What does the diagnosis of chronic calculous cholecystitis. Acute manifestation of pathology

Date: 04.04.2019

A favorable prognosis for this disease is possible only if the patient is adequately and promptly treated. As a result of complex therapy, the patient fully restores his ability to work. The maximum danger in cholecystitis is a complication, sometimes leading to rupture of the gallbladder.

What is chronic cholecystitis

The calculous form of the disease is inflammation in the gallbladder area, which occurs due to the deposition of stones in it. Dense masses consist of impurities of calcium, cholesterol, dye bile. Gall bladder calculi cause problems with the flow of bile and impair the blood supply to the walls of the organ, as a result of which numerous substances that trigger the inflammatory process begin to come out. Over time, this pathological process is complemented by the reproduction of bacteria.

severe cholecystitis;
moderate calculous cholecystitis;
mild form of cholecystitis.

Why does calculous cholecystitis develop?

The main reason for the development of inflammation of the gallbladder is the formation of calculus in the organ lumen. Stones arise as a result of changes in the level of bile, as a result of which cholesterol crystallizes and causes stagnation of secretions. Concretions with a high degree of probability can be formed due to a violation of the outflow of bile (stagnation of this substance): this leads to the fact that the walls of the gallbladder begin to inflame. Stones in the organ are caused by:

excessive consumption of carbohydrates, fats;
avitaminosis;
long-term adherence to strict diets;
passive lifestyle;
acute viral hepatitis;
helminthiasis;
pancreatitis;
crohn's disease;
chronic gastritis;
cholecystopancreatitis;
cirrhosis of the liver;
biliary dyskinesia;
endocrine disorders, which contributes to diabetes, treatment with hormonal drugs, obesity, menopause, etc .;
hereditary predisposition.

Signs of

With a calm course of chronic calculous disease, the symptoms are mild. Patients with cholecystitis usually complain of:

A nagging pain in the peritoneum. The symptom is localized in the right hypochondrium, while it may be permanent or occur 1-3 hours after ingestion of fatty, fried foods.
Pain in the upper torso. Patients feel pain near the right shoulder blade, neck, right shoulder. Sometimes there may be a sharp pain, as during an attack of biliary colic, but this symptom quickly passes.
Nausea, insomnia, irritability.

To confirm the diagnosis, the doctor performs an ultrasound scan, which is the main method of examination of patients with suspected inflammation of the bile organ. Echo signs:

decrease / increase of the bubble;
thickening of the walls of the body more than 3 mm;
deformation of the external and / or internal contours of the gallbladder;
the presence of heterogeneous fixed or free-floating inclusions;
three-layer wall (typical for pronounced exacerbation of chronic calculous cholecystitis).

Aggravation

During the acute phase of calculous disease, the patient has additional symptoms. Signs of this are:

dizziness;
acute pain near the liver, extending to the sternum, shoulder, or shoulder blade;
weakness;
a slight increase in body temperature;
vomiting, severe nausea;
spasms of the peritoneum;
bloating;
constipation or intestinal disorders.

How to treat chronic cholecystitis

The doctor chooses the treatment based on the form and severity of the pathology. Acute calculous cholecystitis requires inpatient therapy, while self-medication at home is unacceptable and very dangerous. Conservative treatment includes taking certain types of drugs: the patient simultaneously drinks antispasmodics, choleretic, detoxification, and antiemetic drugs. When the patient's condition is stabilized, cholecystectomy is prescribed or laparoscopic surgery (the doctor can only remove stones or the entire gallbladder).

Is gallstone disease treated with folk remedies?

It is impossible to cure chronic calculous cholecystitis, but folk remedies can help reduce the intensity of symptoms. For this purpose, using various herbs that have a choleretic effect. They are used to prepare decoctions and infusions that help relieve inflammation from the gallbladder and eliminate the congestive processes that occur in it. The following recipes of folk remedies are recommended periodically used to prevent the exacerbation of chronic cholecystitis in order to avoid removal of the organ.

Decoction of immortelle flowers. Pour boiling water (80 ml) dry flowers (15 g), hold the liquid in a water bath for no longer than half an hour. When the decoction of chronic cholecystitis cools, take it twice a day before meals, 2 tbsp. l
Infusion of lingonberry leaves from calculous cholecystitis. Pour 3 tbsp. l raw materials in a thermos, pour barely boiling water (1 l) and wait 8-10 hours. After that, you can start taking the national medicine, it is recommended to drink the infusion as a tea throughout the day, and prepare a fresh batch the next day.

How to treat chronic cholecystitis

Drug treatment helps to temporarily eliminate the symptoms of cholecystitis, and chronic pathology can be completely cured only in the surgery department by removing the gallbladder (a laser, a method of chemical litolysis, laparoscopy, abdominal surgery, etc.) can be used for this purpose. Conservative treatment involves taking the following medications:

Antibiotics. If the patient has fever and leukocytosis, the doctor prescribes a 7-10-day course of antibiotic therapy, while taking macrolides (Azithromycin), penicillins (Amoxicillin), cephalosporins and gentamicin (the last two are put intramuscularly in a hospital). In addition, in the presence of Giardia, furazolidone or metronidazole is used. If a patient with a calculous type of cholecystitis manifests inflammatory symptoms, a wide-spectrum pill is prescribed.
Choleretic. These drugs stimulate the formation of bile, the lack of which leads to disruption of the digestive process. Such remedies prevent the formation of stones, dilute the bile masses, and are used, as a rule, during the exacerbation of calculous chronic cholecystitis, when the ducts of the bladder are blocked. The doctor can prescribe the patient Odeston, Tsikvalon, Oxafenamid and other choleretics with antispasmodic effect.
Antispasmodics. To relieve unpleasant symptoms (spasms, colic), such drugs as No-shpa, Platyfillin, Atropine, Drotaverin, Duspatalin, etc. are prescribed. However, conventional painkillers like Ibuprofen or Aspirin with cholecystitis do not give the expected effect.
Cholekinetics. Clear the gallbladder from accumulated excess bile. To this end, take drugs Lutkens, Oddi, vegetable oils, magnesium sulfate, synthetic hormones (Choleritin, Pituitrin, Cholecystokinin).
Enzymes with bile. If a patient with cholecystitis has a concomitant pancreatitis, the doctor prescribes Cholensim or Festal to improve digestion.
Drugs that contribute to the dissolution of stones. During the period of subsiding inflammatory process, the administration of Litofalk, Urosan, and Henofalk can be indicated.
Complexes of vitamins. For the treatment of chronic calculous cholecystitis, the administration of vitamins B and C is recommended.

