Complications of acute cholecystitis. Complications of cholecystitis Complications of acute cholecystitis

Date: 08.03.2020

The gallbladder plays an important role in the normal course of digestive and other life processes. Diseases of this organ require urgent treatment to avoid complications. One of the most common is acute cholecystitis. With this disease, a strong inflammatory process begins, accompanied by pain, so it is important to recognize the first symptoms and start treatment.

What it is

Acute cholecystitis is an inflammation of the gallbladder, more precisely, of the walls of an organ, which occurs due to a disturbance in the movement of bile as a result of blockage of its outflow. Most often, this disease is associated with the formation of stones, but sometimes acalculous acute cholecystitis occurs.

According to statistics, the disease is more common in women than in men, the risk of its development is especially high at the age of 40–45 years.

Why do signs of acute cholecystitis require urgent treatment? The fact is that the gallbladder plays an important role in the functioning of the digestive system, especially in processes such as:

activation of intestinal peristalsis;
breakdown of lipids;
elimination of toxins;
normalization of the amount of cholesterol, excretion of excess;
suppression of harmful bacteria, including those that enter the intestines with food.

Given such an extensive functionality of the gallbladder, when it is affected by cholecystitis, this negatively affects the entire process of digestion. Because of this, the quality of life deteriorates, a person experiences constant pain. If the disease becomes chronic, the painful sensations are especially strong during exacerbation.

Symptoms of different types and reasons for the appearance

Most pathogenic microorganisms are present in the body of a healthy person, the disease appears when, under the influence of negative factors, their number increases and begins to exceed the norm. There are also predisposing factors that can also cause acute cholecystitis. These include:

malfunctions of the endocrine system, including hormonal disruptions;
gastrointestinal diseases associated with inflammation of the digestive system;
diseases of the ENT organs and respiratory tract;
obesity and physical inactivity;
the use of drugs that have the property of thickening bile;
low immunity, which makes the body susceptible to many infections;
chronic infectious diseases of various organs;
defeat by atherosclerotic plaques of vessels and arteries leading to the gallbladder;
frequent stress.

The presence of these factors by itself rarely provokes inflammation of the gallbladder. But when they are present in combination or several pathogenic microorganisms penetrate into the organ, they accelerate the development of cholecystitis.

Bad eating habits, frequent overeating adversely affect the gallbladder, in people who lead such a lifestyle, the risk of developing inflammatory diseases of the organ is great.

There are several types of acute cholecystitis, this classification of the disease also allows us to understand its causes. By the nature of the formation of the inflammatory process, it happens:

calculous - with it, stones form in the gallbladder;
non-calculous - without the formation of stones.

In adults over the age of 35, the calculous form of the disease is more often diagnosed, inflammation without the formation of stones is more common among young people.

Depending on how strongly the inflammatory process has developed, acute cholecystitis is of the following types:

purulent - purulent organ lesions appear;
catarrhal - the main symptom of this type of cholecystitis is a severe pain syndrome - pain can be given to the lower back, neck, shoulder blade (on the right side);
phlegmonous - acute pain occurs with sudden movements, for example, changing the position, when coughing, sneezing;
gangrenous - if there is no proper treatment for acute cholecystitis at the phlegmonous stage, it acquires a gangrenous form;
mixed - a combination of several forms of the disease.

Acute cholecystitis is a progressive disease, so the disease is constantly taking on a new form. This confirms the need for timely treatment.

Signs of cholecystitis

The acute form of the disease has a distinctive feature - severe pain syndrome. Painful sensations appear in the right hypochondrium, upper abdomen, then they can be given to the scapula.

In rare cases, the localization of pain affects the organs located on the left side of the body: scapula, neck on the left side, upper abdomen.

Symptoms of acute cholecystitis depend on the form of the disease. The calculous form, in which they are present, has more vivid manifestations, progresses intensively. In addition to acute pain syndrome, symptoms of the disease include:

digestive disorders - loss of appetite, not assimilation of food;
nausea, vomiting, especially after eating fatty foods;
constant belching, heartburn;
unpleasant taste in the mouth, often bitter;
fever, increase in body temperature to 37.5–38.5 degrees;
general weakness, malaise.

Painful sensations can be so strong that they begin to constrain movement, impairing the patient's quality of life.

Possible complications

If the therapy of acute cholecystitis is not started on time, it becomes chronic, in which the disease periodically reminds of itself. Such a patient is assigned lifelong adherence to a strict diet, medication treatment on an ongoing basis. However, the transition of cholecystitis to a chronic form is not the only possible complication. They also include:

stopping the work of the bubble;
the beginning of the development of pancreatitis and other diseases of the gastrointestinal tract;
the appearance of fistulas in the organs of the digestive system;
development of reactive hepatitis;
cholangitis (inflammation of the bile ducts);
intestinal obstruction;
rupture of the gallbladder.

With the development of these pathologies and conditions, surgical intervention and emergency therapy are required. Otherwise, they can be fatal, for example, due to rupture of the gallbladder, affected by infection and pus, intoxication of the whole body occurs.

Diagnostics

Diagnosis includes a series of tests that help confirm the presence of cholecystitis. Despite the presence of obvious symptoms of the disease, only instrumental studies can confirm the exact diagnosis. These include:

General blood analysis. If the gallbladder is inflamed, its results can confirm the presence of the disease. In acute cholecystitis, the level of leukocytes increases, the erythrocyte sedimentation rate (ESR), alpha-globulins, sialic acids and other harmful substances are found.
Ultrasound. One of the main diagnostic methods that allows you to make a diagnosis. The main symptoms of cholecystitis are such changes in the gallbladder as an uneven contour, thickening of the wall, and an increase in its size.
Duodenal intubation. To carry it out, take bile, examine it under a microscope. Usually, an ultrasound scan is sufficient to make a diagnosis. This and other similar studies are prescribed when the doctor has questions or doubts.

