Exacerbation of acute cholecystitis. Acute cholecystitis. Symptoms, diagnosis, treatment of acute cholecystitis. Definition of disease. Causes of the disease

One of the complications of cholelithiasis (hereinafter referred to as cholelithiasis) can be acute cholecystitis. Its treatment in adults is carried out only by surgical methods, so timely diagnosis plays a significant role in this matter.

Of course, it is important to see a doctor when symptoms first appear. A “protracted” disease can negatively affect the patient’s general health. And also his immunity. This will affect further daily well-being and expose the body to a number of infectious diseases.

What is acute cholecystitis?

Acute cholecystitis(from the Greek Cholecystitis - gallbladder) - inflammation of the gallbladder associated with a violation of the outflow of bile. Most often it occurs due to:

• foreign formations inside it;

When it enters the cystic duct, calculous cholecystitis occurs. This process is accompanied by swelling of the walls of the gallbladder.

The disease can also occur for other reasons, the so-called acalculous cholecystitis. It appears as a result of infection of bile by bacteria.

Acute cholecystitis is coded according to the World Clinical Database (hereinafter referred to as ICD 10), as a disease whose manifestation may be due to a number of factors and may vary. Due to this, its characteristics are divided into acute and chronic. There are many forms of it. The general classification does not depend on the reason for which the disease arose or its course.
Photo: classification Also, the division into types depends on the patient’s well-being, the level of symptoms, and other things.

Distinguish different shapes diseases. They depend on the stage and level of development of the disease at the stage of examination and treatment:

1. Catarrhal.
2. Phlegmonous.
3. Gangrenous.

Each of these stages of acute cholecystitis is a continuation of the previous one and is accompanied by worsening general condition. Also, as the disease progresses, the complexity of its treatment increases. And if at the very beginning the disease can still be cured without surgical intervention, then if it worsens, it cannot be avoided.

This is precisely the main advice to see a doctor as soon as possible if the patient notices the first symptoms of the disease:

1. In the first stages, pharmacological intervention can be used.
2. In the second and third stages, only the surgery department will help. And since such intervention is a potential threat to human life, even with the most standard operations, every doctor tries to identify the disease at the first, mild stage of its development.

The disease is considered chronic when inflammation recurs frequently, even after successful treatment. Remissions lead to deterioration in well-being and the need for constant pharmacological intervention in the functioning of the human body.

Chronic manifestation It can be either stoneless or accompanied by the presence of stones in the gastric bladder. Chronic cholecystitis can lead to yellowing of the skin over time, in which case the patient needs to receive emergency care. In any case, she will already demand surgical intervention doctors

Why is acute cholecystitis dangerous?

IN advanced stages acute cholecystitis can develop into:

• inflammation of the pancreas;
• perforation of the gallbladder;
• formation of vesico-intestinal fistula;
• peritonitis.

These diseases may require urgent surgical intervention and put the patient at great risk.

Less dangerous occurrence and development bacterial infections, which appear inside the gallbladder and also require timely treatment. However, such therapy takes place at an easy level, requiring only a course of special tablets, which can be purchased without difficulty at any pharmacy according to your doctor’s prescription.

Symptoms and signs of acute cholecystitis

The main symptom is biliary colic - acute pain in the right hypochondrium. It is accompanied by nausea, vomiting and fever.

The patient may complain of:

• bitterness in the mouth;
• decreased appetite.

More severe stages of the disease are accompanied by yellowing of the skin and whites of the eyes, similar to symptoms of jaundice. This may indicate the development of peritonitis.

Diagnosis of acute cholecystitis

When initial symptoms appear, the patient should be hospitalized in the clinic. For an accurate diagnosis, differential diagnostic methods are used. Doctor:

1. Conducts an examination of the patient.
2. Prescribe tests:

• blood;
• urine;
• Ultrasound of the abdominal cavity.

If, based on the test results, the patient is diagnosed with acute cholecystitis, the doctor analyzes the medical history and extreme cases insists on the use of surgery.
Photo: Ultrasound of the gallbladder

Treatment of the disease

On early stages Help for acute cholecystitis is carried out by prescribing a course of medications. These include:

1. Amoxiclav.
2. Atropine.
3. Cefotaxime.
4. Diclofenac.

The patient is prescribed special diet, preventing the worsening of the stage of acute cholecystitis. Antibiotics are also used in treatment to fight bacteria and viruses. This helps to avoid serious complications in mild forms of the disease.

In more advanced stages, surgery may be required - cholecystectomy. It comes in several different forms, but the main purpose of this operation is to remove the gallbladder.

Surgeries for acute cholecystitis are prescribed by doctors, and their choice depends on:

• conditions of the disease;
• contraindications.

Most often, surgery is resorted to when stones are detected. But even after removal of the gallbladder, you can lead a normal life, following a mandatory diet.

Diet for acute cholecystitis

Regardless of the method of treatment, the patient is prescribed diet No. 5. In case of acute cholecystitis, it is important to exclude harmful foods from the diet, such as:

• flour;
• fat;
• fried;
• smoked.

The structure of the gallbladder In the first two days, it is better to abstain from food completely and drink only water. This diet allows.

Acute cholecystitis develops in 13-18% of patients with acute surgical diseases abdominal organs. Women get sick 3 times more often than men.

Causes of development of acute cholecystitis diverse. These include hypertension in the biliary tract, cholelithiasis, infection in the biliary tract, poor diet, stomach diseases accompanied by dyscholia, decreased nonspecific resistance of the body, changes in the vessels of the biliary tract due to atherosclerosis.

Violation of the closing function of the sphincters located in the terminal section of the common bile duct and the large duodenal nipple leads to the development of spasm. This delays the release of bile into the duodenum and causes hypertension in the biliary tract. The causes of hypertension can also be morphological changes - stricture of the terminal part of the common bile duct, which occurs in the presence of long-term choledocholithiasis. This stricture causes permanent cholestasis. In patients, the liver becomes enlarged and hyperbilirubinemia syndrome develops. Hypertension can also be caused by the presence of single gallstones larger than 0.3-0.5 cm, which are displaced into the distal part of the common bile duct, which leads to the development of progressive obstructive jaundice and cholecystocholangitis.

It has been established that in 80 - 90% of cases acute cholecystitis is a complication of gallstone disease. With this disease, stones long time located in the lumen of the gallbladder, disrupt the integrity of the mucous membrane and contractile function gallbladder. Often they obstruct the mouth of the cystic duct, which contributes to the development of the inflammatory process.

