When the gallbladder is inflamed. We talk about cholecystitis

Cholecystitis

Which doctors should I contact?

After detecting symptoms indicating cholecystitis, you should immediately consult a doctor.
Usually in such cases they turn to a surgeon, therapist, gastroenterologist, and in acute cases call an ambulance. All patients with acute cholecystitis and suspected of having this disease are subject to referral to a surgical hospital with a team of qualified surgeons and anesthesiologist on duty around the clock. In severe cases, the participation of a resuscitator is required. Treatment of cholecystitis
The main goals of treatment of chronic acalculous cholecystitis are relief of pain and inflammation in the gallbladder, correction of digestive and metabolic disorders, treatment of complications and concomitant diseases.

• During the period of exacerbation, patients with chronic cholecystitis are recommended bed rest, fasting for 1-3 days, then diet therapy - limiting fatty foods and their calorie content (diet No. 5, 5A), eating 4-6 times a day.
• Antispasmodics and analgesics are the main drugs for the treatment of exacerbation of cholecystitis, allowing to alleviate biliary colic.
• Analgesics are used to relieve pain.
• To stop the infectious inflammatory process, broad-spectrum antibiotics are prescribed.
• When helminthiasis is confirmed, anthelmintic drugs are used.
• Relief of dyspeptic disorders is carried out with the help of enzymatic, antiemetic drugs that suppress gastric secretion, etc.
• Violation of the outflow of bile is corrected with choleretic agents.
• If the stones are cholesterol, then there is a possibility of dissolving them with the help of drugs based on ursodeoxycholic acid.

Lithotripsy is a shock wave method that is used to crush stones, which are subsequently safely removed from the body or dissolved.
The selection criterion for patients for this procedure is limited by the size of the stones - single stones no more than 2 cm, a few up to 1 cm. The standard solution for the treatment of chronic calculous cholecystitis is surgical intervention, which eliminates new exacerbations and possible complications. Laparoscopic cholecystectomy is the main surgical method for treating chronic calculous cholecystitis. Removal of the gallbladder is performed with special instruments through one or more small incisions in the abdominal wall. Complications

Cholecystitis can lead to a number of serious complications.

• Due to inflammation, the gallbladder can stretch and increase in size (dropsy), which increases the risk of its rupture (perforation) and the development of peritonitis.
• Stagnation of bile in the gallbladder is a risk factor for infection of bile by bacteria, as a result of which the infection can enter the bloodstream with the development of sepsis.
• Violation of blood microcirculation in the wall of the gallbladder with the further development of ischemia and focal or total necrosis of the wall is the cause of gangrene of the gallbladder.

The following complications of cholecystitis require emergency surgical care:

• empyema of the gallbladder - accumulation of pus in the cavity of the gallbladder;
• peri-vesical infiltrate and abscess - an inflammatory process that spreads beyond the gallbladder;
• perforation is a rupture of the wall of the gallbladder with the release of its contents into the abdominal cavity.

Intraoperative complications include bleeding and bile duct injury.
Postoperative complications include pneumonia, myocardial infarction, thromboembolic complications, and pulmonary embolism. Prevention of cholecystitis

Primary prevention consists of eliminating risk factors leading to the development of chronic cholecystitis - timely sanitation of the biliary tract, elimination of dyskinesia, early detection of stones in the gallbladder and timely adequate treatment, including surgery.

Secondary prevention involves reducing the frequency of relapses, preventing the progression of the disease and the development of complications. Active identification of patients with clinically pronounced forms of chronic cholecystitis, frequent exacerbations and their adequate non-drug and drug therapy.

Diet plays a significant preventive role - low-calorie, predominantly plant-based food is useful, the use of vegetable fats containing polyunsaturated fatty acids, phospholipids, vitamin E, which help normalize cholesterol metabolism, participate in the synthesis of prostaglandins that dilute bile, and increase the contractile function of the gallbladder. Vegetable fats are especially important for bile stagnation. Vegetables, fruits, and bran promote the discharge of bile, reduce the cholesterol content in bile, thereby reducing the likelihood of stone formation.

Sources:

1. National clinical guidelines “Acute cholecystitis”. Russian Society of Surgeons, 2015.
2. Beburishvili A.G., Panin S.I., Zyubina E.N., Bykov A.V. Optimal timing of surgical treatment of acute cholecystitis according to evidence-based studies. Annals of surgical hepatology. 2020;25(3):12-19.
3. Vorotyntsev A.S. Modern ideas about the diagnosis and treatment of cholelithiasis and chronic calculous cholecystitis. "Attending doctor". No. 02, 2012.

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor.

Medicines

Conservative treatment involves the use of broad-spectrum antibiotics (Norfloxacin, Cephalexin, Spiramycin) and intravenous administration of antispasmodics (No-Shpa, Papaverine, Spazmalgon).

To support digestive function, enzyme-containing supplements are used: Pancreatin, Mezim, Festal.

To support liver function, hepatoprotectors are indicated: Gepabene, Chofitol.

Doctors also recommend choleretic agents of natural origin Allochol, Cholenzym and sorbents Activated carbon, Atoxil, etc.

Symptoms

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

The main symptoms of chronic cholecystitis:

1. Bitterness in the mouth, bitter belching;
2. Heaviness in the right hypochondrium;
3. Low-grade fever;
4. Possible yellowing of the skin;
5. Indigestion, vomiting, nausea, lack of appetite;
6. Dull pain on the right under the ribs, radiating to the back, shoulder blade;
7. Very rarely, atypical symptoms of the disease occur, such as heart pain, difficulty swallowing, bloating, constipation.

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

Diagnostics

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

Instrumental and hardware methods for diagnosing chronic cholecystitis:

• Ultrasound;
• cholegraphy;
• scintigraphy;
• duodenal intubation;
• arteriography;
• cholecystography.

Laboratory tests reveal:

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

Classification

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

There are 2 main types of chronic cholecystitis:

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

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

What is the danger of pathology?

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

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

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

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

Causes and risk factors

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

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

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

Prevention of exacerbations

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

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

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