to prescribe carbon dioxide and other medicinal baths, as well as mud therapy. In remission, patients can be referred to resorts with mineral waters (Borjomi, Essentuki).

Laparoscopic cholecystectomy is indicated to prevent relapses clinical symptoms and further complications. This operation is also justified in cases of porcelain gallbladder, which is a risk factor for the development of carcinoma.

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Chronic cholecystitis: symptoms and treatment

The inflammatory process of the gallbladder is called “chronic cholecystitis” in medicine. As practice shows, the disease occurs most often in women after forty years with excess weight or cholelithiasis. However, it is not uncommon for signs of chronic cholecystitis to appear in patients with normal or even reduced body weight. IN last years Cases have become more frequent when doctors diagnose this common disease in men.

Clinically, there are two forms of the disease, which are diagnosed using ultrasound:

Stoneless (non-calculous);
Calculous.

In the first case, the focus is localized in the neck of the bladder. The inflammatory process can be purulent, catarrhal and give rise to destructive forms.

Reasons for the development of the disease

The main cause of cholecystitis is bacteria (staphylococcus, coli, fungi, paratyphoid, streptococcus, Proteus or Pseudomonas aeruginosa). The microorganism enters the gallbladder from the intestine. In other words, a contact path occurs.

The disease develops gradually, and the microbial flora upon first contact with the gallbladder causes inflammation of its mucous membrane. As a result, the progression of the process begins, which can subsequently move to the muscular and submucosal layer. Infiltrates (seals) form at the site of the lesion and connective tissue begins to grow, which deform the bladder.

The inflammatory process in the gallbladder causes a change in the pH of the bile, so it thickens and can contribute to the formation of stones.

If immunity is weakened, stressful situations or the rules of the diet are violated during illness, an acute form of cholecystitis may develop.

Signs

This disease has a progressive course with periods of exacerbation and remission. The main symptom of cholecystitis is pain that occurs in the hypochondrium on the right. With hypotension of the gallbladder, the pain is mild, aching and constant. In some patients, there may be no pain at all, but is replaced by heaviness in the right side. To make a correct diagnosis, the doctor sends the patient for an ultrasound.

If the tone of the bladder is increased, the pain can be paroxysmal, intense and short-term, reminiscent of colic. In this case, muscle spasm occurs, which occurs as a result of taking fatty foods, carbonated drinks, eggs, alcohol, etc. the patient may have a feeling of bitterness in the mouth, especially in the morning, unpleasant belching, bloating, constipation or diarrhea, fever, itchy skin, decreased appetite, weakness and even food allergies.

Diagnosis of the disease using ultrasound

The attending physician can reliably diagnose the disease using ultrasound. After examining the patient, he will refer him for an ultrasound examination, as a result of which it will be possible to determine the absence or presence of stones, and, if necessary, prescribe additional research methods.

If it is not possible to conduct an ultrasound, it is replaced by cholecystitography. In the absence of stones and for microscopic examination of bile, a specialist may prescribe duodental intubation. Based on the results of these studies and ultrasound, the doctor will be able to decide final diagnosis and prescribe treatment.

If a specialist has prescribed an ultrasound for a patient, then you need to prepare for this procedure:

Complete fasting before ultrasound for 8-12 hours;
You should not drink coffee or tea (especially strong) before the procedure;
Smoking and chewing gum before an ultrasound are also not recommended.

During the sound examination, the patient changes position several times so that the mobility of the structures inside the bladder can be determined. For example, when the position of the body changes, the stones in the gall bladder are displaced, which can serve as an additional criterion for diagnosis during ultrasound, and if the subject ate at night, the bladder may shrink (this will affect the reliability of the results).

Treatment of the disease

An effective and one of the main methods in which the treatment of cholecystitis will be successful is diet. The patient should eat food often - up to six times a day and in small portions.

In addition, treatment should include:

preparing fresh food and eating it warm;
inclusion of baked, boiled and steamed food in the diet;
a complete diet with a limit on fatty, salty, spicy foods, marinades and smoked foods;
treatment of cholecystitis excludes the consumption of spinach, sorrel and onions;
complete failure from alcohol.

If these rules are followed, the treatment will be effective, and the patient will be able to quickly return to his previous life without pain and discomfort in the right hypochondrium. In addition to diet, treatment of cholecystitis is also carried out by medication. If the forms of cholecystitis are clinical, then the doctor prescribes a full course of medication with antibiotics.

Treatment of the disease depends on the signs and form of inflammation:

For severe pain, antispasmodics are prescribed;
For moderate pain, the doctor recommends choleretic drugs;
In case of hypomotor dyskinesia, prokinetics should be taken;
If disorders of the nervous system are expressed, you should definitely take sedatives;
In the absence of signs of exacerbation of the disease, physiotherapy is recommended;
During remission it is carried out Spa treatment and treatment with mineral waters;
In the calculous form, treatment is carried out by removing the affected organ with stones.

