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Cholecystitis

Types and symptoms of acute and chronic cholecystitis


Description of the disease

Contents:

Cholecystitis is an inflammatory process in the gallbladder, often triggered by infection on the intestinal microflora on the background of violations of the outflow of bile through the cystic duct is clogged. Cholecystitis usually acts as a complication of gallstone disease. The gallbladder is located near the liver and is actively involved in the process of digestion. The release of bile while going through the small intestine, but sometimes with the evacuation problems and the bile collected in the gallbladder, resulting in severe pain and increased risk of infection.

As a rule, the disease occurs in combination with cholangitis – inflammation of the bile ducts. Cholecystitis is a common surgical pathology, especially among women middle-aged and older – they get sick three to eight times more often than men-coevals.

The main causes of gender predisposition to cholecystitis:

  • Chronic compression of the gallbladder during pregnancy provokes long-term effects of the imbalance of cholesterol and bile acids, and, as a consequence, the stagnation of bile;
  • Peculiarities of hormonal exchange women, it is proved that progesterone, in large quantities produced during pregnancy and menopause, and other female sex hormones affect the gallbladder;

  • Women tend to fad diets and rigid food restrictions violate motility (contractility) of the gallbladder.
In the risk group, regardless of gender and age, include people previously recover:

  • Intestinal and/or liver infections;
  • Parasitic diseases (helminth and protozoal infestations, localized stationary or on one of the stages of development in the intestine and/or liver);
  • Gallstone disease (GSD) with obstruction (blockage) of the cervix and/or damage to the mucous membranes of the gall bladder;
  • Diseases, violate the blood supply to the wallsgallbladder.

It is proved reflex connection of pathologies of the gallbladder and not anatomically related organs of the abdominal cavity is the so-called viscero-visceral reflexes. All the above mentioned causes of cholecystitis caused by either impaired patency (obstruction) of the gallbladder or the violation of his motor skills (dyskinesia).

By etiological basis distinguish two large nosological groups of cholecystitis:

  • Calculous (lat. Calculus – stone);
  • Acalculous (acalculous).

Adrift cholecystitis is divided into:

  • Sharp;
  • Chronic.

The character of inflammation, they are:

  • Catarrhal;
  • Purulent;
  • Gangrenous;
  • Abscess;
  • Mixed.

Gangrenous and phlegmonous form of the disease belong to the group of destructive cholecystitis.

The gallbladder is anatomically and physiologically close to the liver. Liver function is diverse, one of them is continuous production of bile and its release into the duodenum. Excess bile accumulate in the gallbladder and consumed portions.

The role of bile in the physiology of digestion:

  • Dilutes the food processed by the stomach juices, change gastric digestion intestinal;
  • Stimulates peristalsis of the small intestine;
  • Activates the production of physiological mucus, performs a protective function in the intestine;
  • Neutralizes bilirubin, cholesterol and other substances;
  • Triggers the digestive enzymes.

Symptoms of cholecystitis

The initial symptoms of cholecystitis, as a rule, are sharp pain in the right side below the ribsthat occurs unexpectedly. The reason for that is the rock that blocks the cystic duct. The result is irritation and inflammation of the gallbladder.

The pain goes away after some time by itself or after taking pain medication, but thereafter there is a gradual increase, and then it becomes regular. Is the development of the disease, which is accompanied by high fever, vomiting and nausea. The patient's condition continues to deteriorate.

Stops the normal flow of bile into the intestine, a symptom of what is icteric coloration of the skin and the eye sclera. Prerequisites forjaundice is the presence of stones that block the bile ducts. The severity of pathogenesis is characterized by the pulse of the patient: heart rate usually ranges from eighty to one hundred twenty – a hundred thirty beats per minute (or even higher), which is a serious symptom, meaning that the body took dangerous changes.

With regard to chronic cholecystitis, the symptoms don't manifest in the future, the disease may make themselves known in more running or to take an acute form. In this case, only the treatment in a special medical facility will allow you to avoid deterioration.

