Severe chronic cholecystitis. Acute and chronic cholecystitis: symptoms and treatment. Get treatment in Korea, Israel, Germany, USA

Timely treatment of cholecystitis is carried out using conservative therapy and a special diet. If these therapeutic methods do not have the desired effect, or the patient consults a doctor already with an advanced stage of the disease, they resort to surgical treatment, which consists of.

Causes and mechanisms of development of chronic cholecystitis

Chronic cholecystitis results from repeated attacks. In most cases, attacks are triggered by the presence of gallstones. Gradually, thickening of the walls of the organ occurs, pathological changes in its motility, inflammatory and congestive phenomena in the gallbladder and its ducts.

Thus, the etiology of chronic cholecystitis can be avoided if you consult a doctor in time and undergo treatment for the acute stage of the disease, without provoking its further development.

The disease progresses slowly and can go unnoticed by the patient for a long time. But under the influence of negative factors, such as hypothermia, deterioration of immune defense, infections and overeating, the disease can sharply worsen, up to the development of purulent or phlegmonous cholecystitis.

Classification

Depending on the characteristics of the development and course of the disease, the classification of chronic cholecystitis divides the pathology into the following forms:

latent or sluggish;
recurrent;
purulent ulcerative.

Based on the presence of stones (concretions) there are:

(without cholelithiasis);

Dyskinesia often occurs among children whose sleep and rest patterns, study and nutrition are disturbed, improperly formed eating habits, as well as among people exposed to stress factors at home, at school and at work.

The pathogenesis of chronic cholecystitis of an inflammatory nature leads to gross changes in the functional activity of the organ, stagnation, disruption of the physicochemical properties of bile, which becomes a supporting factor in further inflammation and contributes to the rapid transition of the acute form of the disease to the chronic form, including the formation of stones.

Predisposing factors for the development of cholecystitis are:

insufficient physical activity, sedentary lifestyle;
overeating, especially fatty and protein foods;
pregnancy - in the later stages of gestation in the abdominal cavity, pressure on the organs of the digestive tract by the growing uterus increases, in particular on the gallbladder, which becomes an obstacle to the evacuation of bile from the organ into the duodenum and contributes to the development of inflammation;
chronic constipation;
excess weight;
flatulence;
helminths: roundworms, lamblia.

The genetic factor, metabolic disorders and vascular diseases (atherosclerosis, etc.) play a decisive role in the development of cholecystitis. Often, cholecystitis is diagnosed against the background of tumors in the abdominal cavity.

Symptoms

The chronic form of the disease occurs with alternating remissions and exacerbations. Chronic cholecystitis in the stage of unstable remission can easily turn into an acute form of the disease with all the ensuing complications.

Symptoms of chronic cholecystitis:

- a common localization of pain in chronic cholecystitis, which is intense only during exacerbations, and in other cases does not cause serious discomfort to the patient. The pain may be mild aching, sometimes radiating to the lumbar region or shoulder blade. Pain appears for no apparent reason. It can last more than a day, periodically subside and intensify again as a result of overeating or drinking alcohol.
Belching with a bitter taste , bitterness in the mouth, especially when eating on an empty stomach.
Digestive disorders - an obligatory symptom of the clinic of chronic cholecystitis. is one of the main elements involved in digestion. If it does not enter the duodenum in the required quantity, the patient may have complaints of gastrointestinal disorders - diarrhea, constipation, flatulence, nausea and vomiting.
Increased dry mouth , especially in the morning.
Low-grade body temperature as an indispensable sign of the inflammatory process in the body. When diagnosed with “chronic cholecystitis,” this symptom is observed in almost all cases, and the longer the temperature lasts, the stronger the inflammation process.
Increased fatigue , fatigue, weakness and lack of appetite.

During the period of remission of chronic cholecystitis, therapeutic signs of inflammation of the gallbladder practically do not make themselves felt. Similar hidden symptoms may be characteristic of other diseases of the digestive tract.

Diagnosis of cholecystitis

Before a diagnosis is made, the patient must undergo a series of examinations.

Laboratory methods:

general blood test - determines signs of the inflammatory process in the body;
biochemical blood test - reveals an increase in cholesterol, bilirubin, protein fractions, transaminase, phosphatase;
blood sugar test - necessary for diagnosing diabetes mellitus;
general urinalysis - reveals concomitant kidney pathology;
bacteriological examination of bile;
blood test for giardiasis;
fecal elastase analysis to detect pancreatitis.

Instrumental examination methods:

Ultrasound of the abdominal cavity. Determines changes in the walls of the gallbladder (thickening them by 4 cm or more indicates the presence of cholecystitis), congestion in the organ, thickening of bile, the presence of stones, etc.
An ultrasound with a special breakfast aimed at producing bile is necessary to detect gallbladder dyskinesia.
X-ray examination of the abdominal organs to detect stones.
Duodenal intubation with bile culture. It can only be carried out if there are no stones in the organ or biliary tract.
Fibroesophagogastroduodenoscopy (FEGDS).
ECG - to clarify the presence of concomitant pathologies of the heart and blood vessels.
CT scan.

Treatment

After diagnosis and confirmation of the disease, treatment of chronic cholecystitis begins. The approach to therapy must be comprehensive.

Treatment is carried out using the following methods:

therapeutic measures in the acute stage of the disease;
cupping;
surgical intervention.

The gastroenterologist individually creates a treatment program for the patient for several weeks and months in advance, taking into account the data of diagnostic examinations, the patient’s age and health status with cholecystitis.

In the stage of exacerbation of the pathology, urgent hospitalization of the patient is necessary. Typically, this condition requires rapid elimination of the inflammatory process in the gallbladder and practical knowledge from the patient himself on how to relieve an attack of chronic cholecystitis before the arrival of the medical team.

To relieve inflammation in the affected organ, the patient is prescribed anti-inflammatory drugs. After this, it is important to empty the organ of stagnant bile using choleretic agents. If there are no stones in the organ, then you can refuse medications in favor of traditional medicine recipes.

Pharmaceutical herbs have a milder effect on the gallbladder, unlike medications. With the permission of a doctor, you can use a decoction of milk thistle or immortelle.

