They do not manifest themselves for a long time. The person feels healthy and has no complaints. The vital activity of microorganisms causes inflammation of the walls of the gallbladder. With cholecystitis, this is the main manifestation. The inflammation is acute. Lack of treatment worsens the process. Complicated consequences arise due to the lack of proper treatment and its late detection. Complications of acute cholecystitis cannot be diagnosed independently. Need qualified medical diagnostics.

The next stage of treatment is non-surgical. Conservative therapy consists of limiting the consumption of a category of foods. Diet shown. Avoid foods that cause any irritation. To prevent constipation, it is recommended to limit the consumption of foods rich in fiber. The uncomplicated type of cholecystitis can be quickly cured.

In case of severe and acute course complications, doctors suggest surgical intervention. Surgical method resolving the disease in some cases is the only correct one. If complications become chronic, hospitalization and surgical intervention are indicated. After the operation, other types of complications may occur. Their intensity and healing speed are proportional to the patient’s age. Availability concomitant diseases worsens the condition. Simple wounds can develop rapidly and become complications. Working with elderly patients occupies a special place in medicine. Surgery is indicated for them after a thorough examination and risk assessment.

Unacceptable self-treatment any manifestations of diseases. Medicines have by-effect. The patient does not take this into account when independently combining drugs. Compliance with the doctor's recommendations must be strict. Changing the frequency of taking or concentration of medications cannot be done independently! When the condition improves, medication continues until complete recovery.

- it's spicy inflammatory process happening in gallbladder person.

Normally, the gallbladder has a volume of 40–70 cm3. Produced in the human liver , which is necessary to ensure the digestion process. It is stored in the gallbladder. If a disorder occurs in the body metabolic processes, then stones may appear in the lumen of the gallbladder, and with the simultaneous occurrence of an infectious inflammatory process, acute cholecystitis develops.

Causes of cholecystitis

Most common cause The development of cholecystitis is the entry of microbes into the body and their subsequent development. Cholecystitis can be caused by streptococci , enterococci , staphylococci . That is why for treatment acute or chronic cholecystitis technique is often used . As a rule, the penetration of microorganisms into the gallbladder occurs through the bile ducts from the intestine. This phenomenon occurs as a consequence of insufficient function of the muscle fibers that separate the common bile duct from the intestine. This is often seen as a consequence gallbladder dyskinesia And biliary tract , too low secretory activity of the stomach, high pressure in the duodenum.

Very often, the development of cholecystitis occurs as a consequence of impaired outflow of bile. This may occur in a person who suffers from . If there are fireplaces in a person’s gallbladder, they not only create a mechanical barrier to the outflow of bile, but also irritate the walls of the gallbladder. As a result, it initially develops in the gallbladder aseptic , and later - microbial inflammation of the gallbladder. Thus, the patient develops chronic cholecystitis, which periodically worsens.

However, microbes can end up in the gallbladder, getting there with the flow of blood and lymph, because the vascular network is developed in the gallbladder. In this regard, symptoms of cholecystitis often appear in people who suffer from ailments of the intestines, organs genitourinary system or the presence of other foci of inflammation.

Sometimes cholecystitis is provoked roundworms , Giardia , Availability liver injuries And gallbladder and etc.

Symptoms of cholecystitis

Symptoms of cholecystitis clearly appear already at the earliest early stages development of the disease. Early manifestations of this disease are very diverse. As a rule, they occur after a person has noticeably violated his usual diet, for example, he ate a lot of spicy or very fatty foods, drank a fairly large amount of alcohol, etc. In this case, initially the pain occurs in the upper abdomen and radiates to the right hypochondrium. The pain can be either constant or increasing periodically. Sometimes with cholecystitis there is a very sharp pain which reminds biliary colic . Dyspeptic symptoms may also occur as symptoms of acute cholecystitis. This is a bitter and metallic taste in the mouth, constant nausea, belching, . The person becomes very irritable and often suffers from insomnia.

A patient with cholecystitis vomits bile from time to time, but after such vomiting he does not feel better. In addition, the symptoms of cholecystitis are often manifested by an increase in body temperature, increased heart rate, and the patient's skin may turn slightly yellow. There is a dry tongue.

If the disease is not treated immediately after the symptoms described appear, it may subsequently develop peritonitis , which is a very dangerous condition.

