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  • Cholecystitis( inflammation of the gallbladder) symptoms

    Cholecystitis is an inflammation of the gallbladder. Like most inflammatory diseases, it can be acute and chronic.

    Also classified as calculous and calculous( that is accompanied by the formation of stones).

    The term "cholecystitis" is translated from Greek for inflammation of the gallbladder.

    The main purpose of the gallbladder is deposition( depot - storage, storage) of bile. The gallbladder is most often pear-shaped, located on the lower surface of the right lobe of the liver, projected onto the anterior abdominal wall under the right hypochondrium. How to treat this ailment with folk remedies, look here.

    Inflammation of the gallbladder develops due to infection from the intestine, its transfer to the blood and stagnation of bile in the bladder. With this disease, less bile is released into the intestines than in a healthy person, which makes it difficult to digest fats and absorb them.

    • Parasitic infections, for example giardiasis.

    • Bile stasis due to cholelithiasis or bile ducts.

    • Bacterial infections.

    • Pregnancy.

    • Hypodinamy, that is, a sedentary lifestyle.

    • Overeating, especially abuse of fatty, spicy and fried foods.

    • Excessive consumption of alcoholic beverages.

    The most common cause of cholecystitis is the presence of gallstones that block the outflow of bile from the gallbladder. This leads to acute cholecystitis, which irritates and inflames the gallbladder. Other causes of cholecystitis are a transmitted infection, trauma, for example, after a car accident. There is also acute cholecystitis in people with severe illnesses, such as diabetes. In this case, stones are not the cause of cholecystitis, it is rather a complication of other diseases. Inflammation of the gallbladder largely depends on nutrition, on the lack of food in the diet containing vegetable fibers - vegetables, fruits, bread from wholemeal bread, when in the diet there is an excess of animal fats, various sweets, a sedentary lifestyle, lack of physical activitypromotes stagnation of bile and development of inflammatory process in them.

    Exacerbation of cholecystitis occurs when bile is congestion in the biliary tract. Therefore, you need to increase physical activity, move more, but you should avoid sudden movements, so as not to provoke an attack of hepatic colic.

    A direct impulse to the inflammatory process in the gallbladder is often overeating, especially the reception, very fatty and spicy food, the intake of alcoholic beverages, an acute inflammatory process in another organ( tonsillitis, pneumonia, adnexitis, etc.).

    Cholecystitis can occur after acute, but often develops independently and gradually, against a background of cholelithiasis, gastritis with secretory insufficiency, chronic pancreatitis and other diseases of the digestive system, obesity.

    Chronic cholecystitis occurs when gallbladder inflammation occurs over time, which causes the walls of the gallbladder to thicken.

    Disease is a common, more common in women.

    Pathogenic bacterial flora( Escherichia coli, Streptococcus, Staphylococcus, etc.), in rare cases - anaerobic infection, worms and fungi, hepatitis viruses can cause cholecystitis.

    The main factor in the onset of the disease is stagnation of bile in the gallbladder, which can cause gallstones, compression and kinks of the bile ducts, dyskinesia of the gallbladder and bile ducts, impairment of their tone and motor function under the influence of various emotional stresses, endocrine and nervous disorders.

    Congestion of bile in the gallbladder also contributes to the lowering of the internal organs, pregnancy, sedentary lifestyle, rare meals, etc.

    Immediate impetus to the outbreak of inflammation in the gallbladder is often overeating, taking very fatty and spicy food, drinking alcoholic beverages, spicyinflammatory process in the body( tonsillitis, pneumonia, adnexitis and so on).

    Chronic type cholecystitis can occur after acute cholecystitis, but more often it develops independently and gradually against a background of cholelithiasis, gastritis, chronic pancreatitis and other diseases of the digestive tract, as well as obesity.

    For calculous cholecystitis, that is, for cholecystitis without stones, a dull pain in the right hypochondrium is characteristic, which occurs, usually after some time after ingestion. As well as bloating, belching, unpleasant taste in the mouth, stool and nausea.

    For calculous cholecystitis, in addition to all the features listed above, colic, that is, attacks of acute pain, are characteristic.

    Most often, the first signs of cholecystitis are pain in the right upper quadrant( upper right side of the abdomen), which sometimes can be given back or right shoulder blade. A person can also feel nausea and vomiting and sensation in the right side of the abdomen. There is also an increase in temperature, pain that increases with deep inspiration, or lasts more than 6 hours, especially after eating.

    Inflammation of the gallbladder is registered in almost 10% of the world's population, and 3-4 times more often suffer from cholecystitis of a woman. The age and weight( mass) of the body affect the possibility of cholecystitis disease: the older a person is and the more he weighs, the higher the risk of the emergence and development of chronic cholecystitis.

    For cholecystitis is characterized by a dull, aching pain in the region of the right hypochondrium of a permanent nature or arising after 1 -3 hours after taking abundant and especially fatty and fried foods. Pain can give to the area of ​​the right shoulder and neck, right shoulder blade. However, from time to time there may be a sharp pain resembling biliary colic.

    In the mouth there is a feeling of bitterness and metallic taste, there is an eructation of air, nausea, which is accompanied by flatulence and violation of defecation( often alternating constipation and diarrhea).The person becomes irritable, he is troubled by insomnia.

    Jaundice for cholecystitis is uncharacteristic.

    The disease is diagnosed by ultrasound or computed tomography.duodenal sounding and bacteriological examination of bile can be used to diagnose beskamennogo cholecystitis( it is often helps to identify the causative agent of cholecystitis).

    When examined, the doctor notes that the patient has an enlarged liver. The gallbladder in most cases is not probed, as it is usually wrinkled due to a chronic scar-sclerosing process.

    Bacterial study of bile allows to determine the causative agent of cholecystitis.

    With cholecystography, there is a change in the shape of the gallbladder, sometimes stones are found in it: the inflammatory process is the impetus for their formation.

    Symptoms of chronic cholecystitis are also determined during echography - in the form of thickening of the walls of the bladder, its deformation.

    In most cases, it is long and characterized by alternation of periods of remission and exacerbations. Exacerbations often arise as a result of violations in the diet, after taking alcoholic beverages, heavy physical work. Provoke the process can acute intestinal infection, the overall hypothermia of the body.

    There is a significant difference in the treatment of calculous and calculose-free cholecystitis. The exacerbation of the stone-free cholecystitis is treated with a diet, antibacterial and antiparasitic agents. To eliminate pain, spasmolytics are prescribed. To improve the outflow of bile, cholagogue agents are prescribed. According to the testimony that the doctor considers in each specific case, enzymes and drugs that normalize the motility of the gastrointestinal tract can be prescribed. After the abatement of exacerbation go to treatment with mineral waters and physiotherapy. As for calculous cholecystitis, in most cases surgery is required - removal of the gallbladder.

    Treatment of cholecystitis depends on the symptoms of the disease and the general state of human health. In some cases, people who have gallstones may not need treatment. With the mild form of cholecystitis, sometimes it is sufficient to have a sparing regimen of the digestive system, a course of antibiotics and painkillers.