The nutritional factor, as a rule, is the trigger in almost 100% of patients. Spicy and fatty food taken in excessive quantities, stimulates intense bile formation, which leads to hypertension in the ductal system due to spasm of the sphincter of Oddi. In addition, it is possible that food allergens act on the sensitized membrane of the gallbladder, which is also manifested by the development of spasms.

Among the stomach diseases that can lead to the development acute cholecystitis, it should be noted chronic hypoacid and anacid gastritis, accompanied by a significant decrease in the secretion of gastric juice, especially of hydrochloric acid. With achylia, pathogenic microflora from upper sections alimentary canal can enter the biliary tract from the lumen of the duodenum into the gallbladder.

The development of acute cholecystitis is facilitated by local ischemia of the mucous membrane of the gallbladder and violation rheological properties blood. Local ischemia is the background against which, in the presence of pathogenic microflora, acute destructive cholecystitis easily occurs.

Clinic of acute cholecystitis depends on the pathomorphological changes in the gallbladder, the duration of the disease, the presence of complications and the reactivity of the body. The disease usually begins with an attack of pain in the right hypochondrium. The pain radiates upward to right shoulder and scapula, right supraclavicular region. It is accompanied by nausea and repeated vomiting. Characteristic signs are the appearance of a bitter sensation in the mouth and the presence of bile in the vomit. IN initial stage disease, the pain is dull in nature, as the process progresses it becomes more intense. In this case, there is an increase in body temperature to 38 ° C, and sometimes there is chills. The pulse quickens in accordance with the increase in body temperature. With destructive and especially perforative cholecystitis, complicated by peritonitis, tachycardia up to 100-120 per minute is observed. Sometimes there is icterus in the sclera. Severe jaundice occurs when the patency of the common bile duct is impaired due to obstruction of the lumen by a stone or inflammatory changes.

The tongue is dry and coated. On palpation, the abdomen is painful in the right hypochondrium; protective tension of the abdominal muscles and symptoms of peritoneal irritation are observed here, which are most pronounced in destructive cholecystitis.

Specific symptoms of acute cholecystitis are pain when tapping the edge of the palm along the right costal arch (Grekov-Ortner symptom), pain on deep palpation in the right hypochondrium (Kehr’s symptom), increased pain on palpation during inspiration (Obraztsov’s symptom), pain on palpation between the legs of the right sternoclavicular- mastoid muscle (Mussy-Georgievsky symptom). The patient cannot inhale during deep palpation in the right hypochondrium (Murphy's symptom).

Leukocytosis, neutrophilia, and lymphopenia are detected in peripheral blood. The following is proposed classification of acute cholecystitis:

acute calyx cholecystitis;

acute acalculous cholecystitis - simple (catarrhal), phlegmonous, gangrenous, perforative, complicated (peritonitis, cholangitis, obstruction of the common bile duct, perivesicular abscess, liver abscess, etc.).

Most characteristic symptom acute simple cholecystitis is pain in the right hypochondrium. Half of the patients experience nausea and vomiting. Body temperature is normal or subfebrile. The abdomen is soft, the liver is not enlarged, and the gallbladder is not palpable. Marked positive symptoms Ortner, Kera, Obraztsov and others.

Clinical picture destructive cholecystitis(phlegmonous, gangrenous) is characterized by the presence of constant pain in the right hypochondrium (in 100% of patients), vomiting (in 70%), high body temperature - up to 38-40 ° C (in 65%), jaundice (in 39%). An objective examination reveals sharp pain in the right hypochondrium, muscle tension, enlargement of the gallbladder and liver (in the presence of jaundice). Positive symptoms of Ortner, Obraztsov, Kera, Mussi, Shchetkin - Blumberg, etc. are determined. It should be remembered that with gangrene of the gallbladder, pain may decrease due to death nerve endings in his wall. At the same time, the patient’s condition worsens, and intoxication symptoms increase.

Clinical picture perforated cholecystitis characterized by the appearance of pain first in the right hypochondrium, and then throughout the abdomen. Perforation of the gallbladder most often occurs 48–72 hours after the onset of the disease, and, as a rule, in elderly and senile patients.

Changes in the wall of the gallbladder can develop not only as a result of an inflammatory process of microbial origin, but also as a result of the action of proteolytic enzymes of the pancreas that enter the lumen of the gallbladder through the biliary tract. These enzymes make the gallbladder wall permeable to bile within 4-6 hours. Bile peritonitis develops.

Acute cholecystitis, complicated by cholangitis and hepatitis, from the very beginning it occurs with intermittent fever with chills, heavy sweats and jaundice.

Due to intoxication of the body, lethargy, depression or euphoria develop. Sometimes loss of consciousness occurs. Jaundice is usually intense. It is joined by an acute liver failure, and then acute renal failure.

Differential diagnosis. Acute cholecystitis most often it is necessary to differentiate with renal colic, acute pancreatitis, perforated ulcer of the stomach and duodenum and acute appendicitis.

Renal colic, in contrast to an attack of acute cholecystitis, is characterized by the occurrence of acute pain in lumbar region, radiating to the genital area and thigh, as well as the development of dysuric phenomena. Body temperature remains normal, leukocytosis is absent. Formed elements of blood and salts are found in the urine. There are no symptoms of peritoneal irritation. Pasternatsky's symptom is positive.

Acute appendicitis with high localization vermiform appendix may simulate acute cholecystitis. Unlike acute appendicitis, acute cholecystitis occurs with repeated vomiting of bile, characteristic irradiation of pain to the right shoulder blade and shoulder. There is no Mussi sign in acute appendicitis.

Making a diagnosis is facilitated by a history of evidence that the patient has gallstone disease. Acute appendicitis is usually more severe and is characterized by rapid development of peritonitis.

Perforated ulcers of the stomach and duodenum, mostly covered, sometimes simulate acute cholecystitis. Acute cholecystitis, in contrast to perforated ulcers, is characterized by the absence of a history of ulcers and the presence of indications of cholelithiasis.

Acute cholecystitis occurs with repeated vomiting of bile and characteristic irradiation of pain. The pain is localized in the right hypochondrium and increases gradually, body temperature is increased.

Covered perforations of ulcers have an acute onset. In the first hours after the onset of the disease, pronounced tension in the muscles of the anterior abdominal wall. Often there is local pain in the right iliac region due to leakage of gastric contents, which is not typical for acute cholecystitis. In acute cholecystitis, liver dullness is preserved.

Acute pancreatitis, in contrast to acute cholecystitis, occurs with rapidly increasing symptoms of intoxication, tachycardia, and intestinal paresis. The pain is localized mainly in the left hypochondrium or epigastric region, and is of a girdling nature. It is accompanied by frequent and sometimes uncontrollable vomiting.

Differential diagnosis of acute cholecystitis and acute pancreatitis is very difficult and is carried out in a surgical hospital.

