- reasons cholecystitis
- Classification cholecystitis
- Symptoms of cholecystitis
- Complications of cholecystitis
- Diagnostics cholecystitis
- treatment cholecystitis
- Conservative treatment
- Surgical treatment of cholecystitis
cholecystitis called inflammatory disease,which affects the gallbladder wall changes the biochemical and physical properties of bile.
With this condition often encountered and surgeons (with acute cholecystitis) and therapists (chronic cholecystitis).In recent decades, medical statistics mark a strong tendency to an increase in the incidence of this disease.
inflammation in the gallbladder can occur for a variety of reasons.The main ones are:
- stone formation, permanently damage the mucosa and can interfere with normal zhelcheottoku;
- Diet (abuse of fatty, high-calorie and fried foods, strong drinks, erratic power supply);
- psychoemotional overstrain;
- family history;
- abnormal (often congenital) form of the gallbladder (various
constrictions, curves, partitions predispose to zhelcheottoka violations);
- hormonal imbalance and hormonal agents (including hormonal contraceptives, drugs used during IVF);
- allergy (eg, food);
- immune disorders;
- drugs (cyclosporine contribute to stone formation, clofibrate, octreotide);
- dramatic weight loss;
- infectious agents (bacteria, parasites, viruses) that can penetrate into the gallbladder of the existing body dormant foci of chronic infection.
Infectious factors fall into the gallbladder and ducts together with the lymph (lymphogenous path), blood (hematogenous route) and the duodenum (the upward path).
which arises in the gallbladder inflammation can affect the functions of the body, but may violate both the concentration and motor function (up to completely non-functional, or "disabled" bladder).
Adrift cholecystitis is divided into:
both acute and chronic cholecystitis may be:
- calculous (ie, associated with the formation of stones in the bladder, its share is 80%);
- acalculous (up 20%).
In young patients, usually found cholecystitis without stones, but since the age of 30 the frequency of verification calculous cholecystitis is increasing rapidly.
During the acute stage of chronic cholecystitis interspersed with remission (subsided and the clinical and laboratory manifestations of the activity).
Symptoms of cholecystitis
A small percentage of patients with cholecystitis may be asymptomatic (his chronic version), they have no clear complaint, so often the diagnosis is verified randomly in the survey.
Still, in most cases the disease has a bright clinical manifestations.They often manifest after some dietary errors (feast, eating fried foods, alcohol), psycho-emotional voltage, bumpy ride, or excessive exercise.
All signs of cholecystitis can be grouped into the following syndromes:
- pain (dull or sharp pain, localized, usually in the right upper quadrant, but sometimes it occurs in the epigastric region, and in the left upper quadrant, can be given in the right shoulder,neck, under the shoulder blade);
- dyspepsia (bloating, bitter taste in the mouth, nausea, vomiting, various disorders of the chair, feeling of heaviness in the upper right abdomen, fat intolerance);
- intoxication (weakness, rise in temperature, loss of appetite, muscle aches, etc.);
- syndrome, vegetative disorders (headaches, sweats, premenstrual tension, etc.).
patients can be observed not all listed symptoms.Their severity varies from barely noticeable (at low intensity chronic course) to almost unbearable (for example, in the case of biliary colic - a sudden attack of intense pain).
Complications of cholecystitis
Have any of cholecystitis is always fraught with possible development of complications.Some of them are very dangerous and require immediate surgical intervention.So, as a result of cholecystitis patients may experience:
- gallbladder empyema (purulent inflammation of it);
- wall necrosis (death) of the gallbladder due to inflammation and pressure on her stones (stone);
- wall perforation (forming holes in it) as a result of necrosis, it is in the patient's abdominal cavity as a result of its contents and leads to inflammation of the peritoneum (peritonitis);
- formation of fistula between the bladder and bowel, bladder and renal pelvis, bladder and stomach (the result of necrotic changes zhelchnopuzyrnoy wall;
- «Disabled" (broken) the gallbladder;
- pericholecystitis (transition of inflammation in the near located tissues and organs);
- cholangitis (inflammation spread to the intra- and extrahepatic bile ducts of different caliber);
- blockage of bile ducts;
- «porcelain» gall bladder (deposits result in the bladder wall of calcium salts);
- secondary biliary cirrhosis (a consequence of long-calculous cholecystitis);
- gallbladder cancer
After listening to the complaints of the patient described above, any doctor must examine it, paying attention to the color of the skin, sclera, frenum (they may be icteric)..When probing the abdomen of a possible cholecystitis show tenderness, detectable in the right upper quadrant and in particular bitterly-cystic spots and local muscle tension over this area.These patients often present with pain by gently tapping the right costal arch and the right hypochondrium.