Chronic cholecystitis generally occurs over a long period of time, sometimes it can last for many years. Chronic cholecystitis is usually divided into several types. At acalculous cholecystitis Stones do not form in the lumen of the gallbladder. In the same time calculous cholecystitis characterized by the appearance of stones in the lumen of the bladder. Consequently, calculous cholecystitis is a manifestation of cholelithiasis.

In this case, a person periodically develops exacerbations, alternating with remissions. Exacerbations chronic form illnesses, as a rule, are the result of overeating heavy foods, alcohol abuse, physical overexertion, hypothermia, intestinal infections. In chronic cholecystitis, symptoms similar to those of the acute form of the disease appear. However, their intensity is less pronounced, and the patient’s condition is not so severe.

Diagnosis of cholecystitis

Diagnosis of cholecystitis is carried out by a specialist, first of all, by interviewing the patient and getting to know his medical history. Analysis of anamnesis and clinical course diseases provides the necessary information for subsequent research. Next, the patient is prescribed special method research, which is used for cholecystitis - duodenal intubation . This method is used in the morning, because it is important to conduct such a study on an empty stomach.

It is also important to conduct a thorough bacteriological examination(for this purpose, bile culture is carried out). This is especially important if the patient has reduced acid-forming function of the stomach. In the process of diagnosing cholecystitis, the physicochemical properties of bile should be determined.

It is important to differentiate the chronic form of the disease from chronic cholangitis , cholelithiasis .

Treatment of cholecystitis

If a patient develops acute cholecystitis, then in most cases he is immediately hospitalized in a surgical hospital. Basically, treatment of cholecystitis begins with the use of conservative therapy. It is important that the patient remains in a state of complete rest at all times. Initially, the patient is prohibited from eating food: his nutrition is carried out by intravenous administration nutritional mixtures.

If there is severe inflammation with corresponding symptoms and surges in body temperature, then complex treatment cholecystitis may also include taking antibiotics wide range actions. It is especially important to prescribe antibiotic therapy to elderly patients, as well as people who have diabetes.

At the stage of exacerbation, treatment of cholecystitis is primarily aimed at relieving severe pain, reducing inflammation, as well as eliminating manifestations of general intoxication. During application conservative treatment The patient's condition is closely monitored. And if improvement occurs, the patient continues to be treated using conservative methods.

However, if there is no effect from such treatment, the attending physician often decides on surgical intervention. If there is a suspicion of phlegmon of the gallbladder , , perforation , peritonitis , then the operation is performed urgently.

If a person is diagnosed with calculous cholecystitis and, therefore, there is fire in the gallbladder, then treating the disease is a more difficult task. Accordingly, the prognosis of the disease worsens.

With the calculous form of cholecystitis, very painful hepatic colic . This phenomenon in some ways resembles the symptoms of acute cholecystitis, but the patient suffers from more intense pain. As a rule, such attacks begin at night or in the morning. A little later, the patient shows signs of jaundice: the shade of the skin, urine, and mucous membranes changes. In this case, a person’s stool becomes light-colored, sometimes White color. With such symptoms, hospitalization should be carried out immediately.

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. For calculous cholecystitis, stones are also crushed using different methods. Subsequent treatment measures are aimed at preventing the appearance of new stones.

The doctors

Medicines

Prevention of cholecystitis

As preventive measures that are used to prevent the manifestation of acute cholecystitis, it is important to adhere to all hygiene measures general. An important point in in this case is following the norms proper nutrition: you need to eat food at the same time, at least four times a day, and the calorie content of the daily amount of food should not be exceeded. You should not take large amounts of food at night; such meals have a particularly negative effect if alcohol is consumed at the same time. Important preventative measure– Drink enough fluids every day. You need to drink at least one and a half to two liters of water or other drinks, and the drink should be distributed evenly throughout the day.

Another important point– ensuring regular bowel movements. This process must be controlled to prevent the occurrence of biliary dyskinesia, as well as excretion .

Experts recommend periodically fasting days, during which one type of food should be consumed (for example, milk, apples, cottage cheese, fruits, meat, etc.). Every person should know which foods cause him allergic reaction, and exclude them from the diet.

To stimulate the passage of bile, it is important to do gymnastic exercises every day and maintain an active lifestyle in general.

In addition, it is important to take all measures in a timely manner to cure the manifested inflammation of the abdominal organs.

Diet, nutrition for cholecystitis

Both during treatment and during periods of remission in the chronic form of the disease, the patient is shown a special one. A specially selected diet when following such a diet is aimed at stimulating the secretion of bile from the bladder and stopping the inflammatory process.