Treatment sick acute cholecystitis should start at prehospital stage. An antispasmodic mixture is administered intravenously: 2 ml of a 2% solution of no-shpa, 2 ml of a 2% solution of papaverine hydrochloride, 2 ml of a 0.2% solution of platiphylline hydrotartrate and 1 ml of 0.1 % atropine sulfate solution. This relieves spasm of the sphincter of Oddi and reduces intraductal pressure due to improved outflow of bile into the duodenum.

All patients acute cholecystitis are subject to urgent hospitalization in a surgical hospital for further treatment (conservative and surgical).

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 this is, what are the causes and characteristic signs in adults, as well as treatment methods and diet for the normal functioning of the 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 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 in a sedentary manner life, the nature of nutrition (excessive consumption of foods rich in animal fats - fatty meat, eggs, butter), growth 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 of the disease. As in acute form, the patient may be plagued by 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, E. 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
• Availability helminthic infestation- ascariasis, giardiasis, strongyloidiasis,
• Alcoholism, obesity, an abundance of fatty, spicy foods in the diet, poor diet.

Inflammatory processes in the gallbladder itself or neighboring organs lead to changes in the natural balance of biochemical parameters and tumors. The lack of an adequate response 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 the 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:

• the presence of a dull pain on the right, above the waist, echoing 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 perceptible (with a sluggish chronic course) to almost unbearable (for example, in the case of biliary colic - sudden attack intense pain).

Main symptoms chronic cholecystitis:

• Indigestion, vomiting, nausea, lack of appetite
• Dull pain on the right under the ribs, radiating 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 multiple repetitions of acute attacks of inflammation in the gallbladder, the disease is defined as chronic. This form can occur both in the presence of gallstones and in their absence. It can develop slowly and imperceptibly over a long period from several months to years, or occur immediately as a result of the acute stage of cholecystitis.

How to relieve an attack of cholecystitis?

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

Complications

The presence of any cholecystitis is always fraught with possible development 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. At chronic form disease, it would 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 bile.
• Immunoenzymatic blood test for giardiasis.
• Fecal elastase analysis 1. To diagnose pancreatitis.

Apply following methods diagnostics:

• 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 most the best way Determining the presence of the disease is an early study. 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. At 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.

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.

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 when they find out full picture development of the disease, a final decision is made.

Most often, it is stone disease that causes cholecystectomy. If the disease is not treated in a timely manner, the walls of the gallbladder are destroyed and the digestion process is disrupted. 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.

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

1. Corn silk- 10 g pour 200 ml of water, boil for 5 minutes, take ¼ glass 3 times a day before meals.
2. 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. An effective way to empty the gallbladder.
3. Pumpkin . Prepare as many pumpkin dishes as possible. Taking freshly squeezed juice from vegetable pulp (200 ml per day) is beneficial.
4. Add 2 tsp to boiling water immortelle flowers, 2 tsp lingonberry leaves, 3 tsp knotweed and 1 tsp chamomile flowers. Let it brew for 2-3 hours. Take ½ glass three times a day.
5. Mix the ingredients in the indicated quantities: peppermint, chamomile, kidney tea– 2 tablespoons; 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.
6. 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 the appearance of symptoms of inflammatory processes in the walls of the gallbladder in adults, prevention of cholecystitis at home is required, including:

1. Follow a diet, limit your intake of fatty and fried food, exclude alcoholic and carbonated drinks, give preference to fractional meals, strive to normalize body weight.
2. Timely sanitization of possible foci of infection in the body - organs oral cavity and nasopharynx.
3. Once a year, undergo a medical examination using the method ultrasound therapy 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 of the pathological process, the patient loses his ability to work only during the period of exacerbation. The rest of the time he feels fine.

What is acute cholecystitis? We will discuss the causes, diagnosis and treatment methods in the article by Dr. E. V. Razmakhnin, a surgeon with 22 years of experience.

Definition of disease. Causes of the disease

Acute cholecystitis is a rapidly progressing inflammatory process in the gallbladder. Stones located in this organ are the most common cause of this pathology.

About 20% of patients admitted to the emergency surgical hospital are patients with complicated forms, which include acute cholecystitis. In older patients, this disease is much more common and more severe due to large quantity existing somatic diseases. In addition, with age, the incidence of gangrenous forms of acute cholecystitis increases. Acalculous acute cholecystitis is uncommon and is a consequence infectious diseases, vascular pathology(vesical artery thrombosis) or sepsis.

The disease is usually provoked errors in diet - intake of fatty and spicy foods, which leads to intense bile formation, spasm of sphincters in the biliary tract and biliary hypertension.

Contributing factors are stomach diseases , and in particular gastritis with low acidity. They lead to a weakening of protective mechanisms and the penetration of microflora into the biliary tract.

At cystic artery thrombosis against the background of pathology of the blood coagulation system and atherosclerosis, the development of a primary gangrenous form of acute cholecystitis is possible.

Provoking factors if present cholelithiasis Physical activity, “shaky” riding, which leads to the displacement of the stone, blockage of the cystic duct and subsequent activation of the microflora in the lumen of the bladder, can also serve.

Existing cholelithiasis does not always lead to the development of acute cholecystitis; it is quite difficult to predict this. Throughout life, stones in the lumen of the bladder may not manifest themselves, or at the most inopportune moment they can lead to a serious complication that is life-threatening.

Symptoms of acute cholecystitis

The clinical picture of the disease includes pain, dyspeptic and intoxication syndromes.

Typically, the onset of the disease is manifested by hepatic colic: intense pain in the right hypochondrium, extending to the lumbar, supraclavicular region and epigastrium. Sometimes, in the presence of symptoms of pancreatitis, pain can become girdling. The epicenter of pain is usually localized at the so-called Kehr's point, located at the intersection of the outer edge of the right rectus abdominis muscle and the edge of the costal arch. At this point the gallbladder comes into contact with the anterior abdominal wall.

The appearance of hepatic colic is explained by sharply increasing biliary (biliary) hypertension against the background of a reflex spasm of the sphincters located in the biliary tract. Increased pressure in the biliary system leads to enlargement of the liver and stretching of the Glissonian capsule that covers the liver. And since the capsule contains great amount pain receptors (i.e. noceroreceptors), this leads to pain syndrome.

The structure of Glisson's capsule

The development of the so-called cholecystocardial Botkin syndrome is possible. In this case, with acute cholecystitis, pain occurs in the heart area, and even changes in the ECG may appear in the form of ischemia. Such a situation can mislead the doctor, and as a result of overdiagnosis (erroneous medical conclusion) coronary disease he risks not recognizing acute cholecystitis. In this regard, it is necessary to carefully understand the symptoms of the disease and evaluate the clinical picture as a whole, taking into account the anamnesis and paraclinical data. The occurrence of Botkin's syndrome is associated with the presence of a reflex parasympathetic connection between the gallbladder and the heart.