    In other cases, especially in chronic cholecystitis, the gallbladder is removed surgically. Removal of the gallbladder, as a rule, does not worsen digestion.

    When exacerbation of chronic cholecystitis patients are hospitalized in a surgical or therapeutic hospital.

    In this case, assigned to bed rest, dietary nutrition( diet number 5a), antibiotics and sulfonamide preparations.

    To eliminate dyskinesia of the biliary tract, pain syndrome, improve the outflow of bile, prescribe spasmolytic and cholagogue.

    During the abatement of the inflammatory process, thermal physiotherapeutic procedures are performed on the area of ​​the right hypochondrium.

    From medicinal herbs to restore the work of the gallbladder, decoctions of the flowers of the immortelle sand( 0.5 glass 2-3 times daily before meals), corn stigmas( 1-3 tablespoons 3 times a day) or liquid extract of theseherbs( 30-40 drops 3 times a day).

    After returning from the hospital home, the patient is useful to drink cholagogue tea( sold at the pharmacy): 1 tbsp. Spoon the tea with 2 cups of boiling water, filtered infusion take 0.5 cup 3 times a day for 30 minutes before eating.

    It is useful to treat mineral water( Essentuki No. 4 and No. 17, Slavyanovskaya, Smirnovskaya, Mirgorodskaya, Naftusya, etc.), as well as magnesium sulfate( 1 tbsp of a 25% solution2 times a day) or Karlovy Vary salt( 1 teaspoon per glass of warm water 3 times a day).

    If conservative treatment is not successful, which is often the case in the presence of large stones in the gallbladder, as well as with frequent exacerbations of cholecystitis, surgical intervention is performed - usually cholecystectomy( operation to remove the gallbladder).

    Cholecystitis is an inflammation of the gallbladder. If there are also stones in the bladder, then they speak of calculous, stone cholecystitis.

    Inflammation is most often caused by bacterial infection and stagnation of bile.

    Infectious agents in the gallbladder can get in three ways: from the duodenum, through the blood and through the lymph.

    Also, cholecystitis can occur with acute pancreatitis, when pancreatic enzymes enter the lumen of the gallbladder.

    Cholecystitis may occur due to parasitic infestations, for example, in opisthorchiasis, ascariasis, amebiasis.

    Hereditary predisposition, malnutrition, allergy, metabolic disorders in the body and malfunctions in the blood supply of the gallbladder are important.

    With calculous cholecystitis, the patient has a feeling of heaviness in the right upper quadrant, as well as paroxysmal or persistent blunt pain. Often there is bitterness in the mouth, nausea.

    The necessary medical therapy is prescribed by the attending physician. The patient must strictly observe the prescriptions in order to avoid exacerbations of the disease.

    Treatment also includes constant compliance with the diet.

    With calculous cholecystitis fruit, milk, cereal soups, boiled meat, fish of low-fat varieties, milk, fresh yogurt, kefir, acidophilic milk, cottage cheese( up to 200 g per day), porridges, white and black stale bread, ripe fruit, berriesexcept for acidic varieties), vegetables, greens.

    You can eat jam, honey, sugar( up to 70 grams per day) from sweet, from drinks - vegetable, fruit juices, weak tea with milk.

    But the products rich in fats should be limited: cream, butter - up to 10 g per day, vegetable oil - up to 20-30 g per day. Every day you can eat one egg.

    An exception here are chronic gallbladder lesions occurring with congestion of bile.

    In this case, the amount of fat is recommended to be increased to 120-150 g, of which 60% should be vegetable fats.

    Table salt should be consumed no more than 10 grams per day.

    The meal should be five meals a day.

    It is necessary to exclude from the diet completely fat, fatty meat, fish, fried, spicy, smoked dishes, canned food, spices, legumes, mushrooms, spinach, sorrel, onion, buns, vinegar, ice cream, cocoa, carbonated, alcoholic drinks, chocolate, creams.

    Of folk remedies for cholecystitis, you can recommend to use decoctions and infusions, which have antimicrobial and astringent effect. They can be prepared from the mountaineer snake, St. John's wort, nettle, tansy, chamomile, chicory, dog rose. Spasms from the smooth muscles of the bile ducts remove( and thereby reduce the pain syndrome) immortelle, corn stigmas, mint.

    Drug preparations made from plants show allochol and cholagol.

    Large gallstones with phytotherapy can not be eliminated.

    Also for chronic cholecystitis it is desirable 2-3 times a week for a month to conduct a non-probe tjubazh. It is best to perform this procedure in the morning.

    For this purpose it is necessary to drink on an empty stomach a glass of decoction of cholagogue grasses or at the worst end of warm water. Half an hour later take allochol or cholago and drink warm sweet tea( a glass or a half cup) or again with herbal decoction. Then lie on your left side, and on the right - on the liver area - put a warm water bottle. Take cover with a blanket and lie there for 1.5-2 hours.

    After that, take a few deep breaths and sit-ups and then you can have breakfast.

    With cholecystitis for 3-4 weeks several times a year you can be treated with mineral waters.

    With increased acidity of gastric juice, water is drunk 1.5 hours before meals, with normal acidity - for half an hour. Norm - 0,5-0,75 glasses 2-3 times a day.

    Physiotherapeutic procedures are indicated for chronic cholecystitis during remission. The most effective are diathermy and inductothermy( heating of the body with high-frequency currents), UHF( magnetic field treatment), ultrasound, mud, ozocerite or paraffin applications on the gallbladder, radon and hydrogen sulphide baths.

    To prevent exacerbations, it is necessary to follow a diet, sparing labor regimen, conduct timely sanation of foci of infection, and also 2-3 times a year to conduct preventive treatment.

    Prophylaxis of cholecystitis consists in proper nutrition and regimen, fight against sedentary lifestyle, obesity, diseases of the abdominal cavity.

    Acute cholecystitis: features of clinical manifestations of

    The disease begins violently. The leading symptom is biliary colic. Pain syndrome is caused by the dilatation of the gallbladder, a significant increase in the pressure in it, a violation of the current of the bile through the bladder duct, an inflammatory edema of the gallbladder, and the adjacent peritoneum.

    Pain occurs in the right upper quadrant, radiates to the right shoulder, right shoulder blade, right half of the thorax, sometimes to the left half of the thorax, lumbar or iliac region.

    Within a few hours, the pain intensifies, but rarely reaches a marked intensity. Often the patient takes a forced position on the right side or on the back.

    In patients, the body temperature rises, chills appear. High fever and chills are more typical for purulent or phlegmonous cholecystitis. The patient is often concerned about thirst, nausea, vomiting, constipation, flatulence. The tongue is dry, coated. The abdomen is swollen, the abdominal muscles are tense. Percussion and slight effleurage in the region of the liver cause severe soreness.