Exacerbation diet

The main requirement of a therapeutic diet is fragmentation (the patient should eat 5-6 times a day, making short pauses). Servings for calculous cholecystitis should be small, and nutrition useful and balanced. Evening meals are excluded altogether. Protein, carbohydrate and fat-containing foods should be consumed in accordance with the requirements of the diet. Thus, the menu reduces the amount of animal fats (during exacerbations, they are completely eliminated), they are compensated by vegetable oils, which are better split by bile and improve the cellular metabolism of the liver.

Thanks to vegetable fats, bile mass production is increased and the risk of stone formation is reduced. During a diet in chronic cholecystitis of the calculous type, it is recommended to include such foods in the diet:

lean meat (poultry, except duck, rabbit, beef), fish;

Calculous cholecystitis - inflammation of the gallbladder wall, accompanied by the formation of biliary calculi. This disease is more common in women. Endocrine diseases, menopausal syndrome, low physical activity, unhealthy diet and others can be contributing factors.

In the pathogenesis of stone cholecystitis, there are three fundamental links:

slowing the flow of bile from the biliary tract,
violation of the rheological and physico-chemical properties of bile;
damage to the wall of the body.

On the one hand, chronic cholecystitis in itself contributes to the formation of biliary concretions. On the other hand, inflammation may develop against the background of an already existing gallstone disease (GI). Consider the main signs of calculous cholecystitis and methods of treating the disease.

Symptoms of stone cholecystitis

Exacerbation of the disease can provoke the use of fatty and spicy foods, alcohol, hypothermia, excessive exercise, and sometimes it occurs for no apparent reason. As with other types of inflammation of the gallbladder, for chronic calculous cholecystitis, the main symptom is abdominal pain. It usually has a dull, pulling or aching character and in most cases is localized in the area of the right hypochondrium. 20-30% of patients suffer from pain in the epigastric zone or pain syndrome has no clear localization.

Irradiation of pain in the right lumbar region, shoulder, under the scapula and the lateral surface of the neck to the right is characteristic. A distinctive feature of calculous cholecystitis is the occurrence of so-called biliary colic. This condition is characterized by a sudden acute cramping pain beneath the right edge. Stone cholecystitis often proceeds latently, and hepatic colic becomes its first sign.

Biliary colic occurs as a result of blockage of the bile duct by calculus

In general, the inflammation of the bladder on the background of the GCB has a greater variety of clinical manifestations than the boneless form of the disease. So, for calculous cholecystitis symptoms of jaundice and intoxication of the body with bile acids are characteristic. Skin, sclera, mucous membranes become yellowish. Patients often complain of itchy skin, and when viewed on the skin you can see traces of scratching. With a significant violation of the outflow of bile, the urine becomes dark, and the stool, on the contrary, becomes discolored. The manifestations of biliary intoxication include:

low blood pressure
heart rate reduction
irritability, frequent mood swings,
headache,
sleep disturbances (during the daytime the sick are drowsy, and at night they are tormented by insomnia).

As a result of inadequate supply of bile to the duodenum, the process of digestion is disturbed, which is manifested by dyspeptic symptoms:

unstable chair;
nausea;
belching;
metallic or bitter aftertaste, dry mouth.

When the gallbladder dramatically emptied, possible heartburn, vomiting bile. More information about the manifestations and prevention of the disease can be found in the video at the end of the article.

Complications of stone cholecystitis

Among the complications of calculous cholecystitis, the most significant are:

choledocholithiasis (congestion of the common bile duct);
stenosis of the Vater papilla;
or pancreatitis;
reactive cholangitis, hepatitis;
subphrenic abscess;
empyema and perforation of the gallbladder;

Important: to avoid serious complications, you must consult a doctor at the first signs of inflammation.

Treatment of calculous cholecystitis

With a diagnosis of chronic calculous cholecystitis, treatment can be both conservative and surgical. The choice of method depends on the severity of symptoms, frequency of exacerbations, composition, size and number of stones, as well as the presence of complications.

Conservative treatment

Non-surgical treatment includes:

compliance,
medications.

You can eat stewed and boiled vegetables, cereals, lean birds (chicken), beef, egg whites. Do not drink alcohol, soda. In general, the amount of fluid consumed per day should be at least one and a half liters, otherwise thick bile will stagnate. One of the main principles of nutrition is fragmentation: you need to eat at least 5-6 times a day, but do not overeat.

Of the drugs, the doctor may prescribe antispasmodics, hepatoprotectors, herbal remedies, enzymes, antibiotics (if the infection has joined). With calculous cholecystitis, treatment without surgery is possible if the stones are small (up to 15 mm) and consist of cholesterol. To dissolve them use preparations of bile acids. Another important condition for conservative treatment is the normal motor activity of the gallbladder. If these nuances are not taken into account, the litholytic therapy may worsen the patient's condition and even lead to complications.

Important: in cholecystitis on the background of cholelithiasis, any choleretic drugs are contraindicated, since they can cause bladder blockage and the development of dangerous complications.

Surgical treatment methods

Quite often, patients with calculous cholecystitis are treated by surgery. The essence of the operation usually consists in cholecystectomy - the removal of the gallbladder, along with the stones in it. Depending on the clinical situation, access may be laparoscopic and laparotomic. Most often, laparoscopy is performed as a less traumatic method of intervention.

