Cholecystitis - Causes, Symptoms and Treatment .MF .
cholecystitis - an inflammatory disease of the gallbladder.It is the most common disease of the abdominal cavity.Cholecystitis currently suffers 10-20% of the adult population, and the disease has a tendency to further increase.This is due to a sedentary lifestyle, food character (excessive consumption of food rich in animal fats - fat meat, eggs, butter), the growth of endocrine disorders (obesity, diabetes).Women suffer 4 times more often than men, this is due to oral contraceptives, pregnancy.
Among the many diseases of the biliary tract is isolated functional disorders (dyskinesias), inflammation (cholecystitis), metabolic (cholelithiasis).These states are the phases of the pathological process: first, there is a gallbladder dysmotility - dyskinesia, then joins the inflammatory process - formed acalculous cholecystitis, which eventually transformed into cholelithiasis (cholelithiasis).
causes of cholecystitis: basic and advanced.
The main causes include infectious factor.The infection penetrates
primary sources of infection can be:
- acute or chronic inflammation of the gastrointestinal tract (infectious enterocolitis - an inflammatory bowel disease, pancreatitis, appendicitis, intestinal dysbiosis),
- respiratory tract infections (sinusitis, tonsillitis), oral cavity (periodontal disease),
- inflammatory diseases of the urinary system (pyelonephritis, cystitis),
- the reproductive system (adnexitis - in women, prostatitis - men),
- viral liver disease,
- parasitic infestation of the biliary tract (giardiasis, ascariasis).
1. Biliary dyskinesia.This functional impairment of tone and motility of the biliary system (gall bladder and bile ducts).It occurs in every case of chronic cholecystitis, it leads to disruption of drainage and stagnation of bile.
2. Congenital malformations of the gallbladder.
3. Pancreatic reflux.Casting duodenal contents into the biliary tract.Pancreatic juice with enzymatic activity of the enzyme causes damage to the walls of the gallbladder.It occurs in diseases of the pancreas, the duodenum.
4. Violation of the blood supply to the gallbladder.Occurs against a background of atherosclerosis, hypertension, diabetes, lead to narrowing of the lumen of blood vessels.
5. Violation of the normal composition of bile (diskholiya).Changing the composition of gallbladder bile and the ratio of its components resulting in damage to the gallbladder wall.This is facilitated by the reception uniform, high-fat food.
6. Allergic and immunological reactions cause inflammatory changes in the gallbladder wall.
7. hereditary factor.
8. Endocrine changes (pregnancy, oral contraceptives, obesity, menstrual disorders).
Additional factors create conditions for the development of inflammation and prepare fertile ground for the introduction of microbial flora.
Symptoms of cholecystitis.
Cholecystitis is an acute and chronic.
acalculous Acute cholecystitis is rare, usually occurs without complications and ends in recovery, can sometimes become chronic.The disease most often develops in the presence of gallstones and is a complication of cholelithiasis.At the beginning of the disease there is intense paroxysmal pain in the right hypochondrium, nausea, vomiting, body temperature rises to 38-39 degrees.Maybe appear chills, jaundice of the sclera and skin, delayed stool and gas.
for acute calculous cholecystitis is characterized by severe course of the spread of inflammation to the surrounding organs and tissues.
complicated by cholecystitis, liver abscess, local or diffuse peritonitis, cholangitis (inflammation of the bile ducts), pancreatitis.In such a state should immediately consult a doctor - a surgeon, physician to decide on admission to the surgical hospital.
disease begins gradually, often in adolescence.Complaints arise under the influence of diet disorders, psycho-emotional overload.
main manifestation of the disease is a pain in the right upper quadrant.It can be shifted in the left upper quadrant, the upper half of the abdomen.Nekalkuleznogo cholecystitis is accompanied by some form of secondary dyskinesias, it often determines the nature of pain.When concomitant gipomotornoy dyskinesia pain are constant, aching, not intense.Often the pain is equivalent to a feeling of heaviness or burning sensation in the right upper quadrant.In cases of hyperkinetic dyskinesia pain intense, short-term, it is paroxysmal in nature.Pain gives to the supraclavicular fossa in the lumbar region, in the subscapular region, the area of the heart.
Holetsistokardialny syndrome - includes pain in the heart, heart attacks, cardiac dysrhythmia, is associated with infectious - toxic effect on the heart muscle.
With long-term course of the disease possible involvement in the pathological process of the solar plexus, there is a solar syndrome.Its main symptom is searing, intense pain in the umbilical region, extending to the back.
emergence and increased pain associated with errors in diet, physical activity, vibration, exposure to cold, emotional overload, alcohol.
Nausea, vomiting occurs in 30-50% of cases, it is reflexive in nature and is associated with impaired gallbladder tone or is caused by a concomitant or gastroduodenitis pancreatitis.The vomit revealed admixture of bile.Vomiting, like pain, is provoked by alcohol, errors in diet.