After this, the doctor prescribes a repeat ultrasound to verify the effectiveness of the treatment. Only after an additional examination and ultrasound will it be possible to verify the absence of inflammation and stones in the gall bladder.

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Chronic cholecystitis, clinical picture, diagnosis

Chronic cholecystitis is a disease associated with the presence of inflammatory changes in the wall of the gallbladder. Chronic cholecystitis can occur after acute cholecystitis, but more often it develops independently and gradually. In chronic cholecystitis, the inflammatory-scarring process covers all layers of the gallbladder wall. It gradually scleroses, thickens, and in some places lime is deposited in it. The gallbladder is reduced and fused with adjacent organs by adhesions; adhesions deform the gallbladder and disrupt its function, which creates conditions for maintaining the inflammatory process and its periodic exacerbations. Two factors play a major role in the development of this disease: infection and bile stagnation. They act simultaneously.

There are chronic acalculous (non-calculous) and chronic calculous cholecystitis. Clinical difference they are separated from each other is due practically only to the fact that with calculous cholecystitis another mechanical factor(migration of stones), which gives a clearer picture of the disease. In practice, it can be difficult to distinguish between these two diseases. The documented division of chronic cholecystitis into calculous and non-calculous is ultrasound and x-ray examination (cholecystography, cholangiography), which reveals stones in the gall bladder or bile ducts.

Chronic acalculous cholecystitis is most often caused by conditionally pathogenic microflora: Escherichia coli, streptococcus, staphylococcus, less commonly Proteus, Pseudomonas aeruginosa, enterococcus. Occasionally, chronic acalculous cholecystitis occurs, caused by pathogenic microflora (Shigella, typhoid bacilli), viral and protozoal infections. Microbes penetrate the gallbladder by hematogenous (through the blood), lymphogenous (through lymph) and contact (from the intestines) route.

The infection can enter the gallbladder through the common bile and cystic ducts from gastrointestinal tract(ascending infection). Spread of infection from duodenum into the biliary system is more often observed with reduced acid-forming function of the stomach, insufficiency of the sphincter of Oddi and the presence of duodenitis and duodenostasis.

Downward spread of infection from the intrahepatic bile ducts is also possible. The development of the inflammatory process in the gallbladder is facilitated by changes in the chemical properties of bile and sensitization of the body to autoinfection. Chronic inflammatory changes in the wall of the gallbladder in the acute phase may have different character- from catarrhal to purulent (phlegmonous, phlegmonous-ulcerative and gangrenous) forms.

Outside of severe exacerbation, cholecystitis can be represented by sluggish inflammation in the wall of the gallbladder. The outcome of the inflammatory process in the gallbladder can be dropsy and empyema, pericholecystitis with a constant focus of infection. Chronic cholecystitis is often accompanied by involvement in the pathological process of other digestive organs (liver, stomach, pancreas, intestines), nervous and cardiovascular disorders. Inflammatory diseases of the gallbladder are often accompanied by the formation of stones in it.

The clinical picture of chronic acalculous cholecystitis is characterized by a long progressive course with periodic exacerbations. The picture of the disease is dominated by pain, which occurs in the area of the right hypochondrium, less often - simultaneously or even predominantly in the epigastric region. The pain often radiates to right shoulder blade, collarbone, shoulder joint and shoulder, less often in left hypochondrium, has an aching character, lasts for many hours, days, sometimes weeks. Often, against this background, acute cramping pain occurs due to exacerbation of inflammation in the gallbladder. The occurrence of pain and its intensification is often associated with a violation of the diet, physical stress, cooling, intercurrent infection. Particularly characteristic is the occurrence or intensification of pain after eating fatty and fried foods, eggs, cold and carbonated drinks, wine, beer, spicy snacks, as well as under the influence of neuropsychic stress. Aggravation pain attack usually accompanied by increased body temperature, nausea, vomiting, belching, diarrhea or alternating diarrhea and constipation, bloating, a feeling of bitterness in the mouth, and general neurotic disorders.

Pain in chronic acalculous cholecystitis can be intense, paroxysmal (hepatic colic); less intense, constant, aching; paroxysmal pain can be combined with constant pain. Many have an exacerbation constant feeling gravity in upper sections belly. Sometimes pain occurs in the epigastric region, around the navel, in the right iliac region. The intensity of pain depends on the degree of development and localization of the inflammatory process, the presence of spasm of the gallbladder muscles, and concomitant diseases. For example, in chronic acalculous cholecystitis, manifested by hypertensive dyskinesia, the pain is usually intense, paroxysmal, and with hypotonic dyskinesia- less intense, but more constant, pulling.