If potential problems with chronic cholecystitis occur during pregnancy, antibiotic therapy is not recommended.

While carrying a child, it is better for a woman to avoid drug therapy as much as possible, so a gastroenterologist can prescribe treatment with mineral waters, which is also acceptable in case of serious complications of the disease.

Typically, a specialist prescribes sulfite and chloride-sulfite waters, which should be taken 3 times a day 1 hour before meals. Mineral water should be heated to a warm state immediately before use. You should definitely drink mineral water in courses; every 2 weeks you need to take a break of the same duration.

Nutrition

What to eat for chronic cholecystitis - one of the first questions that patients ask the doctor with this diagnosis. All persons suffering from cholecystitis are advised to follow a special diet during remission and during exacerbation of the disease.

In acute and chronic cholecystitis, the use of alcoholic beverages and foods prohibited by the diet, as well as an erratic diet, is contraindicated.

You should eat in small portions, every 3 hours. Diet restrictions are imposed on certain food groups: fried, fatty, spicy, salty and spicy foods, carbonated and alcoholic drinks.

You should also avoid egg yolks, baked goods, buttercreams, ice cream, and nuts. You cannot eat chilled food, that is, straight from the refrigerator - cold dishes cause spasms of the digestive organs, especially in chronic cholecystitis with hypomotor dyskinesia of the gallbladder.

It is also necessary to limit the consumption of raw fruits and vegetables. During remission, you can give preference to watermelons and melons, carrots, dried apricots, prunes and fresh raisins. These products have a positive effect on the motility of the affected organ and prevent constipation.

Among the drinks, one can highlight decoctions of medicinal herbs, such as milk thistle, immortelle, fennel, cucumber, chicory - all these plants have a choleretic and anti-inflammatory effect, positively affecting the condition of the gallbladder.

For example, a doctor, answering the question whether it is possible to drink chicory for chronic cholecystitis, will most likely give a positive answer, because chicory stimulates the secretion of bile, dissolves stones in the gallbladder and promotes their removal from the body.

Neglect of nutritional principles can cause serious consequences of chronic cholecystitis, leading to relapse of the disease and progression of inflammatory-destructive changes in the walls of the gallbladder.

Prevention

Acute and chronic cholecystitis can be prevented by leading a healthy lifestyle, drinking alcohol in moderation, giving up unhealthy eating habits, and not excluding healthy physical activity.

If congenital defects of internal organs are detected, it is necessary to promptly identify and correct congestion in the gallbladder.

To prevent exacerbations of the chronic form of the disease, it is important to strictly follow a diet and adhere to the principles of fractional meals, eliminate physical inactivity, hypothermia, stress and heavy physical activity.

Patients with chronic cholecystitis should be registered at a dispensary and undergo routine examinations at least once a year. Spa treatment is also recommended.

Complications of chronic cholecystitis

Timely treatment of chronic cholecystitis allows you to maintain quality of life and avoid such serious complications as:

peritonitis - extensive inflammation of the peritoneum, which can occur as a result of perforation of the gallbladder and bile ducts;
purulent abscesses in the abdominal cavity, including those localized on the liver;
internal biliary fistulas;
cholangitis.

Rehabilitation for chronic cholecystitis after treatment requires timely administration of medications, a gentle daily routine and strict adherence to a dietary diet. If you follow all the specialist’s recommendations, you don’t have to worry about possible complications or subsequent relapses of the disease.

The relevance of the topic of chronic cholecystitis is still high, since it is a serious disease that is widespread among the population, having a wide range of causes and subtle clinical symptoms.

It is impossible to independently determine the presence of the disease, including its form. For any signs of pathology listed above, it is important to seek help from a specialist in time and undergo the necessary treatment if the pathology is confirmed.

An inflammatory disease of the gallbladder wall, combined with motor-tonic disorders of the biliary system. This is one of the most common gastrointestinal diseases.

The incidence is 6-7 cases per 1000 population. It occurs in all age groups, but mostly affects middle-aged people (from 40 to 60 years old). Women get sick 3-4 times more often than men. The disease is more common in economically developed countries.

Under pathological conditions, asynchronous work of sphincters and ducts occurs, which leads to difficulty in the outflow of bile into the duodenum, and consequently to a sharp increase in pressure in the bile ducts (the so-called hypermotor biliary dyskinesia). This causes severe pain in the right hypochondrium even in the absence of inflammatory changes in the gallbladder.

There are two types of disease - non-calculous (calculous) and calculous - they are considered transitional stages of one disease. An exacerbation most often occurs 2-4 hours after eating fatty, smoked, fried foods. An attack can also be triggered by shaking (for example, riding a tram or cycling), hypothermia, stress and prolonged physical activity.

Gallbladder

Gallbladder, shaped like a regular pear, is located in the lower lobe of the liver. The liver regularly produces bile, it accumulates in the bladder, then is excreted through the bile ducts into the duodenum.

In the ducts, bile meets pancreatic juice, which is also produced during digestion. Normally, bile does not enter the intestines, but it also happens that reflux occurs not only into it, but also into the pancreas.

More often this happens when the patency of the bile ducts is impaired. For example, when stones occur or the proper flow of bile is blocked. Bile can destroy any organ, including itself.

Such a risk may arise during prolonged stagnation. The gallbladder works in close relationship with the pancreas; their ducts form the papilla of Vater, where the sphincter of Oddi is located.

The latter acts as a regulator of pancreatic juice and bile. It also protects the ducts from refluxing contents from the intestines. When it works properly, bile enters the duodenum.

Causes of chronic cholecystitis

The disease is usually caused by opportunistic microflora - Escherichia, streptococci, staphylococci, less often - Proteus, Pseudomonas aeruginosa, Enterococcus. Sometimes chronic cholecystitis is observed, caused by pathogenic bacterial microflora (Shigella, Salmonella), viral and protozoal infections. Microbes penetrate the gallbladder by hematogenous, lymphogenous and contact (most often from the intestines) route.

An important predisposing factor in the development of the disease is considered to be a violation of the outflow of bile and its stagnation; the pathology usually occurs against the background of cholelithiasis or biliary dyskinesia; on the other hand, a chronic inflammatory process in the gallbladder is always accompanied by a violation of its motor-evacuation function and contributes to the formation of stones.