Symptoms of cholecystitis detected during the collection of anamnesis, physical examinations (inspection and palpation), laboratory and instrumental studies:

  • The symptoms identified during history-taking. On the basis of complaints of the sick set previously migrated diseases of the gastrointestinal tract, liver and other organs, the character of the pain in the abdomen and digestion disorders (nausea and vomiting, diarrhea, constipation, bloating);

  • Symptoms are determined by physical methods. Coated tongue – a sign of stagnation in the gallbladder. The main symptom of cholecystitis is pain, determined by palpation, manifested in different projections of the trunk;
  • Differential diagnosis on the basis of laboratory and instrumental methods of research. The basis of instrumental diagnostics of cholecystitis is the sensing of the duodenum and various modifications of x-ray and ultrasound studies. They determine the motility of the bladder, flow of bile in the lumen of the duodenum and other important functional and morphological parameters.

Nausea cholecystitis is common symptom. Nausea is a condition that usually precedes the gag reflex. In some cases nausea and vomiting is a defensive reaction of the organism to toxicity. In case of cholecystitis nausea and vomiting is always a part of the pathogenesis of the disease.

Nausea cholecystitis should be differentiated from the similar symptoms of other diseases and pathologies:

For the differentiation of nausea and vomiting incholecystitis matters:

  • Time of day for which the most characteristic nausea;
  • How long after a meal it appears;
  • The duration and outcome of nausea (whether it ends in vomiting);
  • Comes or no relief after vomiting;
  • The composition of the vomit (digested or undigested food);
  • The presence in the vomit blood clots or other impurities.

Diarrhea (diarrhea) in case of cholecystitis occurs very often. Diarrhea, constipation, bloating – constant signs of diseases of the gastrointestinal tract, including cholecystitis. The sudden appearance of disorders of the chair during treatment cholecystitis indicates a complicated course of the disease.

The appearance of diarrhoea is typical:

  • Dysbacteriosis – consequence antibiotic treatment of the cholecystitis;
  • The layering of the diseases;
  • A variety of disorders of peristalsis in the involved in the pathogenesis of other digestive organs.

Constipation and bloating are typical for:

  • Paresis of the intestine (peritonitis) and complicated form of cholecystitis (the analysis should take into account other symptoms);

  • Hypokinetic conditions (immobility) of patients on long-term bed rest;
  • Reflex effects on the intestine long flowing inflammation of the gallbladder.

Causes of cholecystitis

The causes of the disease can be very different, but most often cholecystitis occurs due to the accumulation of stones in the cystic duct, the body and neck of the gallbladder, making it difficult to release bile. The cause can also be any trauma or infection, and the presence of such severe diseases as diabetes mellitus, however, there cholecystitis will occur as a complication of existing disease, and not as a separate disease.

The result of all the above can be acute cholecystitis with inflammation of the gallbladder. The chronic form of the disease is usually observed in cases when the irritation subsides for a long time and are protracted, with the result that the wall body sealed.


Acute cholecystitis

Harbingers of acute cholecystitis – nausea and pain after some timefatty meal, remove only potent painkillers.

Acute cholecystitis manifests clinically after the formation of concretions and obstruction of their bile duct, or acute extension of the cavity of the body. The most important symptom – severe pain.

Besides the pain, define the following symptoms of acute cholecystitis:

  • Nausea and vomiting in conjunction with a bitter taste in the mouth;
  • Febrile fever (a temperature increase from 38 to 390 C);

  • Enlargement of the liver;
  • Neutrophilia in blood with left shift (increase in the proportion of band forms of neutrophils).

Complications of acute cholecystitis:

  • Purulent diffuse or limited peritonitis;
  • Perforation (rupture) of the gallbladder;
  • Acute pancreatitis (inflammation of the pancreas);
  • Obstructive (mechanical) jaundice.