If complications of gastrointestinal disease or chronic calculous cholecystitis occur, open laparotomy is used. The opening of the abdominal cavity is also shown with a sharp deformation of the bladder, the presence of adhesions with surrounding organs. These operations are performed under general anesthesia.

There are also minimally invasive interventions, which consist in grinding the stones and their subsequent removal. Stones are destroyed by directed ultrasound, laser, or with the help of a special loop.

Diet after cholecystectomy

Patients undergoing surgery for calculous cholecystitis are given a diet after surgery. In the absence of the gallbladder, which serves as a physiological reservoir, frequent unloading of the biliary tract is necessary. Therefore, the patient throughout his later life is obliged to observe a fractional diet. Otherwise, stones may form again in the bubble cult or in the moves themselves. Meals should be at least 5-6 times a day.

After cholecystectomy, there is a shortage of bile acids responsible for the digestion of fats. Therefore, from the menu it is necessary to exclude lard, mutton and beef tallow. Consumption of fatty dairy products and butter should be limited. To compensate for the lack of lipids in the diet include more vegetable oil. They can be filled with cereals, salads, vegetable purees.

Calculous cholecystitis is a form of a chronic process in which various calculi (stones) are present in the gallbladder. Their number and size may vary. Sometimes it is one large enough stone whose diameter can reach 5-6 cm or more, and maybe a lot of very small stones with a diameter of a fraction of a millimeter, in other words, sand. Calculous cholecystitis - what is it? This will be discussed in this article.

According to statistics, 10% of the adult population suffers from GIB. Chronic calculous cholecystitis in women is disturbed five times more often than men. The age category of patients is from 40 years and older. Children and young people under 30 years old are rarely worried about this disease.

Gallstones. What is the danger?

It is the size of gallstones that determines the symptoms, the severity of the course, the clinical picture of the disease and possible complications (JCB). Chronic calculous cholecystitis is dangerous for its complications.

In most cases (75%), the stones are located in the body of the gallbladder, but sometimes small stones can get into the bile duct, thereby making it difficult or completely blocking it and causing bouts of gallstone colic.

If stones up to 3 mm in size are able to exit independently through ducts, stones ranging in size from 3 to 7 mm can obturiate (block) the bile duct when leaving the gallbladder, and this complication will require urgent surgical assistance.

The composition of gallstones also varies. They can be:

cholesterol - stones of this kind are not visible during radiography;
calcareous;
pigment;
mixed

Most often there are mixed types of gallstones, their shape is very diverse (rounded, multi-faceted or even branchy).

Causes of the problem

Calculous cholecystitis (JCB) is not formed immediately. Consider the factors that contribute to the formation of calculi in the gallbladder:

cholestasis, or stagnation of bile, for example, may be when the body of the gallbladder bends;
dyscholium, or a modified composition of bile, its thickening due to elevated cholesterol or impaired secretion;
cholecystitis, or inflammation in the gallbladder.

In addition, a calculous cholecystitis diet, more precisely, systematic eating disorders (too high-calorie, fatty and cholesterol-rich food, lack of vitamins in the diet) is capable of provoking. Systematic fasting and low-calorie diets, and even long-term use of contraceptive hormonal drugs can also lead to gallstones.

Among the diseases that often become the impetus for the formation of gallstones are known:

obesity and metabolic disorders;
endocrine diseases, such as diabetes;
liver diseases, such as hepatitis and cirrhosis;
biliary dyskinesia;
pancreatitis;
duodenitis;
crohn's disease;
chronic gastritis;
helminthiasis.

Pathogenesis of gallstones

The composition of bile includes acids, lipids, pigments and minerals. Normally, all these components are in a colloidal (dispersed) state. At the adverse factors listed above, the level of cholesterol coefficient of bile is violated, that is, the ratio of its acid concentration to cholesterol content. This contributes to the loss of cholesterol in the sediment and its subsequent crystallization. This is the formation of stones in the gallbladder.

Classification

Calculous cholecystitis - what is it? The clinical course of gallstones can be acute or chronic. Depending on the symptoms, there is typical, esophagalgic, cardiological, intestinal, and atypical calculous cholecystitis. Symptoms and treatment may vary depending on the course of the disease.

There are four stages of JCB in accordance with ultrasound examination:

Pre-stone, or initial - its characteristic are the presence of thick bile, biliary stasis and the formation of microliths (sand) in the gallbladder. This stage of the disease with the correct choice of treatment and the normalization of nutrition in most cases is reversible.
Concretion - with ultrasound, one or more small stones are found.
Chronic calculous cholecystitis - this stage of the disease involves the presence of stones of various sizes in the gallbladder. It can be as one large stone, and the formation of a small diameter or several small ones.
Complicated calculous cholecystitis - this stage of the disease is characterized by the development of various complications, such as obstruction of the bile ducts.

Diagnostics

Ultrasound is the main method of diagnostic examination for the diagnosis of calculous cholecystitis. What it is, the presentation has already taken shape. Using an ultrasound, the specialist will determine the number and size of the stones in the gallbladder, and their location, as well as the condition of the bladder walls.

Endoscopic retrograde cholangiopancreatography (ERCP) is also referred to as instrumental examination methods for calculous cholecystitis. This method allows you to examine the condition of the biliary tract and determine the degree of obstruction, which will help the specialist to choose the desired tactics of the operation. The method boils down to filling the biliary tract with an X-ray contrast agent during FGDS, followed by an x-ray examination.

In addition to these instrumental methods of examination used laboratory, such as general analysis and biochemical blood tests. With the first in this disease, you can see increased ESR in the event of an inflammatory process in the gallbladder, as well as an increase in neutrophils in the leukocyte analysis formula.

Biochemical analysis of blood in this disease is reduced to determining the level of the following:

ALT and AST;
bilirubin;
alkaline phosphatase;
total protein;

These indicators will be increased in the case of (cholestasis). Such a development of the disease is possible with obstruction with a calculus of any of the bile ducts.