It is important that the diet for cholecystitis includes exclusively easily digestible . In this case, it is suitable for patients vegetable oils(oil from sunflower, corn, olives), butter. Such fats activate the process of bile secretion.

In addition, your diet should include products containing large amounts of magnesium salts. These are fruits, vegetables, buckwheat. They not only accelerate the secretion of bile, but also relieve pain and spasms.

The diet for cholecystitis should not contain foods that are irritating: broths from meat and fish, sauces, smoked, fatty foods, too sour and spicy dishes. You can't drink alcohol, very cold food and drinks. Fried foods excluded. It is important to adhere to a proper diet, eating food five times a day.

The diet for cholecystitis includes soups, lean meat and fish, crackers from wheat bread, omelettes, boiled vegetables, cereals, and dairy products. Fruit juices are also included in the diet, and it is recommended to consume jelly, gingerbread, jelly, jam, and honey as sweets.

Complications of cholecystitis

As complications of this disease identify some ailments that occur in parallel with cholecystitis, joining it. This chronic cholangitis , hepatitis . Often cholecystitis is the initial cause of gallstones .

In addition, the patient may develop secondary inflammation of the pancreas. In this case, the person also feels pain in the left hypochondrium. This inflammation is diagnosed by ultrasound.

In patients with calculous cholecystitis, due to blockage of the common bile duct, subhepatic jaundice followed by cholestasis . Also, complications of cholecystitis are often dropsy And gallbladder perforation . The latter disease is very dangerous and difficult to treat.

List of sources

• Bolotovsky G.V. Cholecystitis and other gallbladder diseases. St. Petersburg: Nevsky Prospekt, 2003;
• Kuchanskaya A.V. Cholelithiasis. Modern look for treatment and prevention: IG "Ves", 2007;
• Dadvani S.A., Vetshev P.S., Shuludko A.M., Prudkov M.I. Cholelithiasis. M.: Vidar-M, 2000;
• Gallbladder diseases. Cholecystitis, cholangitis; AST, Poligrafizdat, Sova - Moscow, 2010.

State budgetary educational institution of higher professional education

"Tyumen State Medical AcademyMinistry of Health of the Russian Federation"

DEPARTMENT OF FACULTY SURGERY WITH A COURSE OF UROLOGY

ACUTE CHOLECYSTITIS AND ITS COMPLICATIONS

Module 2. Diseases bile ducts and pancreas

Methodological guide for preparing for the exam in faculty surgery and the Final State Certification of students of the Faculty of Medicine and Pediatrics

Compiled by: DMN, prof. N. A. Borodin

Tyumen - 2013

ACUTE CHOLECYSTITIS

Questions that a student should know about the topic:

Acute cholecystitis. Etiology, classification, diagnosis, clinical picture. Choice of treatment method. Methods of surgical and conservative treatment.

Acute obstructive cholecystitis, definition of the concept. Clinic, diagnosis, treatment.

Hepatic colic and acute cholecystitis, differential diagnosis, clinical picture, methods of laboratory and instrumental studies. Treatment.

Acute cholecystopancreatitis. Causes of occurrence, clinical picture, methods of laboratory and instrumental studies. Treatment.

Choledocholithiasis and its complications. Purulent cholangitis. Clinical picture, diagnosis and treatment.

Surgical complications of opisthorchiasis of the liver and gall bladder. Pathogenesis, clinical picture, treatment.

Acute cholecystitis This is an inflammation of the gallbladder from catarrhal to phlegmonous and gangrenous-perforated.

In emergency surgery, the concept of “chronic cholecystitis” or “exacerbation of chronic cholecystitis” is usually not used, even if this was not the patient’s first attack. This is due to the fact that in surgery any acute attack cholecystitis is considered as a phase of a destructive process that can result in purulent peritonitis. The term “chronic calculous cholecystitis” is used almost only in one case, when the patient is admitted for planned surgical treatment in the “cold” period of the disease.

Acute cholecystitis is most often a complication of cholelithiasis (acute calculous cholecystitis). Often the trigger for the development of cholecystitis is a violation of the outflow of bile from the bladder under the influence of stones, then an infection occurs. A stone can completely block the neck of the gallbladder and completely “turn off” the gallbladder; this cholecystitis is called “obstructive”.