The pain in acute cholecystitis is pathognomonic (main) symptom.

The pain manifested in the following projections of the body:

  • Right hypochondrium, the area located in the front, on the right side of the torso, the upper horizontal border (line) directly under the last rib and the bottom horizontal line – from the overhang of the Ilium to the umbilicus, the Central vertical line from the solar plexus to the navel;
  • The epigastric region. Triangular area directly below the xiphoid process;
  • The navel area. Is limited to four lines, the top connects the bottom of the last rib, lower – connects the right and left protrusions of the Ilium, the vertical through the centre popartuk ligaments.

The pain with cholecystitis is the subjective sensation, patients describe her as strong, sharp, stabbing, dull, burning, aching, pressure, throbbing and arching.

For the diagnosis of cholecystitis use methods of provocation of pain, and acute cholecystitis manifested by sharp pain in response to:

  • Touch and light strikes on the lower right rib is a symptom of Ortner;
  • Palpation of the neck under the ear, palpation of the sternocleidomastoid muscles is a symptom of Musi-St. George;
  • The cessation of deep palpation (pressure) in the right hypochondrium – symptom Shchetkina-Musci.

Chronic cholecystitis

Periods of remission cholecystitis is always replacedexacerbations.

Causes of chronic cholecystitis:

  • Attenuation of the acute form of this disease;
  • The slow development of pathogenesis.

Symptoms of chronic cholecystitis smoothed, it is characterized by:

  • A feeling of heaviness in the epigastric region;
  • Bloating;

  • Nausea;
  • Bitterness in the mouth;
  • Subfebrile body temperature (from 37 to 380 C);

  • Enlargement of the liver (in some cases, the organ is palpated through the abdominal wall);
  • Thickening of the walls of the gall bladder (detected during instrumental examination).

Sharp pain in chronic cholecystitis are observed. In some cases the pain syndrome may not be present. Most patients can have a dull or aching pain. Chronic acalculous cholecystitis may occur without obvious pain. Methods of provocation of pain show negative or weakly positive reaction. The pain intensifies during exacerbation of the disease.


The types of cholecystitis

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There are two main types of cholecystitis:

  • Calculous cholecystitis in the acute and chronic forms;
  • Acalculous cholecystitis in acute and chronic forms.

In fact, they are two different from the point of view of etiopathogenesis of the disease. In the first case the reason is the irritation and tension of the membranes of the gall bladder, and the second – a violation of the functioning of the bladder walls due to insufficient blood supply and innervation.

Calculous cholecystitis

Calculous cholecystitis (stone cholecystitis) is a combination and mutual influence of the three pathological processes in the body, including metabolic disorders, stone formation and inflammation.

The pathogenesis of calculous cholecystitis develops in several stages:

  • The metabolic – the formation of stones (cholelithiasis) in the gallbladder, or gallstone disease (GSD);
  • Injury to the mucous membranes of acute gallbladder stones;
  • Infection of the intestinal microflora and subsequent inflammation of the walls of the gallbladder.

The stone formation is the result of pathological processes caused by infringement of themetabolism. The stones are composed of cholesterol, pigments (bilirubin) and lime, they are almost always mixed, with a predominance of cholesterol. Normal excess cholesterol, bilirubin and calcium are removed with feces.

Stones in the gallbladder may have the following structure:

  • Crystalline;
  • Fibrous;
  • Amorphous;
  • Layered.

The size of the stones varies. Stones with a diameter less than 3 mm, having a smooth shape, easily removed from the body through the intestines.

When calculous stones cholecystitis is divided into:

  • The primary (only formed in the gallbladder);
  • Secondary (formed in the gallbladder and intrahepatic ducts).

Pogrebna article about this type of cholecystitis is here

Chronic calculous cholecystitis is inflammation of the walls of the gallbladder, which is characterized by periods of remission and exacerbation. Acute and chronic calculous cholecystitis should be considered as acute inflammation.

