Cholecystitis

Chronic cholecystitis: treatment, diet, signs of biliary disease, causes

Improper nutrition, the presence of bad habits, poor environmental background - all these factors contribute to the development of various diseases of the gallbladder in a person. Cholecystitis in a chronic form is one of the most common such ailments. It is worth telling in more detail about what this disease is, how to identify and cure it.

What is chronic cholecystitis

The name cholecystitis received the disease (ICD code 10 - K81.1), in which the walls of the bladder became inflamed. It affects adults, more often women than men. The chronic course is characterized by periods of remission (when the patient is not worried) and exacerbations (symptoms of the disease appear). An inflamed gallbladder affects the body as follows:

  1. Food is digested too slowly, because it is difficult for the cells of the body to cope with increased stress.
  2. The outflow of bile is impaired, so its biochemical composition is changing.
  3. The inflammatory process is slow, but this leads to a gradual degeneration of the walls of the gallbladder.
  4. The general condition of the patient is unsatisfactory.

Classification

There are several varieties of the disease. Classification of chronic cholecystitis by etiology and pathogenesis:

  • viral,
  • unexplained etiology
  • bacterial,
  • enzymatic
  • parasitic,
  • allergic,
  • non-microbial (aseptic or immunogenic).

According to clinical forms, the disease can be:

  • stoneless
  • with a predominance of the inflammatory process,
  • calculous
  • with a predominance of dyskinetic phenomena.

By the nature of the course:

  • with rare relapses (no more than one seizure per year),
  • monotonous
  • with frequent relapses (two or more attacks per year),
  • camouflage.

The following phases of the disease are distinguished:

  • decompensation (exacerbation),
  • subcompensation (exacerbation decaying),
  • compensation (remission).

Absolutely no one is safe from the disease, so everyone should know what provokes it and who is at risk. As a rule, it occurs with infections in other organs, because in a person everything is interconnected. Possible causes of chronic cholecystitis:

  1. Inflammation of the digestive tract (infectious enterocolitis, dysbiosis, pancreatitis, phlegmonous appendicitis, atrophic gastritis, ulcer).
  2. Diseases of the respiratory tract or oral cavity (tonsillitis, pneumonia, asthma, periodontal disease).
  3. Parasites in the biliary tract.
  4. Inflammation of the urinary system (cystitis, pyelonephritis).
  5. Mechanical damage to the gallbladder.
  6. Cholecystolithiasis.
  7. Viral diseases of the liver (hepatitis, jaundice).
  8. Cholecystomegaly.
  9. The genitals are inflamed (adnexitis, prostatitis).

There are a number of additional factors that increase a person's chances that he may develop chronic cholecystitis:

  1. Biliary dyskinesia.
  2. Pancreatic reflux.
  3. Congenital pathologies of the gallbladder and its poor blood supply.
  4. Heredity.
  5. Incorrect bile composition.
  6. Any endocrine changes as a result of pregnancy, menstrual irregularities, hormonal contraceptive use, or obesity.
  7. Allergic or immunological reactions.
  8. Improper nutrition (abuse of fatty foods, fried foods).
  9. Taking drugs with the ability to make bile thicker.
  10. Sedentary lifestyle, lack of physical activity, constant stress.

Complications

If untreated, the disease will progress, which can cause a number of negative consequences. The list of complications of chronic cholecystitis:

  • reactive hepatitis,
  • gallstones
  • chronic duodenitis (ICD code 10 - K29.8),
  • peritonitis,
  • sepsis,
  • chronic hepatocholecystitis,
  • reactive pancreatitis,
  • cholangitis
  • fistulas
  • destructive cholecystitis,
  • pleurisy,
  • choledocholithiasis,
  • duodenal stasis (bile congestion) is chronic,
  • acute pancreatitis (ICD code 10 - K85),
  • pericholecystitis,
  • purulent abscess in the abdominal cavity.

Diagnosis of chronic cholecystitis

If a person is concerned about any symptoms, he must definitely seek help from a doctor. The specialist will conduct all the necessary studies and analyzes, make an accurate diagnosis and prescribe treatment. The patient should visit a gastroenterologist. Diagnosis of chronic cholecystitis begins with a detailed survey of the patient, then additional laboratory and instrumental studies are prescribed:

  1. Inspection, palpation.
  2. Ultrasound of the abdomen. Helps to identify echoes of the inflammatory process and make sure that there are no stones in the gallbladder.
  3. Cholegraphy. X-ray research method to detect inflammation. It is not carried out with exacerbations, pregnancy.
  4. Cholecystoscopy
  5. Blood tests: general, biochemical. To detect signs of inflammation.
  6. Computed tomography, MRI. It shows foci of inflammation, adhesions.
  7. Analysis of feces for parasites.
  8. Duodenal sounding.

The list of signs indicating a disease depends on a huge number of factors. Symptoms of chronic cholecystitis can be both pronounced and hidden. Some patients go to the doctor with many complaints, others with only one. The main signs of chronic cholecystitis:

  1. Dull pain with localization in the right hypochondrium. Gives under a spoon, in a shoulder, a shovel. As a rule, the stomach begins to hurt after consuming something fatty, spicy, fried, alcohol and does not relieve itself from a few hours to a day. May be accompanied by vomiting, fever.
  2. Acute abdominal pain after overeating.
  3. Mussi's Bubble Symptom. Pain on pressing the phrenic nerve on the right.
  4. Dyspeptic syndrome. Taste of bitterness in the mouth, unpleasant belching, plaque on the tongue.
  5. Flatulence.
  6. Symptom of Ortner. Pain when tapping ribs on the right side.
  7. Upset stool. Constipation can alternate with diarrhea.