Much less often, acute cholecystitis can develop without gallstones- in this case it is called acute acalculous cholecystitis. Most often, such cholecystitis develops against the background of impaired blood supply to the gallbladder (atherosclerosis or thrombosis a.cistici) in elderly people; the cause may also be reflux of pancreatic juice into the gallbladder - enzymatic cholecystitis.

Classification of acute cholecystitis.

Uncomplicated cholecystitis

1. Acute catarrhal cholecystitis

2. Acute phlegmonous cholecystitis

3. Acute gangrenous cholecystitis

Complicated cholecystitis

1. Peritonitis with perforation of the gallbladder.

2. Peritonitis without gallbladder perforation (sweaty biliary peritonitis).

3. Acute obstructive cholecystitis (cholecystitis against the background of obstruction of the neck of the gallbladder in the area of ​​its neck, i.e. against the background of a “switched off” gallbladder. The usual reason stone wedged into the area of ​​the bladder neck. With catarrhal inflammation this takes on the character hydrocele of the gallbladder, with a purulent process occurs gallbladder empyema, i.e. accumulation of pus in the disabled gallbladder.

4. Acute cholecysto-pancreatitis

5. Acute cholecystitis with obstructive jaundice (choledocholithiasis, strictures of the major duodenal papilla).

6. Purulent cholangitis (spread of purulent process from the gallbladder to the extrahepatic and intrahepatic bile ducts)

7. Acute cholecystitis against the background of internal fistulas (fistulas between the gallbladder and intestines).

Clinical picture.

The disease begins acutely as an attack of hepatic colic (hepatic colic is described in the manual on cholelithiasis); when an infection occurs, a clinical picture of the inflammatory process and intoxication develops; the progressive disease leads to local and diffuse peritonitis.

The pain occurs suddenly, patients become restless and do not find rest. The pain itself is constant and increases as the disease progresses. Localization of pain is the right hypochondrium and epigastric region, most severe pain in the projection of the gallbladder (Ker's point). Irradiation of pain is typical: in the lower back, under the angle of the right shoulder blade, in the supraclavicular region on the right, in the right shoulder. Often a painful attack is accompanied by nausea and repeated vomiting, which does not bring relief. A subfibrile temperature appears, sometimes accompanied by chills. The last sign may indicate the addition of cholestasis and the spread of the inflammatory process to the bile ducts.

On examination: the tongue is coated and dry, the abdomen is painful in the right hypochondrium. The appearance of tension in the muscles of the anterior abdominal wall in the right hypochondrium (village Kerte) and symptoms of peritoneal irritation (Shchetkina-Blumberga village) speaks of the destructive nature of inflammation.

In some cases (with obstructive cholecystitis), you can feel an enlarged, tense and painful gallbladder.

Symptoms of acute cholecystitis

Ortner-Grekov symptom– pain when tapping the edge of the palm on the right costal arch.

Zakharyin's symptom– pain when tapping the edge of the palm in the right hypochondrium.

Murphy's sign– when pressing on the area of ​​the gallbladder with the fingers, the patient is asked to take a deep breath. In this case, the diaphragm moves down and the stomach rises, the bottom of the gallbladder collides with the examiner’s fingers, severe pain occurs and breathing is interrupted.

In modern conditions, Murphy's symptom can be checked during an ultrasound examination of the bladder; an ultrasound sensor is used instead of a hand. The sensor needs to be pressed on the front abdominal wall and force the patient to take a breath, the device screen shows how the bubble approaches the sensor. When the device approaches the bladder, severe pain occurs and the patient interrupts his breath.

Mussi-Georgievsky's sign(phrenicus symptom) - the occurrence of painful sensations when pressing in the area of ​​the sternocleidomastoid muscle, between its legs.

Ker's symptom- pain when pressing with a finger into the angle formed by the edge of the right rectus abdominis muscle and the costal arch.

Pain on palpation of the right hypochondrium is called Obraztsov's symptom, but since it resembles other symptoms, sometimes this sign is called the Kera-Obraztsev-Murphy symptom.

Pain when pressing on the xiphoid process is called the xiphoid process phenomenon or Likhovitsky's symptom.

Laboratory research. Acute cholecystitis is characterized by an inflammatory reaction of the blood, primarily leukocytosis. With the development of peritonitis, leukocytosis becomes pronounced - 15-20 10 9 /l, the band shift of the formula increases to 10-15%. Severe and advanced forms of peritonitis, as well as purulent cholangitis, are accompanied by a shift of the formula “to the left” with the appearance of young forms and myelocytes.