    To probe the increased, intense, sharply painful gallbladder it is possible not always. In the elderly, there is often a discrepancy between the clinical manifestations of acute cholecystitis and the severity of inflammatory changes in the gallbladder. Moreover, the development of gangrenous changes in the wall of the gallbladder can be clinically manifested by the so-called period of imaginary well-being-a reduction in pain due to receptor necrosis of the sensory apparatus.

    The catarrhal form of acute cholecystitis with timely antibiotic therapy results in recovery.

    With the reflexive form of acute cholecystitis, the process proceeds more severely. A fever with a strong fever is characteristic. Rapidly increasing symptoms of intoxication: dry mouth, thirst, nausea. Pain in the abdominal cavity reaches a high intensity. The abdomen becomes swollen, symptoms of irritation of the peritoneum appear.

    With a favorable current, febrile state, reaching the greatest severity by the 2-4th day of the disease, is held for several days, then recovery may occur. In a number of cases, the disease becomes chronic.

    The dangerous complications of acute cholecystitis include pancreatic necrosis, pancreatitis, gallbladder perforation, bile peritonitis.

    The main symptoms of perforation of the gallbladder are sudden severe pain in the right hypochondrium, hiccups, bloating, stopping of gases, violation of the defecation process, hypotension.

    In acute cholecystitis, there may be fusion between the bladder and other organs - pericholecystitis with a deformation of the bladder.

    Cholecystitis: maintenance therapy during remission of

    After in-patient treatment and the acute period is over, patients with cholecystitis receive maintenance therapy.

    Most patients are recommended daily walking at least 5-6 km, morning exercises without jumps and exercises for the abdominal. Swimming is recommended.

    Food should promote persistent remission of the disease and inhibit the thickening of bile. It is necessary to have a balance and strictly follow the stability of body weight. The food should not be redundant. Food should be taken fractionally, at least 4 times a day. It is desirable to enrich the diet with vegetables, vegetable oil. Prohibited refractory fats, cold effervescent drinks, spicy seasonings, fried foods, especially undesirable abundant food at night.

    With increasing feeling of heaviness in the right hypochondrium or occurrence of heartburn 2-3 times a year for a month, a course of treatment with choleretic drugs is performed.

    Patients with prolonged pain and dyspeptic syndromes should be blinded by duodenal sounding, that is, turmoil, once every 7-10 days. To this end, the patient on an empty stomach sips 1-2 glasses of hot solution of Karlovy Vary salt( 2 sachets) or xylitol( 15 g), dissolved in water. After that, for 40-60 minutes, it is convenient to lie on your right side, putting a warm water bottle on the liver area. The same patients sometimes almost always have to take cholagogue funds - 5-6 drops of the choir after breakfast.

    The basis of drug treatment for chronic cholecystitis is anti-inflammatory therapy.

    To suppress infection in the biliary tract, antibiotics are widely used. The choice of an antibacterial drug depends on individual tolerability and on the sensitivity to the antibiotic of the bile microflora.

    Correction of antibacterial therapy is performed after obtaining the results, analysis of bile planting on the microflora and determining its sensitivity to the antibiotic.

    The most effective are:

    Semisynthetic penicillins can be used: ampicillin - 0.5 g 4 times a day;Oxacillin - 0.5 g 4 times per day;ampiox - 0.5 g 4 times a day, although they are less active.

    In severe cases, the doctor prescribes cephalosporins( ketoceph, cefobide, cloforan, cefepime, rocefin).

    Preferably oral( through the mouth) reception of an antibiotic in a conventional therapeutic dose. The course of treatment is 7-8 days. It is possible to repeat the course with other antibiotics 3-4 days later.

    In the absence of sensitivity of the bile microflora to antibiotics or the presence of allergies to them, it is recommended that cotrimaxosol( biseptol, bactrim) - 2 tablets

    2 times a day, although its effectiveness is significantly lower than antibiotics, and the adverse effect on the liver is higher. A good effect is the use of nitrofuran drugs - furazolidone, furadonin, and metronidozole - 0.5 g 3 times a day for 7-10 days.

    When expressed painful syndrome in order to reduce the spasm of the sphincter Odzi, with dysfunction of the gallbladder, the hypermotor type shows spasmolytic agents.

    There are several groups of antispasmodics that differ in the mechanism of action.

    As antispasmodics use metacin, gastrocepin, buscopan, platifillin. However, when taking this group of drugs, there may be a number of side effects( dry mouth, delayed urination, visual impairment, tachycardia, constipation).The combination of rather low efficiency of this group of drugs with a wide range of side effects limits the use of this group of drugs.

    Direct-acting antispasmodics, such as papaverine, drotaverin( no-sppa), are effective for cramping spasms. However, for them, the selectivity of action is uncharacteristic and they affect all tissues where smooth muscles are present.

    Mebeverina hydrochloride( duspatalin) has a much more pronounced antispastic activity, which also has a direct effect, but it has several advantages over other antispasmodics. It relaxes the smooth muscles of the digestive tract, does not affect the smooth muscle wall of the vessels and does not have the systemic effects characteristic of cholinolytics. The drug has a prolonged action, and should not be taken more than 2 times a day in the form of 200 mg capsules.

    Pinaverium bromide( dicetel) belongs to the spasmolytic. The main mechanism of its action is the blockade of calcium channels located in the cells of the smooth muscles of the intestine, bile ducts and in the peripheral nerve endings. Dicetel is prescribed for 100 mg 3 times a day with pain.

    A drug that exerts an selective spasmolytic effect on the sphincter of Oddi is gimecromone( claston).This drug combines spasmolytic and choleretic properties, provides a harmonious emptying of intra- and extrahepatic biliary tract. Odeston does not have direct choleretic action, but it facilitates the flow of bile into the digestive tract, thereby increasing the circulation of bile acids. The advantage of claston is that it has virtually no effect on other smooth muscles, in particular the circulatory system and intestinal musculature. Apply claston 200-400 mg 3 times a day for 30 minutes before eating. All antispasmodics are given a course of 2-3 weeks.

    In the future, they can be used if necessary or repeated courses. In acute pain syndrome drugs can be used once or in short courses.

    For dysfunction of the gallbladder caused by hypomotor dyskinesia, prokinetics is used for 10-14 days to increase the contractile function: domperidone( motilium, motinium, motilac) or metoclopramide( cerucal)

    - 10 mg 3 times a day 20 minutes before meals.

    The administration of cholagogue means requires a differentiated approach depending on the presence of inflammation and the type of dysfunction. They are shown only after the inflammation has subsided. All cholagogue preparations are divided into two large groups: bile stimulating agents, and bile stimulating agents.

    The first include drugs that increase the secretion of bile and stimulate the formation of bile acids( true choleretics), which are divided:

    The second group of drugs that stimulate bile secretion include:

    - platyphylline, no-spa, duspatalin, claston, dicetel.

    Drugs of these groups the doctor appoints patients differentially - depending on the type of dyskinesia that accompanies chronic cholecystitis.

    During the exacerbation of chronic stone-free cholecystitis, physiotherapy procedures are shown: electrophoresis with spasmolytic diseases with hypermotor type dysfunctions and with magnesium sulphate in hypomotor dysfunction. Assign diathermy, inductotermia, paraffin, ozocerite, UHF-therapy on the gallbladder. During the beginning of remission, therapeutic exercise is applied, which facilitates the emptying of the gallbladder.