Aggravation

During the period of remission, a chronic disease may practically not manifest itself. However, there are a number of symptoms of exacerbation of cholecystitis, requiring immediate medical attention:

  1. Biliary colic. Severe pain on the right, can be both constant and paroxysmal. After vomiting, it becomes palpable. It subsides when a warm compress is applied.
  2. In the presence of inflammation in the peritoneum, an increase in pain is observed with bends, movements with the right hand, and turns.
  3. Dizziness, nausea, vomiting with bile.
  4. Bitter belching, leaving an unpleasant aftertaste in the mouth, dryness.
  5. Heartburn.
  6. Itchy skin.
  7. Chills, high fever.
  8. In some cases, pain in the heart.

Chronic cholecystitis - treatment

The disease is very serious and requires constant monitoring and control. Treatment of chronic cholecystitis is prescribed taking into account its form, the degree of compensation is taken into account. The patient must always follow the recommendations of specialists, take medications as prescribed. It is very important to independently monitor your health: eat right, observe the regime of the day, abandon bad habits. Permissible use of folk remedies. All this together will help significantly extend the periods of remission and reduce the number of exacerbations.

Calculous cholecystitis - treatment

A form of a disease in which inflammation is caused by the presence of gallstones. As a rule, in chronic calculous cholecystitis, the main treatment is diet and other conditions aimed at maximizing the prolongation of remission. It is allowed to take painkillers, for example, No-shpa. Only surgical intervention can completely get rid of chronic cholecystitis.

Currently doing the following types of operations:

  1. Laparoscopic Removal of the gallbladder through small incisions on the abdomen. All that remains is the duct, which is directly connected to the liver.
  2. Cholecystostomy percutaneous.
  3. Cholecystectomy

Chronic stoneless

From the name it is clear that stones (stones) do not form with this form of the disease. Chronic stoneless cholecystitis during remission does not require treatment. It is necessary to follow a diet, take measures to prevent exacerbations, engage in exercise therapy. If pain begins, painkillers should be taken. Be sure to drink tablets containing enzymes to improve digestion, stimulate the production of bile.

Causes of chronic cholecystitis

The pathogenesis of the disease is very extensive. Among all the reasons that can provoke inflammation of the gallbladder, the most important is the reproduction of pathogenic organisms:

  • streptococcus
  • staphylococci,
  • Pseudomonas aeruginosa and some others.

Once in the gall bladder from the intestine, these microorganisms cause various stages of inflammation. Also, factors that increase the risk of the onset of the disease include:

  • poor nutrition,
  • gastritis,
  • genetic predisposition
  • the presence of parasitic diseases,
  • untreated caries
  • pancreatitis
  • disorders in the lymphatic system,
  • inflammation of the oral cavity,
  • alcoholism,
  • lack of physical activity.

Thus, in chronic cholecystitis, the causes can be not only completely different, but also quite unpredictable - this is the etiology of this disease. Photo: classification

Acute (calculous)

It is also called calculous. In turn, it is classified as:

  1. Catarrhal. Its first symptoms are repeated severe pain in the right hypochondrium with a discharge to the lumbar region, shoulder blades, and the right half of the neck.
  2. Phlegmonous cholecystitis. The clinical symptoms of this type of disease are much stronger. The pain is very strong, worse with a change in body position and cough. Often accompanied by vomiting, fever, tachycardia, bloating.
  3. Gangrenous. It is characterized by very violent clinical manifestations that repeat the symptoms of phlegmonous cholecystitis, only more pronounced.

Chronic (non-calculous)

Development occurs, as a rule, gradually, over a long time. In the absence of quality treatment, the inflammatory process in chronic cholecystitis passes to the deeper muscle layers of the organ, accompanied by:

  • the occurrence of infiltrates (seals),
  • proliferation of connective tissue.

Table: risk factors All this leads to:

  • gallbladder deformities,
  • biliary sludge
  • a change in pH - the composition of its contents (bile),
  • increased risk of stone formation.

Against the background of a weakened immune system, stress and general diseases, the symptoms and signs of chronic cholecystitis in adults are exacerbated, which will be described in more detail later in the article.

What is the danger of chronic cholecystitis?

Chronic cholecystitis is a rather dangerous disease. With his acute stage, young men are not even taken into the army. If treatment is not performed, the consequences can be hazardous to health. So, one of the most unpleasant complications are:

  • cholangitis (the transition of inflammation to the bile ducts),
  • hepatitis,
  • duodenitis.

All these diseases are subject to long-term treatment, often their occurrence is accompanied by an ambulance call, since the stages of chronic cholecystitis quickly replace one another, and the patient's condition worsens. Biliary sludge

Symptoms and signs of chronic cholecystitis

A distinctive feature of the disease is a long course, progressing and accompanied by periods of remission. If we talk about the symptoms of the disease, then in the first place you need to put an acute piercing pain that does not stop for several weeks. Its localization is the right hypochondrium. In some cases, the pain may be completely absent, but there is a very strong sense of heaviness.

In addition to severe pain or severity, permanent symptoms may include:

  • the appearance of a feeling of bitterness in the mouth,
  • vomiting mixed with bile,
  • belching, nausea,
  • diarrhea or, conversely, constipation,
  • bloating
  • an increase in body temperature in the acute phase,
  • diffuse thickening of the walls of the bubble,
  • itchy skin
  • irritability and general weakness of the body,
  • decreased appetite
  • swallowing disorder
  • dull pain in the heart,
  • allergic reactions that may occur to food.