Other blood counts change when complications occur (see below).

Instrumental research methods.

There are several methods for instrumental diagnosis of bile duct diseases, mainly ultrasound and radiological methods (ERCP, intraoperative cholangiography and postoperative fistulocholangiography). Method computed tomography It is rarely used to study the bile ducts. This is written in detail in the Guidelines on cholelithiasis and methods for studying the bile ducts. It should be noted that for the diagnosis of cholelithiasis and diseases associated with impaired bile outflow, both ultrasound and x-rays are usually used. methods, but to diagnose inflammatory changes in the gallbladder and surrounding tissues - only ultrasound.

At acute cholecystitis, the ultrasound picture is as follows. Most often, acute cholecystitis occurs against the background of cholelithiasis, so in most cases indirect sign cholecystitis is the presence of stones in the gall bladder, or bile sludge or pus, which are determined in the form of suspended small particles without an acoustic shadow.

Often acute cholecystitis occurs against the background of obstruction of the neck of the gallbladder; this cholecystitis is called Obstructive; on ultrasound it is visible as an increase in the longitudinal (more than 90-100 mm) and transverse direction (up to 30 mm or more). Finally straight Ultrasound signs destructive cholecystitis is: thickening of the bladder wall (normally 3 mm) to 5 mm or more, stratification (doubling) of the wall, the presence of a strip of liquid (effusion) next to the gallbladder under the liver, signs of inflammatory infiltration of surrounding tissues.

Cholecystitis is an inflammation of one of them internal organs body - the gallbladder, it can be acute and chronic. Among diseases of internal organs, cholecystitis is one of the most dangerous, since it causes not only severe painful sensations, but also inflammatory processes and the formation of stones, during the movement of which a person needs emergency surgical care, and if it is not provided in a timely manner, death may occur.

Chronic and acute cholecystitis, the symptoms and treatment of which we will describe in our article, are closely related to cholelithiasis and almost 95% of cases are diagnosed simultaneously, while determining the primacy of a particular disease is significantly difficult. 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.

How does cholecystitis manifest - causes?

Cholecystitis can be catarrhal, purulent, phlegmonous, perforated, gangrenous.

• Acute cholecystitis - causes

The most dangerous is the acute form of cholecystitis, which is accompanied by the formation of stones both in the bladder itself and in its ducts. It is stone formation that is the most dangerous in this disease; this disease is also called calculous cholecystitis. First, the accumulation of bilirubin, cholesterol, and calcium salts on the walls of the gallbladder form calcifications, but then with prolonged accumulation, the size of the deposits increases and can present serious complications in the form of inflammation of the gallbladder. There are often cases when stones enter the bile ducts and form serious obstacles to the outflow of bile from the gallbladder. This can lead to inflammation and peritonitis if medical care is not provided to the patient in a timely manner.

• Chronic cholecystitis - causes

Chronic cholecystitis is a longer-lasting form of the disease. It is characterized by periods of remission and exacerbations. The development of the pathology is based on damage to the walls of the bladder against the background of impaired evacuation of bile from it (hypo or hypermotor dyskinesia, pathologies of the sphincter of Oddi). Secondarily, nonspecific factors are superimposed on these factors. bacterial infection, supporting inflammation or turning it purulent.

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

Stoneless forms arise due to anomalies in the development of the bladder and ducts, their kinks, ischemia (with diabetes mellitus), tumors and strictures of the common cystic duct and bladder, irritation by pancreatic enzymes, obstruction of the ducts by worms, sludge of bile in pregnant women who have quickly lost weight or are receiving total parenteral nutrition.

The most common microorganisms causing inflammation, there are streptococci and staphylococci, as well as Escheria, enterococci, protea. Emphysematous forms are associated with clostridia. Less commonly, chronic cholecystitis can be viral origin, or be caused by a protozoal infection. All types of infections penetrate the gallbladder by contact (through the intestines), lymphogenous or hematogenous route.

At various types helminthic infestations, such as - with opisthorchiasis, strongyloidiasis, fascioliasis, partial obstruction of the bile duct may occur (with ascariasis), symptoms of cholangitis may occur (from fascioliasis), persistent dysfunction biliary tract observed in giardiasis.

