Chronic cholecystitis: symptoms, causes, treatment, diet
What it is? Chronic cholecystitis - is an inflammatory disease of the gallbladder, which most often occurs as a result of its infection with opportunistic microorganisms.
The disease most often affects people older than 40 years. With regard to gender differences, women are most likely to develop this disease.
With this pathology there is a violation of the motor function of the gallbladder. Chronic cholecystitis can often or rarely recur, lethargic or have an atypical course.
In addition, during the pathological process, inflammation may predominate, and may go to the forefront of dyskinesia( hyperkinetic or hypokinetic with sphincter normostonia).
Staphylococci, streptococci, E. coli can play the role of the main pathogens of cholecystitis. There are cases of infection of the gallbladder with helminths, fungi, viruses.
In addition to the main etiological causes in the development of chronic cholecystitis, a significant role is played by predisposing provoking factors, among which a special place is occupied by:
Symptoms of the disease disturb the patient only during periods of exacerbation. The main clinical sign of noncalcular( no stone) chronic cholecystitis is pain in the right upper quadrant, which is blunt with aching, often bursting. Duration of pain without taking antispasmodic drugs can vary from several days to several weeks.
Pain for chronic cholecystitis is characterized by a tendency to irradiation in the right half of the lumbar or cervical region, in the right scapula or shoulder. Provoke the appearance of pain or to strengthen the already available can receive fatty foods or alcoholic beverages. If we are talking about calculous cholecystitis, then the pain syndrome is characterized by severe pains, which go by the type of colic.
In addition to the pain syndrome in chronic cholecystitis, there are signs of dyspepsia: bitterness or metallic taste in the mouth, nausea, belching of the stomach, bloating and flatulence, alternating constipation with diarrhea, impaired appetite.
Often patients with chronic cholecystitis may note increased irritability, sleep disturbance( insomnia), general weakness. It may cause fever and itchy skin.
Complications of chronic non-calculous cholecystitis are quite rare. However, it is impossible to exclude the development of the following conditions:
In order to diagnose chronic cholecystitis, it is sufficient to conduct such research methods as:
Therapy for chronic cholecystitis during exacerbation and during periods of remission is somewhat different. The first is aimed at the removal of symptoms and the elimination of pathogenetic reactions of the disease, the second - to prevent relapses.
Conservative treatment of chronic cholecystitis during periods of exacerbation should be complex. In this case, the following groups of pharmaceuticals are used:
As during periods of exacerbation and during remission, one should not forget about the importance of diet therapy, which consists of eating food, thermally, mechanically and chemically sparing the gallbladder( Pevzner's diet No. 5).
Treatment of chronic cholecystitis in a "quiet" from the clinical manifestations of time consists of observing dietotherapy, choleretic therapy( the use of choleretics, cholekinitis, cholepysmolithics), sanatorium treatment. In addition, it is important to remember the auxiliary effect of physiotherapy.
In chronic cholecystitis during the remission period, the following are actively used: electrophoresis with novocaine, inductothermy, balneotherapy. In chronic calculous cholecystitis, a planned cholecystectomy( removal of the gallbladder) is indicated.
Prophylaxis of chronic cholecystitis is aimed at preventing exacerbations.
It is based on compliance with dietary rules, treatment of dyskinesia of the gallbladder, treatment of concomitant diseases. In addition, hypodynamia, general body hypothermia and frequent stressful situations should be avoided.
The disease most often affects people older than 40 years. With regard to gender differences, women are most likely to develop this disease.
With this pathology there is a violation of the motor function of the gallbladder. Chronic cholecystitis can often or rarely recur, lethargic or have an atypical course.
In addition, during the pathological process, inflammation may predominate, and may go to the forefront of dyskinesia( hyperkinetic or hypokinetic with sphincter normostonia).
Causes of chronic cholecystitis
Staphylococci, streptococci, E. coli can play the role of the main pathogens of cholecystitis. There are cases of infection of the gallbladder with helminths, fungi, viruses.
In addition to the main etiological causes in the development of chronic cholecystitis, a significant role is played by predisposing provoking factors, among which a special place is occupied by:
- dyskinesia of bile ducts, mainly hypotonic;
- congenital deformity of the gallbladder;
- metabolic disorders in certain endocrine diseases( most often with diabetes mellitus);
- history of traumatic gallbladder lesions;
- tumors of nearby organs;
- violation of diet, unhealthy( unhealthy) diet;
- pathological processes, accompanied by a violation of blood circulation in the gallbladder and / or its blood supply;
- is a sedentary lifestyle;
- pregnancy.