The feeling of bitterness in the mouth, "bitter" burp - these complaints are most common in inflammation of the gallbladder.
Itching, its appearance is associated with impaired secretion and is the result of irritation of the skin receptors bile acids accumulated in the blood.Violation of the outflow of bile leads to short-term appearance of jaundice.
Chills, fever observed during exacerbation of the inflammatory process in the gall bladder.
Patients often suffer severe vascular dystonia.Painful attacks they are accompanied by neurotic syndromes, such as weakness, sweating, palpitations, headache, emotional lability (mood instability), sleep disturbance.
Patients with allergies, exacerbation of chronic cholecystitis may cause allergic reactions (urticaria, angioedema).
Women may develop premenstrual tension syndrome.For 2-10 days before menstruation headaches, pasty face, hands, feet, mood instability.At the same time observed symptoms of exacerbation of chronic cholecystitis.
Manifestations of chronic cholecystitis are diverse, they are made up of various features, to establish an accurate diagnosis and prescribe the necessary range of surveys can doctor - internist, a gastroenterologist.
diagnosis of cholecystitis.
1. Complete blood count.Identify signs of inflammation.
2. Biochemical analysis of blood: total bilirubin and its fractions, transaminases, alkaline phosphatase, cholesterol.There has been a moderate increase in their.
3. Blood Sugar.For the diagnosis of diabetes.
4. Urinalysis.For the differential diagnosis with kidney disease.
5. Feces on eggs of worms.To detect giardia, askorid.
6. microscopic and bacteriological examination of bile.
7. immunofermentative blood test to giardiasis.
8. Fecal elastase 1. For the diagnosis of pancreatitis.
1. Ultrasonography of the abdomen.Identifies thickened gallbladder wall (thickening over 4 mm - is the main diagnostic criterion cholecystitis), bile stasis and zguschenie - "sludge", the presence of gallstones, gallbladder deformation.
2. ultrasound with choleretic breakfast - to identify gallbladder dyskinesia.
3. multifractional duodenal intubation (performed only in the absence of gallstones) with microscopy and culture of bile.Register duodenal contents is performed every 10 minutes and allows you to set the type of secretion (hypersecretion, irregular, giposekretorny), the state of the sphincter of biliary tract, determines the nature of the contractility of the gall bladder, the presence of inflammatory cells and bacterial flora.
4. X-ray examination of the abdominal cavity (to detect radiopaque stones).
5. FEGDS - fibroezofagogastroduodenoskopiya.
6. ECG.For the differential diagnosis of diseases of the cardiovascular system.
7. Computed tomography and magnetic resonance imaging.Perform in difficult to diagnose cases.
Consultations of experts:
mandatory inspection of the therapist, and a gastroenterologist.
According to the testimony:
- surgeon for suspected complications (pericholecystitis, cholelithiasis, gallbladder empyema, pancreatitis);
- cardiologist, to exclude a pathology of the cardiovascular system;
- gynecologist, if necessary, correction of hormonal background in women;
- psychotherapist, conducting a rational therapy.
Treatment of cholecystitis.
1. In the presence of clinical symptoms and laboratory signs of inflammation, the positive results of bile sowing - appointed antibacterial treatment.The choice of antibiotics carries the doctor evaluating his ability to concentrate in the bile.
2. Symptomatic therapy.
To normalize the function of the biliary tract, and pain-designate:
- anticholinergic agents (Riabal 2ml / m or 1-2 tablets 3 times a day), myotropic antispasmodics (Nospanum 2 tablets 3 times a day, papaverine 2ml 2% solution / m 2-3 times daily, 1-2 mebeverin tablets 3 times a day), anticholinergics (platifillin) analgetics (analgin, Baralginum).
3. Where there is evidence of hypotension and gallbladder without stones appoint:
- cholagogue preparations.Apply allohol (1-2 tablets 3 times a day after meals), holenzim (2 tablets 3 times a day after meals), phytotherapy.
widely used recipes of traditional medicine - herbal therapy.
Immortelle - 15g of flowers, St. John's wort grass 10g, the mixture is poured 0.5 liters of water, boil 5 minutes, filter.Take 0,5 cup 3 times a day for 15 minutes before eating.
Corn silk - 10 g pour 200 ml of water, boil for 5 minutes, take ¼ cup 3 times a day before meals.
Tansy - 5g flowers insist in 250 ml of boiling water for 30 minutes, take 1 tablespoon 3 times a day before meals.
peppermint leaves 5g pour 200 ml boiling water and put in a water bath for 15 minutes.Take ½ cup 3 times a day before meals.