After relief of hepatic colic, the pain does not completely go away, as with chronic calculous cholecystitis. It becomes somewhat dull, takes on a constant bursting character and is localized in the right hypochondrium.

In the presence of complicated forms of acute cholecystitis, the pain syndrome changes. With the occurrence of perforation of the gallbladder and the development of peritonitis, the pain becomes diffuse throughout the abdomen.

Intoxication syndrome is manifested by increased temperature, tachycardia (increased heart rate), dry skin (or, conversely, sweating), lack of appetite, headache, muscle pain and weakness.

The degree of temperature rise depends on the severity of ongoing inflammation in the gallbladder:

• in the case of catarrhal forms, the temperature can be subfebrile - from 37°C to 38°C;
• for destructive forms of cholecystitis - above 38°C;
• when an empyema (ulcer) of the gallbladder or a perivesical abscess occurs, hectic temperature is possible with sharp rises and falls during the day and heavy sweat.

Dyspeptic syndrome is expressed in the form of nausea and vomiting. Vomiting can be either single or repeated with concomitant damage to the pancreas, which does not bring relief.

Pathogenesis of acute cholecystitis

Previously it was believed that the main factor leading to the development of acute cholecystitis was bacterial. In accordance with this, treatment was prescribed aimed at eliminating the inflammatory process. Currently, ideas about the pathogenesis of the disease have changed and treatment tactics have changed accordingly.

The development of acute cholecystitis is associated with a block of the gallbladder, which triggers all subsequent pathological reactions. The block is most often formed as a result of a stone wedging into the cystic duct. This is aggravated by a reflex spasm of the sphincters in the biliary tract, as well as increasing edema.

As a result of biliary hypertension, the microflora located in the biliary tract is activated and develops acute inflammation. Moreover, the severity of biliary hypertension directly depends on the degree of destructive changes in the wall of the gallbladder.

Increased pressure in the biliary tract is a trigger for the development of many acute diseases of the hepatoduodenal zone (cholecystitis, cholangitis, pancreatitis). Activation of intravesical microflora leads to even greater edema and disruption of microcirculation, which, in turn, significantly increases the pressure in the biliary tract - a vicious circle closes.

Classification and stages of development of acute cholecystitis

Based on morphological changes in the wall of the gallbladder, four forms of acute cholecystitis are distinguished:

• catarrhal;
• phlegmonous;
• gangrenous;
• gangrenous-perforative.

Different severity of inflammation suggests a different clinical picture.

With catarrhal form the inflammatory process affects the mucous membrane of the gallbladder. Clinically, this is manifested by pain of moderate intensity, intoxication syndrome is not expressed, and nausea occurs.

With phlegmonous form inflammation affects all layers of the gallbladder wall. A more intense pain syndrome, fever up to febrile levels, vomiting and flatulence occurs. An enlarged, painful gallbladder may be palpable. Symptoms are revealed:

• With. Murphy - interruption of inhalation when palpating the gallbladder;
• With. Mussi - Georgievsky, otherwise called phrenicus symptom - more painful palpation on the right between the legs of the sternocleidomastoid muscle (the exit point of the phrenic nerve);
• With. Ortner - pain when tapping on the right costal arch.

In gangrenous form intoxication syndrome comes to the fore: tachycardia, heat, dehydration (dehydration), symptoms of peritoneal irritation appear.

With perforation of the gallbladder(gangrenous-perforative form) the clinical picture of peritonitis prevails: muscle tension of the anterior abdominal wall, positive symptoms of peritoneal irritation (Mendel village, Voskresensky village, Razdolsky village, Shchetkina-Blumberg village), bloating and severe intoxication syndrome.

Forms of cholecystitis without appropriate treatment can flow from one to another (from catarrhal to gangrenous), and the initial development of destructive changes in the wall of the bladder is also possible.

Stages of acute cholecystitis

Complications of acute cholecystitis

Complications can arise with a long course of untreated destructive forms of acute cholecystitis.

If inflammation is limited, it occurs perivesical infiltrate. Its obligatory component is the gallbladder, located in the center of the infiltrate. The composition most often includes an oil seal, which may include transverse colon, antrum of the stomach and duodenum. It usually occurs after 3-4 days of the disease. At the same time, pain and intoxication may decrease somewhat, and dyspeptic syndrome may be relieved. With correctly chosen conservative treatment, the infiltrate can resolve within 3-6 months; if unfavorable, it can abscess with development perivesical abscess(characterized by severe intoxication syndrome and increased pain). Diagnosis of infiltrate and abscess is based on anamnesis of the disease, objective examination data and is confirmed using ultrasound.

Peritonitis- the most dangerous complication of acute destructive cholecystitis. It occurs when the wall of the gallbladder is perforated and bile leaks into the free abdominal cavity. As a result of this, a sharp increase in pain occurs, the pain becomes diffused throughout the abdomen. The intoxication syndrome becomes more severe: the patient is initially excited, groans in pain, but as peritonitis progresses, he becomes apathetic. Peritonitis is also characterized by severe intestinal paresis, bloating and weakened peristalsis. Upon examination, defence (tension) of the anterior abdominal wall and positive symptoms of peritoneal irritation are determined. Ultrasound examination reveals the presence of free fluid in the abdominal cavity. At x-ray examination signs of intestinal paresis are noticeable. Emergency surgical treatment is necessary after short-term preoperative preparation.

Another serious complication of acute cholecystitis is cholangitis- inflammation spreads to the biliary tree. In essence, this process is a manifestation of abdominal sepsis. The condition of the patients is severe, intoxication syndrome is pronounced, high hectic fever occurs with large daily temperature fluctuations, heavy sweats and chills. The liver increases in size, jaundice and cytolytic syndrome occur.

Ultrasound reveals dilation of the intra- and extrahepatic ducts. Blood tests show hyperleukocytosis, increased bilirubin levels due to both fractions, increased activity of aminotransferases and alkaline phosphatase. Without appropriate treatment, such patients quickly die from liver failure.

Diagnosis of acute cholecystitis

Diagnosis is based on a combination of medical history, objective data, laboratory and instrumental studies. In this case, the principle must be respected from simple to complex, from less invasive to more invasive.

When collecting anamnesis(during the survey) patients may indicate the presence of cholelithiasis, previous hepatic colic, diet violations in the form of consumption of fatty, fried or spicy foods.