Common causes of cholecystitis:

• Congenital anomalies of the gallbladder, pregnancy, prolapse of the abdominal organs
• Biliary dyskinesia
• Cholelithiasis
• Availability helminthic infestation— ascariasis, giardiasis, strongyloidiasis, opisthorchiasis
• Alcoholism, obesity, an abundance of fatty, spicy foods in the diet, poor diet

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

When formulating the diagnosis of chronic cholecystitis, the following is indicated:

• stage (exacerbation, subsiding exacerbation, remission)
• degree of severity (mild, moderate, severe)
• nature of the course (monotonous, often relapsing)
• state of gallbladder function (preserved, non-functioning bladder)
• nature of biliary dyskinesia
• complications.

Symptoms of acute cholecystitis

The provoking factor that gives rise to the development of an acute attack of cholecystitis is powerful stress, overeating acute, fatty foods, alcohol abuse. At the same time, the person experiences following symptoms acute cholecystitis:

• Acute paroxysmal pain in the upper abdomen, in the right hypochondrium, radiating to the right shoulder blade, less often it can radiate.
• Increased fatigue, severe weakness
• Slight increase in body temperature to subfebrile levels 37.2 -37.8C
• An intense taste appears
• Vomiting without relief, constant nausea, sometimes vomiting bile
• Empty burp
• The appearance of a yellowish tint to the skin - jaundice

The duration of acute cholecystitis depends on the severity of the disease, and can vary from 5-10 days to a month. In mild cases, when there are no stones and a purulent process does not develop, the person recovers fairly quickly. But with weakened immunity, the presence of concomitant diseases, and perforation of the gallbladder wall (its rupture), severe complications and death are possible.

Symptoms of chronic cholecystitis

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 begin; the more carefully you follow the diet and supportive therapy, the more longer period absence of symptoms.

The main symptom of cholecystitis is Blunt pain in the right hypochondrium, which can last several weeks, it can radiate to right shoulder, and the right lumbar region, 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:

• 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
• Low-grade fever
• Possible yellowing of the skin
• Very rarely, atypical symptoms of the disease occur, such as heart pain, difficulty swallowing, bloating, constipation

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

• cholegraphy
• duodenal intubation
• cholecystography
• Ultrasound of the abdominal organs
• scintigraphy
• A biochemical blood test shows high levels of liver enzymes - GGTP, alkaline phosphatase, AST, ALT.
• Diagnostic laparoscopy and bacteriological examination are the most modern and accessible diagnostic methods.

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

Treatment of chronic cholecystitis

Treatment of a chronic process without the formation of stones is always carried out conservative methods, the main one of which dietary food(diet 5 - fractional meals with sufficient fluid volume, mineral water). If there are gallstones, limit hard work, physical overload, and bumpy driving.

The following drugs are used:

• Antibiotics, most often broad-spectrum or cephalosporins
• Enzyme preparations - Pancreatin, Mezim, Creon
• Detoxification - intravenous infusions of sodium chloride, glucose solutions
• NSAIDs - sometimes used to relieve inflammation and pain

Choleretic drugs are usually divided into:

• Choleretics are drugs that enhance the formation of bile. Preparations containing bile and bile acids: allochol, lyobil, vigeratin, cholenzyme, dihydrocholic acid – hologon, sodium salt dehydrocholic acid – decholine. Herbal preparations increase bile secretion: flakumin, corn silk, berberine, convaflavin. Synthetic drugs: osalmide (oxaphenamide), hydroxymethylnic otinamide (nicodine), cyclone, hymecromone (odeston, holonerton, cholestil).
• Cholekinetics are divided into: promoting the secretion of bile and increasing the tone of the gallbladder (magnesium sulfate, pituitrin, choleretin, cholecystokinin, sorbitol, mannitol, xylitol) and cholespasmalytic and reducing the tone of the biliary tract and sphincter of Oddi: drotaverine hydrochloride, olimethine, atropine, platiphylline, aminophylline , mebeverine (duspatalin).

During periods of exacerbation, herbal medicine is very widely used; in the absence of allergies to it, decoctions of chamomile, dandelion, peppermint, valerian, and calendula are used. And during periods of remission it is possible to prescribe homeopathic treatment or herbal medicine, but with other herbs - yarrow, marshmallow, tansy, buckthorn.

It is very important to follow a strict diet after an exacerbation of cholecystitis, then the symptoms gradually subside. In addition, it is also recommended to periodically carry out tubing with xylitol, mineral water or magnesia, physiotherapy is effective - reflexology, SMT therapy.

