Cholecystitis - Causes, symptoms and treatment. MF.
Cholecystitis is an inflammatory disease of the gallbladder. It is the most common disease of the abdominal cavity. Currently, cholecystitis affects 10-20% of the adult population, and this disease tends to grow further. This is due to the inactive way of life, the nature of nutrition( excessive consumption of rich in animal fats food - fatty meat, eggs, butter), the growth of endocrine disorders( obesity, diabetes mellitus).Women are sick 4 times more often than men, this is due to the intake of oral contraceptives, pregnancy.
Among the numerous diseases of the biliary tract, functional disorders( dyskinesia), inflammatory( cholecystitis), metabolic( cholelithiasis).These conditions are phases of one pathological process: first there is a violation of gall bladder motility - dyskinesia, then an inflammatory process joins - there is an acalculous cholecystitis that eventually transforms into cholelithiasis( cholelithiasis).
The causes of cholecystitis: the main and additional.
The main causes include the infectious factor. Infection penetrates the gallbladder through the blood, lymph and the ascending path from the intestine.
The primary sources of infection can be:
- acute or chronic inflammatory processes of the gastrointestinal tract( infectious enterocolitis - inflammatory bowel disease, pancreatitis, appendicitis, intestinal dysbacteriosis),
- respiratory tract( sinusitis, tonsillitis), oral cavity( periodontal disease),
- inflammatory diseases of the urinary system( pyelonephritis, cystitis),
- reproductive system( adnexitis - in women, prostatitis in men),
- viral liver damage,
- parasitic invasionevyvodyaschih paths( giardiasis, ascariasis).
Additional factors:
1. Dyskinesia of bile ducts. These are functional disorders of the tone and motor function of the biliary system( gallbladder and bile ducts).Occurs in any case of chronic cholecystitis, leads to impairment of outflow and congestion of bile.
2. Congenital malformations of the gallbladder.
3. Pancreatic reflux. Throwing the contents of the duodenum into the biliary tract. Pancreatic juice with active enzymes causes enzymatic damage to the walls of the gallbladder. It occurs in diseases of the pancreas, duodenum.
4. Disturbance of blood supply to the gallbladder. Arise against a background of atherosclerosis, hypertension, diabetes, lead to a narrowing of the lumen of blood vessels.
5. Violation of the normal composition of bile( discolor).The change in the composition of the gallbladder and the ratio of its components leads to damage to the gallbladder wall. This is facilitated by the reception of monotonous, fat-rich food.
6. Allergic and immunological reactions cause inflammatory changes in the wall of the gallbladder.
7. Hereditary factor.
8. Endocrine changes( pregnancy, intake of oral contraceptives, obesity, menstrual irregularity).
Additional factors create conditions for the development of inflammation and prepare a fertile ground for the introduction of microbial flora. Symptoms of cholecystitis.
Cholecystitis is acute and chronic.
Acute cholecystitis
Acute cholecystitis without cholecystitis is rare, occurs usually without complications and ends with recovery, sometimes it can go into a chronic form. The disease most often develops in the presence of stones in the gallbladder and is a complication of cholelithiasis. At the beginning of the disease there is an intense paroxysmal pain in the right hypochondrium region, nausea, vomiting, the body temperature rises to 38-39 degrees. Maybe a chill, a jaundice of sclera and skin, a stool and gas retention.
Acute calculous cholecystitis is characterized by a severe course with the spread of the inflammatory process to surrounding organs and tissues.
Complications of cholecystitis with liver abscess, local or diffuse peritonitis, cholangitis( inflammation of the bile ducts), pancreatitis. In this condition, one should immediately consult a doctor - a surgeon, a therapist - to resolve the issue of hospitalization in a surgical hospital.
Chronic cholecystitis.
The disease begins gradually, often in adolescence. Complaints arise under the influence of a diet violation, psycho-emotional overstrain.
The main manifestation of the disease is pain in the right upper quadrant. It can be displaced in the left hypochondrium, the upper half of the abdomen. Noncalculous cholecystitis is accompanied by some form of secondary dyskinesia, this often determines the nature of the pain. With concomitant hypomotor dyskinesia, pains are permanent, aching, not intense. Often the equivalent of pain is a feeling of heaviness or burning in the right upper quadrant. In cases of hyperkinetic dyskinesia, the pain is intense, short-term, has a paroxysmal character. The pain gives to the supraclavicular fossa, the lumbar region, the subscapular region, the heart region.
Cholecystocardial syndrome - includes pain in the heart, heart palpitations, a violation of the rhythm of the heart activity, this is due to the infectious - toxic effect on the heart muscle.
With prolonged course of the disease it is possible to involve the solar plexus in the pathological process, a solar syndrome arises. Its main sign is a burning, intense pain in the navel, giving back.