Clinical data assessed by the manifestations of pain, dyspeptic and intoxication syndromes. In the presence of complications, concomitant choledocholithiasis and pancreatitis, cholestasis syndrome and moderate cytolytic syndrome are possible.

From instrumental methods diagnostics the most informative and least invasive is ultrasonography . At the same time, the size of the gallbladder, its contents, the condition of the wall, surrounding tissues, intra- and extrahepatic bile ducts, and the presence of free fluid in the abdominal cavity are assessed.

In the case of an acute inflammatory process in the gallbladder, ultrasound reveals an increase in its size (sometimes significant). Wrinkling of the bladder indicates the presence of chronic cholecystitis.

When assessing the contents, pay attention to the presence of stones (number, size and location) or flakes, which may indicate the presence of stagnation of bile (sludge) or pus in the lumen of the bladder. In acute cholecystitis, the wall of the gallbladder thickens (more than 3 mm), can reach 1 cm, and sometimes becomes layered (in destructive forms of cholecystitis).

With anaerobic inflammation, gas bubbles can be seen in the wall of the bladder. The presence of free fluid in the peri-vesical space and in the free abdominal cavity indicates the development of peritonitis. In the presence of biliary hypertension against the background of choledocholithiasis or pancreatitis, dilation of the intra- and extrahepatic bile ducts is observed.

Evaluation of ultrasound data makes it possible to determine treatment tactics even at the admission stage: patient management conservatively, emergency, urgent or delayed surgery.

X-ray methods studies are carried out if a block of the biliary tract is suspected. Survey radiography is not very informative, since stones in the lumen of the gallbladder are usually X-ray non-contrast (about 80%) - they contain a small amount of calcium, and they can rarely be visualized.

With the development of such a complication of acute cholecystitis as peritonitis, signs of paresis can be identified gastrointestinal tract. To clarify the nature of the biliary tract block, contrast research methods are used:

• endoscopic retrograde cholangiopancreatography - the biliary tract is contrasted retrogradely through the papilla of Vater during duodenoscopy;
• percutaneous transhepatic cholecystocholangiography - antegrade contrast enhancement by percutaneous puncture of the intrahepatic duct.

If making a diagnosis and carrying out differential diagnosis is difficult, CT scan belly. With its help, you can evaluate in detail the nature of changes in the gallbladder, surrounding tissues and bile ducts.

If necessary, differential diagnosis from another acute pathology abdominal organs can be performed diagnostic laparoscopy and visually assess existing changes in the gallbladder. This study can be performed either under local anesthesia, and under endotracheal anesthesia (the latter is preferable). If necessary, the issue of switching to therapeutic laparoscopy, that is, performing cholecystectomy - removal of the gallbladder, is decided right on the operating table.

Laboratory diagnostics consists of performing general blood test, where leukocytosis is detected, shift leukocyte formula to the left and an increase in ESR. The severity of these changes will depend on the severity of inflammatory changes in the gallbladder.

IN biochemical blood test there may be a slight increase in bilirubin levels and aminotransferase activity due to reactive hepatitis in the adjacent liver tissue. More pronounced changes in biochemical parameters occur with the development of complications and intercurrent diseases.

Treatment of acute cholecystitis

Patients with acute cholecystitis are subject to emergency hospitalization in surgery department hospital. After carrying out the necessary diagnostic measures, further treatment tactics are determined. In the presence of severe complications - perivesical abscess, destructive cholecystitis with peritonitis - patients are subject to emergency surgery after short preoperative preparation.

Preparation consists of restoring the volume of circulating blood, detoxification therapy by infusion of crystalloid solutions in a volume of 2-3 liters. If necessary, correction of cardiac and respiratory failure. Perioperative antibiotic prophylaxis is performed (before, during and after surgery).

Online access is selected depending on technical capabilities clinics, individual characteristics patient and surgeon qualifications. The most commonly used is laparoscopic access, which is the least traumatic and allows for full inspection and sanitation.

The mini-access is not inferior to the laparoscopic approach in terms of morbidity and has the advantage of eliminating the need to apply pneumoperitoneum (to limit the mobility of the diaphragm). If technical difficulties arise, expressed adhesive process in the abdominal cavity and diffuse peritonitis, it is more advisable to use laparotomic access: upper-median laparotomy, Kocher, Fedorov, Rio Branca access. At the same time, upper midline laparotomy is less traumatic, since in in this case the muscles do not intersect, however, with oblique subcostal approaches, the subhepatic space is more adequately opened for surgical intervention.

The operation consists of performing a cholecystectomy. It should be noted that the presence of perivesical infiltrate implies certain technical difficulties in mobilizing the neck of the gallbladder. This leads to an increased risk of damage to the elements of the hepatoduodenal ligament. In this regard, we should not forget about the possibility of performing cholecystectomy from the fundus, which makes it possible to more clearly identify the elements of the cervix.

There is also the “Pribrama” operation, which consists of removing the anterior (lower) wall of the gallbladder, suturing the cystic duct in the neck area and mucoclasia (removal of the mucous membrane) by electrocoagulation of the posterior (upper) wall. Performing this operation with a pronounced infiltrate in the area of ​​the bladder neck will avoid the risk of iatrogenic damage. It is applicable for both laparotomic and laparoscopic approaches.

If severe complications acute cholecystitis is absent, then upon admission of the patient to the hospital, it is prescribed conservative therapy aimed at unblocking the gallbladder. Antispasmodics, M-anticholinergics, infusion therapy To relieve intoxication, antibiotics are prescribed.

An effective method is to block the round ligament of the liver with a solution of novocaine. The blockade can be performed blindly special technique, and under the control of a laparoscope when performing diagnostic laparoscopy and under ultrasound control.

If ineffective conservative therapy within 24 hours, the question is raised about conducting radical surgery - cholecystectomy.

Of no small importance for determining treatment tactics is the time that has passed since the onset of the disease. If the interval is up to five days, then cholecystectomy is feasible; if it is more than five days, then it is better to adhere to the most conservative tactics in the absence of indications for emergency surgery. The fact is that in the early stages the perivesical infiltrate is still quite loose, it can be divided during surgery. Later, the infiltrate becomes dense, and attempts to separate it may result in complications. Of course, a period of five days is quite arbitrary.

If there is no effect from conservative treatment and the presence of contraindications for performing radical surgery - severe pathology of the cardiovascular and respiratory systems, five days have passed since the onset of the disease - it is better to resort to decompression of the gallbladder by cholecystostomy.

Cholecystoma can be applied in three ways: from a mini-access, under laparoscopic control and under ultrasound control. The most minimally traumatic procedure is to perform this operation under ultrasound guidance and local anesthesia. Single and double punctures of the gallbladder with sanitation of its lumen under ultrasound guidance are also effective. A necessary condition is the passage of the puncture channel through the liver tissue to prevent bile leakage.