The nutritional factor is of great importance in the formation of the disease. Irregular meals with long intervals between meals, large meals at night with a preference for meat, spicy, fatty foods cause spasm of the sphincter of Oddi and bile stasis. An excess of flour and sweet foods, fish, eggs, and a lack of fiber cause a decrease in the pH of bile and a violation of its colloidal stability.

Inflammation of the gallbladder develops gradually. Functional disorders of the neuromuscular system lead to hypo- or atony. The introduction of microbial flora contributes to the development and progression of inflammation of the mucous membrane of the gallbladder.

With further progression of the pathological process, inflammation spreads to the submucosal and muscular layers of the gallbladder wall, where infiltrates and connective tissue growths develop.

When the process moves to the serous membrane, adhesions are formed with the Glissonian capsule of the liver and neighboring organs (stomach, duodenum, intestines). This condition is referred to as pericholecystitis. In addition to catarrhal inflammation, a phlegmonous or even gangrenous process may occur.

Important: in severe cases, small abscesses, foci of necrosis, and ulcerations form in the wall of the gallbladder, which can cause its perforation or the development of empyema. The gangrenous form (rarely develops) occurs during an anaerobic infection and leads to putrefactive destruction of the walls of the gallbladder.

Signs and symptoms of chronic cholecystitis

The clinical picture of chronic cholecystitis is characterized by a long progressive course with periodic exacerbations.

The symptoms of the disease are due to the presence of an inflammatory process in the gallbladder and impaired flow of bile into the duodenum due to concomitant dyskinesia.

Pain

Pain syndrome is the main one in the clinic of gallbladder inflammation. The pain is localized in the right hypochondrium, less often in the epigastric region, radiating to the right scapula, collarbone, shoulder, and less often to the left hypochondrium. The occurrence of pain and its intensification is usually associated with the following reasons:

violation of diet;
physical activity;
stress;
hypothermia;
concomitant infection.

The intensity of pain depends on the degree of development and localization of the inflammatory process, the presence and type of dyskinesia. Intense paroxysmal pain is characteristic of the inflammatory process in the neck and duct of the gallbladder, constant pain is characteristic of the body and bottom of the gallbladder.

In a disease accompanied by hypotonic dyskinesia, the pain is less intense, but more constant, nagging. Aching, almost continuous pain can be observed with pericholecystitis. This pain intensifies when shaking, turning or bending the body.

With an atypical location of the gallbladder, pain can be localized in the epigastrium, at the xiphoid process, around the navel, in the right iliac region. On palpation, pain in the right hypochondrium is determined.

Positive pain symptoms of cholecystitis

Ker's symptom

Pain when pressing on the projection of the gallbladder.

Murphy's sign

A sharp increase in pain upon palpation of the gallbladder during inspiration.

Grekov-Ortner's sign

Pain in the area of the gallbladder when tapping along the costal arch on the right.

Georgievsky-Mussi sign

Pain when pressing on the right phrenic nerve between the legs of the sternocleidomastoid muscle.

Dyspepsia

Dyspeptic syndrome is manifested by bitter belching or a constant bitter taste in the mouth. Patients often complain of a feeling of fullness in the upper abdomen, bloating of the intestines, and abnormal stool.

Vomit

Nausea and bitter vomiting occur less frequently. When combined with hypo- and atony of the gallbladder, vomiting reduces pain and a feeling of heaviness in the right hypochondrium. With hypertensive dyskinesia, vomiting causes increased pain.

In vomit, as a rule, an admixture of bile is found. The more significant the congestion, the more bile is found in the vomit.

Important: vomiting is usually provoked by diet disorders, emotional and physical overload.

Body temperature

The exacerbation phase is characterized by an increase in body temperature. More often the fever is subfebrile (characteristic of catarrhal inflammatory processes), less often it reaches febrile values (with destructive forms of cholecystitis or due to complications).

A hectic temperature curve, accompanied by severe sweating and severe chills, is always a consequence of purulent inflammation (empyema of the gallbladder, liver abscess).

In weakened patients and the elderly, body temperature, even with purulent cholecystitis, can remain subfebrile, and sometimes even normal due to reduced reactivity.

Jaundice

Descriptions of symptoms of chronic cholecystitis

Forms of chronic cholecystitis

Atypical forms of the disease are observed in a third of patients.

Diagnosis of chronic cholecystitis

Blood tests in the acute phase often reveal:

increase in ESR;
neutrophilic leukocytosis;
shift of the leukocyte formula to the left;
eosinophilia.

In complicated forms, the levels of bilirubin, cholesterol, and transaminases in the blood may increase.

The severity of the inflammatory process in the gallbladder can be judged by the results of a study of bile obtained during duodenal intubation. With inflammation, the bile is cloudy with flakes, with a significant admixture of mucus, cylindrical epithelium, and cellular detritus, although these signs are not pathognomonic for cholecystitis, but mainly indicate concomitant duodenitis.

Bacteriological examination of all portions of bile allows us to establish the etiology of the inflammatory process and the sensitivity of the microflora to antibiotics. The most commonly used are ultrasound and x-ray examination methods. X-ray examination reveals numerous signs of functional or morphological changes in the gallbladder or other digestive organs.

A contrast study of the gallbladder (cholecystography, cholangiography) can reveal:

Uneven filling of the cystic duct, its tortuosity, and kinks are often detected.

To study the state of the biliary tract and the absorption and excretory function of the liver, the radioisotope method is used. For a more accurate diagnosis, it is combined with multicomponent fractional duodenal intubation.

For a more detailed study of the gallbladder and bile ducts, a radio-X-ray chromodiagnostic method has been proposed. Its essence lies in the fact that cholecystography is performed simultaneously with multicomponent probing and radioisotope research. Comparison of the results allows us to judge changes in the position, shape, size and structure of the gallbladder shadow.

The main method for diagnosing cholecystitis is ultrasound, allows not only to establish the absence of stones, but also to assess the contractility and condition of the gallbladder wall (its thickening of more than 4 mm indicates chronic cholecystitis). In chronic cholecystitis, thickening and sclerosis of the gallbladder wall and its deformation are often detected.