There are other additional methods of diagnosing a disease such as calculous cholecystitis. Symptoms and treatment will depend on the condition of the biliary tract and the general condition of the liver as a whole. These diagnostic methods include:

intravenous cholegraphy;
oral cholecystography;
hepatobiliary scintigraphy.

Calculous cholecystitis. Symptoms and treatment. general information

In some cases, the patient does not suspect that he has calculous cholecystitis. What it is, he learns only after the onset of biliary colic. It is characterized by a sharp pain in the hypochondrium on the right, which can be given to the epigastrium, lower back, shoulder blade or neck.

Such attacks often occur after the holidays and feasts, when an unsuspecting person about his illness allows himself to take alcohol and eat well with fatty, spicy, smoked or salty foods. To provoke such attacks can and physical exertion or strong emotions. After the patient is taken to a medical institution and examined, he learns about the diagnosis of calculous cholecystitis. An exacerbation may be accompanied by nausea and vomiting.

To operate or not?

With a diagnosis of calculous cholecystitis, the symptoms and treatment may vary depending on the stage of the development of the disease and the condition of the biliary tract. If reversible processes are still possible in the pre-stone or in the initial stage, then in all the others, when the formation of stones has already begun, the most correct solution will be the diagnosis of calculous cholecystitis surgery. And the sooner the surgery is carried out, the less the likelihood of complications.

Preparation for surgery consists in taking antibiotics and rehydrating the body, if necessary. The fight against dehydration is necessarily carried out if the patient at the time of the attack had repeated vomiting. These activities will significantly reduce the risk of sepsis.

With a diagnosis of chronic calculous cholecystitis, surgery is most often performed with a laparoscope. This modern method allows to reduce pain in the rehabilitation period and reduce recovery time, as well as reduce the risk of postoperative complications.

Pain Relief

Attacks of gallstone disease may differ in the nature of the pain and its intensity. In severe cases, nausea and vomiting are possible, and if the stone completely blocks the common bile duct, the color of the stool may become light, because there will be no bile pigment. With such severe attacks, you should immediately contact the hospital or call an ambulance.

If the disease manifests itself exclusively painful attacks, you can try to relieve the pain yourself. To do this, take a couple of pills of the drug "No-shpa" or "Papaverin" and put cold on the right hypochondrium area. Eating at the same time to stop at least 12 hours. If this does not work, you should seek medical attention.

Without surgery, this disease can be treated, but each of these methods has its own contraindications and complications, and also does not guarantee that there will be no recurrence of the disease. We list these methods:

treatment with acidic drugs;
contact destruction of gallbladder calculi;
extracorporeal shock wave lithotripsy.

Now specifically talk about each of them.

Currently, with the diagnosis of chronic calculous cholecystitis, treatment is possible without surgery, but this method is too expensive and there is no guarantee that there will be no recurrence. The course of therapy is long - at least 24 months. There are necessary conditions related to the size of the stones, their composition, the state of the gallbladder and its ducts:

The size of the stones should not be more than 1.5 cm in diameter.
The composition of the stones is exclusively cholesterol.
The gallbladder and its ducts should function normally and be in good condition.

With the diagnosis of calculous cholecystitis, treatment without surgery is carried out with drugs “Henofalk” and “Ursofalk” - this is chenodesoxycholic and urodecoxycholic acid, respectively.

The essence of treatment is that these acid-containing drugs accumulate in the composition of bile and gradually dissolve cholesterol stones. But guarantees that the disease will never return, no. Relapse is possible.

Contact destruction of gallbladder calculi

This method of treatment involves not one, but several procedures. They are carried out as follows. During the ultrasound examination, the doctor pierces the anterior abdominal wall with a long needle in the area of projection of the gallbladder, and a catheter is inserted into the bladder itself, through which special preparations are received that can dissolve the gallstones. These procedures are performed several times. Keep in mind that they are not suitable for everyone. There are certain limitations, the same as with the method described above. In addition, there may be complications, such as inflammation of the intestinal mucosa.

Extracorporeal shock wave lithotripsy

With this procedure, a sensor is located on the patient's skin in the area of the projection of the gallbladder on the anterior abdominal wall, shock waves will emanate from it and act on gallstones. To perform this procedure, the following conditions are necessary:

there should be no inflammatory processes in the gallbladder;
stone size - not more than 3.5 cm;
the gallbladder and ducts should work well.

This method is not completely safe. The following complications are possible:

stone closing ducts of the gallbladder;
obstructive jaundice;
development of acute pancreatitis or diabetes.

Until now, cholecystectomy remains the safest method of treatment for calculous cholecystitis with respect to complications. removal of the gallbladder.

Possible complications

Calculous cholecystitis must be treated, because it is dangerous because of its complications. Here are the most common ones:

Acute pancreatitis.
(inflammation followed by filling the bladder with purulent contents).
Destructive cholecystitis.
Cholangitis (inflammatory process in the bile ducts).
Secondary biliary cirrhosis.
Fistula formation between the bile ducts and the bladder.
Intestinal obstruction.
Oncology of the gallbladder.
Choledocholithiasis (stones in the bile ducts).

Diet

Ideally, you need to eat right before the patient is diagnosed with chronic calculous cholecystitis. A properly selected diet can serve as a preventive measure against the disease in question. Denote its main goals:

Reduced lipid content in the blood. This mainly applies to cholesterol and its fractions.
To ensure the normal functioning of the gallbladder and prevent stagnation in it.
Gradually strive for weight loss, if necessary. Weight loss should be smooth, in a month you can lose no more than 2-3 kg.
Drink plenty of fluids, up to 2 liters per day.
Eat enough vitamins and trace elements with food, vegetables, fruits and a lot of greens should be present in the diet.
To ensure good intestinal motility, eat foods rich in fiber, as well as wheat bran.
Abandon animal fats.
Vegetable fats should be present in the diet, but not more than 80 g per day.
Meat eaten should be lean (not fat).
Abandon salty and spicy foods, as well as fried foods. Meals should be boiled or steamed, and eating salads from raw vegetables is also welcome.
It is necessary to eat in small portions 5-6 times a day.