If there is a suspicion of the presence of oncological processes and other complications, an MRI is prescribed. This research method is considered one of the most accurate in examining various organs.

A differential diagnosis is made only after a diagnosis is made, in which it may be necessary to study all organs of the abdominal cavity to determine how extensive the inflammatory process is. Such DPF-diagnostics will allow to reduce the diagnosis to the only exact disease.

Treatment

How long treatment lasts in adults depends on how long the patient went to the hospital, how intensively the inflammatory process developed, and the individual characteristics of the organism. The tactics of the health worker largely depends on the intensity of the pain syndrome. If the patient presents with a severe attack, it is important to provide emergency first aid.

If the patient comes to the doctor on time, conservative treatment is prescribed after diagnosis. If the patient's condition is serious, an operation is prescribed. And it is also important for the patient to follow the diet and other recommendations of the attending physician.

First aid

An attack of acute cholecystitis is accompanied by unbearable pain. The first thing to do to help the victim is to call an ambulance. In a severe attack, only doctors can decide how to safely relieve spasms and determine the tactics of treatment. However, while waiting for an ambulance, some measures can be taken at home:

put the patient in a calm place, provide peace;
he can take any position in which it will be at least a little easier for him;
give an anesthetic drug (Spazmalgon, Nimesil, other);
if the patient vomited, provide him with a drink, mineral, still water in small sips is recommended;
if the temperature rises, apply a cold compress.

Emergency doctors, and then the doctor in the hospital, need to be informed about which drugs the patient has already taken.

It is strictly forbidden to apply a heating pad to the area that hurts during an attack of acute cholecystitis. If it contains pus, exposure to high temperatures will negatively affect it. And it is also not advised to take any medications other than pain relievers, including those that lower the temperature, remove nausea and other unpleasant symptoms. The appointment will be made by the attending physician.

Drug therapy

The basis of treatment for acute cholecystitis is drug therapy. Its purpose is to stop the inflammatory process, eliminate painful sensations, and normalize the flow of bile through the ducts. Drug therapy should be comprehensive, it is prescribed on an individual basis. It usually consists of drugs of the following groups:

antibiotics are the basis of treatment, they help fight infection, that is, the cause of the disease;
enzymes - to normalize digestive processes;
choleretic drugs;
antispasmodics;
non-steroidal anti-inflammatory drugs;
prokinetics.

When the attacks of acute pain have passed, the attending physician can prescribe physiotherapy, therapeutic gymnastics is especially effective, but it should be carried out by an experienced specialist.

There is no general treatment regimen, the appointment is made by the doctor, taking into account the degree of development of the inflammatory process, the cause of the disease, and the patient's characteristics. Often, treatment is carried out in an inpatient setting, so that the patient is under the supervision of a doctor. If the exacerbation passes, you can continue to be treated at home.

If the patient's condition is severe, the inflammatory process is strong and complications have developed, surgical intervention is required. It involves the removal of the gallbladder either by the usual method, or with the help of a safer one - laparoscopy.

Diet

Diet is an important part of treatment. It is necessary to provide such nutrition so that the load on the digestive organs, including the gallbladder, is reduced.

Prohibited foods for acute cholecystitis include:

fatty meats and fish, offal;
all legumes;
sour fruits;
mushrooms;
fresh bread, pastries, flour;
canned food;
smoked meats;
alcohol, carbonated drinks, coffee.

When a patient is admitted with an attack of acute pain, a strict diet is required for the first few days; for a while, the doctor may recommend refusing food. Then the diet is gradually diversified.

And it's also important to limit your salt and sugar intake. Dishes from permitted products can be prepared in several ways: boil, stew, bake. The daily menu must include:

lean meat, preferably boiled;
fresh vegetables, fruits (non-acidic);
porridge, especially oatmeal and buckwheat;
dairy products with a low percentage of fat;
natural vegetable oils.

Acute cholecystitis is a common disease, especially in people over 35-40 years old. It is important to recognize the first symptoms in time so as not to wait for bouts of severe pain and consult a doctor. After the diagnosis, treatment is prescribed, which can be either medication or surgical. An obligatory addition to it is diet therapy.

Acute cholecystitis is an inflammatory disease of the gallbladder that occurs rapidly against the background of a disturbed outflow of digestive secretions. Pathology is characterized by the sudden onset of symptoms. With adequate treatment of acute cholecystitis, unpleasant symptoms can be quickly stopped. This helps prevent severe complications from occurring. Therefore, it is worth considering in more detail what acute cholecystitis is, what pathology has symptoms and treatment.

Bile is a digestive secretion that is produced by liver cells and accumulates in the cavity of the gallbladder. Normally, pathogenic microbes penetrate into it from the duodenum. However, only with a disturbed outflow of digestive secretions are conditions favorable for inflammatory processes created.

In 90% of patients, the cause of acute cholecystitis is considered to be stagnation of bile against the background of the appearance of calculi in the organ. The disease develops with mechanical blockage of the ducts with stones. If this process provokes inflammation, then acute calculous cholecystitis occurs. This form of pathology is diagnosed more often in patients over 40 years old.

The following causes of acute acalculous cholecystitis are distinguished:

Changes in the rheological characteristics of bile;
Anomalies in the development of the digestive organ;
Violation of the patency of the ducts due to tumor pressure;
Injuries to the hepatobiliary system;
Inflammation in adjacent organs;
Wearing tight clothing (corset).