Ultrasound has no contraindications and can be used during the acute phase of the disease, with increased sensitivity to contrast agents, pregnancy, and obstruction of the biliary tract.

When the bilirubin level is above 51 µmol/l and clinically obvious jaundice, endoscopic retrograde cholangiopancreatography is performed to determine its causes.

Differential diagnosis

Differential diagnosis is carried out primarily with duodenal ulcer and chronic duodenitis. It is necessary to take into account the peculiarities of the occurrence of pain in these diseases and the seasonality of exacerbations. The results of endoscopic examination of the stomach and duodenum play a decisive role.

Sometimes it can be difficult to distinguish between cholecystitis and biliary dyskinesia. However, dyskinesias are not characterized by fever, neutrophilic leukocytosis and increased ESR. Ultrasound in combination with duodenal intubation helps clarify the diagnosis.

Diet for gallbladder inflammation

The diet should help prevent stagnation of bile in the gallbladder and reduce inflammation.

Small meals (5-6 times a day), low-fat varieties of meat and fish, cereals, puddings, cheesecakes, and salads are recommended. Allow weak coffee, tea, fruit, vegetable, berry juices to barely subside the exacerbation. Vegetable fats (olive, sunflower oil) containing polyunsaturated fatty acids and vitamin E are very useful.

Polyunsaturated fatty acids help normalize cholesterol metabolism, participate in the synthesis of Pg, which dilutes bile, and increase the contractility of the gallbladder. With a sufficient amount of protein and vegetable fats in the diet, the cholatesterol index increases and, thus, the lithogenicity of bile decreases.

Prohibited for use

egg yolks;
alcohol;
fatty and fried foods;
hot, spicy, sour food;
carbonated drinks;
baked goods;
products with butter and butter cream;
nuts;
ice cream;
raw fruits, vegetables and berries;
legumes;
canned food;
chocolate and cocoa;
fresh bread;
tomato juice.

Treatment of chronic cholecystitis

During the period of clinically significant exacerbation, patients are indicated for hospitalization in a gastroenterological or therapeutic department.

If there is a threat of development of destructive cholecystitis, with severe pain syndrome occurring for the first time, patients are hospitalized in the surgical department. For mild cases of the disease, treatment is carried out on an outpatient basis.

Which doctors should I contact for chronic cholecystitis?

Drug treatment

Drug treatment is determined by the phase of the disease, the severity of cynical manifestations (primarily pain and dyspeptic symptoms), and the nature of dyskinesia.

Complex therapy is carried out with antibacterial, anti-inflammatory drugs that normalize the motility of the biliary tract. Antibacterial therapy is prescribed in cases where there are clinical and laboratory data confirming the activity of the inflammatory process in the gallbladder.

The choice of drug depends on the type of pathogen identified during bile culture, its sensitivity to the antibacterial drug, as well as the ability of the antibacterial drug to penetrate the bile and accumulate in it. The duration of antibiotic treatment is 7 days. If necessary, after a 3-day break, treatment can be administered.

It is advisable to combine antibacterial drugs with choleretic drugs, which also have an anti-inflammatory effect: cyclovalone (tsikvalon) 1 g 3-4 times a day before meals, nicodin 0.5 g 3-4 times a day before meals.

It should be remembered that according to the degree of penetration into bile, antibacterial agents can be divided into three groups.

Penetrating into bile in very high concentrations

erythromycin (0.25 g 4 times a day);
oleandomycin (0.5 g 4 times a day after meals);
rifampicin (0.15 g 3 times a day);
ampicillin (0.5 g 4-6 times a day orally or intramuscularly);
oxacillin (0.25-0.5 g 4-6 times a day orally or intramuscularly);
ampiox (0.5 g 4 times a day orally or intramuscularly);
ericycline (0.25 g every 4-6 hours).

In addition, lincomycin (0.5 g orally 3 times a day 1-2 hours before meals or 1 ml of a 30% solution 3 times a day intramuscularly).

Penetrating into bile in fairly high concentrations

benzylpenicillin (intramuscular 500,000 units 6 times a day);
phenoxymethylpenicillin (0.25 g 6 times a day before meals);
tetracyclines (0.25 g 4 times a day);
metacycline (0.3 g 2 times a day);
oletethrin (0.25 g 4 times a day).

Poorly penetrating bile

streptomycin;
ristomycin;
chloramphenicol.

For giardiasis

Metronidazole 0.25 g 3 times a day after meals for 7 days
or tinidazole 2 g once;
or aminoquinol 0.1 g 3 times a day for 5 days (repeated course after 10 days);
or furazolidone 0.15 g 3-4 times a day.

With opisthorchiasis, fascioliasis, clonorchiasis

For strongyloidiasis, trichuriasis, hookworm

Choleretic drugs, physiotherapeutic treatment and mineral waters are prescribed depending on the type of concomitant dyskinesia.

Instructions for the use of drugs for chronic cholecystitis

Physiotherapeutic treatment

For physiotherapeutic treatment, 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.

Surgery

Surgical treatment is indicated for a frequently recurrent course with the development of adhesions and the outcome of a wrinkled gallbladder (which leads to a pronounced impairment of its contractile function), a “disabled” gallbladder, and the development of complications (dropsy, empyema).

Typically, a cholecystectomy is performed. If for certain reasons (old age of the patient, concomitant diseases) cholecystectomy is impossible, cholecystotomy is performed. The essence of the operation: a tube is inserted into the gallbladder through the skin, through which the bile is drained out. Cholecystotomy helps relieve the process of inflammation in the gallbladder, which will help remove a person from a dangerous condition.

Another method is laparoscopy, which leaves no scars, is safer and the patient's recovery period after surgery takes a couple of days. Laparoscopy is completely safe for the patient and is done through a couple of small punctures in the abdominal area; this method allows you to reduce the amount of blood loss to a minimum.

Unfortunately, the laparoscopic method cannot be used in all cases. In case of anomalies, adhesions, large stones, or exacerbation of a chronic advanced stage, a conventional, open operation is performed.