further examined patient is usually sent to a precise definition of the diagnosis.Identify help cholecystitis following diagnostic methods:
- hemogram (when disease activity revealed signs of inflammation: leukocytosis, thrombocytosis, ESR acceleration);
- biochemical blood tests (an exacerbation of cholestasis markers can be detected - the rise of the alkaline phosphatase, bilirubin, gamma-glutamyl, increased acute phase inflammatory protein - CRP, haptoglobin, and others.);
- urine (after an attack bile pigments may be present in it);
- ultrasonography (research estimates the amount of the gall bladder, the presence of a strain, stones, tumors, uniformity of bile, a condition of its walls and the tissues around it, stratify acute cholecystitis wall, there is their "double loop", and in chronic thickening, sometimesspecification of functional disorders of this study complement sample with choleretic breakfast);
- MRI / CT (diagnostic capabilities beskontrastnyh observational studies are similar to ultrasonography, more informative different MRI cholangiography, which analyzes the condition and patency of the ducts, eliminating the complications of the cholecystitis);
- endoscopic ultrasonography (method combines fibrogastroduodenoscopy and ultrasonography as a diagnostic probe is placed on the endoscope, it is better to visualize the state of the bile duct);
- duodenal intubation (the method of indirect evidence of cholecystitis, if the cystic portion of the collected bile is turbid with flakes, parasites are present);
- crop of bile (identifies pathogens, said their views and sensitivity to various antibacterial medicines);
- sightseeing abdominal radiography (simple research can confirm the perforation of the inflamed gallbladder, its calcification, discover some stones);
- cholecystography - X-ray contrast method, in contrast it is administered directly into a vein or by mouth (detects stones, "disconnected" bubble, functional disorders, but also after the widespread introduction of ultrasound in routine practice is rarely used);
- retrograde cholangiopancreatography (allows you to set a complication - blockage of the duct system, and even to remove some stones);
- holestsintigrafiya technetium (radioisotope technique is indicated for verification of acute cholecystitis and exclusion of "disabled" bladder);
- gepatoholetsistografiya (Radioisotope diagnostic procedure to clarify the type of functional disorders);
- stool microscopy for the detection of eggs or worms fragments lamblia cysts;
- immunoassays (ELISA) and molecular genetic tests (PCR) for the detection of parasites.
Medical tactics determined by the shape of cholecystitis, its stage and severity.The acute form of the disease is treated only in a hospital.In chronic cases without hospitalization can cost patients with mild and uncomplicated forms without intense pain.
Therapeutic measures can be conservative and radical (surgery).
Basically it is used in chronic cases of the disease.Possible non-surgical methods include:
- drug therapy;
- extracorporeal lithotripsy (shockwave).
Dining patients in the acute phase of the process is sure to be gentle and fractional.In particularly serious cases, sometimes even resorting to a pair of "hungry" days, during which only allowed the use of liquids (rather weak warm tea, rose hips broth, diluted fruit juice or berries, etc..).Further, all foods are boiled or cooked with the help of a double boiler, then wipe.Quenching and bake until remission is prohibited.From supply removes all fatty dishes and products (milk, pork, goose, lamb, duck, red fish, bacon, pastry creams, etc.), Smoked, canned food, hot spices, sweets, cocoa and caffeinated beverages, chocolate, egg yolks, baking.Welcome mucous soups, pureed oatmeal, vegetables, fish, meat or cereals souffles, puddings, dumplings, steam cutlets, jelly, mousse, protein omelets.Allowed butter (as a protector of the mucous source - vitamin A) and vegetable oils (soybean, corn, vegetable, cottonseed, olive, etc.).All drinks and food should be fed to the patient warm, as cold can cause excruciating pain attack.