Cholecystitis attacks are more common in women. Experts associate this with the following characteristics of the body:

The negative effects of progesterone;
Compression of the organs of the biliary tract during pregnancy;
Passion for rigid diets.

Important! There is and. In the first case, the pathology has a sudden onset, leading to the appearance of an intense pain syndrome. The chronic form causes pathological changes in the wall of the organ, characterized by a long course.

Disease types

The modern classification of acute cholecystitis suggests the existence of the following forms of the disease:

Catarrhal. This form of pathology is characterized by a favorable prognosis. The disease leads to an increase in organ size, thickening of the walls. Cholecystitis provokes the onset of pain syndrome, bouts of vomiting;
Phlegmous. The disease causes the appearance of pus in the tissues of the organ, accompanied by severe pain. Patients note the following symptoms of acute cholecystitis: indomitable vomiting, which does not bring relief, fever, signs of intoxication;
Gangrenous. The most dangerous form, leading to necrotic changes in the tissues of the organ. It can provoke perforation of the walls, the occurrence of peritonitis.

According to the classification of acute cholecystitis by the severity of the disease, a mild, moderate and severe form of the disease is distinguished.

Clinical manifestations

The first symptom of acute cholecystitis is acute pain in the right hypochondrium. Characterized by the sudden development of pain syndrome, which can be stopped only by strong painkillers. However, over time, the soreness reappears.

The nature and localization of pain in acute cholecystitis are as follows:

Intense pain, which is constantly growing, radiates to the right shoulder blade, lower back;
Progressive weakness;
Decreased pressure;
Flatulence and tension of the abdominal muscles.

The patient also has other characteristic symptoms of an attack of cholecystitis:

A sharp rise in temperature;
Dyspeptic symptoms (flatulence, bitter taste in the mouth, diarrhea, belching);
Nausea and bouts of vomiting, which do not bring relief, only exhaust the patient;
Yellowness of the sclera and skin;
Development of tachycardia. If the heart rate exceeds 120 beats, then one can suspect the development of serious disorders in the body;
Change in the shade of feces and urine.

Possible complications

If signs of acute cholecystitis appear against the background of the migration of calculi, then perforation of the ducts or the wall of the organ may occur. This condition poses a direct threat to the patient's life, since it provokes inflammation of the abdominal cavity.

The listed complications in acute cholecystitis are characterized by the following symptoms:

Sharp pain that increases with palpation;
Intense thirst;
Increased body temperature;
A sharp decrease in pressure against the background of tachycardia;
Great weakness;
Enlargement of the abdomen;
Vomiting of green contents;
Pale skin and tongue.

Important! With the development of peritonitis, the patient needs emergency medical care, urgent hospitalization.

With an advanced form of the disease, the following complications of acute cholecystitis develop:

The appearance of emphysema of the gallbladder;
Fistulas;
Development of purulent inflammation;
Sepsis (the occurrence of a generalized infection);
Digestive necrosis.

Diagnostic measures

Diagnosis of acute cholecystitis involves the following activities:

Examination and questioning of the patient in order to identify violations in dietary nutrition, the presence of stressful situations, the appearance of symptoms of an attack of cholecystitis;
Ultrasound of the organs of the hepatobiliary system. The method allows you to differentiate the type of inflammation by increasing the size of the organ, thickening the walls, the presence of calculi;
Computed tomography. The survey is used for a detailed study of the structure of the organs of the hepatobiliary tract;
Performing endoscopic retrograde cholangiopancreatography. This type of diagnosis of acute cholecystitis allows you to investigate the state of the bile ducts;
Blood test. The test results will show pronounced leukocytosis, increased ESR, high levels of bilirubin, amylase, ALT, AST.

In acute cholecystitis, differential diagnosis makes it possible to exclude the development of other diseases of the digestive organs, which have similar symptoms. At the time of diagnosis, acute cholecystitis is differentiated from appendicitis, pyelonephritis, pancreatitis, urolithiasis, perforated ulcer, liver abscess, right-sided pleurisy.

How to remove an attack of cholecystitis at home?

What if a person has an acute attack of cholecystitis? It is important to call an ambulance immediately. First-aid emergency care for acute cholecystitis involves the following algorithm:

Put the patient on the bed, exclude any kind of physical activity.
Place an ice pack on the abdominal area.
To eliminate pain, you can use antispasmodic drugs (Drotaverin, Baralgin, Papaverine).
To eliminate vomiting, you should drink mint tea, still water, medicines (Trimedat, Cerukal). During an attack, care must be taken so that the patient's tongue does not sink.

First aid for cholecystitis should exclude the use of analgesics and drugs. Such drugs can only lubricate the manifestations of cholecystitis in adults. Therefore, the treatment and diagnosis of acute cholecystitis can be complicated.

Important! With inflammation of the gallbladder, you need to stop taking alcoholic beverages, cleansing the intestines with enemas, applying a warm heating pad to the abdomen.

How to treat acalculous cholecystitis?

If the disease is diagnosed for the first time, the patient does not have stones, purulent complications, then conservative treatment of acute cholecystitis is indicated. In such situations, antibiotic therapy is prescribed to eliminate pathogenic microflora.

To eliminate pain, expansion of the bile ducts, antispasmodics are indicated. With symptoms of intoxication, detoxification therapy is performed. When cholecystitis appears, treatment involves adherence to a therapeutic diet.