Aching, almost continuous pain can be observed with pericholecystitis. Pain in chronic acalculous cholecystitis is usually less intense than in chronic calculous cholecystitis, and is relieved or disappears after the use of antispasmodics and analgesics. Sometimes the nature of the pain helps to recognize concomitant diseases of adjacent organs. Thus, irradiation of pain to the left hypochondrium can be observed with pathological changes in the pancreas; pain in the area corresponding to the projection of the duodenum is characteristic of periduodenitis developing due to chronic cholecystitis.

Vomiting is not an obligatory symptom of chronic acalculous cholecystitis and, along with other dyspeptic disorders (nausea, bitter belching or constant bitter taste in the mouth), can be associated not only with the underlying disease, but also with concomitant pathology - gastritis, pancreatitis, periduodenitis, hepatitis. Often an admixture of bile is found in the vomit, and it turns green or yellow-green. Outside of an exacerbation, vomiting occurs when the diet is violated, after eating fatty foods, smoked foods, spicy seasonings, alcohol, sometimes after smoking, strong excitement.

There is weakness, lethargy, increased irritability, excitability, sleep disturbance. Sometimes, when the temperature rises, chills occur, which, however, is more often a sign of cholangitis or acute cholecystitis.

A typical palpation symptom of chronic cholecystitis is pain in the gallbladder area, especially on inspiration. Pain is also often observed when tapping in the right hypochondrium, especially at the height of inspiration, when the abdomen protrudes. Often, pain during palpation of the gallbladder area is detected more in sitting position sick. However, palpation of the gallbladder may be hampered by an excessively thick fat layer on the anterior wall of the abdomen, or significantly developed abdominal muscles, or an atypical location of the gallbladder. With long-term chronic cholecystitis, the gallbladder may shrink due to the development of connective tissue, and in this case, even with purulent cholecystitis, it cannot be palpated.

Generally clinical picture chronic demon calculous cholecystitis has no specific features and does not allow one to confidently differentiate calculous and acalculous lesions without special research methods.

The clinical and radiological method is most often used to diagnose chronic cholecystitis.

In chronic cholecystitis, in the acute phase, the ESR often increases, an excessive number of leukocytes is detected with a shift in the leukocyte formula to the left (a clear sign of inflammation), and a large number of eosinophils. Dynamic blood testing is important. For the diagnosis of complicated forms of chronic cholecystitis, biochemical research venous blood, in particular, determination of bilirubin, cholesterol, alkaline phosphatase, liver cytolytic enzymes, C-reactive protein, etc. in blood serum.

Duodenal intubation in chronic acalculous cholecystitis often reveals dyskinetic disorders. Normally, the gallbladder usually contains 30-50 ml of bile, and with hypodynamic dyskinesia of the gallbladder, its amount reaches 150-200 ml or more, but it is released much more slowly than normal. Often, even with repeated probing, gallbladder bile (portion B) cannot be obtained, which may be due to obliteration and shrinkage of the gallbladder, with pericholecystitis, in which its contractility is always impaired.

X-ray examination methods include cholegraphy, which is carried out after oral or intravenous administration of a contrast agent. In this case, the gallbladder and ducts are well contrasted and X-ray films reveal various symptoms of gallbladder damage: elongation, tortuosity, uneven filling (fragmentation) of the cystic duct, its kinks, etc.

However, the use of traditional methods does not always make it possible to identify certain forms of chronic cholecystitis. Thus, in some forms of cholecystitis in the remission phase of the disease, radiological signs of damage to the gallbladder may be absent or minimal.

Thus, the clinical and radiological method cannot be considered absolutely reliable. In recent years, they have increasingly begun to use complex methodology, which, in addition to conventional cholecystography, includes cholecystocholangiography, ultrasound and radionuclide scanning, computed tomography, laparoscopy, as well as examination of other organs and systems. In a number of cases, according to special indications laparoscopic cholecystography is performed. The use of this method allows you to examine various departments gallbladder, note the degree of its filling, the presence of adhesions and adhesions, deformations, and the condition of the gallbladder wall. Despite the fact that there are practically no complications when using this method, non-invasive methods are preferred in the diagnosis of chronic cholecystitis.

Non-invasive methods for studying the biliary tract include ultrasound scanning and thermography.

Ultrasound scanning has no contraindications and can be used in cases where X-ray examination cannot be performed: in acute phase diseases, with hypersensitivity To contrast agents, pregnancy, liver failure, obstruction of main biliary tract or cystic duct. Ultrasonography allows not only to determine the absence of stones, but also to evaluate contractility and the condition of the gallbladder wall (thickening and sclerosis).

The thermography method for the diagnosis of chronic cholecystitis is not of significant importance, but with its help it is possible to identify a number of features in acute and destructive forms of cholecystitis. In chronic cholecystitis, thermography data usually turn out to be negative, and only with exacerbation in the thermogram of the right hypochondrium area is sometimes observed bright spot, the size and intensity of which depend on the nature and severity of inflammation of the gallbladder. Thermography in chronic acalculous cholecystitis can be used mainly for dynamic monitoring of the state of the inflammatory process and identification of complications. Thermography can be used for any condition of the patient; the method is harmless and simple.