Most often, the flow of chronic stoneless cholecystitis in its acute phase is facilitated by eating disorders, deviations in the diet.

Diagnostic Methods

To make the correct diagnosis, a certain series of procedures is necessary. The very first step in the diagnosis of chronic cholecystitis is an ultrasound scan (ultrasound) in a clinic with an experienced medical staff. It is it that will allow you to get reliable information about the presence or absence of stones in the gallbladder. But this is not the only method for determining the disease, its form and stage of development. Diagnosis of chronic cholecystitis includes the following manual, instrumental and laboratory methods:

  • cholecystography (performed using x-rays),
  • endoscopy,
  • examination of the contents of the gallbladder under a microscope,
  • palpation.

Using the data from all these studies, a doctor who knows exactly how to treat chronic cholecystitis can correctly and quickly diagnose and prescribe treatment.

The speed of diagnosis is not in last place, since many symptoms of chronic cholecystitis are quite difficult to tolerate.

Disease treatment

The very first treatment for chronic cholecystitis, which every patient must meet immediately after being diagnosed, is to follow a diet. The doctor can tell you what you can and cannot eat.

In addition to normalizing nutrition, drug therapy is prescribed. Mandatory drugs are:

  • antibiotics (in the presence of an inflammatory process),
  • antispasmodics (with severe pain)
  • choleretic and sedative drugs.

The following medications are recommended:

Treatment with a diagnosis such as chronic cholecystitis should be comprehensive, supplemented by physiotherapy and spa treatment.

There are methods for crushing stones non-surgical way. But often complete recovery does not occur, as they are formed again.

In the event that the disease has gone into the acute phase, often the only guaranteed method is to remove the gallbladder - an operation called cholecystectomy. Surgery allows you to remove not only the affected organ, but also stones. If the patient is diagnosed with chronic stoneless cholecystitis, then organ removal can be omitted.

What is cholecystitis

Cholecystitis is a rather serious disease, with dangerous consequences in case of neglect. The disease is characterized by inflammation of the gallbladder, sometimes the presence of calculi in this organ.

Excess cholesterol, salt, bilirubin - all this is deposited on the walls of the bubble in the form of plaque, flakes, which gradually grow, turning into solid formations that interfere with the work of the body.

Crystallized formations, stones can be in the gall bladder for quite some time without causing any symptoms in a person, but as soon as something provokes their movement, the pathology becomes aggravated, severe bouts of pain appear, in which an ambulance and surgical intervention are required.

In more than half of cases of cholecystitis, the presence of cholelithiasis is also observed (calculous cholecystitis) However, there is a place to be stoneless (noncalculous) pathology of the gallbladder.

Causes of cholecystitis

  • The presence of any calculi in the gallbladder will certainly cause inflammation of the walls of the organ, therefore gallstone disease is the most common cause of cholecystitis. Inflammation occurs due to blockage by the stones of the bile outflow.

The cause of cholecystitis is always the same - a violation of the outflow of bile, but this process can have many reasons:

  • banal overeating. Improper nutrition in the form of fried foods, alcohol, fatty desserts, the use of carbonated drinks will certainly lead to irritation of the gallbladder,
  • physical inactivity, sedentary lifestyle. Stagnation of bile in the ducts can occur due to lack of movement, therefore, with exacerbation of cholecystitis, it is recommended to move a lot, but without sudden movements, so as not to provoke an attack of hepatic colic,
  • other chronic diseases: diabetes, pathologies of the endocrine system, gastritis, pancreatitis, biliary duct dyskinesia, obesity, etc.,
  • heredity,
  • ingress of pathogenic microflora into the gallbladder: hepatitis, bacterial infection, parasites, fungal microorganisms,
  • pregnancy. With the onset of pregnancy in women, the hormonal background changes, as a result of which the elasticity and tone of smooth muscles decrease. Loss of muscle tone leads to stagnation of bile and difficult outflow,
  • inflammatory processes in other organs, for example, tonsillitis or pneumonia,
  • allergic to anything
  • gallbladder injury
  • strong body shake: jumping, bumping, rides.

Acute cholecystitis - symptoms

The gallbladder is located in the region of the hypochondrium on the right, hence the most common complaint is pain in the right side, directly under the ribs. In acute cholecystitis, the pain becomes unbearable, acute and burning, often extending to the shoulder blade or shoulder. In addition to pain, an attack of acute cholecystitis is manifested by the following symptoms:

  • taste of metal in the mouth
  • increased body temperature (in the region of 38-39 ° C),
  • cardiopalmus,
  • nausea and vomiting.

Symptoms of chronic cholecystitis - signs

Chronic form the disease is completely different in nature, it affects the gallbladder itself more destructively, atrophic changes in the walls of the organ are observed.

The chronic stage of cholecystitis manifests itself in other symptoms:

  • constant pulling or cutting pains on the right side under the rib, can give under the shoulder blade, in the arm,
  • dry mouth after waking up, the presence of a bitter taste, the presence of belching,
  • diarrhea,
  • the occurrence of periodic bouts of nausea,
  • bloating.

Against this background, appetite disappears.