In case of calculous chronic cholecystitis with pronounced symptoms, it is recommended to remove the gallbladder, the source of the growth of stones, which can pose a threat to life if they move. The advantage of chronic cholecystitis with stones from acute calculous cholecystitis, is that this operation is being planned, it is not emergency measure and you can calmly prepare for it. Both laparoscopic surgery and cholecystectomy from a mini-access are used.

When it is contraindicated surgery, sometimes with chronic cholecystitis, treatment may involve the method of crushing stones - shock wave lithotripsy; this extracorporeal procedure does not remove stones, but simply crushes, destroys them, and often causes them to re-grow. There is also a method for destroying stones using salts of ursodeoxycholic and chenodeoxycholic acid, in addition to the fact that this therapy does not lead to complete cure, it is also quite long in time and lasts up to 2 years.

Treatment of acute cholecystitis

If acute cholecystitis is registered for the first time, stones and a severe clinical picture are not detected, there are no purulent complications, then standard medical conservative therapy is sufficient - antibiotics, antispasmodics, NSAIDs, detoxification and enzyme therapy, choleretic agents.

At severe forms destructive cholecystitis in mandatory cholecystotomy or removal of the gallbladder is indicated (see. Most often, cholecystectomy is performed from a mini-access. If the patient refuses surgery, an acute attack can be relieved and medications, but it should be remembered that large stones necessarily lead to relapses and transition to chronic cholecystitis, the treatment of which may still end with surgery or cause complications.

Today there are 3 types used surgical interventions for the treatment of cholecystitis - open cholecystotomy, laparoscopic cholecystotomy, for weakened people - percutaneous cholecystostomy.

All patients with acute cholecystitis, without exception, are prescribed a strict diet - in the first 2 days you can drink only tea, then you are allowed to switch to the 5A diet, where food is only steamed or boiled, a minimum of fat is used, fried, smoked, seasonings, carbonated and alcoholic drinks. Read more about this in our article.

Complications of cholecystitis appear regardless of the form in which the disease occurs. However, for acute and chronic course cholecystitis consequences will be different. In addition, complications may arise after surgery to remove the gallbladder.

Cause the formation severe complications maybe not many factors. However, the most serious of them are - ignoring symptoms - for the acute form, violating recommendations regarding therapeutic nutrition– for chronic.

Each consequence has its own clinical picture, from which a gastroenterologist or surgeon will be able to determine which one. pathological process occurs in humans. But for the final identification of one or another complication of cholecystitis, laboratory and instrumental tests will be required. diagnostic measures.

The appearance of complications of inflammation of the gallbladder is a reason for hospitalization of the patient in surgery department. Almost all consequences of such a disease are performed through surgical intervention.

Etiology

Complications of acute cholecystitis or the chronic form of the disease have their own prerequisites for occurrence. Thus, the consequences of acute inflammation can be caused by:

• connection of secondary infectious process in the gallbladder;
• blood infection with purulent contents that accumulate in this organ;
• inflammation in the pancreas;
• thickening of bile;
• perforation of the wall of the affected organ;
• ignoring the symptoms of the disease;
• late diagnosis;
• untimely initiation of therapy.

Causes of complications of chronic cholecystitis:

• violation of the rules of therapeutic nutrition, which must be observed by every patient with a similar diagnosis. In all cases, dietary table number five and its variations are prescribed;
• conducting unhealthy image life, in particular addiction to drinking alcoholic beverages;
• the presence of infectious or inflammatory processes.

In gastroenterology, there are many complications of acute cholecystitis, which are a threat to human life and require immediate medical intervention.

Empyema of the affected organ is characterized by the formation in the gallbladder, in addition to inflammation, of a purulent process, due to which there is an accumulation of a large amount of purulent fluid in this organ. If the patient has stones in the bile ducts, then this condition is eliminated surgically.

Symptoms of this complication are:

• strong pain syndrome;
• an increase in body temperature, up to a feverish state;
• colic in the right hypochondrium;
• attacks of nausea and vomiting;
• increased gas formation;
• an increase in the size of organs such as the gallbladder and liver;
• yellowness of the skin.

Perforation of this organ often occurs in the acute course of calculous cholecystitis, in which, in addition to the formation of stones, the tissues of the walls of this organ die. In advanced cases, contents are released into the peritoneum. However, the formation of adhesions between the gallbladder and nearby organs and the formation of abscesses are often observed.