    Acute galloping cholecystitis occurs due to the penetration of infection into the gallbladder with reduced evacuation ability( bile stagnation promotes the development of infection).

    In the development of inflammation, the importance of reflux of pancreatic juice in the bile duct and gall bladder, which damages the mucosa of the gallbladder, also plays a significant role. Very often acute acalculous cholecystitis is combined with inflammatory changes in the pancreas( cholecystopan-creatite).

    Symptoms of effeminate chronic cholecystitis are similar to those of chronic cholecystitis, only pain in the right hypochondrium is less intense, although longer.

    With prolonged persistent disease, with ineffective conservative treatment, cholecystectomy( removal of the gallbladder) is prescribed.

    Chronic cholecystitis often develops on the background of the existing cholelithiasis as a result of permanent trauma with hard concretions of the mucous membrane of the gallbladder.

    However, the common opinion that chronic cholecystitis must necessarily be combined with cholelithiasis is incorrect. There is no such direct dependence. It can appear for many other reasons.

    If, in the presence of inflammation in the gallbladder, stones are also found, talk about calculous cholecystitis. If there is inflammation, but there are no stones - about the stoneless.

    However, acalculous cholecystitis often precedes the formation of stones. Therefore, even in the absence of symptoms, there is still need to treat cholecystitis without cholecystitis, in order to avoid further unpleasant consequences and exacerbations of the disease.

    Pain and discomfort in exacerbations of chronic cholecystitis are caused by spasms of the gallbladder and dyskinesia of the biliary tract, so doctors use antispasmodics to remove discomfort, in addition to anti-inflammatory treatment.

    Spasmolytics such as atropine, metacin, belladonna, spasmolithine were widely used. But we must know that this group of drugs is contraindicated in patients with glaucoma, adenoma of the prostate gland, pregnancy, which limits their use in a significant proportion of patients.

    Another group of antispasmodics, such as drotaverin, papaverine, bcycliklan, acts on smooth muscles, providing anti-spasmodic, and hence an analgesic effect. However, these drugs affect all the smooth muscles of the body, including the one from which the walls of the blood vessels and urinary tracts are composed, which can cause heart palpitations, urinary incontinence and some other undesirable consequences.

    In this regard, most doctors prescribe antispasmodic drugs strictly individually, preferring those that do not have systemic action and strictly selective effects on the cells of the gastrointestinal tract.

    To improve the outflow of bile, as a rule, prescribe cholagogue - allochol, cholenzim, broth of corn stigmas and flowers of the main cholagogue grass - immortelle.

    Diagnosis of acute cholecystitis is complex. The purpose of diagnostic measures is not only to establish the fact of cholecystolithiasis and

    signs of inflammation of the gallbladder wall, but also the possibility of choosing an appropriate method of treatment.

    Severe general condition of the patient, high body temperature, severe chills, tachycardia, sharp tenderness in the right upper quadrant, increased ESR give an opportunity to suspect acute cholecystitis.

    In patients older than 60 years, the diagnosis of acute cholecystitis is often difficult due to atypical flow. General and local reactions can be poorly expressed, purulent and destructive forms are often observed, spilled peritonitis develops.

    For accurate diagnosis, ultrasound, biochemical blood test and several specific examinations are performed.

    Ultrasound examination can show signs of acute cholecystitis - thickening of the walls of the bladder( more than 4 mm), a "double contour" of the wall, an increase in size, a stone in the mouth of the vesicle.

    The role of ultrasound in predicting the nature of the proposed operation is extremely important. Reliable signs of technical complexity of the planned cholecystectomy are: absence of free lumen in the gallbladder;

    thickened or thinned wall of bladder;large fixed stones;accumulation of fluid.

    Diagnostics also uses dynamic ultrasound - a regularly conducted ultrasound. It helps to assess, change or remain stable clinical picture of the disease. Dynamic ultrasound allows for timely analysis of the course of the inflammatory process and early necessary surgical intervention.

    Laparoscopy is indicated for patients with an unclear clinical diagnosis. In acute cholecystitis, laparoscopy has a high resolving power, and it also provides essential assistance in the differential diagnosis of other inflammatory diseases of the abdominal organs and tumor lesions.

    The aim of the study is to isolate acute cholecystitis in a number of other pathological conditions: distinguish it from acute appendicitis, acute pancreatitis, painful manifestations of urolithiasis, pyelonephritis, liver abscess, perforated ulcer of the stomach and duodenum.

    Patients with acute cholecystitis are to be hospitalized in a surgical hospital.

    Absolute indication for surgical treatment is suspected perforation, gangrene, phlegmon bubble.

    In the absence of complications, doctors often practice expectant management under the guise of massive daily doses of broad-spectrum antibiotics that are effective against the intestinal microflora typical of bile duct infection.

    Antibiotic therapy uses drugs that can penetrate bile well.

    Active therapeutic tactics are used for all destructive forms of acute cholecystitis, which occurs with signs of purulent intoxication or peritonitis. Expectant therapeutic tactics are preferable in this form of acute cholecystitis, when as a result of conservative therapy it is possible to stop the inflammatory process.

    The question of choosing the tactics of treatment of a patient with acute cholecystitis in the clinic is decided in the first hours of stay in the hospital, from the moment of setting and confirming the clinical diagnosis by ultrasound or laparoscopic methods.

    If the choice falls on a surgical procedure, the operation is performed at different times from the moment of hospitalization.

    The pre-operative hospital stay is used for intensive care, the duration of which depends on the severity and physical condition of the patient. In mild cases, surgical treatment is performed in the first 6-12 hours from the time of admission to the hospital( after preoperative preparation).If the physical condition of the patient requires more intensive and prolonged preoperative preparation - in the period from 12 to 48 hours.

    In any case, it is advisable to maintain a sparing diet( table number 5).

    Treatment of chronic acalculous cholecystitis is usually performed on an outpatient basis, with exacerbation and prolonged course - in the therapeutic department of the hospital, in the phase of remission - at a spa or in a dispensary.

    Therapeutic measures are aimed at suppressing the infection, reducing the inflammatory process, increasing the defenses of the body, eliminating metabolic and dyskinetic disorders.

    In the acute stage, a special diet is prescribed - table number 5.

    No-shpa, halidor, papaverine, metoclopramide are used to eliminate pain. With severe pain, use baralgin. As a rule, pains stop in the first 1-2 weeks from the beginning of treatment, usually therapy with these drugs does not exceed 3-4 weeks.

    Pain in chronic stoneless cholecystitis depends not only on pronounced dyskinetic disorders, but also on the intensity of the inflammatory process in the biliary tract.

    Very early is the use of antibiotic therapy. It is advisable to prescribe broad-spectrum antibiotics that do not undergo significant biotransformation in the liver. Assign erythromycin( 0.25 g 6 times per day), doxycycline hydrochloride( 0,05-0,1 g 2 times a day);Metacycline hydrochloride( 0.3 g 2-3 times a day).It is possible to use furazolidone( 0.05 g 4 times per day).