When examining patients with chronic cholecystitis, it is necessary to examine the systems and organs associated with the biliary tract anatomically and functionally. This allows you to judge the condition of the gallbladder by indirect signs, as well as exclude diseases with similar clinical symptoms. If necessary, fluoroscopy and endoscopy of the esophagus, stomach, duodenum, colon, echography of the liver and pancreas, laparoscopy, and excretory urography are performed.

is an acute inflammatory process occurring in the human gallbladder.

Normally, the gallbladder has a volume of 40–70 cm3. Produced in the human liver , which is necessary to ensure the digestion process. It is stored in the gallbladder. If metabolic processes are disrupted in the body, stones may appear in the lumen of the gallbladder, and with the simultaneous occurrence of an infectious inflammatory process, acute cholecystitis develops.

Causes of cholecystitis

The most common cause of cholecystitis is the entry of microbes into the body and their subsequent development. Cholecystitis can be caused by streptococci , enterococci , staphylococci . That is why for treatment acute or chronic cholecystitis technique is often used . As a rule, the penetration of microorganisms into the gallbladder occurs through the bile ducts from the intestine. This phenomenon occurs as a consequence of insufficient function of the muscle fibers that separate the common bile duct from the intestine. This is often seen as a consequence gallbladder dyskinesia And biliary tract , too low secretory activity of the stomach, high pressure in the duodenum.

Very often, the development of cholecystitis occurs as a consequence of impaired outflow of bile. This may occur in a person who suffers from . If there are fireplaces in a person’s gallbladder, they not only create a mechanical barrier to the outflow of bile, but also irritate the walls of the gallbladder. As a result, it initially develops in the gallbladder aseptic , and later - microbial inflammation of the gallbladder. Thus, the patient develops chronic cholecystitis, which periodically worsens.

However, microbes can end up in the gallbladder, getting there with the flow of blood and lymph, because the gallbladder has a developed vascular network. In this regard, symptoms of cholecystitis often appear in people who suffer from diseases of the intestines, organs of the genitourinary system, or the presence of other foci of inflammation.

Sometimes cholecystitis is provoked roundworms , Giardia , Availability liver injuries And gallbladder and etc.

Symptoms of cholecystitis

Symptoms of cholecystitis clearly appear at the very early stages of the development of the disease. The early manifestations of this disease are very diverse. As a rule, they occur after a person has noticeably violated his usual diet, for example, ate a lot of spicy or very fatty foods, drank a fairly large amount of alcohol, etc. In this case, initially the pain occurs in the upper abdomen and radiates to the right hypochondrium. The pain can be either constant or increasing periodically. Sometimes with cholecystitis there is a very sharp pain which reminds biliary colic . Dyspeptic symptoms may also occur as symptoms of acute cholecystitis. It's a bitter and metallic taste in my mouth, constant nausea, the occurrence of belching, . The person becomes very irritable and often suffers from insomnia.

A patient with cholecystitis vomits bile from time to time, but after such vomiting he does not feel better. In addition, symptoms of cholecystitis are often manifested by an increase in body temperature, increased heart rate, the patient's skin may turn slightly yellow. There is a dry tongue.

If the disease is not treated immediately after the symptoms described appear, it may subsequently develop peritonitis , which is a very dangerous condition.

Chronic cholecystitis generally occurs over a long period of time, sometimes it can last for many years. Chronic cholecystitis is usually divided into several types. At acalculous cholecystitis Stones do not form in the lumen of the gallbladder. In the same time calculous cholecystitis characterized by the appearance of stones in the lumen of the bladder. Consequently, calculous cholecystitis is a manifestation of cholelithiasis.

In this case, a person periodically develops exacerbations, alternating with remissions. Exacerbations of the chronic form of the disease, as a rule, are the result of overeating heavy foods, alcohol abuse, physical overexertion, hypothermia, intestinal infections. In chronic cholecystitis, symptoms similar to those of the acute form of the disease appear. However, their intensity is less pronounced, and the patient’s condition is not so severe.

Diagnosis of cholecystitis

Diagnosis of cholecystitis is carried out by a specialist, first of all, by interviewing the patient and getting to know his medical history. Analysis of the history and clinical course of the disease provides the necessary information for subsequent studies. Next, the patient is prescribed special method research, which is used for cholecystitis - duodenal intubation . This method is used in the morning, because it is important to conduct such a study on an empty stomach.

It is also important to conduct a thorough bacteriological examination (for this, bile culture is performed). This is especially important if the patient has reduced acid-forming function of the stomach. In the process of diagnosing cholecystitis, the physicochemical properties of bile should be determined.

It is important to differentiate the chronic form of the disease from chronic cholangitis , cholelithiasis .

