Chronic cholecystitis - Causes, Symptoms, Diagnosis and Treatment
Chronic cholecystitis - Inflammation of the gall bladder, accompanied by a violation of its motor function and in some cases - the formation of stones. Clinically manifested by pain and heaviness in the right upper quadrant, often occurring after ingestion of fatty foods and alcohol, nausea, vomiting, dryness and bitterness in the mouth. Informative method of diagnosis of chronic cholecystitis are biochemical blood tests, ultrasound gallbladder cholecystography, duodenal intubation. Conservative treatment includes the use of medications, herbal medicine, physiotherapy; with calculous cholecystitis shows removal of the gallbladder.
Chronic cholecystitis
pancreatitis, gastro, enterocolitis. Chronic stagnation of bile contribute to the formation of gallstones and Development calculous cholecystitis. The pathology occurs in approximately 0.6% of the population, predominantly in females aged 40-60 years. Chronic cholecystitis often suffering population of economically developed countries, due to the peculiarities of diet and lifestyle.
gastroenterology chronic cholecystitis classified according to several principles. In the presence of stones in the gallbladder it is subdivided into calculous and without stones. Adrift distinguish: latent (subclinical), often recurrent (more than 2 attacks per year) and recurrent rarely (less than 1 attack in a year or less).
According to the severity of chronic cholecystitis may be mild, moderate and severe, with and without complications.
Depending on the functional state of the following forms distinguish biliary dyskinesia:
fistulas.
The development of chronic cholecystitis contribute to the following factors:
exacerbations. The main symptom of chronic cholecystitis is pain. Moderately expressed pain, localized in the right upper quadrant, has a dull aching in nature, it can last up to several days (weeks). Irradiation may take place in the back under the right shoulder, the right half of the lumbar region, right shoulder. Chronic cholecystitis is characterized by amplification of pain symptoms after taking spicy or fatty foods, carbonated beverages, alcohol. Exacerbation of chronic cholecystitis often precede similar violations in the diet, as well as hypothermia and stress.
Pain symptom in calculous chronic cholecystitis can proceed according to the type of biliary colic (acute pain, severe, cramping). In addition to pain symptoms in patients often notice nausea (up to vomiting), belching, buckwheat taste in the mouth. During an exacerbation there may be a rise in body temperature to subfebrile values.
Atypical manifestations of chronic cholecystitis: dull pain in the heart, constipation, flatulence, dysphagia (swallowing disorder). Chronic cholecystitis is characterized by the development of these symptoms after disturbances in the diet.
Complications of chronic cholecystitis: the development of chronic inflammation of the bile ducts (cholangitis), perforation of the gallbladder wall, purulent inflammation of the bladder (cholecystitis, purulent), reactive hepatitis.
liver and intestinal parasitic diseases.
In a survey, and abdominal palpation reveals features and localization of the pain symptom. Determine the characteristic symptoms of inflammation of the gallbladder: Murphy, Musso, Chauffard.
In a laboratory study of blood in acute non-specific signs of inflammation (increased erythrocyte sedimentation rate, leukocytosis). Biochemical blood test reveals elevated liver enzymes (ALT, AST, r-GTP, alkaline phosphatase).
The most informative in the diagnosis of cholecystitis instrumental methods of diagnosis: ultrasound of the abdomen, cholecystography, cholegraphy, scintigraphy, duodenal intubation.
On ultrasound gallbladder determine the size, wall thickness, possible deformation and the presence of gallstones. Also marked adhesions, inflammation of the gall ways, dilated bile ducts of the liver, bladder dysmotility.
When duodenal sounding note dysmotility gallbladder bile taken analysis. When sowing bile is possible to detect bacterial contamination, determination of the infectious agent, also can be tested culture on antibiotic sensitivity for optimal selection of a therapeutic agent. For chronic cholecystitis acalculous characterized by reduction of bile acids derived from bladder and bile acid increased the concentration litoholievoy. Also, at an exacerbation in the bile increases the amount of protein, bilirubin (more than 2 times), free amino acids. Often detected in bile cholesterol crystals.
To determine the shape and motility of the gallbladder can be used cholecystography, cholegraphy. Arteriography reveals thickening of the gallbladder wall and the expansion of the vasculature in the duodenum and the adjacent liver sections.
gastroenterologist conservatively. Treatment during the acute directed to the relief of acute symptoms, sanitation focus of bacterial infection by antibiotic (used broad-spectrum drugs, usually cephalosporins group), detoxification (infusional glucose solutions, sodium chloride), the restoration of digestive function (enzyme preparations - Creon, panzinorm etc.).
For pain relief and reduce inflammation apply preparations of non-steroidal anti-inflammatory drugs, removal of spasm of smooth muscles of the bladder and ducts carry antispasmodics.
To eliminate stagnation of bile used drugs that increase the motility of the biliary tract (olive oil, sea buckthorn, magnesium), choleretic (drugs that increase the secretion of bile) used with caution so as not to cause amplification of pain and aggravation of stagnation.
For treatment in acute uncomplicated chronic cholecystitis used methods Phytotherapy: herbal teas (peppermint, valerian, dandelion, chamomile), marigold flowers.
After calming down aggravation of symptoms and diseases go into remission recommended diet, tyubazh with magnesia, xylitol or sorbitol. Phytotherapy Therapy of chronic cholecystitis is receiving infusions of tansy, buckthorn, marshmallow, yarrow. Used physiotherapy: reflexology, electrophoresis, SMT-therapy, mud therapy and other spa treatment shown in spa resorts
In chronic calculous cholecystitis, surgical removal of the gallbladder - a source of formation of stones. In contrast to the treatment of acute calculous cholecystitis, surgery to remove the gallbladder (cholecystendysis laparoscopic or open) in chronic cholecystitis is not an emergency measure that is assigned to planning. Apply the same surgical technique as for acute cholecystitis - laparoscopic gallbladder removal surgery, cholecystectomy from minimal access. For frail and elderly patients - percutaneous cholecystostomy to generate alternative ways of outflow of bile.
In chronic cholecystitis in the case of contraindications for surgery, you can try a non-surgical method of crushing stones using extracorporeal shock wave lithotripsy, but it is worth remembering that the destruction of the stone does not lead to a cure, and often is their re-shaping.
There is also a method of destruction of medical stones using salt preparations and ursodeoxycholic acid henodezoksiholievoy, but this treatment takes a very long time (up to 2 years), and also does not lead to a complete cure, and does not guarantee that the stones will not form over time again.
constipation.
Violation of the principles of clinical nutrition patients leads to the development and exacerbation of the disease progression of destructive processes in the wall of the gallbladder.
Prevention of chronic cholecystitis
Primary prevention of cholecystitis is the observance of healthy lifestyle, limiting admission of alcohol, lack of bad eating habits (overeating, addiction to spicy and fatty foods), a physically active life. In the presence of congenital anomalies of the internal organs - the timely detection and correction of stagnation in the gallbladder. Avoiding stress and timely treatment of gallstones and parasitic infections of the intestine and liver.
For the prevention of exacerbations of chronic cholecystitis patients should strictly follow the diet and the principles of fractional power, avoid inactivity, stress and exposure to cold, heavy physical exertion. Patients with chronic cholecystitis consists in the dispensary and twice a year should be screened. He showed a regular spa treatment.