The same rules apply to nutrition after cholecystectomy (removal of the gallbladder).

Alcohol should be mentioned separately. Any alcoholic beverages are strictly prohibited in this disease. As not one case history shows, acute calculous cholecystitis very often occurs after taking alcohol. Very often, patients are hospitalized right from the holiday table.

Alternative Medicine Recipes

With the diagnosis of calculous cholecystitis, folk remedies can also be used for treatment. Apply medicinal fees, infusions and decoctions with choleretic effect, to reduce the concentration of bile and reduce stagnation in the gallbladder.

An effective remedy among the people is considered a decoction. To prepare it, 15 g of dry raw material is poured 80 ml of hot water and boiled in a water bath for 30 minutes. The drink is allowed to cool and filter, then add to 100 ml of cold boiling water and take 50 ml twice a day before meals.

For the treatment of gallstones, people widely use infusion of For preparation of medicine 3 tablespoons of raw materials fall asleep in a thermos and pour boiling water of 1 liter. If these manipulations are done in the evening, by the morning the healing tea will be ready.

Conclusion

It is believed that the best treatment - prevention of the disease. This fully applies to such a disease as calculous cholecystitis. Proper nutrition and adherence to a healthy lifestyle will help to avoid this unpleasant illness. And if it so happened that the JCB still formed, then urgent measures should be taken to eliminate it. Recall that at the initial stage, when sand is present in the gallbladder and not large stones, the process can still be reversed.

Calculous cholecystitis is an acute or chronic inflammatory process. It is accompanied by irritation of the tissues of the organ and severe pain due to the formation of stones of various sizes. It can manifest itself during the movement of calculus and their accumulation and stretching of the walls of the bile ducts.

The disease is long-term in nature, it is characterized by periods of attacks and remission. At the same time, the disease does not weaken, but is constantly complicated, the number and size of stones grows and begins to push harder on the bile ducts and bladder.

Among the entire population of the earth, about 10% of them are experiencing a similar pathology. At the same time, the majority of cases are patients of mature age of 40-50 years. In rare cases, cholecystitis is diagnosed in children under 14 years of age. The main threat in the development of JCB is blockage of the neck of the gallbladder and organ ducts.

Attention!!! With such disorders, symptoms of jaundice develop, as well as aggravation of biliary colic. In this case, the patient experiences severe pain intractable. It is important not to confuse the problem with hepatitis and promptly assign adequate therapy.

Types of calculous cholecystitis

Experts distinguish between two forms of the disease - acute and chronic. Each type of cholecystitis can also be of two types - acute-complicated and uncomplicated (smooth).

Acute complicated type Cholecystitis calculous species is diagnosed in rare cases. Such a form may appear due to the prolonged course of gallstone disease without showing any symptoms. In the acute complicated form, the calculus completely clogs the common duct of the gallbladder. Because of this, there is an inflammation of the walls of the body, which causes severe pain.

Additionally, with such a disease, dangerous bacteria and infections from adjacent organs penetrate into the cavity of the gallbladder. This phenomenon occurs due to violations in the antiseptic effects of bile. Gradually, under the influence of the violations that occurred, the tissues of the walls of the gallbladder begin to thicken, then they are gradually destructed (destroyed). Because of the blockage of the bile duct, all the pus formed due to the inflammatory process accumulates in the cavity of the gallbladder. This condition provokes biliary peritonitis.

Chronic form JCB can also last a long time and manifest itself only during serious exacerbations. In this case, infections and bacteria play a secondary role. In this form of developing disease, the main factors are problems with the composition of biliary secretion, which is why it begins to thicken and stagnate, causing irritation on the walls of the gallbladder. Abnormal nutrition, increased body weight, diabetes mellitus, diseases of the endocrine system and the presence of permanent harmful bacteria and dangerous infections in the body are launching pathological processes.

Attention!!! Patients who have been diagnosed with biliary duct dyskinesia, persistent gastritis, liver disease, should more often check themselves for the possible formation of stones.

Video - Chronic cholecystitis and cholelithiasis

Symptoms of various forms of the disease

The symptoms of calculous cholecystitis are directly dependent on the form of the disease. Thus, the chronic and acute forms of the disease have a different manifestation.

Complicated-acute form of JCB

unbearable cutting pains localized in the right side;
pain give to the scapula on the right side or the right shoulder;
such pain is provoked by eating disorders, depression, poor emotional state, alcohol abuse;
the patient notes bouts of nausea, which can turn into vomiting;
cleansing the stomach does not reduce unpleasant symptoms;
in vomit traces of bile secretion;
body temperature increases, it reaches the highest rates when pus accumulates in the cavity of the gallbladder;
there is a significant drop in blood pressure;
the patient notes great cold sweating;
gradually, symptoms of jaundice occur;
urine and feces acquire unhealthy color.

Chronic calculous cholecystitis

With this type of disease, the following characteristic symptoms are noted:

prolonged pain of a dull and dull character;
pain localized in the right hypochondrium;
attacks are triggered three hours after a meal rich in fats and salt, as well as having undergone dangerous heat treatment in sunflower or butter;
attacks can subside on their own, after partial digestion of junk food;
patients note nausea;
some patients diagnose themselves burping with a bitter aftertaste;
if you break the diet too much, vomiting begins with a lot of bile;
there is no change in body temperature or blood pressure.

Attention!!! However, in chronic cholecystitis, when the attacks subside, patients do not feel any discomfort and do not notice a significant deterioration in the general condition and a decrease in immunity.

Diagnosis of the disease

If calculous cholecystitis is suspected, urgent medical attention is required. Delay threatens the development of peritonitis, which is dangerous for the patient's life. In most of these cases, urgent surgical intervention will be required. The acute form of the disease is diagnosed by surgeons and is eliminated by them.