Periods of chronic calculous cholecystitis:

  • The period of remission (calm) due to the elimination of the causes of anxiety (a temporary restoration of bile flow into the duodenum);
  • Acute occurs due to secondary obstruction (blockage) of the duct and/or the layering of the infection.

The symptoms of an exacerbation occur some time after a fatty meal:

  • A feeling of heaviness in the epigastric region, right upper quadrant or the umbilicus;
  • Diarrhoeal disorders (diarrhea and constipation, bitter taste in the mouth, heartburn).

Because the basis of calculous cholecystitis cholelithiasis lies (ZHBK), diagnosis, treatment and prophylaxis of chronic calculous cholecystitis consider given the current GSD.

Cholecystitis gallbladder

Gallstone disease (cholelithiasis) is a pathological formation in the bile ducts of the liver and gallbladder stones (gallstones). Initially the disease is as a violation of the metabolism, without the participation of inflammatory responses. The disease is characterized by stages of pathogenesis. GSD may be a long time to occur latent (hidden) or subclinical (minor symptoms). In the later stages of cholelithiasis has a varied clinical picture, including atypical,disguised as a similar disease of the gastrointestinal tract and heart.

There are the following forms of cholelithiasis:

  • Latent. Can occur without clinical manifestations during the whole period of the disease. Diagnosed with ultrasound examination of the liver and gallbladder. The lack of clinics due to the presence of stones small diameter (less than three millimeters). At diagnosis in this phase should refer to a dietitian to correct diet plan and include in the diet foods that reduce the risk of stone formation and has a moderate choleretic effect;
  • Dyspeptic. The reasons for the development of dyspeptic cholelithiasis poorly understood. Clinical manifestation usually provokes a long-hard work, General and local cooling. The disease is characterized by pain in the epigastrium and right hypochondrium. The pain is dull, aching, paroxysmal. In some cases, note dyspepsia (diarrhea, constipation, heartburn, bitter taste in the mouth). The cause of the disorder of the gastrointestinal tract, in this case, changes in the composition (absence) of bile into the small intestine;
  • Torpid. Form of the disease, characterized by sensory deprivation. Occurs after a series of acute cholecystitis. Exhausted nervous system responds to the pathogenesis of only aching in the solar plexus;
  • Shock. Occurs when hepatic colic and acute obstruction (obstruction) of the gallbladder and duct. The pain is accompanied by autonomic responses – pale skin and cold sweat on the background of fever and palpitations.

Chronic cholecystitis gallbladder in remission diagnosed on the basis of laboratory and instrumental methods.

Laboratory methods include studies of:

  • Blood (common parameters (erythrocyte sedimentation rate, leukocyte formula), as well as indicators of cholesterol, triglycerides, bilirubin, Alt, GGT, alpha-amylase);
  • Urine (bilirubin);
  • Duodenal contents (bilirubin and cholesterol).

Apply following instrumental methods:

  • Ultrasound diagnostics. Is carried out to detect signs of pathologically changed tissues of the gallbladder in some cases, the stones;
  • Cholegraphy. The method of roentgenologic studies to complement ultrasound. Used to detect hidden pathologies gallbladder;
  • Sensing the duodenum. Is used to select the contents of the small intestine.

Beskarkasnye cholecystitis

Inflammation of the gallbladder on the background of the complicated flowbile without the participation of cholecystitis is called cholecystitis miscalculated. This disease is always combined with hepatitis, inflammation of the bile ducts and pancreas.

Beskarkasnye cholecystitis may develop under the influence:

  • Microbial infection of the gallbladder;
  • Corrosion of the mucous membranes of the body with pancreatic enzymes;
  • Poor circulation in the walls of the gallbladder.