Diet therapy is based on the following rules:

Fractional meals up to 6 times a day in small portions;
Refusal from alcoholic beverages, fried, fatty and spicy foods;
Food must be freshly prepared, heat treatment involves boiling, baking and steaming;
To prevent the development of constipation, it is necessary to introduce foods enriched with dietary fiber into the menu.

Important! If acute cholecystitis causes destructive changes in the organ, then surgical methods of treatment are used.

How to treat calculous cholecystitis?

There are such methods of treating acute cholecystitis occurring against the background of the appearance of calculi:

Laparoscopic cholecystectomy;
Removal of an organ through abdominal surgery;
Performing percutaneous cholecystectomy. This tactic is used to treat cholecystitis in elderly women.

Important! With large stones, refusal from surgical intervention can provoke the occurrence of repeated attacks, complications, the transition of pathology to a chronic form.

Forecast and prevention

With drug treatment of a mild form of cholecystitis, it is possible to completely eliminate unpleasant symptoms and prevent complications. If the medicines were selected inadequately, then the disease can become chronic. When a patient develops complications, the risk of death is significantly increased.

After an emergency or planned cholecystectomy, the patient's quality of life deteriorates slightly. The synthesis of digestive secretions continues in the liver. Therefore, postcholecystectomy syndrome often occurs, characterized by pain, diarrhea, flatulence. The listed symptoms can be removed with medication or dietary nutrition.

For the prevention of acute cholecystitis, experts recommend adhering to, refusing to use alcoholic beverages, spicy and fatty foods. To normalize digestive processes, you need to eat every 3.5 hours. In this case, the last meal should take place 2 hours before bedtime. To prevent stagnation of digestive secretions, you should increase the level of physical activity, avoid stressful situations, normalize body weight, and promptly treat intestinal parasitic diseases.

Inflammation of the gallbladder, characterized by a sudden disturbance in the movement of bile as a result of blockage of its outflow. The development of pathological destruction of the walls of the gallbladder is possible. In the overwhelming majority of cases (85-95%), the development of acute cholecystitis is combined with calculi (stones), in more than half (60%) of patients, bacterial infection of bile (E. coli, cocci, salmonella, etc.) is determined. In acute cholecystitis, the symptomatology occurs once, develops and, with adequate treatment, fades away, leaving no pronounced consequences. With repeated repetition of acute attacks of inflammation of the gallbladder, they speak of chronic cholecystitis.

General information

Diagnostics

For diagnostics, it is important to identify violations in the diet or stress conditions during the survey, the presence of symptoms of biliary colic, palpation of the abdominal wall. A blood test shows signs of inflammation (leukocytosis, high ESR), dysproteinemia and bilirubinemia, increased activity of enzymes (amylase, aminotransferases) during biochemical analysis of blood and urine.

If an acute inflammation of the gallbladder is suspected, an ultrasound of the abdominal organs is prescribed. It shows an increase in the organ, the presence or absence of stones in the gallbladder and bile duct. During ultrasound examination, the inflamed gallbladder has thickened (more than 4 mm) walls with a double contour, there may be an expansion of the bile ducts, a positive Murphy symptom (bladder tension under the ultrasound transducer).

Computed tomography gives a detailed picture of the abdominal organs. For a detailed study of the bile ducts, the ERCP technique (endoscopic retrograde cholangiopancreatography) is used.

Differential diagnosis

In case of suspicion of acute cholecystitis, differential diagnosis is carried out with acute inflammatory diseases of the abdominal organs: acute appendicitis, pancreatitis, liver abscess, perforated stomach ulcer or 12p. intestines. And also with an attack of urolithiasis, pyelonephritis, right-sided pleurisy. An important criterion in the differential diagnosis of acute cholecystitis is functional diagnostics.

Treatment of acute cholecystitis

In the case of primary diagnosis of acute cholecystitis, if no stones are detected, the course is not severe, without purulent complications, the treatment is carried out conservatively under the supervision of a gastroenterologist. Antibiotic therapy is used to suppress the bacterial flora and prevent possible infection of bile, antispasmodics to relieve pain and enlargement of the bile ducts, detoxification therapy in case of severe intoxication of the body.

With the development of severe forms of destructive cholecystitis - surgical treatment (cholecystotomy).

In the case of gallstones, removal of the gallbladder is most often also suggested. Cholecystectomy from a mini-access is the operation of choice. With contraindications to the operation and the absence of purulent complications, it is possible to use the methods of conservative therapy, but it should be borne in mind that refusal to operatively remove the gallbladder with large calculi is fraught with the development of repeated seizures, the transition of the process to chronic cholecystitis and the development of complications.

All patients with acute cholecystitis are shown diet therapy: water for 1-2 days (sweet tea can be used), after which diet No. 5A. Patients are advised to eat freshly steamed or boiled warm. It is imperative to refuse products containing a large amount of fat, from hot spices, baking, fried, smoked. For the prevention of constipation, it is recommended to refuse food rich in fiber (fresh vegetables and fruits), nuts. Alcohol and carbonated drinks are strictly prohibited.

Surgical options for acute cholecystitis:

laparoscopic cholecystotomy;
open cholecystotomy;
percutaneous cholecystostomy (recommended for elderly and debilitated patients).

Prophylaxis

Prevention consists in adhering to the norms of a healthy diet, limiting the use of alcohol, large quantities of spicy, fatty foods. Physical activity is also encouraged - physical inactivity is one of the factors contributing to the stagnation of bile and the formation of calculi.