After the onset of the long-awaited remission allow baking and stewing, products are no longer cleaned, include in the diet of fresh berries, herbs, vegetables and fruits.In order to improve the composition of bile and reduce its ability to stone formation shown dietary fiber.She has rich cereals (buckwheat, oats, barley and others.), Kelp, bran, vegetables, seaweed, fruit.
Drug treatment cholecystitis
During acute cholecystitis any sick recommended:
- antibiotics that penetrate into the bile in sufficient concentrations to destroy infections (doxycycline, ciprofloxacin, erythromycin, oxacillin, rifampicin, Zinnat, lincomycin, and others.);
- antibacterials (Biseptol, nevigramon, furazolidone, nitroksolin et al.);
- antiparasitic drugs (depending on the nature of the parasite appoint - Makmiror, metronidazole, tiberal, nemozol, biltricid, Vermoxum et al.);
- detoxification means (Ringer's solution, glucose, reamberin etc .;
- narcotic analgesics (baralgin, spazgan, Trigan D, take, etc.);.
- antispasmodics (papaverine, Halidorum, mebeverin, no-spa, Buscopan, etc...)
- perirenal novocaine blockade (with intolerable pain if they are not removed by other medicines);
- means to stabilize the autonomic nervous system (elenium, motherwort, eglonil, imipramine, benzogeksony, etc.);.
- antiemetic medications (domperidone, metoclopramide, etc.);.
- immunomodulators (imunofan, polyoxidonium sodium nukleinat, likopid, Timoptin etc.)
After arresting inflammation in the case of calculous cholecystitis some patients try to dissolve the stones with the help of medication for this doctor prescribed them...funds with chenodeoxycholic or ursodeoxycholic acid (Ursofalk, Henofalk, urdoksa, ursosan et al.).It is better not to take the drugs themselves, since they can be effective only 20% of patients.To receive them, there are some clear indications that can identify qualified personnel only.For each patient the optimal drug dose is determined individually.They must be taken for a long time (about a year) and regularly.Treatment is carried out under medical supervision and laboratory (periodically need to determine blood biochemical parameters, perform ultrasound).Self-medication is fraught with the development of pancreatitis (inflammation of the pancreas), obstruction of the biliary tract, severe pain, severe diarrhea.
In the remission phase acalculous cholecystitis patients can start the course cholagogue drugs.But for this it is advisable to have information about the type of functional disorders.Arsenal advanced choleretic extremely rich.Patients are recommended hofitol, Odeston, oksafenamid, tykveol, holenzim, Nicodin, gepatofalk, milk thistle, tansy, dymyanki, barberry, besssmertnik, galstena, holagogum, magnesium salt, xylitol, and others. If you have confirmed the stones in any fragment of biliary (bile ducts orgallbladder) bile dangerous.
Extracorporeal lithotripsy (shockwave)
Stones are destroyed in special plants to generate shock waves.The technique is only possible if the composition of cholesterol stones and preserved contractility of the bladder.Often it is combined with the drug litholytic (drugs heno- and UDCA) therapy, which is needed to remove stone fragments formed as a result of extracorporeal lithotripsy.In the Russian Federation, this technique is used very often.
Surgical treatment of cholecystitis
With the ineffectiveness of these conservative methods, not functional bubble, a serious acute illness, persistent exacerbations, frequent biliary colic, the appearance of complications treatment may only be operational.Surgeons perform the removal of the affected inflammation of the gallbladder (cholecystectomy).Depending on the access method of and cholecystectomy is:
- with traditional abdominal incision and wide public access (preferable in complicated, but more traumatic, long after the patients recovered more postoperative problems compared with the following two types);
- laparoscopic (considered advantageous embodiment, access to the bladder is provided by several punctures through them introduce the necessary instruments and a video camera, it is easier to bear, patients are better rehabilitated before discharged from the clinic);
miniholetsistektomiya (characterized by minimal access, whose length is not more than 5 centimeters, is an intermediate way, because there are elements of the "open" technique).