The clinical manifestation of such a complication consists of constant nausea, profuse vomiting and severe pain in the upper abdomen.

Paravesical abscess - characterized by suppuration of the affected organ and the tissues that surround it. At the same time, doctors note the person’s serious condition, which manifests itself in:

• severe chills;
• severe weakness;
• increased sweating;
• an increase in the volume of the gallbladder, which can be easily detected during palpation;
• unbearable pain in the area under the right ribs.

Diffuse peritonitis of a purulent nature - develops only in situations where it gets into abdominal cavity purulent contents from the abscess, which entails the development of inflammation in the peritoneum. Clinical picture such a state are:

• severe pain that has no clear location;
• bowel dysfunction;
• severe jaundice;
• increase in heart rate;
• increase in abdominal size;
• increased body temperature;
• dry skin.

Pancreatitis is an independent disease and is often diagnosed as a complication of acute cholecystitis. The formation of this condition indicates that inflammation spreads from the gallbladder to nearby organs. In this case, patients complain of the following:

• severe pain, localization is in the area of ​​the right hypochondrium, but can be encircling in nature;
• severe fatigue and weakness;
• nausea and profuse vomiting, which does not bring relief.

Gangrene is one of the most serious and dangerous complications, which at the same time is considered the rarest. With this consequence, the tissues of the affected organ begin to die, which brings the person unbearable pain. Among the symptoms, it is worth highlighting loss of vision and extremely high temperature bodies. A characteristic feature Such a complication is a high probability of death of the patient.

Jaundice - in addition to being a symptom of inflammation in the gallbladder, is considered a complication of this disease. It develops only when bile duct obstruction occurs and bile cannot leave the intestines. In addition to the skin and mucous membranes becoming yellow, patients also complain of itchy skin.

The formation of biliary fistulas is a long-existing lumen through which bile flows out directly from the bile ducts, which entails its entry into the cavities of nearby organs. In such cases, symptoms may include:

• lack of appetite, against the background of which the patient’s body weight decreases;
• increased bleeding;
• skin changes;
• attacks of nausea and vomiting.

Cholangitis - occurs due to a violation of the outflow of bile and its stagnation in the bile ducts. This consequence of untimely therapy is expressed:

• fever;
• constant dull pain in the area of ​​the right hypochondrium;
• jaundice;
• enlarged liver;
• nausea, vomit contains bile;
• increased body temperature and chills.

In addition to the above consequences and complications, a peculiar consequence of acute inflammation is the transition of the disease to a sluggish course, i.e. chronic cholecystitis.

The chronic course of the inflammatory process is characterized by alternating periods of remission and exacerbation of the disease. There are not as many complications of chronic cholecystitis as with acute form, but they all require surgical treatment. These include:

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

Reactive pancreatitis is an acute inflammatory process of an aseptic nature, which is localized in the pancreas. Characterized by rapid development of symptoms:

• heartburn;
• nausea and vomiting;
• severe girdle pain in the abdomen;
• increased gas formation;
• fever;
• signs of intoxication of the body.

Reactive hepatitis is a secondary diffuse liver injury. Expressed by moderate symptoms, such as:

• increased weakness;
• fast fatiguability;
• reduction or complete absence appetite;
• heaviness and discomfort in the projection of the gallbladder, i.e. in the area under the right ribs;
• increase in liver size;
• jaundice.

Pericholecystitis is an inflammation that is localized in the peritoneum covering the gallbladder. Symptoms include severe pain in the area under the right ribs, as well as the appearance of a bitter taste in the mouth.

Gallstone disease is a pathological process that is accompanied by the formation of stones of various sizes in the gallbladder or bile ducts. The disease is accompanied by:

• biliary colic;
• intense pain in the projection of the affected organ;
• yellowness of the skin and mucous membranes.

Diagnostics

Complicated cholecystitis requires a whole range of diagnostic measures, which combine laboratory, instrumental and physical examinations.

To the main diagnostic methods definitions of complications include:

• studying the patient’s medical history and life history;
• performing a thorough examination, which must include palpation of the entire surface of the abdomen;
• general and biochemical analysis blood;
• general study of urine;
• Ultrasound and radiography;
• CT and MRI;
• endoscopic diagnostic procedures and biopsy.

This will allow the attending physician to accurately determine whether the patient has one or another complication of acute or chronic cholecystitis, as well as obtain a complete clinical picture.