Beskarkasnye cholecystitis manifests with typical and atypical symptoms:

  • The typical form. The disease is characterized by a dull, monotonous pain in the right hypochondrium after forty or ninety minutes after eating, off-roading or carrying heavy loads. Noticed increased pain in the sitting position and comfort in the prone position. The pain combined with indigestion, nausea and belching;

  • Kardialgichesky syndrome. Dull pain in predserdnuu region, arrhythmias and premature beats that occur after a meal. It is noted on the ECG negative T wave, QRS flattened teeth;

  • Ezoterichesky syndrome. Persistent heartburn, dull pain and foreign body sensation behind the breastbone. Temporary dysphagia (difficulty swallowing food);
  • Intestinal syndrome. Bloating with no localized pain and persistent constipation.

Chronic acalculous cholecystitis is inflammation of the gallbladder, which occurs as a result of microbial infection, followed by growth of connective tissue and stagnation of bile without stone formation.

Penetration of microflora in the pathogenesis of the lesion occurs on the upward or the downward way, or lymphokine:

  • Upward way – from the gut to the neck of the bladder and above. Contributes to the dysfunction of the sphincter that prevents back flow of bile from the intestines;
  • The downward path – in the circulation of the pathogen in the blood stream. Sometimes called "hematogenous" spread by infection;
  • Lymphogenous. Lymph is a biological fluid of the body, which is involved in many functions, including, in neutralizing inflammatory reactions. At massive septic infections (urinary, respiratory, digestive sphere) lymph is not doing its role and becomes a factor of transmission.

The development of miscalculating pathogenesis of chronic cholecystitis is accompanied by loss of contractility and suction functions of the gallbladder, which leads to stagnation (occlusion) of bile, thickening of the walls and scarring on.

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Destructive cholecystitis

Two forms of cholecystitis – abscess and gangrenous is included in a single nosological group. Common name severe inflammatory processes — destructive (destructive) cholecystitis. Forecast cholecystitis abscess careful gangrenous is unfavorable. Phlegmonous cholecystitis is almost always a continuation of the catarrhal and suppurative cholecystitis, but in some cases has an independent pathogenesis.

To the main symptom (pain, nausea, bitter taste in the mouth) subscribe:

  • Bloating – the symptom of paresis or atony of the intestine;
  • Tachycardia to 112 beats per minute – excitation of pain centers;

  • When breathing right side of the body is not symmetrical left – sparing reflex reaction.

Gangrenous cholecystitis is a continuation of phlegmonous cholecystitis. The disease is characterized by:

  • Surface breath – sparing reflex reaction;
  • Oppression of consciousness;
  • Severe pain and tension of the wall of the peritoneum – a sign of peritonitis.

Catarrhal cholecystitis

Qatar is a type of exudative inflammation. The main component of catarrhal exudate is mucus. Differential diagnosis of catarrhal inflammation of the gallbladder is performed according to the results of histological and pathological studies of the tissues of the bladder, as well as instrumental methods of laparoscopy.

The symptoms of catarrhal cholecystitis:

  • An intense, paroxysmal pain in the right upper quadrant;
  • Persistent vomiting of gastric and intestinal contents;
  • All parts of the abdominal wall involved in the act of respiration.

Purulent cholecystitis

Empyema of gallbladder (suppurative cholecystitis) is the inflammation of its walls, accompanied by accumulation of pus in the cavity of the body. The reason is the infected by pyogenic microflora and subsequent inflammation of the mucous membrane of the gall bladder.

Complications of suppurative cholecystitis:

  • The melting of the walls of the gallbladder until perforation of the authority and the transition process in the peritonitis;
  • Transformation of empyema in a state of destructive inflammation (abscess and gangrenous process);
  • The total infestation of the body – pyemia (pus in the blood) and sepsis.

Symptoms of suppurative cholecystitis in the initial stage resemblesclinical catarrhal inflammation if complications arise during the phlegmonous form of the disease.

There are three exudative cholecystitis:

  • Phlegmon – diffuse purulent inflammation in the walls of the gallbladder;

  • Abscessfocal purulent inflammation (abscess on the inner wall of the body);

  • Empyema – a purulent inflammation of the covering of the anatomical cavity of the gallbladder.