    Treatment with antibiotics is carried out for 8-10 days. After a 2-4-day break, it is advisable to repeat the treatment with these drugs for another 7-8 days.

    In the phase of subsiding exacerbation on the right hypochondrium area it is recommended to put a heating pad, make hot poultices from oats or flaxseed, use of paraffin and ozocerite will be useful.

    The use of choleretic preparations during the period of exacerbation is contraindicated with pronounced inflammatory processes in the gallbladder and bile ducts.

    With a pronounced allergic component, antihistamines are used - dimedrol, diazolin, suprastin, tavegil, telfast, etc.

    Choleretic preparations - choleretics( bile stimulating agents) are recommended for use in the remission phase in combination with enzyme preparations. If there is a hypotension of the gallbladder, tocholeretics appoint with khola kinetics mi - drugs that enhance the muscular contraction of the gallbladder and thereby contribute to the secretion of bile in the intestine.

    Appointed basically such choleretics: allochol, cholenzim, decholin;a number of synthetic substances - oxaphenamide, nicodine;preparations of plant origin - phiamin, cholagon, corn stigmas.

    Cholekinetic means - this is sulfate magnesia( magnesium sulfate), Carlsbad salt, xylitol, sorbitol, mannitol, holosas.

    Allochol appoint 1-2 tablets 3 times a day after meals, Nikodin - 0.5-1 g 3-4 times a day before meals. The course of treatment with cholagogue funds is 10-30 days, depending on the effect.

    The therapeutic tactics outside the exacerbation are determined by the nature of the dyskinetic disorders. In the hypotonic type of dyskinesia allohol is used in combination with festalom, cholekinetics, and with hypertonic type - spasmolytics( no-shpa, halidor, papaverine).

    In dyskinesia of the gall bladder, olimethine( rovahol) is effective - 3-5 drops per piece of sugar 30 minutes before meals 3-4 times a day. You can take Cerucalum - 10 mg 3-4 times a day.

    Two to three times a week, it is recommended to perform therapeutic duodenal sounding or bezsondeovy turbidity with magnesium sulfate. But it is not used for hyperkinetic dyskinesia.

    Medical duodenal sounding is indicated only in the absence of gallstones.

    With a sluggish course of the inflammatory process, agents that increase the immunological resistance of the organism( vitamins, aloe injections, prodigiozan, etc.) are used.

    Surgical treatment is indicated:

    In the remission phase, treatment also implies compliance with the diet, taking cholagogue preparations, exercise therapy.

    An important role in chronic cholecystitis with insufficient emptying of the gallbladder is played by exercise therapy. The most important are morning exercises and dosed walking. The complex of therapeutic gymnastics includes exercises for the muscles of the trunk in a standing position, sitting and lying on the back and right side with a gradual increase in the volume of movements and load on the abdominal press.

    Balneological resorts with mineral waters for drinking treatment are shown: Arzni, Berezovsky Mineral Waters, Borjomi, Java, Jermuk, Druskininkai, Essentuki, Izhevsk Mineral Waters, Pyatigorsk, "Truskavets".Contraindications to spa treatment are acute cholecystitis or a dysfunctional gallbladder, chronic cholecystitis with frequent exacerbations.

    Changes in the chemical composition of bile( discrinia) in the form of an increase in the concentration of bile salts can cause aseptic inflammation of the gallbladder.

    In the appearance of cholecystitis, the damaging effect of pancreatic juice and the negative value of pancreatic reflux in the bile duct of the gallbladder and the excretory ducts of the liver have been demonstrated.

    With free outflow to the duodenal gut of pancreatic juice, changes in the gallbladder are not detected. But if there is a violation of the outflow and the increase of hypertension in the bile excretory system, when the gallbladder is stretched, the normal capillary blood flow changes in the wall of the bladder. This causes a violation of tissue metabolism, which leads to the development of enzymatic cholecystitis.

    In the inflammatory process in the gallbladder, normal acidity shifts to the acidic side( bile acidosis), which contributes to the precipitation of cholesterol in the form of crystals and a change in the ratio of bile acids towards cholesterol( cholateterin cholesterol ratio).Therefore, in the diet of patients with cholecystitis of enzymatic origin, it is necessary to sharply limit or exclude products that promote tissue acidification. This is primarily flour, spicy dishes, meat, fish, brains, etc.

    Fats stimulate bile secretion, and the majority of patients with cholecystitis do not need their restriction. However, animal fats are rich in cholesterol, and they should be consumed in a limited way.

    With insufficient intake of bile in the intestine, fats are poorly split, which leads to irritation of the intestinal mucosa and the appearance of diarrhea.

    It is proved that diets with an increased amount of fat due to vegetable oil have a positive effect on the lipid complex of bile, bile formation and bile secretion.

    Patients are recommended lipotropic-fat diet with a ratio of animals and vegetable fats 1: 1.

    It should also be remembered that vegetable oils( corn, sunflower, olive), due to the content of unsaturated fatty acids in them - arachidonic, linoleic, linolenic - improve the exchange of cholesterol, participate in the synthesis of certain substances( arachidonic acid), affect the motility of the gallbladder.

    Fats increase the metabolism of fat-soluble vitamins, especially vitamin A.

    Carbohydrates, especially easily digestible( sugar, honey, jam), which were not limited to replenishing glucose in the liver, are now recommended to reduce in the diet, especially with excessive body weight.

    Special studies have shown that glycogen stores are reduced only with massive liver necrosis, and the inclusion of a large number of digestible carbohydrates can enhance lipogenesis and thereby increase the likelihood of gallstones. Therefore, the use of flour and sweet dishes should be limited.

    The diet should be rich in plant fiber, which removes constipation, and it reflexively improves the emptying of the gallbladder. In the diet should include carrots, pumpkin, watermelons, melons, grapes, wheat and rye bran.

    With oxalaturia and phosphaturia, you should limit tomatoes, sorrel, spinach, radish.

    The content of carbohydrates in the first week of acute cholecystitis should be 250-300 g daily, from the second week up to 350 g, but the proportion of simple sugars should not be more than 50-70 g per day.

    When the chronic cholecystitis worsens in the first week, the calorie content of the food is 2,000 calories per day, later on, when the inflammatory process subsides, the caloric value can be increased to 2500 calories.

    The content of proteins in the diet of patients with cholecystitis should correspond to the physiological norm of 80-90 g per day.

    It should be borne in mind that food, poor in proteins, leads to the development of fatty liver dystrophy, a violation of the synthesis of many enzymes and hormones. Prolonged restriction of protein intake in the menu of patients with chronic cholecystitis is not justified.

    The complete vitamin composition of food is a necessary condition for dietary therapy of chronic cholecystitis.

    It is necessary to include in the diet products containing lipotropic factors: oat and buckwheat groats, cottage cheese, cheese, cod, soy products.