If the disease is chronic, the diagnosis is made by a specialist gastroenterologist. This is done in a regular clinic during a scheduled visit or during hospitalization during colic attacks.

At the same time, in order to make an accurate diagnosis, the specialist must collect patient-specific complaints, check his general condition, prescribe laboratory tests of the general type of blood and urine. Additionally, the level of pancreatic enzymes and its efficiency is measured. Liver tests and carrying out coprograms will not be redundant, this is the procedure for examining fecal masses.

A preliminary diagnosis is confirmed by conducting an ultrasound examination of the gallbladder. If necessary, the patient is injected contrast into the gallbladder to get clear X-rays with cholecystography.

Attention!!! To study the properties of the formed stones and their possible danger, sounding is assigned. With this procedure, the laboratory assistant captures part of the bile secretion and carries out its microscopic examination, this will help to select a more accurate treatment plan.

Treatment of calculous cholecystitis

To date, specialists use two methods to eliminate the pathology that has arisen - surgical intervention and traditional.

Acute manifestation of pathology

If calculous cholecystitis occurs in a patient for the first time, the attending physician uses antibacterial, spasmolytic, and analgesic drugs. Toxic substances are removed from the body with special solutions. A mandatory diet is prescribed to the patient and recommendations are given to prevent recurrent seizures. With this form of therapy is carried out strictly within the walls of the medical institution, as self-therapy can lead to a life-threatening situation.

If all the accepted medical and benign methods have not yielded any results, or the patient has already accumulated pus inside the gallbladder, the specialist without any doubts urgently removes the organ along with the stone fractions formed in it.

In most cases, surgeons try to perform surgery with laparoscopy, which is one of the most benign invasive techniques. To remove the gallbladder, several punctures in the abdominal area are made with special small scalpels strictly under constant monitoring of the monitor. If the patient has already developed peritonitis, only an open-type laparotomy is performed. Additionally carried out a revision of the abdominal cavity.

Chronic calculous cholecystitis

With this type of manifestation of the disease, the patient is prescribed a strict mandatory diet. He must completely remove from the diet food that is rich in carbohydrates and fat. It is necessary to minimize the amount of salt, hot spices, to give up alcoholic drinks for life. At the same time, the patient should significantly reduce athletic and physical exertion, lead a relaxed lifestyle whenever possible, and avoid psycho-emotional upheaval.

After it was possible to reduce the seizure and the pain subsided a bit, a litholytic treatment course is carried out. To do this, use drugs that can break down the stones in the gallbladder and its ducts. These tools include Ursosan and Litofalk. Additionally, you can drink antispasmodic drugs.

Attention!!! The chronic form of the disease, unlike acute, can be eliminated at home. Additionally, you can use the methods of folk therapy, but it is important to consult with your doctor on the possibility of their use.

Video - How to prevent the formation of gallstones

Features of drugs for the treatment of gallstones

A drug	Description	Price
Ursosan	Dissolves calculi, restores the mucous membrane of the stomach and gallbladder	1000-1700 rubles
Litofalk	Also contributes to the dissolution of stones in the bile ducts, relieves manifestations of hepatitis, improves the condition of the mucous	400-1500 rubles
Drotaverinum	Perfectly removes the resulting spasm, relieves pain	50-1000 rubles
Librax	Belongs to the class of spasmolytics, which simultaneously improve the general condition of the patient. Allowed to use in case of acute need	800-1200 rubles
Ospin	It has antimicrobial effects, inhibits the production of pathogenic bacteria	780 rubles
Meratin	Relieves inflammation, prevents the formation of pus and the development of peritonitis	1550 rubles
Mebeverin	Eliminates tissue spasm and pain effect, further improving overall well-being	750-2500 rubles

Attention!!! All described substances and drugs can be taken strictly after prior consultation with your doctor and determine the individual dosage.

Traditional methods of treatment of JCB

Horseradish roots

To prepare the product, thoroughly wash the fruits of horseradish and cut off all the wormy or rotten areas. Clean rhizomes grate a large grater. You should get at least one glass with a volume of 250 ml. After that, the mass is poured with one liter of boiling water and insist under a tight lid strictly in an enamel or glass container.

After that, through a gauze dressing, strain the solution and place it in a cold place. Before use, the metered dose should be slightly warmed up. It is required to take the drug three times a knock at 50 g for 10-15 minutes before the main meal. For taste it is allowed to add some sugar or its substitute.

Plant sap

Quite a time-consuming recipe for cooking, but yielding good results, including in the period of exacerbation.

In the same proportions of 500 ml it is necessary to take fresh agave juice, the plant must be at least 3 years old, beets, carrots and black radish.
Having carefully mixed these ingredients, you should add the same amount of liquid honey to them, you can melt it in a water bath, as well as high-quality vodka.
All ingredients are mixed together until homogeneous and poured them a glass jar of three liters.
The can should be closed strictly with a nylon cap and placed in an impermeable bag.
The container is buried in the ground with a neck for 14 days.
After that, the infused liquid is poured into smaller containers and placed in the refrigerator. You should ensure that the direct rays of the sun do not fall on the bottles.
The dosage of the drug is 15 ml before each meal.
The accumulated bile will begin to stand out with feces in the form of mucus.
The course of treatment consists of the use of the whole tincture.

Regardless of how acute or severe the pain that has appeared in the abdominal cavity, is to turn to the therapist first. It will help to exclude some diagnoses and refer you to a specialist. At the same time, if the pain is acute and is not necessarily localized in the right side, it is worth urgently to call an ambulance. The state of peritonitis can manifest pain in any location of the abdomen and abdominal cavity. Only timely treatment will help to avoid death and return the patient to a normal life.

Calculous cholecystitis is a disease of the gallbladder, which is characterized by serious inflammatory processes. Compared with other diseases of the abdominal cavity, this disease is very common.

