Acute and chronic cholecystitis: symptoms andtreatment

Update: December 2018

Cholecystitis is an inflammation of one of their internal organs.
body – the gallbladder, it is acute and chronic. Among
diseases of internal organs, cholecystitis is one of the most
dangerous because it causes not only severe pain, but
and inflammation and the formation of stones, while moving
which a person needs emergency surgical care, while
несвоевременной ее оказании, может наступить летальный Exodus.

Хронический и острый холецистит, симптомы и treatment которых мы
we describe in our article closely related to gallstone disease and
almost 95% of cases are diagnosed at the same time, while
definition of the primacy of a disease significantly
difficult. Every year the number of these diseases increases by
15%, and the occurrence of stones is growing annually by 20% among adults
population. It has been observed that men are less prone to cholecytes,
than women after 50 years.

How is cholecystitis – causes?

Cholecystitis is catarrhal, purulent, phlegmonous,
perforated, gangrenous.

  • Acute cholecystitis – causes

The most dangerous is the acute form of cholecystitis, which
accompanied by the formation of stones, both in the bubble itself and in its
ducts. Stone formation is the most dangerous.
disease, this disease is also called calculous
cholecystitis. First, the accumulation of bilirubin, cholesterol, salts
calcium on the walls of the gallbladder form calcinates, but further
with prolonged accumulation, sediment sizes increase and
can present serious complications in the form of inflammation of the gall
a bubble. Often there are cases when the stones get into the gallstones.
ducts and form serious obstacles to the outflow from the gall
bile bladder. This can lead to inflammation and peritonitis if
time not to provide the patient with medical care.

  • Chronic cholecystitis – causes

Холецистит

Chronic cholecystitis is a longer current form of the disease.
It is characterized by periods of remission and exacerbations. At the heart of development
pathology is damage to the walls of the bladder in the background of a disturbed
evacuation of bile from it (hypo or hypermotor dyskinesia,
pathology of the sphincter of Oddi). Secondarily, these factors are superimposed.
non-specific bacterial infection that supports inflammation
or turning it into purulent.

Chronic cholecystitis can be calculous and non-calculous.
In the first case, it is sand and stones that injure the mucous membrane of the bladder,
clog the bile duct or the neck of the bladder, preventing outflow
bile.

Bezkamenny forms arise because of abnormal development of the bubble and
ducts, kinks, ischemia (diabetes mellitus), tumors and
strictures of the common cystic duct and bladder, irritation by enzymes
pancreas, ductal obturation by worms, squeezing
bile in pregnant women who have quickly lost weight or are receiving full
parenteral nutrition.

The most common microorganisms that cause inflammation
there are – streptococci and staphylococci, as well as ashkheria, enterococci,
Pseudomonas aeruginosa, protei. Emphysematous forms associated with
clostridia. Less commonly, chronic cholecystitis can be viral
origin, or be caused by salmonellosis, protozoan
infection. All kinds of infections penetrate the gallbladder by contact
(through the intestines), lymphogenous or hematogenous.

For various types of helminthic invasions, such as roundworm
adults and children, giardiasis in children, giardiasis in adults,
opisthorchiasis, strongyloidosis, fascioliasis, can occur
partial obstruction of the bile duct (ascariasis), occur
symptoms of cholangitis (from fascioliasis), persistent biliary dysfunction
pathways observed with giardiasis.

Common causes of cholecystitis:

  • Congenital malformations of the gallbladder, pregnancy,
    prolapse of the abdominal organs
  • Biliary dyskinesia
  • Cholelithiasis
  • The presence of worm infestation – ascariasis, giardiasis, strongyloidosis,
    opisthorchiasis
  • Alcoholism, obesity, an abundance of fatty, spicy foods in the diet,
    breaking the diet

For any type of cholecystitis, the development of inflammation of the walls
gallbladder leads to a narrowing of the lumen of the ducts, its
obstruction, to stagnation of bile, which gradually thickens.
There is a vicious circle in which sooner or later appears
component of autoimmune or allergic inflammation.

When formulating a diagnosis of chronic cholecystitis
indicated:

  • stage (aggravation, subsiding aggravation, remission)
  • severity (mild, moderate, severe)
  • flow pattern (monotonous, often recurring)
  • gallbladder function state (saved,
    нефункционирующий пузырь)
  • nature of biliary dyskinesia
  • complications.

Symptoms of acute cholecystitis

A provoking factor giving points the development of an acute attack
Cholecystitis, is a powerful stress, overeating acute, oily
food, alcohol abuse. In this case, the person is experiencing
The following symptoms of acute cholecystitis:

  • Acute paroxysmal pain in the upper part belly, in the right
    hypochondrium radiating to the right scapula, less likely
    irradiate pain in the left hypochondrium.
  • Increased fatigue, severe weakness
  • A slight increase in body temperature to subfebrile numbers 37.2
    -37,8С
  • Intense bitterness appears in the mouth.
  • Vomiting without relief, constant nausea, sometimes vomiting with
    bile
  • Empty burp
  • The appearance of a yellowish skin tone – jaundice

The duration of acute cholecystitis depends on the severity of the disease,
can vary from 5-10 days to a month. In non severe cases,
when there are no stones and the purulent process does not develop, man
recovers quickly enough. But with weakened immunity,
the presence of concomitant diseases, with perforation of the gall wall
bladder (its rupture) may be severe complications and lethal
Exodus.

Symptoms of chronic cholecystitis

Chronic cholecystitis does not occur suddenly, it is formed in
for a long time, and after exacerbations, amid
treatment and adherence to diet come periods of remission than
the more closely diet and maintenance therapy, the longer
period of absence of symptoms.