The emergence and aggravation of pain is associated with inaccuracies in diet, exercise, vibration, hypothermia, emotional overload, alcohol consumption.
Nausea, vomiting occurs in 30-50% of cases, it has a reflex character and is associated with a violation of the tone of the gallbladder or is due to concomitant gastroduodenitis or pancreatitis. In vomit masses found an admixture of bile. Vomiting, like pain, is provoked by alcohol intake, inaccuracies in nutrition.
Sensation of bitterness in the mouth, a "bitter" eructation - these complaints are most common in inflammation of the gallbladder.
Skin itching, its appearance is associated with a violation of bile secretion and is the result of irritation of the skin receptors by accumulated bile acids in the blood. Disturbance of the outflow of bile leads to a short-term occurrence of jaundice.
Chills, fever is noted with exacerbation of the inflammatory process in the gallbladder.
Patients often suffer from severe vegetative-vascular dystonia. Painful attacks are accompanied by neurotic syndromes, such as weakness, sweating, palpitation, headache, emotional lability( mood imbalance), sleep disturbance.
Patients suffering from allergies, exacerbation of chronic cholecystitis can cause allergic reactions( urticaria, Quincke's edema).
Women may develop premenstrual tension syndrome.2-10 days before menstruation, there are headaches, pastosity of the face, hands, feet, unstable mood. In the same period there are also symptoms of exacerbation of chronic cholecystitis.
Manifestations of chronic cholecystitis are manifold, they are composed of various signs, an accurate diagnosis is established and a physician-therapist or gastroenterologist-can prescribe the necessary complex of examinations.
Diagnosis of cholecystitis.
Laboratory tests:
1. General blood test. Detects signs of inflammation.
2. Biochemical blood test: total bilirubin and its fractions, transaminases, alkaline phosphatase, cholesterol. There is a moderate increase.
3. Blood sugar. For the diagnosis of diabetes mellitus.
4. General analysis of urine. For differential diagnosis with kidney disease.
5. Feces on eggs of worms. To identify lamblia, ascorides.
6. Microscopic and bacteriological study of bile.
7. Immunofermentative blood test for giardiasis.
8. Analysis of feces for elastase 1. For the diagnosis of pancreatitis.
Instrumental examinations:
1. Ultrasound of the abdominal cavity organs. It reveals thickening of the gallbladder walls( thickening is more than 4 mm - it is the main diagnostic criterion of cholecystitis), congestion and bile thickening - "sladge", presence of gallstones, deformation of the gallbladder.
2. Ultrasound with choleretic breakfast - for the detection of dyskinesia of the gallbladder.
3. Multifractional duodenal sounding( performed only in the absence of cholelithiasis) with microscopy and bile culture. Registration of duodenal contents is performed every 10 minutes, it allows to establish the type of secretion( hypersecretory, irregular, hypoxecretory), the state of biliary tract sphincters, determines the nature of the contractile capacity of the gallbladder, the presence of inflammatory elements and bacterial flora.
4. Radiographic examination of the abdominal cavity( for the detection of radiocontrast stones).
5. FEGDS - fibroesophagogastroduodenoscopy.
6. ECG.For differential diagnosis with diseases of the cardiovascular system.
7. Computer tomography and nuclear magnetic resonance. Carried out in difficult cases for diagnosis.
Consultations of specialists:
Obligatory examination of the therapist and gastroenterologist.
According to indications:
- surgeon, with suspected complications( pericholecystitis, cholelithiasis, gallbladder empyema, pancreatitis);
- cardiologist, to exclude the pathology of the cardiovascular system;
- gynecologist, if necessary, hormone replacement in women;
is a psychotherapist, conducting rational psychotherapy.
Treatment of cholecystitis.
1. In the presence of clinical symptoms and laboratory signs of inflammation, positive results of sowing bile - antibacterial treatment is prescribed. The choice of antibiotics is performed by the doctor, assessing his ability to concentrate in the bile.
2. Symptomatic therapy.
To normalize the function of the biliary tract and eliminate pain, prescribe:
- anticholinergic agents( riabal 2ml i / m or 1-2 tablets 3 times a day), myotropic antispasmodics( no-sppa 2 tablets 3 times a day, papaverine 2ml 2% solution in / m 2-3 times a day, mebeverin 1-2 tablets 3 times a day), holinolitiki( platifillin), analgesics( analgin, baralgin).
3. In the presence of signs of hypotension of the gallbladder and in the absence of concrements appoint:
- cholagogue preparations. Apply allochol( 1-2 tablets 3 times a day after meals), cholenzim( 2 tablets 3 times a day after meals), phytotherapy.