Today, about 20% of the population is affected by this disease, and these figures are rapidly increasing. This is due to the fact that many people eat foods that are high in fat - oil, fat, fatty meat, eggs, and also adhere to a sedentary lifestyle. In addition, many people have endocrine disruption as a result of diabetes or obesity. Most often, women suffer from cholecystitis - this is due to oral contraception and pregnancy.

Main reasons

Calculous cholecystitis has a major cause - it is an infectious disease. In the human intestine live microorganisms that contribute to the improvement of the digestive process, but they can sometimes conceal a lot of danger.

There are certain factors that provoke an increase in microorganisms, which subsequently cause the organ to malfunction:

Calculous cholecystitis has a rather extensive etiology. The development of the disease is also marked against the background of autoimmune diseases and allergic reactions.

Many people suffer from chronic cholecystitis due to the omission of organs that are in the abdominal cavity, or as a result of congenital disorders of the structure of the gallbladder. Very often, this disease develops against the background of pancreatitis, as a result of a failure in secretion.

Symptoms

According to the clinical course, calculous cholecystitis can be chronic and acute, while in the first case, the remission is replaced by an exacerbation. The period of exacerbation quite often resembles the clinical manifestation of acute inflammation of the organ.

The primary symptoms suggestive of cholecystitis are:

Vomiting and nausea.
Heartburn.
There is bitterness in the mouth.
Feeling of pain in the right hypochondrium.
Belching.

The most prominent manifestation is hepatic colic, which has the following clinical signs of chronic calculous cholecystitis:

An objective examination can be identified those or other symptoms indicating the presence of this disease. All of them consist in the fact that in the process of palpation there is a sharp pain.

In the remission stage, calculous cholecystitis in most cases is asymptomatic. Remission with errors in the diet is replaced by exacerbation.

Diagnostics

If a disease is suspected, a diagnostic search consists of additional research methods:

Ultrasound.
X-ray
Biochemical study of blood with the determination of the total level of protein, its fractions, as well as cholesterol, triglycerides.
Fibrogastroduodenoscopy and others.

Complications

In case of late diagnosis or late treatment, calculous cholecystitis may be affected by the following complications:

Dropsy.
Purulent inflammation (empyema).
Acute inflammation of the biliary tract, acute cholangitis.
Perforation of the gall wall with the further development of peritonitis.
Disturbance of absorption in the intestine with all the ensuing consequences.
Malignant oncological processes.
Repeated inflammation of the pancreas.
Narrowing (stenosis) of the Vater nipple (large duodenal papilla).
Mechanical jaundice, developed in violation of the function of the outflow of bile (blockage of the gallbladder, its outflows or large duodenal papilla).
Stone formation (choledocholithiasis).

Differential diagnosis of chronic calculous cholecystitis

Cholecystitis is distinguished with renal colic, inflammation of the pancreas, appendicitis, perforated duodenal ulcer and stomach.

Compared with acute cholecystitis in renal colic, acute pain is felt in the lumbar region. The pain gives to the zone of the thigh and genitals. Along with this there is a violation of urination. With renal colic, leukocytosis is not fixed and the temperature does not rise. A urinalysis indicates the presence of salts and blood components.

With a high location of the appendix, acute appendicitis can trigger acute calculous cholecystitis (the diet is described below). The difference between acute appendicitis and cholecystitis lies in the fact that in the latter case, the pain gives to the shoulder and right scapula, and there is vomiting with bile. With appendicitis, there are no symptoms of Mussi-Georgievsky.

In addition, acute appendicitis is much more severe, the development of peritonitis is active. The differential diagnosis of chronic calculous cholecystitis in this case is simplified by the presence in the history of the disease that the patient has stones in the gallbladder.

In some cases, perforated duodenal and gastric ulcers are masked as acute cholecystitis. However, unlike ulcers in acute cholecystitis, in the history of the disease, as a rule, there are indications of the presence of stones in the organ.

Acute cholecystitis has painful sensations that spread to other parts of the body, as well as vomiting with bile content. Initially, the feeling of pain is localized in the hypochondrium on the right, increasing gradually, the fever begins.

Hidden perforated ulcers manifest themselves sharply. In the first hours of the disease, the muscles of the anterior abdominal wall are strongly stressed. Very often, patients complain of pain in the right iliac, due to the fact that the contents of the stomach flow into the cavity. When cholecystitis is observed hepatic dullness.

In acute pancreatitis, intoxication increases, intestinal paresis, rapid heartbeat is observed - this is the main difference from cholecystitis. In case of inflammation of the pancreas, pain is often accompanied by severe vomiting. It is difficult to distinguish acute gangrenous calculous cholecystitis from acute pancreatitis, so the diagnosis is carried out in stationary conditions.

Diet

Cholecystitis is a rather serious disease. Proper nutrition with this diagnosis is conducive to rapid recovery. In this case, medical nutrition should be directed at reducing the acidity and secretion of bile.

Smoked and fried foods are excluded from the diet. Include in the menu you need fresh vegetables and fruits, vegetable oil, cereal.

What not to eat if calculous cholecystitis is diagnosed? The menu should be designed to meet certain requirements:

Should abandon the fried and fatty foods.
You need to eat often, the portions should be small.
Reduce the consumption of sweet and flour products.
Avoid hot and cold foods.
Give preference to baked, boiled and stewed foods.
Minimize strong tea and coffee.
There are no more than three eggs per week, while it is desirable to exclude the yolk.
Eat more plant and dairy foods, because fiber improves motility and normalizes stool, and milk normalizes acid-base balance.
Adhere to the diet, there is at the same time.

With a disease such as calculous cholecystitis, the diet after surgery should be the same as with the chronic form of the disease.

Nutrition

Proper nutrition with this disease can provide a long period of remission. From the diet should be removed food that contributes to the formation of stones and weighting the work of the liver.

It is necessary to include in the menu products containing fiber, milk proteins, vegetable oil, and consume large amounts of fluid. Reduce the amount of foods high in fat and cholesterol.