The main symptom of cholecystitis is a dull pain in the right
subcostal space, which can last several weeks, it can
to give to the right shoulder, and the right lumbar region, to be aching.
Increased pain occurs after taking fatty, acute
food, carbonated beverages or alcohol, hypothermia, or
stress, women aggravation may be associated with PMS
(premenstrual syndrome).

The main symptoms of chronic cholecystitis:

  • Digestive upset, vomiting, nausea, lack
    appetite
  • Dull pain on the right under the ribs, extending to the back,
    scapula
  • Bitterness in mouth, burping with bitterness
  • Heaviness in right hypochondrium
  • Low-grade fever
  • Yellowing of the skin is possible.
  • Very rarely, atypical symptoms of the disease such as
    like heartache, swallowing disorder, bloating,
    constipation

For the diagnosis of both acute and chronic cholecystitis
The most informative methods are the following:

  • cholegraphy
  • duodenal sounding
  • cholecystography
  • Abdominal ultrasound
  • scintigraphy
  • Biochemical analysis of blood shows high rates
    liver enzymes – GGTP, alkaline phosphatase, AST, AlT.
  • Diagnostic laparoscopy and bacteriological examination
    are the most modern and affordable methods
    diagnostics.

Of course, any disease is easier to prevent than to treat and
early research, can reveal early abnormalities,
deviations of the chemical composition of bile. And subject to strict
diet, it will be enough for a long time to extend the period of remission
this disease and prevent serious complications.

Treatment of chronic cholecystitis

Treatment of a chronic process without the formation of stones is always
carried out by conservative methods, the main of which
diet food (diet 5 – fractional food with sufficient
liquid volume, mineral water). In the presence of gallstones –
restriction of hard labor, physical overload, shaking
drive away.

The following drugs are used:

  • Antibiotics, most commonly of a broad spectrum or
    cephalosporins
  • Enzyme preparations – Pancreatin, Mezim, Creon
  • Detoxification – intravenous infusion of sodium chloride,
    glucose solutions
  • NSAIDs – sometimes they are used to relieve inflammation and pain
    sensations

Choleretic drugs are divided into:

  • Choleretics – drugs that enhance the formation of bile.
    Preparations containing bile and bile acids: allohol, liobil,
    vigerin, cholenzyme, dihydrocholic acid – hologon, sodium
    salt of dehydrocholic acid – decholin. Herbal preparations
    increase the secretion of bile: flacumin, corn silk, berberine,
    Convaflavin. Synthetic drugs: Osalmide (oxaphenamide),
    гидроксиметилникотинамид (никодин), циквалон, гимекромон
    (Odeston, holonerton, cholestil).
  • Cholekinetics are divided into: contributing to the secretion of bile
    and increase the tone of the gallbladder (magnesium sulfate, pituitrin,
    choleretin, cholecystokinin, sorbitol, mannitol, xylitol) and
    холеспазмалитики, снижающие тонус желчевыводящих путей и
    sphincter of Oddi: drotaverine hydrochloride, no-spa, olimethin, atropine,
    platifillin, aminophylline, mebeverin (duspatalin).

During periods of exacerbation, phytotherapy is very widely used;
the absence of her allergies – decoctions of chamomile, dandelion, mint
pepper, valerian, calendula. And during periods of remission it is possible
prescribing a homeopathic treatment or herbal medicine but others
herbs – yarrow, Althea, tansy, buckthorn.

It is very important to follow a strict diet after an exacerbation.
cholecystitis, then the symptoms gradually subside. In addition to dieting
stones in the gall bladder and cholecystitis are also recommended
periodically carry out tuba with xylitol, mineral water or
magnesia, effective physiotherapy – electrophoresis, reflexology,
SMT therapy.

With calculous chronic cholecystitis with pronounced
symptoms, recommended removal of the gallbladder, the source of growth
stones that can be life threatening when they are movement.
The advantage of chronic cholecystitis with stones from acute
calculous cholecystitis, is that this surgery is planned,
it is not an emergency measure and you can safely
get ready. Laparoscopic surgery is also used,
and cholecystectomy from a mini-access.

When surgery is contraindicated, sometimes
chronic cholecystitis, treatment may be in the method
crushing stones shockwave lithotripsy, this
extracorporeal procedure does not remove the stones, but simply
crushes, destroys them, and often occurs their repeated growth.
There is also a method of breaking stones with the help of salts. 
ursodeoxycholic and chenodeoxycholic acid, except that
this therapy does not lead to a complete cure, it is also quite
It lasts for a long time and lasts up to 2 years.

Treatment of acute cholecystitis

If acute cholecystitis is registered for the first time, do not detect
stones and a severe clinical picture, no purulent complications, then
enough holding a standard medical conservative
therapies – antibiotics, antispasmodics, NSAIDs, detoxification and
enzyme therapy, cholagogue.

In severe forms of destructive cholecystitis in mandatory
The order shows a cholecystotomy or removal of the gallbladder (see
laparoscopy of the gallbladder). Most often produce
cholecystectomy from mini-access. If the patient refuses
surgery, you can remove the acute attack and medication,
but it should be remembered that large stones necessarily lead to
relapse and transition to chronic cholecystitis, whose treatment
may still end operatively or call
complications.

To date, 3 types of surgical
interventions for the treatment of cholecystitis –
открытая холецистотомия, лапароскопическая холецистотомия, для
ослабленных людей  — чрескожная холецистостомия.

One and all patients with acute cholecystitis is shown
strict diet – in the first 2 days you can drink only tea, then
allowed to go on a diet table 5A, where food is prepared only
steamed or stewed, used at least fat, excluded
fried, smoked, seasonings, carbonated and alcohol-containing
the drinks. Read more about what you can eat with cholecystitis in our
article.

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