Rehabilitation of the patient after open surgery is much longer than after laparoscopy from one to two months. After removal of an inflamed organ (cholecystectomy), there is a risk of developing postcholecystectomy syndrome (more about it in the link), you need to adhere to a strict diet for a long time, it is advisable to follow all the doctor’s recommendations, this will eliminate the risk of complications.

Folk remedies for the treatment of chronic cholecystitis

Important: the use of traditional medicine must be agreed with the attending physician.

Oat infusion

We take 500 grams of raw materials per liter of boiling water. Pour in oats and leave for 1 hour. We strain and drink according to? glass three times a day - 15 minutes before main meals (breakfast, lunch, dinner).

White cabbage juice

If you don’t have a powerful juicer, use a grater to chop the cabbage and squeeze out the juice through cheesecloth. We drink 30-50 ml on an empty stomach 15 minutes before meals 3 times a day.

Oregano tea

Take 1 teaspoon of oregano for 1 cup of boiling water. Pour in and leave covered for up to 2 hours. Strain and drink a quarter glass three times a day.

Corn silk infusion

The proportion is one tablespoon of raw material per 1 glass of boiling water. Leave for up to 1 hour. We drink the strained infusion, 1 tbsp. spoon on an empty stomach - every 3 hours before meals - breakfast, second breakfast, lunch and dinner.

Infusion of medicinal sage

We need 2 teaspoons of herbs per 2 cups of boiling water. Leave for half an hour and drink the strained infusion every 2 hours, 1 tbsp. spoon.

Bay oil

We will need vegetable oil (we recommend olive oil). Add 25-30 grated leaves of noble laurel to one glass of oil. Let the mixture sit for up to 7 days, until the leafy material settles to the bottom. Strain, pour into a dark glass container, and place in the refrigerator. We drink 15 drops of bay oil as part of any drink - milk, kefir, tea.

Honey-lemon mixture with olive oil

We need: 1 glass of olive oil, 4 lemons (peel two of them), 1 kilogram of honey. Pass the lemons through a meat grinder, add butter and honey, mix well. Store in a sealed glass container, refrigerated. Stir again before each use. The course of administration is 1 month at a dose of one tablespoon half an hour before meals three times a day. There must be at least three such courses per year.

Complications of chronic cholecystitis

The chronic course is characterized by alternating periods of remission and exacerbations of cholecystitis. Purulent-destructive changes in the gallbladder (empyema, perforation) lead to the development of peritonitis and the formation of bile fistulas.

Pericholecystitis causes the development of adhesions, deformation of the gallbladder and, as a result, disruption of its functions. It is possible that neighboring organs may be involved in the inflammatory process (cholangitis, hepatitis, pancreatitis, papillitis), the development of obstructive jaundice, and the formation of hydrocele of the gallbladder.

There are not as many complications of the chronic course as in the acute form of the disease, but they all require surgical treatment:

reactive hepatitis;
chronic duodenitis;
pericholecystitis;
reactive pancreatitis;
chronic stagnation of bile;
cholelithiasis;
deformation of the affected organ;
formation of adhesions and fistulas.

Forecast and prevention of chronic cholecystitis

With infrequent exacerbations, the prognosis is satisfactory. It worsens significantly with frequent exacerbations with signs of inflammatory process activity, severe pain and the development of reactive pancreatitis.

For preventive purposes, a balanced diet, an active lifestyle, and physical exercise are recommended. Timely and rational treatment of acute cholecystitis, diseases of the digestive tract, focal infections, intoxications, allergies, neurotic and metabolic disorders is necessary.

Questions and answers on the topic "Chronic cholecystitis"

Question:Hello. I have a polyp in my gallbladder, a collection of viscous bile. Could this cause severe pain in the right hypochondrium? I took a course of chemotherapy, the last one was on January 17, 2018. There was inflammation of the iliac and paraortic lymph nodes. I have pain under the right rib and in the navel area, to the left. Thank you

Answer: Pain due to a polyp in the gallbladder is located on the right hypochondrium and is dull in nature. They are rarely constant and are more often of a cramping nature. Pain is provoked by fatty and rich foods, alcoholic drinks, and sometimes stressful situations.

Question:Hello, my husband has chronic cholecystitis, polyps up to 3.8 mm, catarrhal colitis of the intestine and a hyperplastic intestinal polyp, flaccid pancreas, they wanted to diagnose pancreatitis, but after treatment and diet they did not diagnose it, at the last ultrasound of the abdominal cavity they found an enlarged lymph node 17 * 5.5 Tell me, is it scary what they write about oncology on the Internet?

Answer: The cause of enlarged lymph nodes is infection, not cancer. However, it is dangerous to neglect the pathology: there is a risk of developing an abscess or peritonitis due to lymphatic suppuration.

Question:Good afternoon I did an ultrasound scan of the gall bladder and as a result, the transverse size of the gallbladder was increased to 3.1 cm with a maximum of 3 cm. There is also an enlargement of the head of the pancreas to 3.1 cm, with the norm being up to 3 cm. The walls of the gall bladder are thickened, increased echogenicity, echogenic fluid in the lumen . There are no stones. Ultrasound signs of phlebitis, chronic cholecystitis and chronic pancreatitis. Tell me, how dangerous is this? The doctor prescribed only Allochol and a blood test.

Answer: Hello. Here are the possible ones. Treatment: drugs, strict diet and herbs.

Question:Hello, I get nausea when I really want to go to the toilet and it goes away when I go. I have chronic cholecystitis, is this related somehow?

Answer: Hello. The symptoms of various gastrointestinal diseases are similar, so details are important. For example, pain or discomfort in the abdomen that goes away after a bowel movement is a symptom of irritable bowel syndrome. You need an in-person consultation with a gastroenterologist.

Question:Hello, I have the following question: there is aching pain in the right side opposite the navel, a bitter or acidic taste, I am pregnant, I have been diagnosed with chronic cholecystitis. They prescribed Duspatelin and Ursofalk, but the contraindication was “pregnancy”. Can they be taken during pregnancy?

Answer: Hello. Absolutely right, these drugs are contraindicated during pregnancy. Talk to your doctor about replacing them.