Mild forms of acute cholecystitis without complications, as a rule, end in a quick recovery without noticeable consequences. With insufficient treatment, acute cholecystitis can become chronic. If complications develop, the probability of death is very high - mortality from complicated acute cholecystitis reaches almost half of the cases. In the absence of timely medical care, the development of gangrene, perforations, empyema of the gallbladder occurs very quickly and is fraught with death.

Removal of the gallbladder does not lead to a noticeable deterioration in the quality of life of patients. The liver continues to produce the required amount of bile, which flows directly into the duodenum. However, after removal of the gallbladder, postcholecystectomy syndrome may develop. At first, patients after cholecystotomy may have more frequent and softer stools, but, as a rule, these phenomena disappear over time.

Only in very rare cases (1%) did the operated patients report persistent diarrhea. In this case, it is recommended to exclude dairy products from the diet, as well as limit yourself to fatty and spicy foods, increasing the amount of vegetables and other fiber-rich foods consumed. If the dietary correction does not bring the desired result, drug treatment of diarrhea is prescribed.

According to statistics, 16% of the world's population in one way or another suffer from cholecystitis. Doctors associate the widespread spread of the disease with the popularization of fast food, physical inactivity and the growth of endocrine disorders of the body. Surgeons work with an acute form of gallbladder cholecystitis, with a chronic one - therapists. Doctors have noted a clear trend towards an increase in the number of cases in recent decades.

What is cholecystitis?

Disease of the gallbladder with a characteristic inflammatory process occurring in its cavity is considered serious. It is as dangerous as possible in its neglected form. In some cases, calculi are formed in the bile-producing organ. They are capable of causing severe bouts of pain with cholecystitis.

The gallbladder is involved in the digestive process, it is extremely important for the normal functioning of the gastrointestinal tract. The gallbladder is a kind of conductor between the liver and the duodenum. The organ accumulates the secretion produced by the liver. Since it is located under the ribs on the right side of the torso, when an inflammatory process occurs, it hurts on the right, in the side.

The cause of the pathology is a violation of the outflow of bile from the bladder. But this is not the only factor. Over the years, deposits of salts, cholesterol, and bilirubin appear on the walls of the organ. The plaque in the form of flakes grows, and one day it becomes too large. This interferes with the normal functioning of the bubble.

Stones and other crystal fragments for the time being do not annoy a person, being inside. But one day, one of the factors may become a trigger, and the stones will begin to move. During this period, an exacerbation of the condition occurs, a severe pain syndrome occurs. Stone cholecystitis is an indication for urgent hospitalization and subsequent surgical intervention. Along with inflammation in the organ, calculous and non-calculous pathology of the gallbladder is often observed.

Women face this problem 3-4 times more often than men. Biliary disease is triggered by hormonal changes during pregnancy or taking oral contraceptives.

Why is cholecystitis dangerous? First of all, the development of peritonitis, which is fatal.

Causes of the disease

Problems with the outflow of bile from the biliary tissues arise against the background of:

gallstone disease. Pathology occurs in 80–90% of diagnosed cases. Formations in the gallbladder do not allow the secret to escape normally, because they injure the mucous membrane and clog the outlet. Against this background, an adhesive process occurs, and the inflammation does not subside;
congenital anomalies. If the organ is from birth in constrictions and scars, it has narrowed ducts due to abnormal intrauterine development of the fetus, the risk of the disease increases. Pathological conditions lead to a violation of the outflow of bile and stagnation;
dyskinesia of the biliary tract. Pathology arises from a functional impairment of organ motility. In addition, the tone of the biliary system leads to it. As a result, not all of the ZhP is released, part of the secret remains. Against this background, inflammatory processes occur, stones and deposits on the walls are formed. Cholestasis may occur;
other violations of the system of excretion of bile from the body. Neoplasms can also have a negative effect on the functioning of the gallbladder (polyps, cysts, tumors of a benign and malignant nature). Bile stasis worsens the condition of the biliary system. This happens due to compression of the ducts, deformation of the bladder due to Mirizzi syndrome, dysfunction of the valve system of the biliary tract.

The likelihood of the onset of the disease increases under certain conditions that affect the secretion output and the change in composition from normal to pathological:

Dyscholia refers to a similar non-functional disorder (when the consistency of bile is abnormal).
Hormonal changes in the body during menopause or during pregnancy also provoke the development of inflammation in the gallbladder.
An enzymatic type of pathology develops with a constant flow of pancreatic enzymes into the bladder cavity. Gastroenterologists call this condition pancreatobiliary reflux.
Improper diet, alcohol consumption and smoking are other common causes of the disease.

Symptoms of cholecystitis in adults

Sometimes this pathology of the gallbladder is asymptomatic. In this case, they speak of a chronic type of disease. In such patients, there are no characteristic complaints, and cholecystitis is diagnosed by chance during another examination. The impetus for an attack is overeating fatty and spicy foods, serious stress, and drinking.

Medical specialists distinguish the following symptoms of cholecystitis in women and men:

pain with cholecystitis is a clear symptom of the disease. The cut is felt under the ribs, on the right side of the torso. In some cases, a person may complain of pain in the epigastric region, the left side of the torso. The pain can be given under the scapula, in the neck, left shoulder. To the doctor's question where it hurts with cholecystitis, you need to give an exact answer;
dyspepsia - vomiting, a bitter attack in the mouth, a feeling of fullness and bloating, diarrhea or constipation, heaviness in the right upper abdomen;
symptoms of intoxication - muscle aches, chills, loss of appetite, weakness, pallor, lethargy. With cholecystitis, the temperature rises;
vegetative disorders - premenstrual syndrome, hyperhidrosis, migraine.