After stopping the acute inflammatory process, radical surgery is performed in a cold period after three months. Usually this time is enough for the perivesical infiltrate to resolve.

Forecast. Prevention

Forecast with timely and adequate treatment usually favorable. After radical surgery, it is necessary for a certain period of time (at least three months) to adhere to diet No. 5 with the exception of fatty, fried and spicy foods. Food intake should be fractional - in small portions 5-6 times a day. It is necessary to take pancreatic enzymes and herbal choleretic drugs(they are contraindicated before surgery).

Prevention consists of timely sanitation of stone carriers, that is, performing cholecystectomy as planned for patients with chronic calculous cholecystitis. The founder of biliary surgery, Hans Kehr, said that “carrying a stone in the gall bladder is not the same as wearing an earring in the ear.” In the presence of cholecystolithiasis, factors leading to the development of acute cholecystitis should be avoided - do not break the diet.

Bibliography

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Clinical cases

Laparoscopic version of the Pribram operation for acute cholecystitis

Introduction

Patient M., 65 years old, was transported by an ambulance team to city ​​hospital No. 1, Chita with acute pain in the right hypochondrium.

Complaints

Upon admission, the patient complained of pain that radiated to the epigastrium and right shoulder girdle, an increase in body temperature to 38°C, nausea and vomiting twice.

The pain decreased somewhat after taking antispasmodics and analgesics for several hours.

Anamnesis

She became acutely ill three days ago after errors in her diet (using buuz); she independently took the drug “No-shpa” with little effect. The temperature first rose to 38°C on the eve of hospitalization. Cholelithiasis has been present for several years; the patient has repeatedly suffered from hepatic colic, which was relieved by the administration of antispasmodics, and refused surgical treatment.

There is no allergic history. As a child, she suffered from Botkin's disease (hepatitis A). Suffering hypertension, in connection with this, he is observed by a therapist and receives antihypertensive therapy. There were no injuries or operations.

Survey

State medium degree gravity, active position. Patient increased nutrition, BMI - 35. Skin color is normal, humidity is high. Breathing is vesicular, respiratory rate is 18 per minute. Heart sounds are sonorous, rhythmic, heart rate - 88 per minute, blood pressure - 150/80 mm Hg. The tongue is dry, covered with a gray coating. The abdomen is enlarged due to subcutaneous fat, takes part in the act of breathing, during palpation it is moderately tense and sharply painful in the right hypochondrium. An enlarged, painful gallbladder can also be felt there. Symptoms of Ortner, Kehr, Murphy, Mussi - Georgievsky are positive. There are no symptoms of peritoneal irritation. There is no free fluid in the abdominal cavity.

X-ray of the chest organs: diffuse pneumosclerosis.
ECG: sinus rhythm, left ventricular hypertrophy, heart rate - 88 per minute.
CBC: leukocytosis up to 14.6x109/l, total bilirubin - 18 µmol/l.
Ultrasound: the gallbladder is significantly enlarged in size, the wall is layered, thickened to 8 mm, there are many echo-positive signals in the lumen with an acoustic shadow from 3 to 18 mm. Common bile duct - 5 mm. No free fluid was found in the abdominal cavity.

Diagnosis

Cholelithiasis. Acute calculous cholecystitis.

Treatment

After additional examination, the patient was prescribed infusion therapy in a volume of 2.0 liters, antispasmodics and antibacterial therapy. Given the lack of effect, a block of the round ligament of the liver was performed with a short-term effect in the form of pain reduction. 12 hours after the start of treatment, the patient continues to have pain in the right hypochondrium, temperature up to 37.8°C. Given the persistent pain and intoxication syndromes, she was transferred to the operating room.
Laparocentesis (puncture of the abdominal wall) was performed under endotracheal anesthesia, and pneumoperitoneum was applied. Four trocars are installed through standard points. In the right hypochondrium, an infiltrate consisting of the gallbladder, a loop of the transverse colon, greater omentum and duodenal bulbs. This infiltrate was partially divided with technical difficulties; the transverse colon, omentum, and duodenal bulb were separated. The gallbladder is tense, hyperemic, its size is significantly increased, the wall is thickened, and about 60 ml of thick pus is evacuated during puncture. Differentiation of the elements of the bladder neck is impossible due to the rocky density of the infiltrate. It was decided to perform the Pribram operation. The gallbladder is opened, stones of various sizes are evacuated, the walls of the gallbladder are partially excised, leaving small fragments adjacent to the liver and neck. Coagulation (union) of the bladder bed and the remaining fragments of the wall was performed for the purpose of biliary and hemostasis. The neck of the gallbladder is stitched and bandaged. The abdominal cavity was sanitized and drained with a PVC tube to the gall bladder bed.

The postoperative period was satisfactory. During the first two days, the drainage released about 200 ml of serous discharge mixed with bile, which gradually stopped. The drainage was removed on the fourth day after surgery.

On the sixth day after surgery, the patient was discharged in satisfactory condition. She was examined on an outpatient basis two weeks later, had no complaints, the skin and mucous membranes were of normal color, the abdomen was soft, painless, and the stool was colored.

Conclusion

Considering the long period that has passed since the onset of acute cholecystitis, such patients are always expected to have a fairly dense perivesical infiltrate. Of course, in similar cases It is advisable to carry out conservative therapy aimed at unblocking the gallbladder, stopping the inflammatory process and subsequent surgery in a cold period after three months. However, if conservative therapy is ineffective, one must resort to either cholecystostomy or radical surgery. If the infiltrate in the area of ​​the bladder neck is sufficiently dense and inseparable, then you can resort to Pribram’s operation, including the laparoscopic version, which will reduce the invasiveness of the intervention and avoid damage to the tubular structures of the porta hepatis.

This article will talk about what characterizes acute cholecystitis. Symptoms and treatment in adults are determined by the form of the disease.

Her main feature – It's a dull pain in the area of ​​the right side. Sometimes it is so strong that the sick person loses consciousness.

Cholecystitis in adults can be acute or chronic. Each of these forms has specificity in the form of causes and symptoms.

Every year, the number of patients with symptoms of this pathology who turn to a gastroenterologist increases.

Experts attribute this to an unhealthy lifestyle, or more precisely, to poor nutrition and lack of physical activity.

Cholecystitis - characteristics and classification

This disease is dangerous. It appears against the background of cholelithiasis. When a person complains of pain in the right hypochondrium, he should contact a gastroenterologist.

The doctor will carry out the complex diagnostic procedures, after which it will determine the presence or absence of an inflammatory process on the body of the gallbladder.