Question:Hello, lately I have been having abdominal pain on my right side. Keeps t 37.5. At first, my whole stomach hurt and it was unclear where exactly the pain was, now only on the right side, opposite the navel. Please tell me what this could be and what to do?

Answer: Your symptoms may indicate an exacerbation of cholecystitis or cholelithiasis. You need to visit a gastroenterologist, take a general and biochemical blood test and perform an ultrasound of the abdominal cavity. You may need to consult a surgeon; this will become clear after the examination. By the way, you did not specify exactly where on the right you have pain, because this could also be a sign of appendicitis.

Question:The attacks begin with a headache around 3-4 o'clock in the morning, then vomiting begins and continues for 10-12 hours until a bitter greenish liquid begins to flow, while the body does not accept anything, not even water - everything is vomited. Such attacks, as a rule, appear after we eat something with appetite (thirst) and are accompanied by weakness and chills. What's this?

Answer: Severe vomiting accompanied by a headache may be a sign of migraine. Persistent vomiting is not typical for cholecystitis. Be sure to see a therapist for an examination.

Question:I have the same attacks as Anna, only the greenish liquid never appears. I thought it was a migraine, but lately I have become more and more convinced that it is cholecystitis, especially since the headache goes away on its own after the nausea disappears. Can spasm or inflammation of the gallbladder manifest itself with such symptoms?

Answer: Elena, headaches can occur due to gallbladder diseases, however, you should find out whether you have it. Contact a gastroenterologist.

Question:Bile does not kill bacteria; on the contrary, they develop there in the gall sac. Destroys germs? how is this?

Answer: Bile has bactericidal properties, however, often these properties are not enough to destroy a large number of bacteria. In this case, inflammation of the gallbladder develops.

Question:I have chronic cholecystitis and an ultrasound showed that there is a bend in the neck of the gallbladder. Almost every month I have an inflamed lymph node in the neck area, painkillers do not help, nausea and vomiting occur and after 3-4 days everything goes away. Is this due to illness or should I see another doctor?

Answer: Hello. You need to visit a general practitioner who will examine the lymph node and, if necessary, refer you to a more specialized specialist.

Question:I have been suffering from gallbladder dyskinesia for a very long time, now I have cholecystitis and pancreatitis. I have been undergoing treatment all my life, taking choleretic medications, and going on diets from time to time. But the relief is short-lived. Most of all I am tormented by attacks associated with unpleasant sensations in the intestines: strong heartbeat, mortal fear and then leg cramps until you take something sedative.

Answer: Hello. The symptoms you describe occur in disorders of the nervous system.

Question:I was recently diagnosed with chronic cholecystitis, prescribed a diet, Ursofalk and Creon 10,000. Tell me, can these drugs cure it and how long will the treatment take on average? There is a thick stagnation of bile in the gallbladder, but there are no stones. There is another problem with the pancreas, I don’t know exactly what.

Answer: Hello. Following a diet and taking Ursofalk will improve liver function and reduce inflammation of the gallbladder. The duration of treatment is usually several months. As a rule, people experience disruption of the pancreas (usually chronic pancreatitis), since the work of these two organs is closely related. Creon is a drug that helps with the functioning of the pancreas.

Question:An ultrasound showed that I had 1 stone, 1.6 cm. The year before last I didn’t have one. Now there is an exacerbation of cholecystitis (I have had it since childhood). The doctor at our military clinic said, “when there is an attack, come for surgery” and did not prescribe any treatment to relieve the exacerbation. I don’t have any attacks, and while I didn’t know about the stone, nothing really hurt. Is it possible to take treatment according to the usual regimen, but without choleretic drugs?

Answer: Hello. Only a doctor should prescribe treatment for you. If your doctor did not pay enough attention to you, then it is better to consult another specialist.

Inflammation of the gallbladder, accompanied by a violation of its motor function and, in some cases, the formation of stones. Clinically, it manifests itself as pain and heaviness in the right hypochondrium, often occurring after eating fatty foods and alcohol, nausea, vomiting, dryness and bitterness in the mouth. Informative methods for diagnosing chronic cholecystitis include biochemical blood tests, ultrasound of the gallbladder, cholecystography, and duodenal intubation. Conservative treatment includes the use of medications, herbal medicine, physiotherapy; For calculous cholecystitis, removal of the gallbladder is indicated.

ICD-10

K81.1

General information

by hypermotor type;
hypomotor type;
by mixed type;
disabled gallbladder.

Symptoms of chronic cholecystitis

Chronic cholecystitis develops over a long period of time, periods of remission alternate with exacerbations. The main symptom is pain. The pain is moderate, localized in the right hypochondrium, has a dull aching character, and can last up to several days (weeks). Irradiation can occur in the back under the right shoulder blade, the right half of the lumbar region, and the right shoulder. Chronic cholecystitis is characterized by increased pain after consuming spicy or fatty foods, carbonated drinks, and alcohol. Exacerbation of chronic cholecystitis is most often preceded by such violations in the diet, as well as hypothermia and stress.

Diagnosis of chronic cholecystitis

During questioning and palpation of the abdominal wall, the characteristics and localization of the pain symptom are revealed. The symptoms characteristic of inflammation of the gallbladder are determined: Murphy, Mussi, Shoffara.

A laboratory blood test during an exacerbation shows signs of nonspecific inflammation (increased ESR, leukocytosis). A biochemical blood test reveals an increase in the activity of liver enzymes (AlT, AST, G-GTP, alkaline phosphatase).

The most informative methods for diagnosing cholecystitis are instrumental diagnostic methods: ultrasound of the abdominal organs, cholecystography, cholegraphy, scintigraphy, duodenal intubation.

An ultrasound of the gallbladder determines the size, wall thickness, possible deformations and the presence of stones in the gallbladder. Adhesions, inflamed bile ducts, dilated bile ducts of the liver, and impaired bladder motility are also noted.

During duodenal intubation, a violation of gallbladder motility is noted, and a bile analysis is taken. When inoculating bile, it is possible to detect bacterial contamination, determine the causative agent of the infection, and it is also possible to test the culture for sensitivity to antibiotics for the optimal selection of a therapeutic agent. Chronic acalculous cholecystitis is characterized by a decrease in the amount of bile acids in the bile obtained from the bladder and an increased concentration of lithocholic acid. Also, during an exacerbation, the amount of protein, bilirubin (more than 2 times), and free amino acids in the bile increases. Cholesterol crystals are often found in bile.