    Dysfunction of the bile ducts, development of hypotension( relaxation) and atony( loss of efficiency) of the Oddi sphincter, which contribute to reflux of the contents of the duodenum into the biliary tract, leads to long-term use of anticholinergics and antispasmodics with the formation of "pharmacological" cholestasises.

    The sphincter of Oddi is a muscular junction that pinches the junction of the gallbladder into the 12-colon. When this press weakens, the "gates" constantly remain open and the infected contents of the intestine get into the bile duct and gall bladder. So there is inflammation.

    In case of peptic ulcer with localization of the process in the bulb of the duodenum, changes in the bile ducts are also often observed.

    Biliary colic occurs suddenly and quickly reaches a peak - within a few minutes. It is a constant pain, it does not go away, but it can vary in intensity. It lasts from 15 minutes to 4-5 hours.

    If the pain lasts more than 4-5 hours, this usually indicates a complication - gallbladder inflammation( cholecystitis).The pain is usually very strong, but the movement does not increase the pain.

    Virtually no. Usually, a conservative anti-inflammatory treatment is prescribed. The only exception is patients with persistent pain syndrome and a sharply enlarged gallbladder, as well as with severe manifestations of peri-cholecystitis.

    Diet, therapeutic nutrition should be directed to the secretion of bile from the gallbladder and the removal of inflammation. You should only eat easily digestible fats: butter and vegetable oils( olive, sunflower, corn), which stimulate the secretion of bile. The diet includes foods that contain many magnesium salts. They contribute to the secretion of bile, reduce pain, relieve spasm of the gallbladder. Many magnesium salts in buckwheat, in vegetables and fruits.

    The best diet for gallbladder diseases is frequent and fractional nutrition. This is due to the fact that when we eat, there is a reflex reduction of the gall bladder, bile is diluted. There is an outflow of bile. A snack is a sandwich, an apple.

    The main dietary principle for acute cholecystitis( as with exacerbation of chronic) is the maximum sparing of the digestive tract. In the first two days a patient should use exclusively liquid, and in small portions. During this period it is possible to take mineral water without gas, diluted in half with ordinary boiled water, sweet fruit and berry juices - also half-and-half with water, tea not strong, broth of a dogrose.

    As the pain syndrome and inflammatory phenomena diminish, which usually happens after 1-2 days, you can switch to taking a dishwasher. Appoint soups mucous and wiped from oats, rice, semolina;porridges, wiped from rice, oats, semolina;sweet fruit and berry jelly, mousse, jelly. The amount of food is limited, so as not to create a load on the digestive organs.

    Further expansion of the diet is due to inclusion in the ration of mashed low-fat cottage cheese, lean meat, steamed, steamed, lean boiled fish. In this period, you can also include in the diet crackers from white bread. There should be small portions 5 times a day, preferably at certain times. It is necessary to drink abundantly( 2-2.5 liters of liquid).

    After 5-10 days from the onset of acute cholecystitis( or exacerbation of the chronic), the patient passes to the diet number 5a.

    This diet is physiologically complete, with moderate restriction of fats and table salt, mechanical and chemical irritants of the mucosa and receptor apparatus of the gastrointestinal tract, with the exception of products and dishes that enhance the processes of fermentation and putrefaction in the intestines, as well as strong stimulants of bile secretion, gastric secretion,pancreas, substances that irritate the liver( extractives, organic acids, foods rich in essential oils, organic acids, cholesterol, purines, fried foodsa, containing products of incomplete splitting of fat).All dishes are cooked in boiled form or steamed. Individual meals are allowed in the baked form without crusting. The food is mostly rubbed, soups are wiped or with finely chopped vegetables and well-boiled cereals. Mode of nutrition: 5-6 times a day in small portions.

    Food temperature 15-60 ° C.The diet is 5 times a day.

    Not recommended: very fresh bread;puff and dough, fried cakes, cakes, cream cakes;meat, fish, mushroom broths;okroshku, soup green;fatty varieties of meat( lamb, pork);a bird( duck, goose);liver, kidneys, brains;smoked products, canned food, most sausages, fried meat;Fatty varieties of fish( chum, sturgeon, stellate sturgeon);salted, smoked fish, caviar, canned fish. Limit the cream, milk 6% fat, fermented, sour cream, fat cottage cheese, fatty and salty cheese. Exclude beef, mutton fat and fats, cooking oil, margarine;fried eggs and hard-boiled eggs;sorrel, radish, radish, green onion, garlic, mushrooms, pickled vegetables, black pepper, horseradish, mustard;ice cream, chocolate, cream products;black coffee, cocoa, cold drinks. Alcohol is completely excluded.

    Bread and flour products: wheat bread from first and second grade flour, rye from sown and stripped flour( yesterday's baking);baked non-food products with boiled meat and fish, cottage cheese, apples;dry biscuits, dry biscuit, biscuits;puddings and casseroles groats( buckwheat, oatmeal) - steam and baked;boiled vermicelli, dumplings, finely chopped pasta, cheesecakes;boiled pasta.

    Soups : vegetable, cereal on vegetable broth, dairy with pasta, fruit;borscht and cabbage soup vegetarian, beetroot soup. Flour and vegetables for refueling are not roasted, but are dried.

    Meat and meat products: low-fat or low-fat meat - without tendon( beef, young lean lamb, meat pork, rabbit, veal), low-fat varieties of poultry - without skin( chicken, turkey) in a boiled, baked after boiling,or chopped, cabbage rolls, pilaf with boiled meat;sausages of milk;low-fat sausage, ham.

    It is impossible to exclude meat completely from the diet - it contains an animal protein useful for the organism, which includes essential amino acids, necessary for the synthesis of enzymes, hormones, blood elements and for maintaining immunity.

    Fish: low-fat varieties( pike perch, cod, bream, perch, navaga, silvery hake) in chopped form;boiled or steam cooking( knels, meatballs, soufflé).

    Milk and milk products: milk - in kind or in dishes( porridges, casseroles, etc.), fermented milk drinks( kefir, acidophilus, curdled milk), fresh non-acid curd - in kind or in casseroles, raspberries, cheesecakes, lazyvareniki, souffle, pudding, noodles with cottage cheese. Sour cream is used as a seasoning for dishes.

    Cheese : quick, low-fat cheese.

    Eggs: not more than one egg per day, egg whites and baked omelets;with good tolerance, up to two eggs per day are allowed( soft, steam or baked omelettes( in case of cholelithiasis is prohibited)

    Groats: any dishes from different cereals, especially buckwheat and oatmeal, pilaf with dried fruits, carrots, puddings with carrots and cottage cheesebuckwheat and oat groats are very useful, as the carbohydrates contained in them are less converted to fats, they are rich in fiber, vitamins

    Fats: butter - in kind and in dishes, vegetable oils( olive,maize. Th, sunflower)

    Vegetables: various vegetables raw, boiled and baked forms; salads of raw and cooked fruits and vegetables, garnishes, non-acidic sauerkraut, onions after boiling, mashed green peas

    .

