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Acute and chronic calculous cholecystitis

Description of the disease

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Calculous cholecystitis is a form of cholecystitis that is characterized by the presence of stones (calculi) in the gallbladder. The disease is one of the manifestations of gallstone disease.

Calculous cholecystitis is characterized by inflammation of the gallbladder and presence of stones in it. The stones mostly have a mixed composition of (lime-pigment-cholesterol), homogeneous bilirubin (liver) or cholesterol are less common. The size of the stones can reach the size of chicken eggs, and the number varies from a few to hundreds, form different.

They can be located in the gallbladder, which occurs in 75% of cases and to maintain its presence weak inflammatory process leading to fibrosis and deposition of calcium salts (calcification). But if the stones are in the bile duct, they are able to impede or block the flow of bile, cause acute inflammation, characterized by occurrence of attacks of biliary colic.

Prevalence of disease is high, up to 10% of the adult population, most often affects people over 40 years old, but there are known cases, when calculous cholecystitis was diagnosed in children. Women are several times more likely to suffer from this disease that is caused by the peculiarities of their hormonal background.

At risk of developing the disease are the following groups:

  • women and especially pregnant women;
  • people suffering from obesity or those who have sharply reduced weight;

  • representatives of Scandinavian and Indian peoples, they have this disease is much higher than the rest;
  • older people;
  • those who take medicines and contraceptives that affect hormonal balance.

Factors leading to the formation of gallstones and development of calculous cholecystitis:

  • dickhole (change of composition of bile);
  • cholestasis (stagnation of bile);
  • inflammatory component, in this case, a primary cholecystitis.
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In a healthy organism, such components of bile as pigments, minerals, bile acids, lipids have a colloidal state. But when you change the ratio between the concentration of cholesterol and bile acids are first precipitated and subsequently kristallizuetsya. To provoke such a situation may be improper diet, diabetes, hepatitis, obesity, infectious disease.

Dyscholia contributes to the thickening of bile and stagnation, which leads to various types of infection of the gallbladder such pathogens as Bacteroides, E. coli and others. The infection causes inflammatory changes in the walls of the gallbladder.

To increase the lithogenicity (ability to stone formation) of the bile is capable of fasting or overeating, high intake of animal fats, lack of exercise, heredity and long use of hormonal contraception.

Often calculous cholecystitis precedes the normal, acalculous, which leads to disruption of the dynamics of the emptying of the gallbladder.

The risk of disease is higher in patients with pancreatitis, biliary dyskinesia, duodenitis, chronic gastritis, cirrhosis of the liver, helminthiasis, and Crohn's disease.

Characteristics of the clinical picture allows to distinguish chronic and acute calculous cholecystitis. For each of them can be complicated or uncomplicated. Distinguish catarrhal, purulent, phlegmonous and gangrenous forms. On the basis of symptoms can distinguish typical, atypical, cardiac, intestinal, esofagicas options for the development of the disease.

Calculous cholecystitis has 4 stages:

  1. pidkaminna, primary, in most cases reversible phase – dense forms of bile stasis in the gallbladder, there are microlites;

  2. during the formation of stones;

  3. the development of the chronic stage of the disease;

  4. complication of the disease.


Signs and symptoms of calculous cholecystitis

The presence of gall stones may have no effect on the human condition, therefore, at the initial stage of the disease is often asymptomatic, latently.

Symptoms depends onthe stage of the disease, so acute calculous cholecystitis is characterized by the following signs of biliary colic:

  • acute pain localized in the right side and radiating to the shoulder area or right scapula, caused by violations of diet, alcohol, exercise or stress;
  • nausea, vomiting gastric contents and bile;

  • increased temperature, especially for purulent inflammation;
  • a sharp drop in blood pressure;

  • the appearance of weakness and cold sweat;
  • some manifestations of jaundice with a change in color of stool: the stool contains a lot of fat and has a bleached appearance, and the urine darker than usual.

Manifestations of chronic calculous cholecystitis smoother:

  • frequently occurring dull pain in the right hypochondrium;
  • the emergence of acute pain caused by improper food, which he gradually subsides;
  • paroxysmal pain occurring 3 hours after eating greasy, salty or fried foods;
  • nausea and belching with a bitter taste;

  • violation of the rules of power can cause isolated bouts of vomiting bile.


Chronic calculous cholecystitis

Chronic stage in the development of calculous cholecystitis is characterized by presence of stones in the gall bladder, mild inflammatory process and periodic manifestations of the disease.

Chronic period can occur almost asymptomatic or Express themselves by attacks of biliary colic. When the latent form of the disease, the person experiences a feeling of heaviness on the right side of the hypochondrium. Suffering from flatulence, diarrhea, heartburn, belching, feeling bitterness in the mouth. After eating too much or fatty foods unpleasant symptoms are worse.

Hepatic colic may occur suddenly, in most cases it is preceded by a violation of diet, heavy physical labor, emotional stress transferred. The attack of colic cause spastic contractions of the gallbladder and his ways, due to irritation of the mucous stones. There is an acute pain stabbing character varying intensity,localized in the right upper quadrant and a irradiating in the right part of the shoulder, scapula and neck. The duration of the attack may vary from several minutes to a few days.

Colic may be accompanied by fever, vomiting, which does not facilitate the patient's condition. Patients are excited, the dynamics of the pulse may be slow, rapid or irregular. Blood pressure changes are insignificant. Elderly patients may develop a reflex angina.