However, the chronic stage can be complicated by junk food or physical shake. The severity of the pain syndrome depends on the presence and condition of the stones in the gall bladder, they are the indicators of pain. Symptoms of exacerbation:

  • recurrent, frequent constipation,
  • migraine-like headache
  • itching of the skin,
  • pain syndrome, which can be bearable or very strong,
  • a feeling of heaviness in the right hypochondrium,
  • bad taste in the mouth
  • flatulence,
  • insomnia,
  • irritation, tearfulness.

The temperature may increase, symptoms of intoxication increase, yellowness of the skin appears.

For the intensity of pain during exacerbation of chronic calculous cholecystitis, they are also called hepatic colic similar to renal colic or colic in infants.

If you do not seek help, perforation of the overstretched gallbladder is possible with the further development of peritonitis.

IMPORTANT! It is impossible to relieve pain with hepatic colic with warmers, inflammation will increase even more, peritonitis may develop faster.

Treatment of cholecystitis

How to treat cholecystitis? Where to start?
The treatment of this disease is divided into several areas that can be used both separately and in conjunction with others, depending on the form of the course of inflammation:

  • traditional drug therapy
  • ethnoscience,
  • physiotherapy and tubage,
  • surgical intervention.

Each direction has a right to exist and is selected separately for each patient. So, inflammation that occurs without the formation of stones is treated with diet, antibacterial and antiparasitic drugs.

The main principles of the diet for cholecystitis: at first it is better to starve and drink warm water. Next, you need to eat in small portions, but often. Exclude fried, fatty, spicy, flour and smoked. It is better to cook food for a couple.

In this case, outside the acute stage, treatment may be prescribed by the method of tubing, that is, washing the gallbladder from stagnation of bile.

During an exacerbation of the chronic stage of cholecystitis, drug therapy is prescribed with observation in a hospital. Usually, the following drugs are prescribed by a doctor:

  • antibiotics
  • choleretic
  • intramuscular antiemetics,
  • antispasmodics based on drotaverinum,
  • sedatives: motherwort or valerian,
  • NSAIDs, for example, Baralgin.

Without exacerbation, with a calm course of the disease, the following therapy is recommended:

  • diet,
  • choleretic drugs, for example, "Allohol", "Olimetin", "Holosas",
  • electrophoresis and balneotherapy.

Surgical intervention is indicated for patients with moving, numerous gallstones. In the case of an advanced chronic form of the disease, after ineffective conservative therapy.

Today, there are two forms of surgery: open cholecystectomy and laparoscopy.

The second method is more popular today, since it does not leave scars, is safer and the recovery period of the patient 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 region, this method allows you to reduce the amount of blood loss to a minimum.

Unfortunately, the laparoscopic method may not be applicable in all cases. With anomalies, commissures, large stones, exacerbation of the chronic neglected stage, an ordinary, open operation is performed.

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

Diet for chronic cholecystitis

Clinical nutrition calculated to the nearest gram is the key to the speedy recovery of a sick person. Dietary nutrition for cholecystitis and after removal of the gallbladder is negotiated as one of the most important points of therapy. Such nutrition is necessary to normalize and maintain the good functioning of the digestive system.

With easily occurring cholecystitis, the patient is prescribed a diet called "table number 5"In acute forms"table number 5a". These are the medical names of the prescribed diet menus specially selected for the treatment of this disease.

Recommended nutrition for cholecystitis - list of products:

  • cereals on the water, boiled vegetables or steamed, boiled poultry or fish, puddings, vinaigrette,
  • dairy and vegetable soups,
  • from drinks: slightly brewed tea, jelly, dried fruit compote, sour milk.
  • as a dessert to eat are allowed: raisins, watermelon, melon, dried fruits.

In the early days of exacerbation of chronic cholecystitis, the patient is not allowed to eat, but only a warm drink. With the weakening of painful symptoms, it is allowed to introduce pureed food into the diet. Food should be taken at specific times, in small portions and often.

Prevention of gallbladder inflammation

Having a tendency to a disease of the digestive tract, it is worth adhering to the right principles of nutrition: eliminate harmful foods, try to eat less sweet and fatty, fried. Simple carbohydrates are generally best removed from the daily menu.

When the first bells appear: sudden pain in the right hypochondrium, nausea in the middle of the night or after eating, a bitter taste or metallic in the mouth after waking up, it is better to be examined immediately and rinse the gallbladder to rinse all ducts and resume the work of the organ with renewed vigor.

Cholecystitis is an insidious disease with bright painful symptoms, this is just the case that is easier to prevent than to treat.

Cholecystitis: what is it?

Cholecystitis (cholecystitis) is an acute inflammatory process that occurs in a person’s gall bladder. 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 impaired outflow of bile.

The role of bile in the physiology of digestion:

  • Dilutes food processed by gastric juice, changes gastric digestion to intestinal,
  • Stimulates peristalsis of the small intestine,
  • It activates the production of physiological mucus, which performs a protective function in the intestine,
  • It neutralizes bilirubin, cholesterol and a number of other substances,
  • Launches digestive enzymes.

Currently, 10-20% of the adult population suffers from cholecystitis, and this disease has a tendency to further increase. This is due to a sedentary lifestyle, the nature of the diet (excessive consumption of animal-rich foods - fatty meat, eggs, butter), the growth of endocrine disorders (obesity, diabetes).

Chronic form

Chronic cholecystitis. Inflammation of the gallbladder occurs slowly and gradually, often without vivid signs of the disease. As in the acute form, the patient can pursue 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 proportion reaches 80%),
  • stoneless (up to 20%).