To determine the motility and shape of the gallbladder, cholecystography and cholegraphy can be used. Arteriography reveals thickening of the gallbladder wall and proliferation of the vascular network in the duodenum and adjacent parts of the liver.

Treatment of chronic cholecystitis

Treatment of non-calculous chronic cholecystitis is almost always carried out conservatively by a gastroenterologist. Treatment during an exacerbation is aimed at relieving acute symptoms, sanitizing the source of bacterial infection with antibiotic therapy (broad-spectrum drugs are used, usually cephalosporins), detoxifying the body (infusion of glucose solutions, sodium chloride), restoring digestive function (enzyme preparations) .

To relieve pain and relieve inflammation, drugs from the group of non-steroidal anti-inflammatory drugs are used; spasms of the smooth muscles of the bladder and ducts are relieved with antispasmodics.

To eliminate bile stagnation, drugs are used that enhance the peristalsis of the biliary tract (olive oil, sea buckthorn, magnesia). Choleretics (drugs that increase bile secretion) are used with caution so as not to cause increased pain and worsening congestion.

For treatment during exacerbation of chronic uncomplicated cholecystitis, herbal medicine methods are used: herbal decoctions (peppermint, valerian, dandelion, chamomile), calendula flowers.

After the symptoms of exacerbation subside and the disease enters the stage of remission, it is recommended to follow a diet, tubes with magnesium, xylitol or sorbitol. Phytotherapeutic therapy for chronic cholecystitis consists of taking decoctions of tansy, buckthorn, marshmallow, and yarrow. Physiotherapeutic treatment is used: reflexology, electrophoresis, SMT therapy, mud therapy, etc. Sanatorium treatment at balneological resorts is indicated.

In case of chronic calculous cholecystitis, surgical removal of the gallbladder, the source of stone formation, is indicated. Unlike the treatment of acute calculous cholecystitis, surgery to remove the gallbladder (laparoscopic or open cholecystotomy) for chronic cholecystitis is not an emergency measure and is prescribed as planned. The same surgical techniques are used as for acute cholecystitis - laparoscopic surgery to remove the gallbladder, cholecystectomy from a mini-access. For weakened and elderly patients - percutaneous cholecystostomy to form an alternative path for the outflow of bile.

In case of chronic cholecystitis, in case of contraindications to surgical intervention, you can try the method of non-surgical crushing of stones using extracorporeal shock wave cystolithotripsy, however, it is worth remembering that the destruction of stones does not lead to a cure and quite often they re-form.

There is also a method of medicinal destruction of stones using preparations of salts of ursodeoxycholic and chenodeoxycholic acids, but this treatment takes a very long time (up to 2 years) and also does not lead to a complete cure, and does not guarantee that stones will not form again over time.

Nutrition for chronic cholecystitis

All patients with chronic cholecystitis are prescribed a special diet and strict adherence to a certain diet is necessary. For chronic cholecystitis, patients are prescribed diet No. 5 in remission and diet No. 5A during exacerbation of the disease.

Firstly, meals are taken every 3-4 hours in small portions (fractional meals), and secondly, they adhere to restrictions on the consumption of certain foods: fatty, fried, hot, spicy dishes, carbonated drinks, alcohol-containing products.

Egg yolks, raw vegetables and fruits, pastry products, butter and cream creams, nuts, and ice cream are also prohibited. In case of exacerbation, freshly steamed or warm boiled foods are recommended. Vegetables and fruits allowed for patients during non-exacerbation periods: dried apricots, carrots, watermelon and melon, raisins, prunes. These products normalize gallbladder motility and relieve constipation.

Violation of the principles of therapeutic nutrition by patients leads to the development of exacerbation of the disease and the progression of destructive processes in the wall of the gallbladder.

Prevention

To prevent exacerbations, patients must strictly follow the diet and the principles of fractional nutrition, avoid physical inactivity, stress and hypothermia, and heavy physical activity. Patients with chronic cholecystitis are registered at a dispensary and must be examined twice a year. They are indicated for regular sanatorium-resort treatment.

In the practice of gastroenterologists, patient complaints regarding inflammation of the gallbladder (or cholecystitis) occupy an important place. The disease is differentiated into two large groups, determined by the presence (absence) of stones - calculous and non-calculous forms. Each type is characterized by a chronic course with periodic exacerbations.

Chronic acalculous cholecystitis occurs approximately 2.5 times less frequently than the calculous form, accompanied by the deposition of stones in the bladder. This disease affects 0.6%-0.7% of the population, mainly middle-aged and older. Let's look at what acalculous cholecystitis is, the symptoms and treatment of this disease.

What it is?

Chronic cholecystitis is an inflammatory pathology of the gallbladder that develops due to infection of this organ by pathogenic microorganisms.

This diagnosis is usually made to people after 40 years of age, and women are more susceptible to the disease. With the development of the chronic form, the motor function of the gallbladder is impaired. The disease can have a different course - sluggish, recurrent, atypical.

What is the danger of pathology?

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

Despite rare attacks, damage to the gallbladder is quite serious:

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

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

Causes and risk factors

Factors that predispose to the appearance of a chronic form of cholecystitis include the following:

bile stagnation;
prolapse of internal organs;
pregnancy;
disruption of the blood supply to the organ;
entry into the bile ducts of pancreatic juice;
being overweight;
excessive fatigue;
the presence of intestinal infections in the body;
insufficiently active lifestyle;
excessive consumption of alcoholic beverages;
eating disorders;
foci of infection in the body;
eating a lot of spicy and fatty foods;
hypoacid gastritis;
hypothermia;
Stressful situations, endocrine disorders, autonomic disorders can lead to problems with the tone of the gallbladder.

The causative agents of cholecystitis, as a rule, are pathogenic microorganisms - staphylococci, streptococci, helminths, fungi. They can enter the gallbladder from the intestines, as well as through the blood or lymph.