Treatment of cholecystitis

If a patient develops acute cholecystitis, then in most cases he is immediately hospitalized in a surgical hospital. Basically, treatment of cholecystitis begins with the use of conservative therapy. It is important that the patient remains in a state of complete rest at all times. Initially, the patient is prohibited from eating food: his nutrition is provided by intravenous administration of nutritional mixtures.

If there is severe inflammation with corresponding symptoms and surges in body temperature, then complex treatment cholecystitis may also include taking broad-spectrum antibiotics. It is especially important to prescribe antibiotic therapy to elderly patients, as well as people who have diabetes.

At the stage of exacerbation, treatment of cholecystitis is primarily aimed at removing severe pain, reducing inflammation, as well as eliminating manifestations of general intoxication. During application conservative treatment The patient's condition is closely monitored. And if improvement occurs, the patient continues to be treated using conservative methods.

However, if there is no effect from similar treatment The attending physician often decides on surgical intervention. If there is a suspicion of phlegmon of the gallbladder , , perforation , peritonitis , then the operation is performed urgently.

If a person is diagnosed with calculous cholecystitis and, therefore, there is fire in the gallbladder, then treating the disease is a more difficult task. Accordingly, the prognosis of the disease worsens.

With the calculous form of cholecystitis, very painful hepatic colic . This phenomenon in some ways resembles the symptoms of acute cholecystitis, but the patient suffers from more intense pain. As a rule, such attacks begin at night or in the morning. A little later, the patient shows signs of jaundice: the shade of the skin, urine, and mucous membranes changes. In this case, a person’s stool becomes light-colored, sometimes White color. With such symptoms, hospitalization should be carried out immediately.

Treatment of chronic cholecystitis is primarily aimed at stimulating the process of bile discharge and eliminating spasmodic phenomena in the biliary tract and gallbladder. A set of measures is also being carried out that are designed to destroy the causative agent of inflammation. For calculous cholecystitis, stones are also crushed using different methods. Subsequent treatment measures are aimed at preventing the appearance of new stones.

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Prevention of cholecystitis

As preventive measures that are used to prevent the manifestation of acute cholecystitis, it is important to adhere to all hygiene measures general. An important point in this case is to follow the norms of proper nutrition: you need to eat at the same time, at least four times a day, and the calorie content of the daily amount of food should not be exceeded. You should not take large amounts of food at night; such meals have a particularly negative effect if alcohol is consumed at the same time. An important preventive measure is the use sufficient quantity liquids every day. You need to drink at least one and a half to two liters of water or other drinks, and the drink should be distributed evenly throughout the day.

Another important point– ensuring regular bowel movements. This process must be controlled to prevent the occurrence of biliary dyskinesia, as well as excretion .

Experts recommend periodically fasting days, during which one type of food should be consumed (for example, milk, apples, cottage cheese, fruits, meat, etc.). Every person should know which foods cause an allergic reaction and exclude them from the diet.

To stimulate the passage of bile, it is important to do gymnastic exercises every day and adhere to active image life in general.

In addition, it is important to take all measures in a timely manner to cure the manifested inflammation of the abdominal organs.

Diet, nutrition for cholecystitis

In addition, your diet should include products containing large amounts of magnesium salts. These are fruits, vegetables, buckwheat. They not only accelerate the secretion of bile, but also relieve pain and spasms.

The diet for cholecystitis should not contain products that are irritating: broths from meat and fish, sauces, smoked, fatty foods, too sour and spicy dishes. You can't drink alcohol, very cold food and drinks. Excluded fried foods. It is important to adhere to a proper diet, eating food five times a day.

The diet for cholecystitis includes soups, lean meat and fish, wheat bread crackers, omelet, boiled vegetables, cereals, dairy products. Fruit juices are also included in the diet, and it is recommended to consume jelly, gingerbread, jelly, jam, and honey as sweets.

Complications of cholecystitis

As complications of this disease identify some ailments that occur in parallel with cholecystitis, joining it. This chronic cholangitis , hepatitis . Often cholecystitis is the initial cause of gallstones .

In addition, the patient may develop secondary inflammation of the pancreas. In this case, the person also feels pain in the left hypochondrium. This inflammation is diagnosed by ultrasound.

In patients with calculous cholecystitis, due to blockage of the common bile duct, subhepatic jaundice followed by cholestasis . Also, complications of cholecystitis are often dropsy And gallbladder perforation . The latter disease is very dangerous and difficult to treat.

List of sources

Bolotovsky G.V. Cholecystitis and other gallbladder diseases. St. Petersburg: Nevsky Prospekt, 2003;
Kuchanskaya A.V. Cholelithiasis. Modern view of treatment and prevention: IG "Ves", 2007;
Dadvani S.A., Vetshev P.S., Shuludko A.M., Prudkov M.I. Cholelithiasis. M.: Vidar-M, 2000;
Gallbladder diseases. Cholecystitis, cholangitis; AST, Poligrafizdat, Sova - Moscow, 2010.

