Acute cholecystitis - Causes, Symptoms, Diagnosis and Treatment
Acute cholecystitis - Inflammation of the gall bladder, characterized by sporadic malfunctioning of bile movement as a result of the blockade of its outflow. Perhaps the Development of Pathological destruction of the walls of the gallbladder. In most cases (85-95%) of acute cholecystitis combined with calculi (stones), more than half (60%) patients determined bile bacterial contamination (coliform bacteria, cocci, salmonella, etc.). In acute cholecystitis symptoms occur only once, and is developing, with adequate treatment, stuhaet, leaving pronounced effects. Repeated repetition of acute inflammation of the gall bladder attacks say chronic cholecystitis.
Acute cholecystitis
bile duct stones (calculous cholecystitis);
In all cases, the walls of the gallbladder inflammation development causes narrowing of the lumen of the bile duct (or obturation concrement) and stagnation of bile, which gradually thickens.
biliary colic - acute severe pain in the right upper quadrant, the upper abdomen may radiate to the back (under the right shoulder blade). Less irradiation occurs in the left half of the body. Is preceded by the appearance of biliary colic can intake of alcohol, spicy, fatty foods, a lot of stress.
In addition to pain, acute cholecystitis can be accompanied by nausea (up to vomiting the bile), low grade fever.
In mild cases (without the presence of gallstones), acute cholecystitis occurs rapidly (5-10 days) and recovery is completed. When you join an infection develops purulent cholecystitis, in people with weakened protective forces of the body's ability to move into gangrene and perforation (breaking through) the gallbladder wall. These states are fraught with fatal and requires urgent surgical treatment.
Ultrasonography of the abdomen. It shows an increase in the body, the presence or absence of the gallbladder and bile duct stones.
When ultrasound inflammation of the gallbladder is thick (4 mm) double-circuit wall, it can be marked expansion bile duct, positive symptom Murphy (voltage bladder ultrasound sensor).
The detailed picture of abdominal computed tomography gives. For a detailed study of the bile ducts used technique ERCP (endoscopic retrograde cholangiopancreatography).
Blood tests show signs of inflammation (leukocytosis, high erythrocyte sedimentation rate), and Dysproteinemia bilirubinemia, increased activity of enzymes (amylase, transaminases) in the biochemical study of blood and urine.
acute appendicitis, pancreatitis, liver abscess, perforated gastric ulcer or 12P. intestine. And with a bout of kidney stones, pyelonephritis, right-sided pleurisy.
An important criterion in the differential diagnosis of acute cholecystitis is functional diagnostics.
gallbladder empyema (purulent inflammation) and emphysema (gas accumulation) gallbladder, sepsis (infection generalization).
Also, acute cholecystitis can lead to perforation of the gallbladder, resulting in inflammation of the peritoneum becomes (peritonitis) can form vesico-intestinal fistula. Often, cholecystitis complicated by inflammation of the pancreas.
gastroenterologist. Apply antibiotic to suppress bacterial flora and preventing a possible infection of bile, antispasmodics for pain and enlargement of the bile ducts, detoxication therapy in severe intoxication.
In the case of severe forms of destructive cholecystitis - surgical treatment (cholecystendysis).
In the case of gallstones, most often also proposed removal of the gallbladder. Operation of choice is cholecystectomy from minimal access. If contraindications to surgery, and the absence of suppurative complications is possible to use methods of conservative therapy, but it is worth bearing in mind that failure to surgical removal of the gallbladder with large calculi development is fraught with repeated attacks, the transition process in chronic cholecystitis and the development of complications.
All patients with acute cholecystitis is a diet therapy: 1-2 days water (can be sweet tea), then №5A diet. Patients rekomenovana food, freshly prepared steamed or boiled in the form of heat. Mandatory rejection of products containing large amounts of fat from hot spices, muffins, fried, smoked. To prevent constipation recommended refusal of food rich in fiber (fresh fruits and vegetables), nuts. It is strictly forbidden alcohol or carbonated drinks.
Possible surgery for acute cholecystitis:
obesity, intestinal parasites (roundworm, Giardia), severe stress.
postcholecystectomical syndrome. First time in patients after cholecystendysis may experience more frequent and upholstered chair, but as a rule, over time, these effects disappear. Only in very rare cases (1%) underwent surgery noted persistent diarrhea. In this case, it recommended to exclude from the diet of dairy products, as well as to limit yourself in fat and acute, increasing the number of consumed vegetables and other fiber-rich, products.
If dietary correction does not bring the desired result, prescribed medical treatment of diarrhea.