If there is inflammation, it is cholecystitis. The disease is considered dangerous, since its development contributes to disruption of the outflow of bile, which leads to difficult digestion.

The gallbladder is a reservoir organ in human body. It does not produce, but stores a yellow liquid, which is required to ensure the absorption and digestion of food entering the stomach.

Without bile, digestion is impossible. When its outflow in the body is disrupted, stagnation occurs.

Exacerbation of cholecystitis leads to spasm of the reservoir organ, which results in severe pain.

Yes, discomfort is the main one alarming symptom, manifested in all patients with cholecystitis.

The gallbladder can become inflamed for various reasons - infection pathogenic viruses, hit, poor nutrition etc.

But regardless of the reason for the appearance of this process, it must be stopped in time.

We propose to consider in more detail the functions of bile:

• Stimulation of intestinal peristalsis.
• Neutralization of cholesterol, bilirubin and other harmful substances, the entry of which into the body contributes to stone formation.
• Diluting food that has previously been treated with gastric juice.
• Promoting the movement of gastric contents into the intestines.
• Stimulation of the production of physiological intestinal mucus necessary for protection.
• Launch of digestive enzymes produced by the pancreas.

This is the main functionality of the yellow liquid. Thus, when, due to acute cholecystitis in adults, it slowly enters the stomach (or does not enter there at all), digestive function is violated.

Interesting fact! Doctors say that today about 15% of the adult population faces the problem of inflammation of the walls of the gallbladder.

According to experts, there are 3 factors that contribute to the development of this dangerous pathology:

1. Abuse of high carbohydrate and fatty foods.
2. Insufficient physical activity.
3. Failure of endocrine functioning.

These are not all the reasons for the appearance of this disease, however, they are key.

Let's take a closer look at each form of cholecystitis.

Chronic cholecystitis

The inflammatory process may not be felt by a person for a long time. The lesion grows slowly.

But gradually bad feeling, provoked by a pathological process, intensifies.

The patient is worried discomfort in the right hypochondrium. Sometimes they even appear at night.

It is believed that severe discomfort in this form of pathology is provoked by errors in nutrition. This has been proven in practice many times.

As for other characteristic signs of the chronic form of this disease, they are often absent.

However, the patient may complain of weakness, increased fatigue, rapid heartbeat and fever.

This clinical picture does not always occur. This form of pathology is divided into 2 types: acalculous and calculous.

In 80% of cases, a gastroenterologist’s patient is faced with the problem of calculous cholecystitis, which appears as a result of the formation of stones in the gallbladder.

Popularly, such neoplasms are commonly referred to as “stones.” When a person’s reservoir organ is literally clogged with them, its walls become inflamed, which leads to the development of cholecystitis.

But if cholelithiasis does not precede this disease, which happens in 20% of cases, then the person also requires treatment.

Probably, the pathological process on the body of his gallbladder was provoked by another factor.

Acute cholecystitis

An exacerbation of this pathology may have serious consequences not only for the patient’s health, but also for his life.

The main danger is caused by the movement of stones, which provoke an inflammatory process on the body of the reservoir organ.

With this violation, bile stagnates in the duct. In this situation, there is a high probability of purulent peritonitis.

In this case, the patient must be urgently hospitalized. He will be assisted by qualified doctors.

Most often, the appearance of purulent peritonitis ends for the patient with an operation to remove the gallbladder - cholecystectomy.

The main symptoms of acute cholecystitis:

• Labored breathing.
• Severe colic in right side. Many people lose consciousness during such a painful attack.
• Fussiness, lack of perseverance. The person tries to find a position in which the pain will be felt less, but he fails.
• Severe nausea accompanied by vomiting. Such vomiting does not bring relief to a person. He vomits bile.
• The appearance of oral bitterness.
• Yellowing of the eye sclera and epidermis.
• Belching air.
• Temperature rises to 37-37.5 degrees.

What provokes exacerbation of cholecystitis?

1. There is a sudden release of enzymes synthesized by pancreatic cells.
2. Damage to the mucous membrane of the gallbladder due to sharp stones.
3. Infection of yellow liquid with pathogenic microflora.
4. Blockage of the bile ducts with stones.

As practice shows, if a gastroenterologist’s patient ignores dietary recommendations, the stones formed in the gall bladder begin to move.

This clinical picture cannot but worry. Cholecystitis in adults is a dangerous pathology that needs to be treated in a timely manner so as not to provoke complications.

Causes of cholecystitis

Treatment should begin with identifying the factor that provokes the disease. Without observing this point, you cannot proceed to therapy.

Most often, cholecystitis in adults appears as a result of infection of the gastrointestinal tract.

When a pathogenic microbe enters the human body, over time, it begins to actively develop.

This leads to its possible deposition on the mucous membrane of some internal organs, including the gallbladder.

What infections provoke the appearance of this pathology?

• Escherichia coli.
• Streptococcus.
• Staphylococcus.
• Enterococcus, etc.

Now let's look at the main causes of cholecystitis:

• Biliary dyskinesia.
• Helminthic intestinal lesions. In this case, inflammation of the gallbladder is a combination of giardiasis, ascariasis or other types of helminthic infestation.
• Pregnancy. The uterus of some expectant mothers increases in size so much that it begins to put pressure on the abdominal organs. The gallbladder also suffers. As a result of this, it may become inflamed.
• Lack of proper food intake. This is the leading cause causing the appearance of cholecystitis. When a person's diet is unbalanced, he will probably soon encounter a number of stagnation phenomena. It is important to ensure that daily menu everyone was there necessary for the body microelements.
• Descent of the abdominal organs. People are often born with this pathology.
• Obesity, regular errors in nutrition.
• Alcohol abuse.

Important! Give up daily use fried, too salty and smoked. These are foods that take a long time for the stomach to digest. If you have a disease such as cholecystitis, this product should be excluded from the diet.

Thus, wrong image life and the presence of congenital or acquired anomalies are 2 key factors causing the appearance of cholecystitis.

If the inflammation on the body of the gallbladder is not stopped in time, then the likelihood of cancer increases.

In the absence of timely treatment of this pathology, the natural biochemical balance in human body is violated.

Also, congestion leads to a significant deterioration in metabolism. In this case, decay products are retained in the patient’s body.

Experts identify a number of factors that contribute to the growth of the inflammatory process on the body of the gallbladder.

Let's list them:

• Tobacco smoking.
• Poor nutrition.
• Decreased arterial pressure– hypotension.
• Frequent drinking of alcohol.
• Genetic predisposition to cholecystitis.
• Injury to the abdominal area.
• Not following healthy eating rules.