Widely used recipes of traditional medicine - herbal medicine.
Immortelle - 15 g of flowers, St. John's wort 10g of grass, the mixture is poured with 0.5 liters of water, boiled for 5 minutes, filtered. Take 0.5 cup 3 times a day for 15 minutes before meals.
Corn stigmas - 10 g pour 200ml water, boil for 5 minutes, take ¼ cup 3 times daily before meals.
Tansy - 5 g of flowers insist in 250 ml of boiling water for 30 minutes, take 1 tablespoon 3 times a day before meals.
Peppermint 5g pour 200 ml of boiling water and put on a water bath for 15 minutes. Take ½ cup 3 times daily before meals.
Rosehip. Syrup from the condensed water extract of dogrose and sugar - holosas, take 2 teaspoons 3 times a day before meals. Infusion of dog rose - 10 g of crushed fruits pour 400 ml of boiling water and stand on a water bath for 15 minutes, insist. Take ½ cup 3 times daily before meals.
These drugs increase the secretion of bile, reduce its viscosity, and have an anti-inflammatory effect. Assign in the period of remission( without exacerbation) for 2-4 weeks.
The same effect is possessed by mineral waters. Depending on the composition, they can have a stimulating effect on the contractile function of the gallbladder. Mineral water without gas is taken by the doctor 3 times a day for 1 glass for 30 minutes - 1.5 hours before meals( depending on the state of gastric secretion) in warm or hot form( 40-50 degrees);
- blind probing - tjubazh, once a week, 3-5 times.
It is carried out in the morning on an empty stomach. Slowly( in small sips), you should drink 150-200 ml of warm( 40-45 degrees) mineral water with the addition of 20-25 g of sorbitol or xylitol. Lie on your right side, on your back for an hour. Under the right side put a warm water bottle. After bowel movement, it is recommended that you take a shower and rest for 20 minutes. The first meal is 1-1.5 hours after the end of the procedure. This is a glass of tea with honey, cottage cheese.
4. In the presence of microliths in bile, hypotension of the gallbladder, cholestatic syndrome, bile acid drugs( ursodeoxycholic acid) are used for 1 -3 months, under the supervision of a doctor.
5. In order to normalize the bile excretory function of the liver, hepatoprotectors with choleretic properties are prescribed. Hofitol is a hepatoprotector of vegetable origin, containing a dry water extract from the leaves of an artichoke field. Take 2 tablets 3 times a day for 20 minutes before meals for a month. Hepabene is a combined herbal preparation containing the extract of the smoky medicinal and dry extract of the milk thistle fruit. Take 1 capsule 3 times a day after meals.
6. With vegetative vascular dystonia recommend sedatives( valerian, motherwort), anxiolytics( adaptol 500mg 3 times a day for 2 months).
Treatment and diet.
In the period of acute exacerbation of cholecystitis patients are recommended treatment in a hospital - therapeutic or gastroenterological, compliance with bed rest, a state of psychoemotional rest. After the elimination of the expressed signs of exacerbation, the patient's regimen expands to the general.
During the period of exacerbation, in the first two days, only the reception of a warm liquid is prescribed( soft sweet tea, fruit and vegetable juices, diluted with water, mineral water without gas) in small portions up to 1.5 liters a day and a few crackers. As the pain subsides and the general condition improves, the dietary table expands. Recommended:
- mashed potatoes from vegetables and cereals,
- porridge( oatmeal, rice, semolina, buckwheat),
- jelly, mousse, jelly, low-fat cottage cheese,
- lean boiled fish,
- mashed and boiled meat, steamed burgers(veal, chicken, turkey, rabbit),
- white rusks.
Food is taken in divided portions 5-6 times a day.
During an exacerbation it is recommended to spend unloading days 1 day a week:
- curd - kefir day.900g of yogurt for 6 doses, 300g of low-fat cottage cheese for 3 doses and 100g of sugar;
- rice compote. 1.5 liters of compote, made from 1.5 kg of fresh or 240 g of dry fruit for 6 receptions, rice porridge, cooked on water from 50 g of rice - for 3 meals.
After relieving the exacerbation of cholecystitis, a diet is prescribed, table number 5, which is the main one in this disease.
Patients are recommended:
- soups, dairy, fruit, on vegetable broth with cereals, noodles;
- boiled meat, steam cutlets, meatballs( beef, rabbit, chicken, turkey);
- low-fat fish of the sea or river in boiled or baked form, without a peel;
- eggs, up to 1-2 per day - soft-boiled, in the form of steam omelettes;
- dairy products: low-fat milk, cottage cheese, kefir, yoghurt, curdled milk, butter( limited);
- vegetables boiled, baked, partially raw. Potatoes, beets, carrots, tomatoes, cucumbers, pumpkin, sweet pepper, eggplant, cauliflower, zucchini;
- fruits and berries. Pears, melons, bananas, peaches, apricots, watermelons, non-acid varieties of apples;
- porridge - buckwheat, oatmeal, rice, semolina, with the addition of milk, with tolerability;
- sweet dishes - pastille, marmalade, honey, jams, jam, jelly;
- flour products - wheat and rye bread, yesterday, bread crumbs of white bread, dry biscuits.