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

By the nature of inflammation, they are:

  • Catarrhal,
  • Purulent
  • Gangrenous
  • Phlegmonous
  • Mixed.

The most common cause of cholecystitis is getting microbes in the body and their subsequent development. Cholecystitis can provoke streptococci, E. coli, enterococci, staphylococci. That is why antibiotics are used for treatment.

Common causes:

  • Congenital malformations of the gallbladder, pregnancy, prolapse of the abdominal organs
  • Biliary dyskinesia
  • Cholelithiasis
  • The presence of helminthic invasion - ascariasis, giardiasis, strongyloidosis, opisthorchiasis
  • Alcoholism, obesity, an abundance of fatty, spicy foods in the diet, a violation of the diet.

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

  • poor nutrition with a predominance of fatty, spicy, spicy and salty foods,
  • non-compliance with the diet (long breaks between meals, plentiful evening night meals, lack of hot food),
  • alcohol abuse
  • smoking
  • lack of exercise
  • 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 most complain about, is pain under the ribs in the right side, especially when changing the position of the body, which can also be felt in the right shoulder, shoulder blade, side of the neck. The pain goes away after a while on its own or after taking the pain medication, but in the future its gradual intensification is observed, and then it becomes regular.

Characteristic symptoms of cholecystitis:

  • the presence of dull pain on the right, above the waist, responding to the shoulder blade, lower back, arm,
  • lack of appetite,
  • digestion problems
  • endless nausea
  • burping bitter
  • violation of gas formation,
  • the appearance of chills,
  • signs of jaundice on the skin.

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

The main symptoms of chronic cholecystitis:

  • Indigestion, vomiting, nausea, lack of appetite
  • Dull pain on the right under the ribs, giving in the back, shoulder blade
  • Bitterness in the mouth, belching bitterness
  • 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 ones:

  • cholelithiasis,
  • infection in the bile ducts, diseases of the stomach leading to impaired movement of bile,
  • stagnation of bile
  • blockage of the vessels of the biliary tract as a result of atherosclerosis.

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

  • the appearance of sharp, sharp pain on the right, above the waist,
  • yellowing of the skin
  • vomiting after eating
  • the patient cannot find a place
  • the occurrence of severe weakness,
  • pressure reduction
  • heart rate
  • the appearance in the mouth of acute bitterness.

In cases of repeated recurrence 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?

The attack of acute cholecystitis is always sudden, has acute symptoms.

  • provide peace to the patient
  • put a cold compress on the area of ​​severe pain (right side of the abdomen),
  • apply an antispasmodic drug (no-spa),
  • after bouts of vomiting, apply mineral water without gas on a sodium chloride, bicarbonate basis.
  • call for emergency help.

  • drink alcohol,
  • take any other medicine not prescribed by your doctor,
  • do enemas
  • to put a heating pad on the abdomen.

How to treat cholecystitis?

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

Treatment of cholecystitis in adults consists of the following steps:

  • Diet therapy. Following an adequate diet is crucial.
  • Antibiotic therapy. Prescribing an antibiotic is possible after establishing the nature of the inflammation, that is, what pathogen is caused by the pathogenesis of the disease.
  • Symptomatic treatment It is aimed at eliminating the symptoms of the disease. It can be immunostimulating, antihistamines, sedatives, choleretic drugs, hepatoprotectors.
  • Compliance with the regimen, physiotherapy, especially during periods of remission.

Medications

Medicines for cholecystitis should be taken with great care, becausewith improper selection or the order of their intake, the risk of exacerbation of the disease increases. This is especially true if there are stones in the choleretic bladder.

  1. An indication for the treatment of cholecystitis with antibiotics is an exacerbation of the inflammatory process in the biliary tract, accompanied by pain, temperature. The course of antibiotic therapy is short (7-10 days). Antibiotics must be used in combination with bactisubtil and always with vitamins (C, groups B, A).
  2. antibacterial agents (biseptol, nevigramon, furazolidone, nitroxoline, etc.),
  3. antiparasitic drugs (depending on the nature of the parasite, it is prescribed - macmirror, metronidazole, tiberal, nemozole, biltricid, vermox, etc.),
  4. For pain, take antispasmodics. This is a traditional no-spa (2 tablets three times a day, but no more, read the side effects in the annotation and make sure that this is a serious drug and an overdose is unacceptable), papaverine (possible in the candlelight - many say that the effect is even better than from tablets), duspatalin 1 tablet 2 times, 20 minutes before meals.
  5. If you want to increase the secretion of bile, the following medications are prescribed: Allohol, Cholenzym, Oxafenamide.
  6. So that the gastrointestinal tract does not malfunction, there is no severity, indigestion it is recommended to drink enzyme medications: Festal, Mezim, Pancreatin.
  7. A mandatory component of the treatment of patients with cholecystitis should be vitamin therapy (in the acute period, vitamins A, C, B1, B2, PP, and in the future - courses of vitamins B6 and B12, B15, B5, E).

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

  • herbal medicine - teas with immortelle, St. John's wort, corn stigmas, mint,
  • blind sounding (tube) procedure - is carried out 1 time in 7 days, only in the absence of adhesions and pronounced narrowing of the bile ducts,
  • physiotherapy - electrophoresis, diathermy, mud therapy, inductothermy.

The treatment of chronic cholecystitis is primarily aimed at stimulating the process of bile flow, eliminating spasmodic phenomena in the biliary tract and gall bladder. A set of measures is also being taken to destroy the pathogen of inflammation.