At the time of the attack, the tongue becomes moist, may be present plaque, abdomen tense, distended, painful in the area of the right hypochondrium, epigastrium. A blood test does not reveal violations, the gallbladder and the liver is not increased, symptoms of peritoneal irritation no.

Stops a bout of colic suddenly, the patient feels relief, fatigue, and weakness.

Acute calculous cholecystitis

Under acute calculous cholecystitis understand the pronounced inflammation of the gallbladder, which contains stones.

This form of the disease frequency of occurrence ranks second in the list of acute diseases of the abdominal organs. In most cases, it is complicated related ailments.

To the development of acute calculous cholecystitis results penetrated into the gallbladder infection and also disrupted the flow of bile. Staphylococci, Pseudomonas and Escherichia coli, enterococci and other microbial flora can get in the ascending and descending tracts (from duodenum and liver, respectively), as well as lymphokine and hematogenous. To obstruction of the outflow of bile causes a blockage of stones of the cystic duct or neck of the gallbladder pathological processes in the periampullary area. In addition, the development of the acute form of the disease contribute to the caused by atherosclerosis changes in vessels of the organ, damage to the mucosa by pancreatic enzymes, triggered by pancreatobiliary reflux.

Acute calculous cholecystitis divided into three types:

  1. catarrhal;

  2. abscess;

  3. gangrenous.

All of these forms of disease are accompanied by pericholecystitis, which is characterized by local or widespread adhesions, limiting the area of infection solely the right costal margin.

The acute form of the diseaseappears sharp pain, increasing with any physical activity, nausea, repeated vomiting reflex character.

On examination revealed dryness of the tongue, slight bloating, it limited participation in the process of respiration, muscle tension and soreness in the projection of the gallbladder, have increased, hard structure. Body temperature increased, blood produces a neutrophilic leukocytosis and increased ESR.

The duration of the occurrence of the acute form of the disease can be several weeks. Gradually it goes into a chronic stage or appear complications.


Phlegmonous calculous cholecystitis

In the case when calculous cholecystitis complicated by purulent inflammation, accompanied by infiltration of the gallbladder and ulcers on his mucous, then the disease has entered the abscess stage. In this case, the body wall is greatly thickened due to the heavy suction of the inflammatory exudate. The gall bladder much enlarged and filled with pus. Mucosa is hyperemic, covered by fibrin.

The patient experiences severe pain that increases the change of position, breathing, coughing. General condition of the person worsens, the temperature rises, there nausea and repeated vomiting, the pulse reaches 120 beats per minute. The belly is slightly distended due to intestinal paresis, palpation of the right hypochondrium is painful, reveals an enlarged gall bladder. If phlegmonous calculous cholecystitis are not on time will be subjected to treatment, he can go to the gangrenous form, a dangerous probability of death.


Gangrenous calculous cholecystitis

The most dangerous stage of the disease called gangrene of the gallbladder. This form of cholecystitis is characterized by partial or total necrosis of wall of bile on, developing on the background of thrombosis of the cystic artery. The onset of gangrene is marked on the 3-4 day of illness. May occur perforation (through the violation of the integrity) of the bladder wall with subsequent leakage of bile into the peritoneal cavity and the appearance of bile peritonitis. The openings are usually localized on the neck of the gallbladder or Hartmann's pocket, in places of accumulation of stones.

Gangrenous calculous cholecystitis is more common in older people whose regenerative abilities reduced and weakened the circulation of the gallbladder.

Cause this form of disease can infection coming from adjacent connected bodies, blood and lymph.

On the form gangrenous calculous cholecystitis shows a sharp increase in temperature and the lack of complaints on well-being, usually occurring at night. Pain syndrome is pronounced, is spasmodic in nature and can take not only the right region, but spread to the entire abdomen. Pain is long and intense. The condition is complicated by nausea and vomiting, constipation or diarrhea, headaches, weakness, pallor and humidity of the skin, frequent breathing, drowsy, semiconscious state, bloating and lack of participation in the breathing process. There may be signs of jaundice.


Treatment of calculous cholecystitis

Therapy for this disease is aimed at solving the following tasks:

  • to stop an acute condition;
  • to prevent complications;
  • to eradicate the factors that contribute to the formation of new stones.

Treatment of calculous cholecystitis can be conservative and surgical methods. The first includes diet therapy, intake of painkillers and antispasmodic drugs, antibacterial, detoxication therapy and antiemetics. The second is focused on the removal of the gallbladder and stones.

In most cases, surgery is the best way to get rid of the disease, since in this case removes the very source of stone formation. Then conservative measures are used to stabilize the patient and prepare him for surgery.

There are several types of surgical treatment for calculous cholecystitis:

  • Laparoscopy. Belly done a few cuts through them are special instruments and optical instrument – the laparoscope, which transmits to the monitor image. A large opening of the peritoneum is not required, therefore, to reduce the period of postoperative recovery and appearance of the operated person does not suffer.
  • Open operative intervention. The gallbladder is removed through abdominal incision. Method is used in severe cases, in cases of infection of the gallbladder or the presence of abdominal scar adhesions after previous surgery. Postoperative period and requires longer hospital stays.
  • Tereshina cholecystostomy. The gall bladder drainage tube is introduced through a small incision in the abdomen. Apply for elderly and severe patients who have complicationsof acute cholecystitis.

When the gallbladder removal according to certain indicators, it is impossible, prescribe non-surgical crushing stone medical drugs or using extracorporeal shock wave lithotripsy (ESWL). But in the treatment of such methods there is a risk of recurrence of stones.