Cholecystitis is a disease (inflammation) of the gallbladder, the main symptom of which is severe pain in the right side when changing body position. Every year the number of these diseases increases by 15%, and the occurrence of stones annually increases by 20% among the adult population. It has been noted that men are less susceptible to cholecystitis than women after 50 years of age.

What kind of disease is this, what are the causes and characteristic signs in adults, as well as treatment methods and diet for normal functioning gallbladder, we will consider further in the article.

Cholecystitis: what is it?

Cholecystitis is an acute inflammatory process occurring in the human gallbladder. The basic principles of the development of the inflammatory process in the wall of the gallbladder: the presence of microflora in the lumen of the bladder and disturbances in the outflow of bile.

The role of bile in the physiology of digestion:

Dilutes food processed with gastric juice, changes gastric digestion to intestinal;
Stimulates peristalsis thin section intestines;
Activates the production of physiological mucus, which performs a protective function in the intestines;
Neutralizes bilirubin, cholesterol and a number of other substances;
Triggers digestive enzymes.

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), an increase in endocrine disorders (obesity, sugar).

Classification

Depending on the duration of the disease, there are:

Acute cholecystitis

Acute acalculous cholecystitis is rare, usually proceeds without complications and ends with recovery, sometimes it can become chronic. The disease most often develops in the presence of stones in the gall bladder and is a complication of cholelithiasis.

Chronic form

Chronic cholecystitis. Inflammation of the gallbladder occurs slowly and gradually, often without clear signs diseases. As in the acute form, the patient may experience pain in the right side, in the hypochondrium, especially after a sharp shake of the body.

Both acute and chronic cholecystitis can be:

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

In young patients, as a rule, acalculous cholecystitis is detected, but starting from the age of 30, the frequency of verification of calculous cholecystitis rapidly increases.

According to the nature of inflammation, they are:

Catarrhal;
Purulent;
Gangrenous;
Phlegmonous;
Mixed.

Causes

The most common cause of cholecystitis is the entry of microbes into the body and their subsequent development. Cholecystitis can be caused by streptococci, coli, enterococci, . That is why antibiotics are used for treatment.

Common causes:

Congenital anomalies of the gallbladder, pregnancy, prolapse of the abdominal organs
Biliary dyskinesia
Cholelithiasis
The presence of helminthic infestation - ascariasis, giardiasis, strongyloidiasis,
Alcoholism, obesity, excess fat, spicy food in the diet, diet violation.

Inflammatory processes in the gallbladder itself or neighboring organs lead to a change in the natural balance biochemical parameters and tumors. Absence adequate reaction leads to disruption of metabolic processes, in particular to poor outflow of bile, and, consequently, to cholecystitis.

Provoking factors:

poor nutrition with a predominance of fatty, spicy, hot and salty foods;
non-compliance with diet ( long breaks between meals, large evening meals at night, lack of hot food);
alcohol abuse;
smoking;
physical inactivity;
chronic constipation and intoxication of the body;
allergic reactions;
age-related disorders in the blood supply to the abdominal organs;
injuries;
hereditary factor.

Symptoms of cholecystitis in adults

The main symptom of cholecystitis, which patients complain about most, is pain under the ribs in the right side, especially when changing body position, which can also be felt in the right shoulder, shoulder blade, and side of the neck. The pain goes away after some time on its own or after taking a painkiller, but then it gradually increases, and then it becomes regular.

Characteristic symptoms of cholecystitis:

Availability dull ache on the right, above the waist, responding in the shoulder blade, lower back, arm;
lack of appetite;
digestive problems;
endless nausea;
belching bitter;
violation of gas formation;
the appearance of chills;
signs of jaundice on the skin.

Patients may not experience all of the listed symptoms. Their severity varies from barely noticeable (with a sluggish chronic course) to almost unbearable (for example, in the case of biliary colic - a sudden attack of intense pain).

The main symptoms of chronic cholecystitis:

Indigestion, vomiting, nausea, lack of appetite
Dumb painful sensations on the right under the ribs, extending to the back, shoulder blade
Bitterness in the mouth, bitter belching
Heaviness in the right hypochondrium
Possible yellowing of the skin

Occurrence of an attack

An attack of cholecystitis develops for many reasons. Here are the most common:

cholelithiasis;
infection in the bile ducts; stomach diseases leading to disruption of bile movement;
bile stagnation;
blockage of bile duct vessels as a result of atherosclerosis.

With the onset of an attack of cholecystitis, the symptoms take the following form:

the appearance of acute, sharp pain on the right, above the waist;
yellowing of the skin;
vomiting after eating;
the patient cannot find a place for himself;
the occurrence of severe weakness;
decreased blood pressure;
increased heart rate;
the appearance of acute bitterness in the mouth.