List of allowed products

To prevent a possible attack of calculous cholecystitis, it is advisable to get acquainted with the list of approved products:

Milk products.
Vegetable and cereal soups, greens (with the exception of rhubarb, sorrel and spinach), vegetables, cereals, boiled meat and fish.
Cheese, cod liver, soaked herring.
Yesterday's wheat and rye bread, pastry.
Sunflower, olive and butter (small amount).

Calculous cholecystitis: how to treat?

The classic therapy for this disease is pain relief and hospitalization. In the case of the chronic form, treatment can be carried out on an outpatient basis. Appointed bed rest, sulfa drugs or antibiotics, as well as fractional diet. When inflammation subsides, physiotherapy is allowed.

Treatment (exacerbation of calculous cholecystitis) is carried out thus:

According to the prescribed studies, the doctor determines the stage and form of the disease.
A diagnosis is made.
When an acute inflammatory process is detected, the patient is prescribed anti-inflammatory drugs ("No-shpa", "Papaverina hydrochloride") and antibiotics with a wide spectrum of action.
After the inflammation has been removed and the focus of infection has been suppressed, choleretic drugs are prescribed, which accelerate the emptying of the gallbladder and alleviate the inflammatory process.

If stones are found in the ducts of the gallbladder or in the organ itself, and the inflammatory process is pronounced, then an operation is scheduled. Depending on the localization of calculus and their size, either the deposits or the gallbladder as a whole are removed. The failure of conservative treatment or the diagnosis of calculous cholecystitis calculus are absolute indicators for this purpose.

ethnoscience

At the moments of subsiding of the acute process, it is allowed to use popular treatment. To restore the function of the body, decoctions and tinctures (from corn stigmas, immortelle, etc.) are used, which have antimicrobial and astringent effects.

It is helpful for the patient to include in the diet mineral waters (“Yessentuki” No. 4 and No. 17, “Slavyanskaya”, “Naftusya”, “Mirgorodskaya”) and cholagogue teas. From plant-based medical preparations it is allowed to use “Allohol” and “Holagol”.
In chronic cholecystitis, tubeless tube should be used 2-3 times a week. On an empty stomach, drink warm water or decoction (1 cup). After 30 minutes, you need to drink "Allohol", and then - again a decoction of herbs. Next you need to lie on your left side, while on the right you should put a heating pad. In this position it is recommended to stay for 1.5-2 hours.

Therapy of a disease such as calculous cholecystitis (treatment and diet should be carried out only under the supervision of specialists), involves the use of traditional medicine. In the chronic form, such treatment significantly alleviates the condition, and most importantly - leads to positive results.

In general, treatment with traditional medicine can be divided into two main areas:

Through choleretic herbs.
Homeopathic preparations that imply an impact on stones that have a certain chemical composition, the same composition. For example, if phosphate or oxolinic acid was detected in the urine analysis, the same acids are prescribed during the treatment process. For cholecystitis without stones, drugs are used that activate the immune system.

Broth Recipes

Oregano grass (teaspoon) should be boiled with boiling water (glass), and then insisted for two hours. In case of disease of the biliary tract, you need to drink 3 times during the day for 1/4 cup.
Sheets of medicinal sage (2 tsp) are brewed with boiling water (2 cups), then infused for half an hour and filtered. In inflammatory processes in the liver or gallbladder, it is necessary to drink 1 tbsp. spoon every two hours.
Veronika brook (teaspoon) is brewed with boiling water (glass), and then infused for half an hour. You need to drink 3 times a day for 1/4 cup.
Corn stigmas (tablespoon) are brewed with boiling water (glass), and then infused for 60 minutes and filtered. Drink every 3 hours to 1 tbsp. a spoon.
Grass porridge (10 g) is brewed with water (3 cups) and boiled for 10 minutes. Drink the broth should be before a meal three times a day for a glass.
Wheatgrass rootstocks (20 g) are brewed with boiling water (1.5 cups) and infused for several hours and then filtered. For cholecystitis, take one glass 3 times a day. The course is 1 month.
The herb of the perforated Hypericum (tablespoon) is brewed with boiling water (glass), boiled for 15 minutes, and then filtered. You need to drink 3 times a day for 1/4 cup. For this broth is characterized choleretic and anti-inflammatory effect.
Knot fruit (2 tablespoons) is brewed with boiling water (1.5 cups), wrapped and infused for 3 hours. When cholecystitis drink broth half an hour before meals for 1/2 cup 3-4 times a day.
Thoroughly chop the same amount of taken flowers of chamomile, immortelle, trefoil, dill seed and zoster. All mix and pour the resulting mixture (3 tsp.) Boiling water (2 cups). Next, the contents of the glass infused for 20 minutes and filtered. To accept daily after food in the morning and in the evening before a dream on 1/2 or 1/4 glasses.
Finely chop 3 parts of sand immortelle flowers, 2 parts of fennel fruit, wormwood grass, yarrow herb or mint leaf and dill. Pour the resulting mixture (2 tsp) with boiling water (2 cups). Insist for 8-12 hours and strain. Drink before meals 3-4 times a day for 1/3 cup.
Chamomile flowers (tablespoon) brewed with boiling water (glass). With cholecystitis use for enemas in the form of heat. Enemas do 2-3 times during the week.
Boudra ivy-shaped (teaspoon) is brewed with boiling water (glass) and infused for about 60 minutes, then filtered. You need to drink 3 times a day for 1/3 cup (before eating).
Peppermint (tablespoon) is brewed with boiling water (glass) and brewed for half an hour. During the day, drink in small sips (at least three times).

In most cases, people suffer from chronic cholecystitis for many years. Its course and frequency of exacerbations are directly related to the desire of a person to overcome this disease by all possible methods and means. If you are sick, then try to adhere to a healthy and proper lifestyle (physical activity, balanced diet, proper rest and work). Also, do not forget about drug treatment, while in periods of remission, it is desirable to additionally use traditional medicine.