Classification

The disease is characterized by a chronic course and a tendency to alternate exacerbations and remissions. Taking into account their number throughout the year, experts determine the nature of the disease: mild, moderate or severe.

There are 2 main types of chronic cholecystitis:

non-calculous (stone-free) – (inflammation of the walls of the gallbladder without the formation of stones);
calculous (with the formation of hard concretions - stones).

Depending on the course of the disease, there are 3 forms of the disease - sluggish, recurrent and purulent.

Symptoms

The main symptom of chronic cholecystitis is a dull pain in the right hypochondrium, which can last for several weeks, it can radiate to the right shoulder, and the right lumbar region, and be aching. Increased pain occurs after consuming fatty, spicy foods, carbonated drinks or alcohol, hypothermia or stress; in women, an exacerbation may be associated with PMS (premenstrual syndrome).

The main symptoms of chronic cholecystitis:

, belching bitterness;
Low-grade fever;
Possible yellowing of the skin;
Indigestion, vomiting, nausea, lack of appetite;
Dull pain on the right under the ribs, radiating to the back, shoulder blade;
Very rarely, atypical symptoms of the disease occur, such as heart pain, difficulty swallowing, bloating, and constipation.

Chronic cholecystitis does not occur suddenly, it develops over a long period of time, and after exacerbations, against the background of treatment and diet, periods of remission occur; the more carefully you follow the diet and supportive therapy, the longer the period of absence of symptoms.

Diagnostics

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

Instrumental and hardware methods for diagnosing chronic cholecystitis:

cholegraphy;
scintigraphy;
duodenal intubation;
arteriography;
cholecystography.

Laboratory tests reveal:

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

Treatment of chronic cholecystitis

Treatment tactics for chronic cholecystitis vary depending on the phase of the process. Outside of exacerbations, the main treatment and preventive measure is diet.

During the period of exacerbation, the treatment of chronic cholecystitis is similar to the treatment of the acute process:

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

In the presence of stones, litholysis (pharmacological or instrumental destruction of stones) is recommended. Medicinal dissolution of gallstones is carried out using drugs deoxycholic and ursodeoxycholic acids, instrumentally - extracorporeal shock wave methods, laser or electrohydraulic effects.

In the presence of multiple stones, persistent recurrent course with intense biliary colic, large size of stones, inflammatory degeneration of the gallbladder and ducts, surgical cholecystectomy (cavitary or endoscopic) is indicated.

Diet for chronic cholecystitis

In case of illness, it is necessary to strictly adhere to table No. 5 even during the period of remission for prevention. Basic principles of diet for chronic cholecystitis:

You cannot eat during the first three days of an exacerbation. It is recommended to drink rosehip decoction, still mineral water, sweet weak tea with lemon. Gradually, puree soups, porridges, bran, jelly, lean meat, steamed or boiled, fish, and cottage cheese are introduced into the menu.

You need to eat small portions at least 4-5 times a day.
Preference should be given to vegetable fats.
Drink more kefir and milk.
Be sure to eat a lot of vegetables and fruits.
What can you eat if you have chronic cholecystitis? Boiled, baked, steamed, but not fried dishes are suitable.
For the acalculous form of chronic disease, you can eat 1 egg per day. In case of calculosis, this product should be completely excluded.

alcohol;
fatty foods;
radish;
garlic;
Luke;
turnips;
spices, especially hot ones;
canned food;
legumes;
fried foods;
smoked meats;
mushrooms;
strong coffee, tea;
butter dough.

Neglect of nutritional principles can cause serious consequences of chronic cholecystitis, leading to relapse of the disease and progression of inflammatory-destructive changes in the walls of the gallbladder.

Complications of chronic cholecystitis

Timely treatment of chronic cholecystitis allows you to maintain quality of life and avoid such serious complications as:

internal biliary fistulas;
peritonitis - extensive inflammation of the peritoneum, which can occur as a result of perforation of the gallbladder and bile ducts;
purulent abscesses in the abdominal cavity, including those localized on the liver.

Prevention of exacerbations

To prevent the occurrence of the disease or avoid its exacerbation, general hygiene rules should be followed. Nutrition plays an important role. You need to eat food 3-4 times a day at approximately the same time. Dinner should be light and you should not overeat. Excessive consumption of fatty foods in combination with alcohol should be especially avoided. It is important that the body receives a sufficient amount of fluid (at least 1.5-2 liters per day).

In order to prevent chronic cholecystitis, it is necessary to allocate time for physical activity. This could be exercise, walking, swimming, cycling. In the presence of chronic foci of infection (inflammation of the appendages in women, chronic enteritis, colitis, tonsillitis), they should be treated in a timely manner, the same applies to helminthiases.

If you follow the above measures, you can prevent not only inflammation of the gallbladder, but also many other diseases.

Chronic cholecystitis is characterized by a long course, and it can develop either after several cases of the acute form of the disease, or independently.

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

Chronic cholecystitis - what is it?

gallbladder photo

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

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

The following factors can provoke inflammation:

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

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

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

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

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

In case of severe changes in the walls and ducts, the presence of long-formed stones and involvement of nearby organs in the pathological process, surgical intervention is prescribed.

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

Symptoms of chronic cholecystitis

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

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

Other symptoms that occur during illness:

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

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

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

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

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

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

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

Broad-spectrum antibiotics to fight the infection that caused the inflammation - Erythromycin, Ampicillin or other drugs as prescribed by the doctor;
Choleretic medications – Cholenzym, Allohol, Flamin;
Ursosan, which has an immunomodulatory and hepatoprotective effect, is indicated in severe cases when the liver is involved in the inflammatory process.

The duration of therapy is 1 month, and the pain syndrome can be eliminated within 7-10 days. If drug treatment of an exacerbation does not have an effect, then surgical removal of the gallbladder is indicated.

Diagnostic methods

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

Lab tests reveal:

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

Instrumental and hardware methods diagnosis of chronic cholecystitis:

cholegraphy;
scintigraphy;
duodenal intubation;
arteriography;
cholecystography.

Treatment tactics for chronic cholecystitis

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

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

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

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

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

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

Diet for chronic cholecystitis

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

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

Which doctors should you contact if you have any suspicions?

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

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

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