Surgery

The operation is often prescribed for acute cholecystitis. Unlike acute appendicitis, the decision to undergo surgical manipulation is not made immediately. Doctors can monitor his condition for several days, make a biochemical analysis of the contents of the gallbladder, conduct an ultrasound scan, take blood for analysis, and only after finding out the full picture of the development of the disease, the final decision is made.

Most often, it is stone disease that causes cholecystectomy. With untimely treatment of the disease, the walls of the gallbladder are destroyed, and the digestive process is disrupted. The operation can be carried out in two ways: laparoscopy and open cholecystectomy.

The goal of surgery for cholecystitis is to remove the inflammatory focus, i.e. gall bladder, as the primary source of the disease. In this case, it is necessary to make sure that the bile ducts are completely passable, remove obstacles and ensure the free passage of bile into the intestine.

Of course, it is possible to avoid surgery if you seek treatment at the first symptoms, as well as adhere to a diet and follow all the recommendations of doctors.

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

Three main areas of the diet for cholecystitis:

  • Unloading the liver and other digestive organs.
  • Normalization of the level of bile.
  • Improving the performance of the digestive tract.

It is allowed in the early days of the disease to use:

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

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

  • soups on a vegetable broth with various cereals, vegetables, pasta, borscht, beetroot soup, cabbage soup from fresh cabbage, dairy with cereals, fruit with rice,
  • low-fat varieties of meat, poultry (chicken, turkey) and fish (cod, ice, pike perch, hake, saffron cod, etc.) in boiled, baked (pre-boiled), stewed (with juice removed) form, beef stroganoff, pilaf from boiled meat. Meat and poultry are cooked mainly with a piece, can also be in the form of meatballs, meatballs, meatballs,
  • fresh tomatoes, cucumbers, carrots, white cabbage, boiled and stewed carrots, potatoes, beets, zucchini, pumpkin, cauliflower.
  • Non-acidic sauerkraut, fresh greens (parsley, dill) are allowed, from peas - green peas. Onions are allowed to be added to dishes after boiling,

A list of preferred fluids for cholecystitis includes:

  • still mineral water,
  • juice from fruits and berries,
  • weak sugar tea,
  • rosehip compote.

  • Fatty foods - animal fats: pork, lamb, duck, eggs, butter, chocolate.
  • It is necessary to exclude fried. These products complicate the digestion of patients with cholecystitis, since bile enters the intestines poorly.
  • Alcohol (especially beer and champagne) - it contributes to the appearance of stones in the gall bladder.
  • Salty, sour, spicy and smoked - they contribute to the production of bile, which can cause stretching of the inflamed organ.
  • You will also have to forget about carbonated drinks and coffee.

Please note: no procedures for liquefying and withdrawing bile without a preliminary examination are strictly prohibited. If there is even a small stone in the gallbladder or ducts, then the suddenly started movement of bile can lead 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 stigmas - 10 g pour 200 ml of water, boil for 5 minutes, take ¼ cup 3 times a day before meals.
  2. Pour the juice of one lemon and a tablespoon of salt with a liter of boiled water and drink in the morning on an empty stomach. An effective way to empty the gallbladder.
  3. Pumpkin Cook as many pumpkin dishes as possible. It is useful to take freshly squeezed juice from the pulp of a vegetable (200 ml per day).
  4. Add to boiling water 2 tsp immortelle flowers, 2 tsp lingonberry leaves, 3 tsp knotweed and 1 tsp pharmacy chamomile flowers. Let it brew for 2-3 hours. Take ½ cup three times a day.
  5. Mix the ingredients in the indicated quantities: peppermint, chamomile, kidney tea - 2 tablespoons each, soap dish medicinal, ordinary hops (cones) - 3 tbsp. l For 1 liter of boiling water, take 3 tablespoons of the collection. Take 100 ml 6 times a day.
  6. Take 2 teaspoons of chopped sage leaves, brew with 2 cups boiling water. Insist 30 minutes, strain. Take 1 tablespoon every 2 hours for inflammation of the gallbladder, liver.

Diet for chronic cholecystitis

The first thing a doctor prescribes after diagnosing a disease is adherence to a diet and diet. Its basic principles are as follows:

  1. Eating several times a day in small portions.
  2. Eating just cooked food.
  3. The temperature of food intake is comfortable, food should not be hot.
  4. Refusal of fatty and spicy dishes, nutrition should be as neutral as possible.
  5. Cooking only by boiling, stewing and steaming.
  6. Prohibition of the use of alcoholic beverages.

The first two to three days after the beginning of the stage of exacerbation of chronic cholecystitis, food intake is not recommended at all, only:

  • the use of mineral still water,
  • juices in low concentration,
  • such a folk remedy as a rosehip decoction, which is dietary.

Photo: echogram In the acute phase, it is advisable to grind the food before meals. Focus on taking mucous porridges and mashed soups.

You can gradually enter the menu:

  • cottage cheese,
  • low-fat fish
  • herbs
  • meat passed through a meat grinder,
  • homemade crackers made of white bread.

Diet and nutrition for chronic cholecystitis should be of high quality. Everyone should know what patients with this diagnosis eat. After the symptoms are weakened, as well as in the remission stage, the patient is assigned a table No. 5a.

The causes and mechanism of development of chronic cholecystitis

Chronic cholecystitis is an infectious disease. As a rule, microorganisms such as bacteria of the cocci group (staphylococci, streptococci), E. coli, less often Pseudomonas aeruginosa, Proteus and others cause it.