    Snacks: salad of fresh vegetables with vegetable oil, fruit salads, vinaigrettes, caviar roe;jellied fish after boiling;soaked lean herring, stuffed fish, salads from seafood( squid, sea kale, scallop, mussels), from boiled fish and boiled meat, sausages - doctor's, milk, diet;low-fat ham.

    Spices: parsley and dill greens;in a small amount of red ground paprika, bay leaves, cinnamon, cloves, vanillin;white sauce with the addition of a small amount of sour cream without toasting the flour;dairy, vegetable, sweet fruit sauce. They do not pass flour.

    Fruits: various fruits and berries( except sour) in raw form and in dishes;lemon, black currant - with good tolerability;jams, jam from ripe and sweet berries and fruits;dried fruits, compotes, kissels, jellies, mousses.

    Sweet dishes and sweets: jujube, non-chocolate candy, pastille, jam, sweet ripe fruit jam, honey. However, one should not get involved in sweet dishes. It is recommended not more than 50-70 grams of sugar per day( including sugar, contained in sweets, fruits, confectionery).For the elderly, this rate is 30-50 g. You can replace the sugar part with xylitol, sorbitol. Persons inclined to fullness should exclude sugar completely.

    Drinks: tea, coffee with milk, fruit, berry and vegetable juices. It is recommended to constantly use vitamin decoctions and infusions of rose hips and wheat bran. Infusions and decoctions of special collections of herbs are recommended to take 1/2 cup 2-3 times a day for 20-30 minutes before meals, the course of 2-3 months( a break between them 2-3 weeks).

    For normal functioning of the digestive system, natural dietary fibers are needed, which are found in large quantities in wheat bran, to a lesser extent - in oat, walnut, vegetables, fruits.

    Wheat bran consumption is a means of preventing and treating constipation, gallbladder disease, obesity, diabetes mellitus. In addition, wheat bran are rich in Group B vitamins, have the ability to neutralize and adsorb toxic substances formed during digestion.

    Wheat bran can be consumed in kind( 2-3 tablespoons) or cook meals from them.

    Preparation of wheat bran: 2-3 tablespoons of bran soak with steep boiling water and insist for 30 minutes. Divide into four portions and eat throughout the day, adding soups, borscht, cereals or simply squeezing milk. Very useful broth of bran, which can be prepared as follows: bran grind on a coffee grinder, pour boiling water, boil for 10 minutes and insist for several hours( up to a day).Decoction strain, introduce sugar or xylitol, sorbitol, lemon juice. Instead of sugar you can honey.

    It is also recommended for this disease a vitamin beverage made of rose hips, rose hips infusion, tea of ​​hips and blackberries, tea made from rose hips with raisins, tea of ​​hips and berries of mountain ash, yeast drink.

    1-st breakfast: souffle curd steam, porridge rice milky rubbed, tea.

    2nd breakfast: apple baked with sugar.

    Lunch: pearl barley soup with vegetarian vegetated vegetables, meat steak cutlets with carrot puree, jelly.

    Snack: broth of dog rose.

    Dinner: fish kelly with mashed potatoes, casserole with sweet gravy, tea.

    At night: kefir.

    Sample menu( second option)

    On an empty stomach: broth of a dogrose - 1 glass.

    1st breakfast: vegetable salad-150 g, buckwheat porridge with butter, sausage dairy - 60 g, tea.

    2nd breakfast: fresh cheese - 100 g, with milk - 50 g and sugar - 10 g.

    Lunch: milk soup with semolina dumplings, meat meat cutlets, boiled vermicelli.

    Dinner: cheese pudding from low-fat fresh cheese, tea.

    Before going to bed: 1 cup kefir.

    For the whole day: bread - 400 g, butter - 15 g, sugar - 50 g.

    Dishes for a diet with cholecystitis are cooked mostly for steaming or boiling. Bake dishes are allowed, but fried ones are definitely excluded, because with this method of cooking, substances that irritate the liver, the mucous membrane of the stomach and intestines are formed.

    During the period of remission, meat, for example, can only be lightly fried, pre-boiling it.

    Daily intake of table salt should not exceed 10 g. For the normal functioning of the gallbladder, it is important that in food proteins of animal and plant origin are in the optimal proportion.

    You can not eat the eaten food for a long time, but only during an exacerbation.

    In chronic cholecystitis, the diet has general recommendations with acute cholecystitis:

    1. Food intake should be frequent( 4-6 times a day), in small portions, and optimally eat at the same time. The second breakfast, afternoon snack and the second dinner should not be done too much.

    2. The number of the main components of food - as in the usual diet: protein 90-100 g, fat 80-100 g, carbohydrates 400 g, daily caloric value 2500-2900 kcal. A distinctive feature is an increase in the content of vegetable oil( olive, sunflower, corn, soybean) to 50% of all fats.

    3. Inclusion in the diet of additional sources of plant fiber( apples, melon, tomatoes, etc.).It is important to note that in chronic cholecystitis it is extremely undesirable to use red currants, cowberries, and legumes. It is useful to conduct courses of intake for 4--6 weeks of wheat bran: chop the bran with boiling water, fry, drain the liquid, then add 1-1.5 tablespoons to the dishes 3 times a day.

    4. Not recommended: spicy, salty, fried foods, dishes with a high content of extractives( strong meat and fish broths, egg yolks, vinegar, pepper, mustard, horseradish, fried and stews);alcoholic beverages and beer;cold and carbonated drinks. Refractory and indigestible fats( lard, lard, fatty meats and fish) should be excluded. Especially dangerous is the combination of alcoholic beverages and fatty foods.

    5. It is recommended: dairy, fruit, vegetable soups;low-fat varieties of meat( beef, rabbit, chicken, turkey) and fish( hake, cod, bream, perch, pike perch) in boiled or steam form;doctor's sausage, ham, soaked herring;porridge;puddings, casseroles, cheese cakes;boiled vermicelli, noodles, various vegetables in raw, boiled, baked form;salads from boiled and raw vegetables and fruits;albuminous omelets. Sour-milk products, fresh cottage cheese, lazy vareniki, soufflé from cottage cheese, neoprene cheese( Russian, Yaroslavl).Of animal fats, butter is recommended.

    6. As a seasoning, you can use parsley greens, dill in small quantities, fruit and berry sauces. Vegetables such as radish, radish, turnip, onion, garlic, as well as sorrel and spinach are usually poorly tolerated and should be excluded.

    7. From drinks you can use light tea, fruit, vegetable, berry juices( but not decoctions of cowberry or red currant), broth of wild rose. All drinks should be warm;taking cold drinks stimulates contraction and can cause pain. You can not drink heavily carbonated drinks( cola, phantom, sprite, heavily aerated mineral water).

    Together with medical nutrition, patients are advised to be treated with mineral waters and medicines.

    If cholecystitis is combined with reduced secretory function of the stomach, then mineral water should be taken 30 minutes before meals, with increased secretion - 1.5 hours before meals.