In cases of repeated acute attacks inflammation in the gallbladder, the disease is defined as chronic. This form can occur both in the presence of gallstones and in their absence. May develop slowly and unnoticed over a period of time long period from several months to years, or occur immediately as a result of previous acute stage cholecystitis.

How to relieve an attack of cholecystitis?

An attack of acute cholecystitis is always sudden and has acute symptoms.

Actions during an attack	What is prohibited to do
provide rest to the patient; put cold compress to the area of severe pain ( right part abdomen); submit antispasmodic drug(no-shpa); give after bouts of vomiting mineral water without gas on a sodium chloride, hydrocarbonate basis. call emergency help.	First of all, analgesics and narcotic painkillers are prohibited. Such assistance blurs the symptoms of acute cholecystitis, and the doctor may prescribe the wrong treatment. In addition, during an attack, it is strictly prohibited: drink alcohol; take any other medications not prescribed by a doctor; do enemas; place a heating pad on the abdominal area.

Complications

The presence of any cholecystitis is always fraught with the possible development of complications. Some of them are very dangerous and require immediate surgical intervention.

Prolonged inactivity can lead to the development of quite unpleasant complications:

cholangitis;
formation of a fistula in the stomach, hepatic flexure, duodenum;
reactive hepatitis;
“switching off” the bladder (the gall bladder no longer performs its functions sufficiently);
pericholedocheal lymphadenitis (inflammation develops in the bile ducts);
empyema of the bladder (purulent inflammation);
intestinal obstruction;
gall gangrene with the appearance of;
perforation (blister rupture).

Diagnostics

A gastroenterologist treats cholecystitis. In the chronic form of the disease, it will be useful to consult a nutritionist. A physical therapist may provide additional assistance.

To make a diagnosis, the following activities are carried out:

taking anamnesis;
examination of the patient;
laboratory examinations;
instrumental studies.

Laboratory research:

General blood analysis. Reveals signs of inflammation.
Blood chemistry: total bilirubin and its fractions, transaminases, alkaline phosphatase, cholesterol. Their moderate increase is observed.
Blood sugar. For the diagnosis of diabetes mellitus.
General urine analysis. For differential diagnosis with kidney diseases.
Feces on. To identify , .
Microscopic and bacteriological examination of bile.
Immunoenzymatic blood test for giardiasis.
Fecal elastase analysis 1. To diagnose pancreatitis.

The following diagnostic methods are used:

Ultrasound diagnostics. It is carried out to detect signs of pathologically altered gallbladder tissue, in some cases, stones;
Holegraphy. An X-ray examination method that complements ultrasound. Used to identify hidden pathologies of the gallbladder;
Probing of the duodenum. Used to sample the contents of the small intestine.

The best way to determine the presence of the disease is early research. Most often, identifying certain deviations in the chemical composition of bile may only require adherence to a non-strict diet.

How to treat cholecystitis?

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

Treatment of cholecystitis in adults consists of the following steps:

Diet therapy. Maintaining an adequate diet is extremely important.
Antibiotic therapy. Prescribing an antibiotic is possible after establishing the nature of the inflammation, that is, what pathogen caused the pathogenesis of the disease.
Symptomatic treatment. Aimed at eliminating the symptoms of the disease. These can be immunostimulating, antihistamines, sedatives, choleretic drugs, hepatoprotectors.
Compliance with the regime, physical therapy, especially during periods of remission.

Medications

Medicines for cholecystitis should be taken with great caution, because If the selection or order of administration is incorrect, the risk of exacerbation of the disease increases. This is especially true if there is choleretic bladder stones.

Be sure to consult your doctor, who, based on the diagnosis, will prescribe you a course of treatment for cholecystitis, following which the positive prognosis for recovery increases significantly!

Additional events:

herbal medicine - teas with immortelle, St. John's wort, corn silk, mint;
blind probing procedure (tubage) - performed once every 7 days, only in the absence of adhesions and pronounced narrowing of the bile ducts;
physiotherapy - electrophoresis, diathermy, mud therapy, inductothermy.

Surgery

Surgery is often prescribed for acute cholecystitis. Unlike acute cases, the decision to perform a surgical procedure is not made immediately. Doctors can monitor his condition for several days, do a biochemical analysis of the contents of the gallbladder, conduct an ultrasound, take blood for analysis, and only after finding out the full picture of the development of the disease, a final decision is made.

Most often, it is stone disease that causes cholecystectomy. At untimely treatment The disease destroys the walls of the gallbladder and disrupts the digestion process. The operation can be performed in two ways: laparoscopy and open cholecystectomy.

The purpose of surgery for cholecystitis is to remove the inflammatory focus, i.e. gallbladder as the primary source of the disease. In this case, it is necessary to ensure complete patency of the bile ducts, remove obstacles and ensure the free passage of bile into the intestines.