Microorganisms enter the gallbladder in different ways: from the intestine - rise along the bile ducts, from the intrahepatic bile ducts - lower (in these two cases, the infection spreading mechanism is called contact), from the foci of infection located in other organs - with blood and lymph flow. Any focus of chronic infection - caries, pyelonephritis, endocarditis - can cause the development of chronic cholecystitis, therefore, for the prevention of the latter, it is necessary to carry out rehabilitation (treatment) of such foci.

Risk factors that increase the likelihood of developing a disease are:

  • unbalanced nutrition
  • irregular meals
  • passive lifestyle,
  • decreased tone of the biliary tract (hypotonic and atonic dyskinesias),
  • casting pancreatic enzymes into the gallbladder (pancreatic reflux),
  • parasitoses (opisthorchiasis, giardiasis, schistosomiasis, ascariasis, amoebiasis and others),
  • genetic predisposition.

The disease develops gradually. The infection enters the gallbladder, and in case of its hypotension (decreased tone), a non-purulent (catarrhal) inflammation of the internal (mucous) membrane of this organ develops. The pathological process progresses over time and becomes deeper - first the submucosal, and then the muscle layer of the bladder wall is involved. Inflammatory seals occur in the affected tissues - infiltrates, which are subsequently replaced by connective tissue, causing bladder deformities. The inflammatory process changes the composition of bile, its pH, increasing the tendency to stone formation.

When exposed to a number of adverse factors on the inflamed gallbladder (hypothermia, decreased immunity or bacteriostatic (inhibiting the growth and reproduction of bacteria) properties of bile), the process can sharply aggravate to the development of purulent or even phlegmonous acute cholecystitis.

Chronic cholecystitis occurs in waves - with alternating periods of remission and exacerbations that periodically replace each other.

The main clinical signs of this disease are pain and dyspepsia syndrome.

With a typical location of the gallbladder, the pain is localized in the right hypochondrium 4-6 cm to the right of the midline. This is the so-called "bubble" point - the place of projection of this organ on the anterior abdominal wall. The nature of the pain directly depends on the type of dyskinesia:

  • if the tone of the muscles of the gallbladder is reduced (this is called hypotonic dyskinesia), the pain, as a rule, is constant, aching, of moderate intensity, the pain may be completely absent, and instead of it, patients are disturbed by a feeling of heaviness in the right hypochondrium,
  • if the tone of the muscles of the gallbladder is increased (that is, there is hypertonic dyskinesia), the pain is paroxysmal in nature, sharp, intense, not constant, but short-term.

Pain usually occurs as a result of errors in nutrition (eating fried, fatty, salty, spicy foods, alcohol, eggs and other products), but in the case of hypertonic dyskinesia, pain can be the result of psychoemotional overstrain.

As for dyspepsia syndrome, its main manifestations are:

  • constant feeling of dryness, bitterness in the mouth, especially expressed in the morning, after waking up,
  • burping bitter
  • vomiting of bile
  • bloating
  • stool disorders - constipation, diarrhea,
  • itchy skin associated with irritating bile acids on the skin.

Chronic cholecystitis is accompanied by weakness, fatigue, irritability, decreased appetite and other signs of astheno-vegetative syndrome.

With an exacerbation of the inflammatory process, the temperature may rise.

Often people suffering from chronic cholecystitis are concerned about food allergies.

Duodenal sounding

It is carried out only if previous studies with a 100% probability exclude the presence of stones in the bladder.

For research, use a special thin probe with olive. It is injected into the duodenum and 3 fractions of bile are obtained. The method allows you to diagnose hyper- and hypokinetic dyskinesia (depending on the rate of bile secretion), as well as conduct a subsequent examination of bile under a microscope (you can detect signs of its tendency to form calculi, as well as inflammatory signs, helminth eggs and giardia). If necessary, you can sow bile on a nutrient medium in order to detect bacterial colonies (normally they are not there), and also determine the level of substances such as bilirubin, cholesterol, phospholipids, bile acids and others.

The complex of therapeutic measures for chronic cholecystitis includes the following items:

  • diet therapy (fractional (5-6 times a day in small portions) meals at the same time, food - warm, freshly prepared, boiled, baked, steam dishes, exclude pickles, marinades, fried, smoked, fatty foods, onions, garlic, spinach, sorrel, alcohol, nutrition full, balanced, not "one-sided"),
  • anesthesia during exacerbation (no-shpa forte, baralgin),
  • antibiotic therapy during an exacerbation (ciprofloxacin, doxycycline, cefotaxime and others),
  • reception of choleretic drugs (allochol, cholenzyme, cyclavalone, magnesium sulfate and others),
  • “Blind” duodenal sounding (patient alone in the morning on an empty stomach, slowly - for 20-30 minutes, lying on a hard surface in the position on the right side with a warm heating pad on the hypochondrium, he drinks 500 ml of choleretic composition (for example, a rosehip broth, mineral water, xylitol, dissolved in warm boiled water), the procedure is repeated 1-3 times a week - depending on the severity of the exacerbation),
  • drugs affecting the autonomic nervous system (herbal soothing drugs (persen, novopassit) and "small" tranquilizers (afobazole, adaptol),
  • after the exacerbation has been stopped - physiotherapy (UHF, inductothermy, electrophoresis with magnesium sulfate, acupuncture and other methods),
  • in the phase of remission - the use of mineral waters,
  • Spa treatment.