    With the disappearance of all acute events in 3-4 weeks, the patient can be transferred to diet No. 5: they are allowed the same dishes, but already unprotected. Wipe only wiry meat and vegetables, very rich in fiber( cabbage, carrots, beets).Fried products are excluded. You can give dishes from stews, as well as in baked form( after preliminary digestion).The amount of fat in the diet is adjusted to the physiological norm, 1/3 of the fat is given in the form of vegetable oil. Vegetable oil( olive, sunflower, corn) is added to salads, to vegetable and cereal side dishes. Along with white bread( 200 g), small amounts of rye seed are allowed, from flour of grinding( 100 g).

    Therapeutic nutrition is combined with the appointment of antibacterial therapy, antispasmodics and compliance with bed rest.

    The importance of therapeutic nutrition in the therapy of patients with liver and gall bladder lesions is especially increased in chronic cholecystitis. Proper nutrition can provide a lasting state of remission. Disturbance of the food regime, qualitative and quantitative deviations in it, can cause an aggravation of the disease. Among the causes contributing to the aggravation of chronic cholecystitis, one of the first places is the use of fatty and spicy foods, alcohol, cold and carbonated drinks, etc. Improper nutrition is also one of the reasons for the transition of acute cholecystitis to chronic.

    The diet for patients with chronic cholecystitis outside the period of exacerbation is constructed with the expectation that its main components will have an active effect on the bile excretory function and prevent bile stasis. An appointed diet should also have a stimulating effect on the secretory and motor functions of the intestine. If you are inclined to diarrhea, the diet should be appropriately changed.

    Patients with chronic cholecystitis are recommended frequent fractional meals at the same hours, which contributes to a better outflow of bile. A plentiful amount of food disrupts the rhythm of bile separation and causes spasm of the biliary tract. Reflexively, the pyloric spasm may come, normal secretory-motor activity of the intestine is disrupted.

    Hence the frequent occurrence of pain and various types of dyspepsia after a plentiful meal.

    The main dietary requirement for patients with chronic cholecystitis is diet № 5.Fats are preferable to enter in the form of vegetable oils, primarily because of their good choleretic effect. With chronic cholecystitis occurring with the bile-dyspersic syndrome, it is recommended to increase the fat content in the diet to 100-120 g due to vegetable oils( 1/2 of the total amount of fat).This variant of the diet contributes to the activation of bile secretion, improves the hepatic-intestinal circulation of the compounds that make up the bile, increases its bactericidal properties and motor function of the intestine, promotes the excretion of cholesterol from the intestine and feces.

    Choleretic action of vegetable oils can serve as a contraindication to their introduction into the diet of patients with cholelithiasis. In these cases, activation of the functional activity of the biliary system can be accompanied by an attack of biliary colic. For patients of this profile, a diet with the usual ratio of animal and vegetable fat is prescribed.

    From animal fats, butter is recommended as the most easily digestible and absorbed.

    The question of introducing eggs into the diet should be decided individually. Eggs are a valuable food product, have an active choleretic effect, enhance the motor function of the gallbladder, and therefore show their introduction into the diet of patients with chronic cholecystitis. At the same time, the presence of these properties provokes the appearance of pain in some people when eating eggs, which in such cases causes them to restrict their introduction to the diet.

    Vegetables, fruits and berries exert a stimulating effect on the secretion of bile and other digestive juices, contribute to the elimination of constipation. You can recommend carrots, zucchini, tomatoes, cauliflower, grapes, watermelon, strawberries, apples, prunes, etc. Bile excretion activity is especially enhanced with the simultaneous introduction of vegetables with vegetable oils. Therefore, it is recommended to consume salads with vegetable oil, etc. Wheat bran in pure form or in special types of bread should be present in the diet.

    With cholecystitis flowing with diarrhea, vegetables and berries are introduced into the diet in the form of juices, preferably diluted in half with water, or in a grubby form. In these cases, preference is given to juices containing tannins( bilberries, quinces, grenades, etc.).Vegetables rich in essential oils( radish, radish, turnip, onion, garlic), as well as oxalic acid( sorrel, spinach), are poorly tolerated by patients due to their irritating effect on the mucosa of the digestive tract.

    Cholecystitis is quite common among women, especially during pregnancy. Despite the fact that overweight often leads to the formation of gallstones, a sharp decrease in weight can further complicate the course of cholecystitis.

    It is also known that cholecystitis is more common among fans of a low-calorie diet with a predominance of proteins or those who prefer diets that allow you to lose weight in a short time. Prophylaxis of cholecystitis and chronic cholecystitis consists in adherence to diet, exercise, physical education, prevention of obesity, treatment of focal infection.

    The best way to prevent the development of cholecystitis is to maintain a normal weight and maintain a low calorie diet.

    Often, chronic cholecystitis develops against a background of obesity. In this case, it is useful for a week to spend 1-2 days of fasting, for which you can use the following diets:

    1. Curd-kefir day( 900 g of kefir for six meals, 300 grams of cottage cheese for three meals and 50-100 g of sugar)

    2(1.5 l of compote made from 1.5 kg of fresh or 250 g of dry fruit is divided into six receptacles, rice porridge cooked on water from 50 g of rice is divided into two doses).

    3. Watermelonor grape day( 2 kg of ripe watermelon or grapes are divided into six receptions)

    4. Fruit day( 1,5-2kg of mature apples for six meals).This diet is especially good with a tendency to constipation and putrefactive processes in the intestines.

    Prophylaxis of cholecystitis is rational nutrition, prevention of obesity, a mobile lifestyle.

    Prophylaxis of chronic cholecystitis consists of adherence to diet, exercise, physical education, prevention of obesity, treatment of focal infection.

    Those of people with bile in the gallbladder are particularly prone to developing cholecystitis. This happens when:

    Strengthen bile stasis:

    In chronic cholecystitis, you must follow the rules of healthy eating, including frequent fractional techniques to write.

    From medicines it is desirable to take antispasmodics and preparations containing pancreatin - mezim-forte, penzital, creon, pancitrat. It is useful to conduct several courses of reception of probiotics - enterol, bifiform, hilak-forte. Daily intake of multivitamin complexes with microelements is mandatory.

    Cholagogue preparations, including plant origin, are prescribed only after examination of the gallbladder and pancreas.

    Bandage with cholecystitis is not worn, it is used only if there is a hernia of the anterior abdominal wall.

    What changes occur in the gallbladder as a result of inflammation?

    In chronic catarrhal( edematic) inflammation( cholecystitis), the walls of the gallbladder become denser. At the same time in some areas of the epithelium is absent, on others it grows with the formation of small polyps.

    Muscle wall layer is usually hypertrophied( thickened), and the mucous membrane, on the contrary, is atrophied. The walls of the gallbladder are covered with inflammatory infiltrates, which can lead to the development of ulcers on the mucosa, which then is cicatrized by the cells of the epithelium.

    In some parts of the wall of the gallbladder can occur deposits of calcium salts.

    Bubble is often deformed due to the fact that there are spikes with neighboring organs.

    The forecast is generally favorable.