Not all of the above syndromes may appear. Some symptoms of cholecystitis in men and women may be mild or absent. But during an attack of biliary colic, the pain syndrome is intense and acute.

Types of cholecystitis

Gastroenterologists distinguish between several types of pathology and choose a suitable therapy strategy for each. According to its etiology, the disease is divided into two types:

calculous. In this case, formations of an unclear nature appear in the bubble cavity. Of all the varieties of identified problems with gallbladder, the calculous form occurs in almost 90% of patients. Often it is accompanied by severe colic and other pronounced symptoms. Sometimes the pathology may not have symptoms for a long period of time;
non-calculous. With this nature of the flow in the organ, no calculi are formed. It is diagnosed only in 10% of cases. This type is characterized by the absence of stones, a calm course, rarely occurring periods of exacerbation.

According to the severity of symptoms, doctors divide cholecystitis into:

acute form. This type is characterized by a stormy onset, severe attacks of pain, symptoms of intoxication. Wave-like pain syndrome;
chronic form. There are no pronounced manifestations, the course is sluggish. The pain either does not occur, or is of a mild nature.

The acute type of pathological disorder of gallbladder is subdivided into the following types.

Catarrhal

There is a pain in the area of the ribs on the right, the pain radiates to the neck, shoulder, shoulder blades, lower back. At the first stage of the disease, the pain syndrome is unstable - it arises, then it passes over again. After a while, an organ that is constantly tense due to improper work shows signs of pathology: vomiting of bile and stomach contents, constant pain, an increase in body temperature (up to 37.5 ° C). The attack may not go away within 2-3 days.

Concomitant pathological conditions are:

tachycardia;
hypertension;
the appearance of a white coating on the tongue;
pain in the abdomen on the right;
leukocytosis and an increase in ESR;
hyperemia.

Most often it is provoked by an improper diet for many years. Pathology can be caused by food "on the run", long breaks between meals, addiction to fried, smoked foods.

Phlegmonous

Characterized by a pronounced pain syndrome and a vivid clinical picture of the disease. A person suffers from a persistent feeling of nausea, vomiting of bile occurs, and pain in the side appears even when sneezing, coughing, changing body position.

The patient develops chills in parallel with a rise in temperature to 39 ° C, the abdomen is strongly swollen, tachycardia increases. On palpation of the peritoneal region, pain occurs. The gallbladder is palpable, because most often in this state it is enlarged. A clinical blood test indicates a pathology with a strong increase in ESR and high leukocytosis.

Characterized by a noticeable thickening of the walls of the inflamed organ. On them and in the lumen of the gallbladder, there are abscesses and exudate is determined. Leukocytes seep through them.

Gangrenous

This is the 3rd phase of acute cholecystitis. The maximum damage to the organ is observed, the immunity is weakened, pathogenic microorganisms infect the internal organs without difficulty. In some cases, peritonitis is diagnosed, which is indicated by pronounced intoxication. Tachycardia occurs, the temperature rises sharply, the nasopharyngeal mucosa dries up, breathing becomes difficult. On palpation, there is a strong bloating of the abdomen, there is no intestinal peristalsis, and irritation of the entire abdominal cavity is observed. In the blood, an increased ESR, a malfunction of the acid-base balance, high leukocytosis, and a violation of the electrolyte composition of the blood are determined.

This type of biliary pathology occurs due to thrombosis of an organ artery. It leads to deterioration of tissue and atherosclerosis. In most cases, the third stage of cholecystitis occurs in the elderly.

The definition also qualifies for the intensity of the flow:

easy form. Characterized by the absence of pain or slight manifestations of pain for a few minutes. After an attack, the pain goes away on its own. Disorders in the digestive system are not detected. In the exacerbation phase, unpleasant symptoms are felt for two weeks. This condition occurs no more than 2 times a year. The rest of the organs (pancreas, liver, stomach) are working normally. As a rule, it is a stoneless form;
medium shape. With severe pain syndrome, dyspeptic disorders are added. Exacerbation phases occur more often (up to 3 times per year), the duration of the course may increase up to a month. The work of the liver worsens (the growth of bilirubin and other important indicators);
severe form. This stage is characterized by prolonged pain and dyspepsia. Flare-ups happen every month and can last for several weeks. Conservative treatment will not help to stop this stage; in severe cases, only surgical intervention is required. In parallel, pancreatitis, hepatitis can be observed.

The disease is characterized by an inflammatory process. On this basis, it can be:

relapse. Signs of the disease appear periodically, after which the exacerbation passes and remission occurs, the person does not feel sick;
monotonous flow. Lack of improvement is the most characteristic feature of this stage. A person constantly experiences discomfort and pain in the abdomen on the right. He has a permanent stool disorder, periodically there is a feeling of bitterness in the mouth and nausea;
intermittent flow. The disease proceeds in a sluggish form, but against this background, exacerbations periodically flare up in the form of colic and signs of intoxication of the body.

Diagnosis of gallbladder inflammation

The basis for the diagnosis of cholecystitis is the anamnesis collected by the therapist. During the initial examination, the doctor palpates the abdomen. During probing of the abdominal cavity, he asks about painful sensations on the right side of the torso, determines the point muscle tension in the area of the examined organ. Pain syndrome occurs with light tapping on the right hypochondrium zone.

In the course of the patient's study, hepatic colic is excluded or confirmed. The presence of stones in the bile ducts and an increase in the size of the organ are diagnosed using an ultrasound machine. The organ ducts are checked in detail using endoscopic retrograde cholangiopancreatography.

At the point of mandatory tests: urine and blood, which show ESR, leukocyte count, bilirubin level, indicate the presence of dysproteinemia. Biochemistry of urine reveals a high activity of amylase and aminotransferases.