In conclusion, I would like to note that chronic cholecystitis is still difficult (almost impossible) to completely cure, but by eating correctly and following other doctor's recommendations, you will surely be able to bring the disease into a stage of deep remission - in this case it will not cause you any significant discomfort .

Clinic "Moscow Doctor", general practitioner V. V. Karabaeva talks about chronic cholecystitis:

Symptoms of the disease

For chronic cholecystitis, a characteristic symptom is pain in the right hypochondrium. She is most often stupid, fuzzy. A connection is observed between the pain syndrome and the use of fatty or spicy foods, and psychoemotional stress. Pain can reflexively spread to the heart, lumbar region, under the right scapula and on the right half of the neck. The pains become more intense after physical exertion, shaking, with a deep breath.

The pain syndrome is often accompanied by other signs of chronic cholecystitis:

  • slight rise in temperature
  • nausea,
  • heartburn and bitter belching,
  • vomiting of bile
  • bitter or metallic taste, dry mouth,
  • violation of the stool (usually by type of constipation).

With calculous chronic cholecystitis, there may be bouts of biliary colic. They are characterized by sharp cramping pain in the right hypochondrium, accompanied by vomiting, chills, high fever. Violation of the outflow of bile contributes to the development of obstructive jaundice, which is manifested by skin itching, yellowness of the skin, sclera and mucous membranes.

Symptoms of chronic cholecystitis in women can worsen during menstruation and pregnancy, when the body's defenses are reduced.

Disease complications

The most dangerous complications of chronic cholecystitis are empyema, perforation of the bladder wall and peritonitis. Empyema - accumulation of pus in the cavity of the gallbladder with stretching of its walls. Perforation of the organ develops with purulent fusion of the shells. This condition without treatment ends with peritonitis - inflammation of the peritoneum.

Prevention of chronic cholecystitis

To prevent the occurrence of the disease or to avoid its exacerbation, general hygiene rules should be observed. An important role belongs to nutrition. You need to eat food 3-4 times a day at about the same time. Dinner should be light, not overeating. Especially avoid excessive consumption of fatty foods in combination with alcohol. 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 may be charging, walking, swimming, cycling. In the presence of chronic foci of infection (inflammation of the appendages in women, chronic enteritis, colitis, tonsillitis), their treatment should be timely carried out, the same applies to helminthiases.

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

Causes of Chronic Cholecystitis

Most often, the development of the disease is observed if:

    • The structure of the gallbladder is disturbed by a congenital malformation,
    • A person overeats, suffers from obesity, alcoholism, eats fatty and spicy foods,
    • Intestinal parasites live in the body (roundworms, giardia, opisthorchias, amoeba), there is a conditionally pathogenic flora (streptococcus, Escherichia, staphylococcus, Proteus, enterococcus, Pseudomonas aeruginosa) or pathogenic (typhoid fever, yeast cells, hepatella, virus ),
    • Gallstone disease or biliary tract dyskinesia is present,
    • There is stagnation and concentration of bile in the gallbladder for other reasons (pregnancy, inactive lifestyle, lowered position of some organs),

Medicines and methods for treating cholecystitis

Non-calculous, stoneless chronic cholecystitis, as a rule, is treated by a gastroenterologist on an outpatient basis. With exacerbations of cholecystitis, it is important to relieve acute symptoms and remove the focus of infection with antibiotics, analgesics and anti-inflammatory, usually cephalosporins, non-steroidal anti-inflammatory drugs, antispasmodics. By introducing solutions of sodium chloride and glucose, detoxification of the body is carried out, and digestive functions are restored with enzyme preparations such as panzinorm and creon.

Stagnation of bile is eliminated by means such as sea buckthorn, olive oil and magnesia, which increase the motility of the biliary tract. Medicines used to increase the production of bile (choleretics) are used strictly as prescribed by doctors, so as not to aggravate the painful phenomena and biliary congestion.

Herbal medicine is widely used: it is used during periods of attacks of non-calculous chronic cholecystitis. Decoctions of chamomile flowers, calendula, herbs, peppermint, valerian and dandelion are considered a classic folk treatment for cholecystitis.

In the period of remission, after the acute symptoms of the disease have subsided, it is recommended to use magnesia, sorbitol or xylitol. From the field of traditional medicine, decoctions of yarrow, tansy, marshmallow and buckthorn are used here.

The appointment of physiotherapy (mud therapy, reflexology, SMT therapy and electrophoresis), as well as treatment in sanatoriums and balneological resorts is effective.

Surgery (gallbladder excision) is used when chronic calculous cholecystitis progresses to calculous. The stones are disposed of with medicines containing chenodeoxycholic acids or salts of ursodeoxycholic acid.

Diet and regimen in the treatment of chronic cholecystitis

Diet is an important component of an effective treatment for chronic cholecystitis. During an exacerbation of the disease, it is recommended to reduce the amount of food consumed by one to three days as much as possible, to five to six glasses of warm liquid per day and several crackers. In the remission stage, you can add low-fat meat and fish, cereals, cottage cheese to the daily diet. Take food five to six times a day.

From the diet should be excluded:

  • Fatty, spicy, salty, fried foods,
  • Sweet baking,
  • Alcohol.

It is recommended to add fresh vegetables and fruits, olive, corn or sunflower oil, whole-bread to your food.

The treatment will be successful, there are strictly follow all the recommendations of the doctor and lead a healthy lifestyle.

Watch the video: Diseases of the Gallbladder (February 2020).