Treatment of cholecystitis

When a person is diagnosed with cholecystitis, he should not delay treatment. It's hard to realize the need therapeutic measures in the chronic form of the disease, which is not characterized by obvious symptoms.

However, the sooner the patient manages to get rid of this pathology, the greater the chance that it will not become complicated.

The danger of this disease lies in the destruction of the gallbladder, a reservoir for storing bile.

When the body of an organ becomes inflamed, its performance decreases, which negatively affects a person’s well-being.

Important! Remember that cholecystitis should be treated by a qualified doctor. Do not try to take therapeutic measures yourself, at home, as this may lead to complications of the pathology. However, during the period of hepatic colic, you need to help yourself before the ambulance arrives.

First aid for an attack of cholecystitis:

1. First, make sure that the room in which the sick person is located has enough fresh air. If possible, open the window.
2. Now provide the patient with complete rest. A stressful situation can become a factor in increasing pain.
3. Sit the patient so that his body is slightly tilted down. And in this position there are fewer uncomfortable feelings. The patient should not take a lying position! A big mistake is to use hepatic colic sleeping pills, in order to “sleep through” the pain. Remember that severe discomfort indicates a pathological process occurring in the body, which in no case should be ignored.
4. Don't hesitate and call ambulance. But while the doctors are on their way, give the patient antispasmodic. For cholecystitis, doctors advise drinking No-shpu. But in case of a pronounced pain attack, the use of analgesic and antispasmodic tablets will not stop the spasm. In this case, the person is advised to get an injection. No-shpa is administered intravenously.
5. If there are no contraindications, warm the area of ​​the patient’s right hypochondrium. We recommend using a heating pad filled with boiling water for this. To avoid burns, place a hot heating pad on a cloth applied to the sore spot.

In some cases, doctors who arrived by ambulance insist on hospitalization. Usually the indication for it is severe hepatic colic.

If you have previously been diagnosed with cholecystitis, and doctors have determined that the cause of pain is the progression of the inflammatory process, then we do not recommend refusing hospitalization.

The surgeons will probably operate on you, after which they will inform you about your future lifestyle.

You should not be afraid of cholecystectomy, an operation to remove a reservoir organ. Without it, bile, as before, will flow from the liver to the stomach.

Only the mechanism of its movement will change. Today, doctors offer their patients suffering from cholecystitis several options to combat this pathology:

• Therapeutic diet.
• Crushing stones using ultrasound.
• Drug therapy.
• Cholecystectomy is an operation to remove the gallbladder.
• Physiotherapy.
• Treatment with folk remedies - use herbal infusions to improve your well-being.
• Tubazh.
• Healing the affected gallbladder with healing mineral water.
• Phytotherapy.

To achieve the best medicinal effect, we advise you to approach the treatment issue comprehensively.

It is not necessary to choose a particular treatment method. They must be combined.

We do not recommend taking therapeutic measures for cholecystitis on your own.

In this matter you need to trust a gastroenterologist. So to warn you reappearance inflammatory process (and stop the present one), it is necessary to regularly use medications.

First of all, a sick person needs to take anti-inflammatory drugs.

Also choleretic drug therapy helps eliminate congestion in cholecystitis.

To increase the tone of the gallbladder and restore its functionality, the gastroenterologist prescribes vitamin E to the patient.

Also useful for cholecystitis is the use of other vitamin complexes. When the body is weakened, doctors advise using retinol and thiamine.

Also, do not forget about antispasmodics, thinning yellow liquid and relieving pain syndrome.

Important point - never tolerate severe pain! If you feel it, this means that a pathological process is occurring in your body, which negatively affects the performance of the entire organism.

Yes, taking antispasmodics will not help cure cholecystitis, but such therapy will eliminate severe pain, as a result of which the patient will be able to concentrate on treatment.

So, summing up all the theoretical information about the use of medications during the growth of the inflammatory focus, we will highlight the following groups of medications recommended for cholecystitis:

• Antispasmodics and analgesics.
• Vitamin complexes.
• Antiviral drugs (prescribed only if the disease appears as a result of damage to the gastrointestinal tract by a pathogenic microbe).
• Anti-inflammatory drugs are prescribed only for exacerbation of the pathology.
• Medicines that relieve symptoms of intoxication in the body.
• Hepatoprotectors.
• Enzymes.
• Homeopathic medicines.

I would like to dwell in more detail on drugs from the enzyme group. These are purpose-specific drugs that are used to improve digestive function.

For cholecystitis, enzymes must be taken regularly. Why? The fact is that bile, stagnating in the duct, slowly enters the stomach, therefore, digestion slows down.

Stagnation of undigested food in the stomach is fraught with its suppuration. If the food rots, the patient experiences unbearable nausea.

To avoid such clinical picture, and you need to take enzyme group medications.

An alternative to Mezim is Festal and Pancreatin. It is advisable to take enzymes after a medical prescription.

Diet for cholecystitis

In the treatment of this pathology Special attention need to pay attention to dietary nutrition. A gastroenterologist’s patient should not make mistakes in eating so as not to provoke a painful attack.

Let's consider the specifics of nutrition for cholecystitis. Main principles therapeutic nutrition: one should be gentle and fractional.

Avoid large and heavy portions. It is important to relieve the stomach as much as possible if there is an inflammatory process in the body.

Remember that any dietary error will certainly lead to hepatic colic.

You need to eat 4 to 6 times a day. Regardless of what you eat, the amount of food should be minimal.

It is better to eat often, but little by little, than rarely and in large portions. Ignoring this principle will lead to a deterioration of not only your health, but also your figure.

The patient's diet should be balanced. The yellow liquid should not be allowed to stagnate in the duct without entering the stomach.

Main medical purposes Diets for cholecystitis:

• Normalization of bile outflow.
• Unloading the liver.
• Improving the functioning of the gastrointestinal tract.

In the first days after starting to take choleretic medications, the patient should include in his diet:

1. Mineral water. You need to drink a lot and often. The patient should not be allowed to feel thirsty. Mineral water should not be carbonated.
2. Vegetable soups and broths. It is better to prepare first courses without using fatty meat and fish products.
3. Weak tea, juice. Coffee drinks are excluded.
4. Apples baked in the oven.
5. Rye bread.
6. Rose hip decoction. Very useful folk remedy to relieve inflammation of internal organs.
7. Boiled potatoes.
8. Puree porridge.
9. Vegetable or fruit salad.

Bakery, canned, fried and smoked food products should be excluded from the diet.

You will also have to give up sweets and fats of animal origin. Without this, you can’t count on recovery.

But despite the strict prohibitions, the patient does not have to deny himself the pleasure of eating sour products.

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