Take food in small portions, slowly 5-6 times a day. Do not recommend long breaks between meals, starvation. Breakfast is obligatory, dinner for 2 - 3 hours before bedtime, uninvited. The amount of liquid is not limited. A plentiful amount of food taken once, breaks the rhythm of bile secretion, causes a spasm of the gallbladder and provokes pain.
In chronic cholecystitis, it is necessary to increase the intake of products that improve the outflow of bile and lower cholesterol:
- rich in dietary fiber( bran, vegetables, fruits, berries).Bran pre-steam and add to the dishes, 1-1.5 tablespoons 3 times a day;
- rich in magnesium salts( buckwheat and oatmeal, dried fruits, bran);
- containing essential polyunsaturated fatty acids, phospholipids, vitamin E( corn, olive, sunflower and other oils);
- containing lactic acid bacteria( fermented milk, cottage cheese).
We do not recommend products:
- high in animal fats( fried foods, fatty fish, pork, lamb, duck, sausages, smoked meats, mayonnaise, creams, cakes, pastries);
- raw onion, garlic, radish, sorrel, spinach, mushrooms, bean dishes( peas, beans);
- cold and carbonated drinks, concentrated juices, coffee, cocoa, alcoholic beverages.
Rehabilitation.
Physiotherapy and sanatorium treatment is an important component of complex rehabilitation of patients. As thermal procedures for correction of hypertonicity of the gallbladder, anti-inflammatory and analgesic effects, inductothermy, the electric field of UHF, is used. The course of treatment is 12-15 procedures, daily. To stimulate the emptying of the gallbladder, a pulsed low frequency current is prescribed. To reduce the dyskinetic phenomena, electrophoresis of 5% novocaine, 2% papaverine is recommended. To normalize the functional state of the nervous system, a galvanic Shcherbakov collar, electrophoresis with bromine is used. With the same purpose appoint coniferous, oxygen and carbonic baths. Sanatorium treatment is indicated not earlier than 2-4 months after acute cholecystitis. Patients are sent to balneogryazevye resorts: Essentuki, Zheleznovodsk, Truskavets, Morshin.
Complications of cholecystitis.
Complications include: pericholecystitis, pancreatitis, cholangitis, reactive hepatitis, duodenitis.
Pericholecystitis occurs when all the walls of the gallbladder and the serous membrane( peritoneum) are involved in the pathological process. In this condition, the pain syndrome has a constant and intense character, spreads to the right side, is strengthened by turning and tilting the trunk.
Cholangitis is an inflammatory process in the bile ducts. The main symptom is an increase in temperature to 40 degrees with tremendous repeated chills, nausea, vomiting, cramping pain in the right hypochondrium.
In noncalculous cholecystitis, other organs of the digestive system are often involved in the pathological process: if along with pain in the right hypochondrium painful sensations of the "surrounding" character appear, weakening of the stool - it is possible to involve the pancreas in the pathological process. If the pain extends to the entire region of the liver and is accompanied by its increase - the attachment of reactive hepatitis, the occurrence of late, hungry pain in the upper abdomen indicates the presence of duodenitis.
Complications not only cause disability, but also pose a threat to the life of the patient, so when the first symptoms of the disease appear, you should immediately contact a doctor - therapist or gastroenterologist.
Prophylaxis of cholecystitis.
It is necessary to adhere to a long-term diet with restriction of fatty, fried foods, frequent fractional meals are recommended, and alcoholic and carbonated beverages are excluded. Gradual normalization of body weight.
Sanitation of foci of chronic infection of the oral cavity and nasopharynx.
Annual check-up at the doctor with ultrasound of the hepatobiliary system.
Consultation of a doctor on the topic of cholecystitis
Question: Can I remove an attack of biliary colic in calculous cholecystitis myself with the help of folk remedies or medications?
Answer: No, you urgently need to see a surgeon. In case of untimely treatment, development of life-threatening complications is possible.
Question: What are the contraindications for blind probing?
Answer: Blind probing is contraindicated in cholelithiasis, acute infectious diseases, active hepatitis and cirrhosis of the liver, severe cardiovascular diseases. It is not recommended to perform the procedure for women during menstruation, pregnancy.
Vostrykova Irina Nikolaevna, therapeutist of the highest category