Symptoms of chronic cholecystitis
Symptoms of the disease disturb the patient only during periods of exacerbation. The main clinical sign of noncalcular( no stone) chronic cholecystitis is pain in the right upper quadrant, which is blunt with aching, often bursting. Duration of pain without taking antispasmodic drugs can vary from several days to several weeks.
Pain for chronic cholecystitis is characterized by a tendency to irradiation in the right half of the lumbar or cervical region, in the right scapula or shoulder. Provoke the appearance of pain or to strengthen the already available can receive fatty foods or alcoholic beverages. If we are talking about calculous cholecystitis, then the pain syndrome is characterized by severe pains, which go by the type of colic.
In addition to the pain syndrome in chronic cholecystitis, there are signs of dyspepsia: bitterness or metallic taste in the mouth, nausea, belching of the stomach, bloating and flatulence, alternating constipation with diarrhea, impaired appetite.
Often patients with chronic cholecystitis may note increased irritability, sleep disturbance( insomnia), general weakness. It may cause fever and itchy skin.
Complications of the disease
Complications of chronic non-calculous cholecystitis are quite rare. However, it is impossible to exclude the development of the following conditions:
- perforation, fistula formation in the duodenum, stomach, hepatic bending of the colon;
- cholangitis;
- reactive hepatitis;
- "disconnected" gallbladder - the gallbladder ceases to perform its functions in full;
- peri-choledochal lymphadenitis - development of the inflammatory process along the course of extrahepatic bile ducts;
- empyema of the gallbladder( the formation of a purulent focus of inflammation).
Diagnosis
In order to diagnose chronic cholecystitis, it is sufficient to conduct such research methods as:
- 1) General blood test( leukocyte level is important( leukocytosis and left leukocyte shift are observed in this disease, ESR);
- 2) Biochemical blood test( special attention is paid to such factors as: direct bilirubin, alkaline phosphatase, γ-glutamyltranspeptidase, α₂ globulins, β-globulins);
- 3) Duodenal sounding - allows not only to detect the presence of flakes in bile, decrease its pH, but also to detect the presence of microorganisms and determine their sensitivity to certain groups of antibacterial drugs;
- 4) Ultrasonography of the gallbladder - this study allows you to assess the size of the gall bladder, the thickness of its walls, as well as the presence of deformities, pathological constrictions, stones, tumors;
- 5) ERCPG - allows to identify the presence of obstruction of the biliary and pancreatic pathways;
- 6) A survey of the abdominal organs is performed to diagnose the possible perforation, as well as the detection of foci of defilement and gallstones;
- 7) Oral cholecystography - helps diagnose dyskinesia of cervical cholecystitis;
- 8) Radionuclide cholecystography;
- 9) Cholescintigraphy;
- 10) Intravenous cholegraphy.
Treatment of chronic cholecystitis
Therapy for chronic cholecystitis during exacerbation and during periods of remission is somewhat different. The first is aimed at the removal of symptoms and the elimination of pathogenetic reactions of the disease, the second - to prevent relapses.
Conservative treatment of chronic cholecystitis during periods of exacerbation should be complex. In this case, the following groups of pharmaceuticals are used:
- antibiotics( Ciprofloxacin, Erythromycin, Doxycycline, Biseptol, Furozolidone, Oxacillin, Metranidazole);
- antispasmodics( Papaverin, Drotaverin, Platifillin, Pitophenone);
- cholagogue preparations( Allochol, Tsikvalon, Sorbitol, Nikodin);
- non-steroidal anti-inflammatory drugs( Spazgan, Baralgin);
- propulsants - stimulate peristalsis( Domperidone);
- polyenzymes( Festal, Pancreatin);
- non-perishables( diprasine, Cerucal);
- sedative drugs( tincture of Valerian or Motherwort).
As during periods of exacerbation and during remission, one should not forget about the importance of diet therapy, which consists of eating food, thermally, mechanically and chemically sparing the gallbladder( Pevzner's diet No. 5).
Treatment of chronic cholecystitis in a "quiet" from the clinical manifestations of time consists of observing dietotherapy, choleretic therapy( the use of choleretics, cholekinitis, cholepysmolithics), sanatorium treatment. In addition, it is important to remember the auxiliary effect of physiotherapy.
In chronic cholecystitis during the remission period, the following are actively used: electrophoresis with novocaine, inductothermy, balneotherapy. In chronic calculous cholecystitis, a planned cholecystectomy( removal of the gallbladder) is indicated.
Prevention of disease
Prophylaxis of chronic cholecystitis is aimed at preventing exacerbations.
It is based on compliance with dietary rules, treatment of dyskinesia of the gallbladder, treatment of concomitant diseases. In addition, hypodynamia, general body hypothermia and frequent stressful situations should be avoided.