Rosehip.Syrup of condensed water extract of rose hips and sugar - holosas, take 2 teaspoons 3 times daily before meals.Infusion of rose hips - 10g chopped fruit pour 400 ml of boiling water and kept in a water bath for 15 minutes, insist.Take ½ cup 3 times a day before meals.This
drugs increases bile secretion, reduce its viscosity, possess anti-inflammatory action.Assign remission (non-acute) for 2-4 weeks.
The same effect have and mineral water.Depending on the composition they can have a stimulating effect on the contractile function of the gallbladder.Mineral water without gas by a physician taking 3 times a day for 1 glass 30 min - 1.5 hours before the food (depending on the state of the gastric secretion) in warm or hot (40 - 50 degrees);
- blind intubation - tyubazh, 1 time per week, 3-5 times.
is carried out in the morning on an empty stomach.Slowly (small sips) should drink 150 -200 ml of warm (40-45 ° C) mineral water with the addition of 20-25g of sorbitol or xylitol.Lie down on the right side, on the back in an hour.Under the right side is placed a warm heating pad.After emptying the bowel it is recommended to take a shower and relax for 20 minutes.The first meal after 1-1,5 hours after the procedure.It's a cup of tea with honey, cheese.
4. microlites in the presence of bile, gallbladder hypotension, cholestatic syndrome medications used bile acid (ursodeoxycholic acid) for 1 to 3 months, under the supervision of a physician.
5. With a view to the normalization of biliary liver functions prescribed gepatoprotektory with choleretic properties.Hofitol - gepatoprotektor vegetable origin, containing a dry aqueous extract of the juice of the leaves artishka field.Take 2 tablets 3 times a day 20 minutes before meals for a month.Gepabene - combined herbal drug containing the extract of Fumaria officinalis and dry fruit extract of milk thistle.Take 1 capsule 3 times daily after meals.
6. When vascular dystonia recommend sedatives (valerian, motherwort), anxiolytics (adaptol 500mg 3 times a day for 2 months).
mode and clinical nutrition.
Between expressed acute cholecystitis patients to recommended treatment in a hospital - or therapeutic gastroenterology, compliance with bed rest, a state of mental and emotional rest.After the elimination of overt signs of exacerbation of the patient mode is extended to the general.
During an exacerbation, the first two days, appointed only receive a warm liquid (rather weak sweet tea, juices from fruits and vegetables, diluted with water, mineral water without gas) in small portions to 1.5 liters per day, and a few crackers.By expanding dietary table stihaniya pain and improve the general condition.Recommend:
- pureed soups, vegetables and cereals,
- porridge (oatmeal, rice, semolina, buckwheat),
- jelly, mousse, jelly, low-fat cottage cheese,
- lean boiled fish,
- rubbed and boiled meat, steamburgers (beef, chicken, turkey, rabbit),
- white crackers.
fractional portions of food taken 5-6 times a day.
During an exacerbation is recommended to arrange fasting days, 1 day a week:
- curd - Kefir day.900g yogurt 6 reception, 300g low fat cottage cheese for 3 doses and 100 g of sugar;
- rice - kompotnyy.1,5 l compote made from 1.5 kg of fresh or dried fruits 240g 6 receptions, rice porridge, boiled in water 50 g of rice - 3 admission.
assigned diet, table number 5, which is the main in this disease after cupping acute cholecystitis.
Patients should be advised:
- soups dairy, fruit, vegetable broth on to cereals, noodles;
- boiled meat, steam cutlets, meatballs (beef, rabbit, chicken, turkey);
- lean sea or river fish in boiled or baked form, without cover;
- eggs, 1-2 per day - boiled, in the form of steam omelettes;
- dairy products: low-fat milk, cottage cheese, kefir, yogurt, buttermilk, butter (limited);
- vegetables in boiled, baked form, partially - raw.Potatoes, beets, carrots, tomatoes, cucumbers, pumpkins, peppers, eggplant, cauliflower, zucchini;
- fruits and berries.Pears, melons, bananas, peaches, apricots, watermelon, sour apple varieties;
- cereals - buckwheat, oat, rice, semolina, with the addition of milk, the tolerance;
- sweet food - candy, marmalade, honey, jams, preserves, jellies;
- flour products - wheat and rye bread, yesterday, crumbs of white bread, dry biscuits nesdobnoe.
Eating is necessary in small portions, slowly 5-6 times a day.Not recommended for long breaks between meals, fasting.Breakfast is optional, dinner for 2 to 3 hours before bedtime, scant.The amount of liquid is not restricted.Copious amounts of food taken once, breaks the rhythm of secretion of bile, causing spasm of the gall bladder and provoke pain.
In chronic cholecystitis need to increase the use of products that improve the flow of bile and cholesterol-lowering:
- rich in fiber (bran, vegetables, fruits, berries).Bran pre-steamed and added to dishes for 1-1.5 tbsp 3 times a day;
- rich in magnesium salts (buckwheat and oat cereals, dried fruits, bran);