Calculous cholecystitis: symptoms and treatment, complications, causes

What is it? - calculous cholecystitis is a clinical and morphological form of cholelithiasis.

It is characterized by the formation in the gallbladder stones with the subsequent development of an inflammatory reaction.

The development of serious complications of this disease dictates the need for timely diagnosis and treatment of calculous cholecystitis.

Causes of calculous cholecystitis

The reasons for the development of calculous cholecystitis have not been fully studied at the present time.

Therefore, a number of predisposing factors are identified that increase the likelihood of gallstones formation. These factors include:

1. 1) Infectious processes in the gallbladder and bile ducts. Against this background, the bile becomes acidic, promoting the cleavage of bile acids and creating a matrix for the formation of stone
   
2. 2) Metabolic disorders in the body that can manifest themselves in different ways. This can be expressed in the violation of cholesterol, calcium metabolism and bile pigments. This is promoted by starvation, lack of protein in food, intoxication of the body
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3. 3) Stagnant processes in the gallbladder. However, stones can also be detected against the background of normal contractile activity of this organ.

It is accepted to distinguish several stages of stone formation, which the doctor takes into account in the process of prescribing treatment.

total are three stages:

1. 1) Physico-chemical stage, which is characterized by an increase in the concentration of cholesterol in the bile with a simultaneous reduction of bile acids and phospholipids
   
2. 2) Kamnenositelstvo the absence of clinical manifestations
   
3. 3) Step marked clinical manifestations, which is accompanied by the development of one orother complications. Symptoms

calculouse cholecystitis

the clinical course of the disease may be acute or chronic, while in the latter case, the remission periods alternate periods of exacerbation. Exacerbation of chronic cholecystitis resembles the clinical manifestations of acute inflammation of the gallbladder.

main symptoms that suggest the presence of calculous cholecystitis, are as follows:

• pain in the right upper quadrant
  
• feeling of bitterness in the mouth
  
• 
  
• heartburn nausea and vomiting
  
• belching and others.

most prominent manifestation of this disease is hepatic colic, which is shown by the following clinical signs:

• occurrence of sudden sharp pain in the upper part
  
• stomach for this pain is characterized by irradiation of a shoulder, the scapular region and in the waist
  
• occurrence of pain associated with predisposing factors,first of all, it is an error in the diet, as well as alcohol, jog, jogging, brisk walking
  
• nausea, which is accompanied by repeated vomiting, dizziness
  
• 
  
• flatulence( bloating)
  
• sharp soreness with palpation of the abdomen.

In the stage of remission chronic calculous cholecystitis usually proceeds in a low symptom. With errors in the diet, remission is usually replaced by exacerbation.

See also symptoms of cholecystitis.

Diagnostics

disease diagnostic list of suspected calculary cholecystitis involves performing the following additional research methods:

1. 1) X-ray examination of the gall bladder( cholecystography)
   
2. 2) Ultrasound examination of the liver and gall bladder
   
3. 3) Biochemical blood with mandatory determination of the total levelprotein and its fractions, triglycerides and cholesterol
   
4. 4) Fibrogastroduodenoscopy and some others. Possible complications of
   With delayed diagnosis and, accordingly, late-started treatment, it is possible to develop various complications of calculous cholecystitis. They can be:
   
   
   
   • choledocholithiasis - the formation of stones in the common bile duct
     
   • mechanical jaundice that develops when the outflow of bile is violated( complete blockage of the gallbladder or its ducts, and also of the large duodenal nipple)
     
   • stenosis( constriction) of the fateria nipple( large duodenal papilla)
     
   • acute cholangitis - acute inflammation of the bile ducts
     
   • acute pancreatitis - secondary inflammation of the pancreas
     
   • malignant oncological process of the gallbladder
     
   • arushenie absorption in the intestine with all the consequences
     
   • empyema( purulent inflammation) gallbladder
     
   • this body edema
     
   • perforation bile wall and the subsequent development of peritonitis.

   Treatment of calculous cholecystitis

   
   Treatment of calculous cholecystitis can be both conservative and operative. However, almost always there are indications for surgical intervention.
   
   This is dictated by the fact that sooner or later some complications develop that may threaten human life.
   
   The operation can be performed in two ways:
   
   
   
   1. 1) Laparotomic - a cut is made on the anterior abdominal wall, through which access to the abdominal cavity is provided
      
   2. 2) Laparoscopic - three punctures are performed instead of the incision, which subsequently become invisible( good cosmetic result).
   The essence of the operation is to remove the gallbladder( cholecystectomy).This prevents further formation of stones. Surgical intervention, which consists only in the removal of concrements, was ineffective, so modern surgery refused it.
   
   In the period of remission of chronic calculous cholecystitis, it is recommended that the following rules should be followed:
   
   
   
   • diet compliance( refusal from acute, roast and fat)
     
   • rational approach to physical activity
     
   • use of drugs that reduce the risk of stone formation( at the stage of physico-chemical changes) andprobability of their subsequent treatment in the second stage of cholelithiasis.
   In case of exacerbation of chronic calculous cholecystitis treatment is arranged as follows:
   
   
   
   • Compliance with bed rest
     
   • hunger pause for several days
     
   • use of analgesics with different mechanism of action( antispasmodics, cholinolytics, blockers of sensitive nerve endings)
     
   • desintoxication therapy.
   If the conservative therapy of worsening inflammation of the gallbladder does not lead to clinical improvement within 24-48 hours, then the question of emergency surgery is raised. Otherwise, the probability of developing peritonitis is high.
   
   

   
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