Certainly, it is possible to avoid surgery, if you seek treatment at the first symptoms, as well as stick to a diet and follow all doctor’s recommendations.

Diet

For cholecystitis, it is recommended to eat small portions, as often as possible, at least 4-5 times a day. It is strongly recommended to create a diet plan with constant time eating. It is very important that the bile does not stagnate. The very intake of food into the body by the hour can be considered as a choleretic agent, especially since this is natural for a weakened gastrointestinal system.

Three main directions of diet for cholecystitis:

Relieves the liver and other digestive organs.
Normalization of bile levels.
Improving the performance of the gastrointestinal tract.

It is allowed to consume in the first days of illness:

freshly prepared (not canned!) juices from berries and fruits;
mineral water without gas;
sweet tea is not strong;
rosehip decoction (if there are no contraindications to its use).

After the acute symptoms of the disease in question subside (as a rule, this happens after 1-2 days), the patient is allowed to introduce pureed soups, slimy porridges, jelly, sweet tea with crackers (they should be made from white bread) into the diet.

Allowed foods during the diet

Prohibited Products

vegetable broth soups with various cereals, vegetables, pasta, borscht, beetroot soup, fresh cabbage soup, dairy soup with cereals, fruit soup with rice;
low-fat varieties of meat, poultry (chicken, turkey) and fish (cod, ice cod, pike perch, hake, navaga, etc.) in boiled, baked (pre-boiled), stewed (with juice removed); beef stroganoff, pilaf made from boiled meat. Meat and poultry are prepared mainly in pieces, but can also be in the form of meatballs, cutlets, meatballs;
fresh tomatoes, cucumbers, carrots, White cabbage; boiled and stewed carrots, potatoes, beets, zucchini, pumpkin, cauliflower.
Non-acidic acid is allowed sauerkraut, fresh herbs (parsley, dill), from legumes - green pea. Onions can be added to dishes after boiling;

The list of preferred fluids for cholecystitis includes:

still mineral water;
juice from fruits and berries;
tea without sugar, weak;
rosehip compote.

Fatty foods - animal fats: pork, lamb, duck, eggs, butter, chocolate.
Fried foods must be excluded. These products make digestion difficult for patients with cholecystitis, since bile does not enter the intestines well.
Alcohol (especially beer and champagne) – it contributes to the appearance of gallstones.
Salty, sour, spicy and smoked - they promote the production of bile, which can cause stretching of the inflamed organ.
You will also have to forget about carbonated drinks and coffee.

Note: It is absolutely impossible to carry out any procedures to liquefy and remove bile without a preliminary examination. If there is even a small stone in the gallbladder or ducts, then the sudden movement of bile can bring the patient to the operating table for emergency surgical care.

Folk remedies

Before use folk remedies for cholecystitis, be sure to consult a gastroenterologist.

Corn silk- 10 g pour 200 ml of water, boil for 5 minutes, take ¼ glass 3 times a day before meals.
Juice of one lemon and pour a tablespoon of salt into a liter of boiled water and drink in the morning on an empty stomach. Effective method emptying the gallbladder.
Pumpkin . Prepare as many pumpkin dishes as possible. Taking freshly squeezed juice from vegetable pulp (200 ml per day) is beneficial.
Add 2 tsp to boiling water immortelle flowers, 2 tsp lingonberry leaves, 3 tsp knotweed and 1 tsp flowers pharmaceutical chamomile. Let it brew for 2-3 hours. Take ½ glass three times a day.
Mix the ingredients in the indicated quantities: peppermint, chamomile, kidney tea - 2 tablespoons each; soapwort, common hops (cones) – 3 tbsp. l. For 1 liter of boiling water, take 3 tablespoons of the mixture. Take 100 ml 6 times a day.
Take 2 teaspoons chopped sage leaf medicinal, brew with 2 cups of boiling water. Leave for 30 minutes, strain. Take 1 tablespoon every 2 hours for inflammation of the gallbladder and liver.

Prevention

The main prevention of cholecystitis is to significantly reduce the likelihood of gallstones. And in order to prevent the formation of stones, you need to be careful about your diet and the foods you eat daily.

To protect yourself from developing symptoms inflammatory processes in the walls of the gallbladder in adults, prevention of cholecystitis at home is required, including:

Follow a diet, limit the consumption of fatty and fried foods, exclude alcoholic and carbonated drinks, give preference to fractional meals, strive to normalize body weight.
Timely sanitization of possible foci of infection in the body - organs oral cavity and nasopharynx.
Once a year, undergo a medical examination using the method of ultrasound therapy of the hepatobiliary system.

Timely detected and prescribed symptoms and treatment of cholecystitis in adults, full compliance with the instructions of the attending physician - all this makes the prognosis for the cure of acute cholecystitis quite optimistic. But even in the case of a chronic course pathological process the patient loses his ability to work only during an exacerbation. The rest of the time he feels fine.