How to distinguish renal colic from cholecystitis

Why is there a suspicion of renal colic in the initial diagnosis of gallbladder inflammation? Pain syndrome in both pathological conditions is localized in approximately one area - the right hypochondrium. It is almost impossible for a person with a sharp attack of pain to distinguish right-sided renal colic from cholecystitis - this is a task for a professional physician. Therefore, the first thing a patient needs to visit is a urologist who is able to deal with the symptoms.

With renal colic, an acute pain under the ribs on the right is caused by a sharp stretching of the gallbladder. Calculous catarrhal form is provoked by a violation of the diet, and this is taken into account during the collection of anamnesis. An attack of cholecystitis is accompanied by respiratory failure, with colic this is not observed. The latter pathological condition is characterized by the localization of pain in the lumbar region, less often in the right side.

Features of pain are important in the initial diagnosis. With cholecystitis, pain is felt in the right side in the hypochondrium. However, soon the pain moves and "gives" between the shoulder blades, in the neck, the right side of the chest, in the shoulder girdle. With colic, the pain syndrome shifts down the body: into the groin, inner thigh, with cholecystitis in men - into the penis and testicles.

In both pathological processes, nausea occurs, vomiting opens with a small amount of duodenal contents. Usually, the eruption of vomit does not relieve the condition.

Complications of cholecystitis

With a long course of the disease, the inflammatory process passes to the adjacent organs of the abdominal cavity. As a result, complicated cholecystitis occurs (pneumonia, pleurisy, pancreatitis develops). With the latter, a peri-vesicular abscess is formed. Cholangitis also often occurs against the background of cholecystitis. If the pathology is diagnosed too late, biliary empyema may occur.

There is a risk of outpouring of bile from a diseased organ into the abdominal cavity. This process is caused by the melting of tissues of a purulent nature or calculus perforation of the bladder wall. When the secretion is poured out, peritonitis develops, which is dangerous with a lethal outcome. When pathogens enter the bloodstream, sepsis begins.

Cholecystitis treatment

At the first stage, the doctor divides the therapy into several directions. They can be applied simultaneously or separately. The nature of the treatment depends on the form of the disease. In medical practice, the following are used:

conservative therapy;
traditional medicinal methods;
surgery.

The exacerbation of the disease, its transition from a chronic stage to an acute one should be controlled by a specialist. The patient is admitted to the hospital, prescribing special drugs. The standard treatment regimen in the acute stage is:

If the disease is not in the acute stage, the patient is shown the following treatment regimen:

drugs that drive bile (Holosas, Allohol, Olimetin);
strict nutrition with the exception of a number of products and dishes;
balneotherapy;
electrophoresis.

Diet for cholecystitis

The first point of therapy, the observance of which guarantees a speedy recovery of the patient, is a well-designed therapeutic diet. A special diet for inflammation of the biliary tissue and after removal of the organ accelerates rehabilitation and prevents complications. To normalize the digestive system, it is necessary to observe it for a long time.

At the primary stage of gallbladder pathology, "diet number 5" is shown. In case of exacerbation of the disease - "diet number 5a". By numbers, doctors mean a special menu with restrictions on products and methods of preparation.

A patient with an exacerbation should eat small meals. In severe cases, doctors recommend a two-day fast to ease the condition of the digestive system. During this short period, only liquid is allowed - healing herbal decoctions from berries or herbs, weak warm tea. After the "hunger days" are over, you can eat some food, steamed and thoroughly mashed.

Fractional techniques are important for exacerbations. You need to eat at least 4 times a day, better 5. It is worth adhering to the regime: breakfast, lunch, afternoon tea and dinner at the same time and so on from day to day. You can not bake and stew foods until the stage of remission comes. With exacerbation and severe pain, a complete exclusion is implied:

animal fats (lamb, pork and lard, red fish, duck, yolks);
confectionery products with creams;
rich pastries;
smoked and salty dishes;
fatty dairy products;
hot spices;
canned food;
coffee, cocoa, strong tea;
chocolate.

mashed porridge;
puree soups with mucus;
vegetable, fish, meat, cereal soufflé;
jelly;
steamed lean meat chops;
protein omelet;
mousses;
vegetable and butter;
puddings.

Food and drinks are consumed warm, since the cold or hot state of food causes a severe pain attack. Dietary fiber improves the quality of bile, so it is allowed to add it to the menu after the onset of remission. After recovery, vegetables, fruits, herbs, berries are included in the diet.

Tubage

The method of therapy is used to empty the inflamed organ during stagnation of bile, in addition, it improves the functioning of the gallbladder. The manipulation is carried out in two ways:

Probe. Implies the introduction of a duodenal probe orally. Bile is removed from the tube, the ways of its output are washed.
Probeless. It is carried out on an empty stomach in the morning using a special choleretic agent. You can use a drug, heated mineral water or herbal infusion. Having taken the remedy, you need to lie down and bend your knees under you. Lie for an hour and a half with a warm heating pad on your right side. With a positive effect, bile will begin to drain along with the feces, making them greenish.

The procedure is carried out 1 time in 7 days, the course is from 2 to 4 months. The specific time of therapy is prescribed by the doctor based on the patient's history. The tyubage method is used for exacerbation of a chronic form.