Diagnosis of suppurative cholecystitis: identifying strong leukocytosis, the laboratory study of blood, increased ESR on the background of high temperature. The result of purulent intoxication is uncontrollable vomiting and a strong headache.

Attack cholecystitis

Seizures typical for primary cholecystitis and acute exacerbations of chronic forms of the disease. The harbinger attacks are unpleasant sensations in the stomach after intake of fatty, spicy foods or alcohol.

Symptoms of an acute attack of cholecystitis:

  • Sharp cramping pain in the right hypochondrium, epigastrium or umbilicus;
  • Nausea and vomiting, belching, gas, bitter taste in the mouth;
  • Subfebrile or febrile body temperature (37-38 0 C or 38-39 0 C).

How to remove attack of cholecystitis?

For relief of an attack of cholecystitis, you must:

  1. To call an ambulance;

  2. Go to bed and attach to the stomach cold;

  3. Take antispasmodic (papaverine, no-Spa) and an analgesic (analgin, baralgin);

  4. To reduce nausea I drink peppermint tea or sparkling mineral water at room temperature;

  5. In the presence of vomiting to collect vomit for analysis.


The effects of cholecystitis

Acute cholecystitis without adequate treatment becomes chronic with periods of exacerbation and remission. A chronic disease is difficult to treat because the pathogenesis involved other organs. Running a form of cholecystitis is diagnosed in 15% of patients. Its result may be gangrene, biliary fistula, which reported bowel, kidneys and stomach with the gallbladder, mechanicaljaundice, abscess, acute pancreatitis, and sometimes sepsis.

Consequences (forecast) and neimenova calculous cholecystitis:

  • The prognosis of uncomplicated calculous cholecystitis is favorable. After intensive treatment the clinical picture of the long time can not occur. Known cases of complete cure. In complicated forms of calculous cholecystitis, the prognosis is more careful;
  • Forecast acalculous cholecystitis is questionable. In this disease should be wary of suppurative and destructive forms of inflammation.

Treatment and diet for cholecystitis

Treatment of acute cholecystitis and chronic diseases in the acute stage is carried out in the surgical hospital. Treatment methods are selected individually on the testimony.

Conservative treatment of cholecystitis:

  • The antibiotic choice depends on the effectiveness of the drug;
  • Antispasmodics to stabilize the function of the passage of bile into the small intestine;
  • Choleretic hypotension gallbladder and normal patency of the bile duct;
  • Medications to maintain liver function.

Surgical treatment of cholecystitis:

  • Cholecystectomy is the complete removal of the gallbladder, is performed immediately when symptoms of peritonitis and acute obstruction of bile, in other cases – in a planned manner.

A list of the most useful products in case of cholecystitis you can learn from this article

Diet for cholecystitis

During the acute attack the patient is given only a warm drink in small portions. The fluid volume is up to half liter a day.

After removal of acute pain in the diet include cereals, jelly, steamed meatballs of lean meat or fish, an egg in the form of scrambled eggs, white bread.

Diet in cholecystitis:

  • You need to eat small portions (5-6 times a day), to maintain the rhythm of the production of bile;
  • It is recommended to eat no later than 4-6 hours before sleep.

The diet of patients with cholecystitis should include:

  • Products of animal origin with a minimum amount of fat, finely chopped and steamed;
  • Vegetable products not containing coarse fiber, rich in vitamins and minerals.

Cholecystitis is prohibitedto use the following products:

  • Canned, pickled, smoked, salted, pickled, fat, binders;
  • Provoking indigestion and flatulence (milk, legumes, carbonated beverages);
  • Changing the pH of the stomach (alcohol, sorrel, spinach, citrus).

Sample menu for a week for patients with cholecystitis with recipes of soups, salads and dishes you can find in this article


orshenin Elena Ivanovna, doctor-gastroenterologist