Surgical treatment of cholecystitis

The operation for cholecystitis differs in terms of carrying out:

Urgent. Should be performed no later than 12 hours after the diagnosis of the disease. Urgent intervention is indicated if there is an acute destructive cholecystitis with a number of complications - intoxication, peritonitis, organ perforation.
Urgent - a manipulation that must be performed no later than 72 hours from hospitalization. If the effect of conservative treatment has not been achieved, the patient is prepared for surgery within 1-3 days.
Early urgent. It is carried out in the interval from 3 to 10 days after the patient is admitted. Many people with a similar history are diagnosed with a destructive form of the disease.
Planned. Can be performed several months after diagnosis. Surgical intervention is prescribed to eliminate the focus of inflammation and restore the patency of the pathways for excreting bile.

In most cases, surgery is a cholecystectomy. It is performed by 85% of patients with exacerbation of gallbladder disease. Such a radical method allows the patient to fully recover.

Surgical intervention is performed in an open way. To access the diseased organ, traditional methods of abdominal surgery or a procedure using video laparoscopic equipment are used. The choice of one or another type of manipulation is influenced by many factors: the age and condition of the patient, the focus of inflammation, the duration of the course of the disease, severity, etc.

Open cholecystectomy implies the standard position of the patient on the operating table - supine. Open cholecystectomy involves making an incision along the right side of the torso, in the hypochondrium. The incision opens access to the duodenum, gallbladder, and bile ducts. This option is traumatic for the surrounding tissues. Rehabilitation increases, the term of a person's incapacity for work is extended. A laparotomic incision is chosen for surgery in case of a disease complicated by peritonitis or with an unclear diagnosis.

The laparoscopic method is more popular than the previous one, because it is safe, it is characterized by low invasiveness, no scars, and a short recovery period. In case of positive dynamics, the patient is discharged on the 3-4th day after the operation. Surgical intervention in the peritoneal cavity is performed through several small punctures. This option reduces blood loss.

Penetration into the abdominal cavity involves the use of special equipment:

a laparoscope equipped with a video camera;
color monitor, to which the image of the viscera from the sensor of the laparoscope is transmitted;
an insufflator (with its help, a sterile gas is injected into the peritoneum, straightening the insides);
a set of surgical instruments;
device for tissue coagulation.

The technique of laparoscopy is not used in all cases when cholecystectomy is indicated. This option of surgical intervention is not used in the presence of large calculi, adhesions, and a chronic form of the disease in the exacerbation stage.

Treatment of cholecystitis with folk remedies

At home, you can carry out therapy for gallbladder disease using medicinal plants. Doctors allow herbal medicine, but it should be an adjunct to mainstream treatment, not a complete replacement. This type of influence on pathology has become popular in recent years. Herbal medicine is often used in the complex treatment of pathological processes of the bile. In addition, treatment with folk remedies allows you to consolidate the effect of conservative medicine.

All herbal preparations for the treatment of cholecystitis are included in 2 large groups: bile-stimulating and choleretic agents:

Choleretics, which include: yarrow, peppermint, common barberry (fruits), corn stigmas, sandy immortelle (flamin), dandelion (root), tansy, elecampane (root), centaury, black radish (juice).
Cholekinetics, which include: tansy, rose hips (fruits), lemon balm, dandelion (root), chicory (root), dill (seeds), valerian (root), lavender, immortelle, hawthorn (flowers), cornflower (flowers), smoke , barberry (fruits), cumin (seeds).

It is necessary to use herbs in the form of tinctures and decoctions, which are prepared according to a certain technology. The course of admission is from 2 to 4 months. The freshness of the medicine is extremely important, the infusion is prepared for 1-2 days. The finished product is taken half an hour before meals, 2-3 times a day, 80-150 grams.

The tincture is not made up of more than 4-5 types of medicinal plants. It is recommended to select them depending on the properties and the effect on the body. During an exacerbation, you need to take a tincture from one plant. It is an antispasmodic or choleretic.

The benefits of herbal medicine are obvious:

fights against the causes of pathology;
minimum of contraindications for use (with the exception of individual intolerance);
does not cause side effects;
differs in affordable cost;
the rich composition ensures the intake of nutrients into the body - trace elements and vitamins;
there are no chemical components.

Reception of phytopreparations is agreed with the attending gastroenterologist. When self-using herbal decoctions, it is important to remember about the allergy to the components of the tincture.

Balneology: treatment of cholecystitis in the resort

When the exacerbation passes, it is important to consolidate the recovery with physiotherapy and balneological methods. The therapy is available at resorts, where for several weeks a person eats a strict diet, uses medicinal mineral water, and undergoes physiotherapy procedures.

Most often, doctors send patients for recovery to Karlovy Vary, Zheleznovodsk, Truskavets, Borjomi, Essentuki, Dorokhovo, Zheleznovodsk, Morshin and other resort towns.

Forecast and prevention

Whether it is possible to cure cholecystitis is an urgent question of our time. If the therapy is carried out according to all the rules, in compliance with the requirements of the doctor, including a strict diet, the prognosis is favorable. The patient's ability to work in a state of remission remains.

But the disease is dangerous with possible complications. First of all, we are talking about a rupture of an inflamed organ and peritonitis that has developed against this background. Such a relapse is dangerous and fatal if urgent medical attention is not provided.

The patient is required to strictly comply with the requirements of the attending physician. The patient should be under constant supervision of a specialist, because in the treatment it is extremely important to monitor the dynamics.

Prevention of gallbladder pathology is the minimization of the risks of occurrence of calculi inside the organ. Proper nutrition prevents the development of stones in the bladder: a person should eat only healthy and correct foods in the daily diet.

Prevention of inflammatory processes in the gallbladder consists in the following rules:

restriction of junk food: the use of fried, spicy, smoked, salty foods is minimized;
exclusion of carbonated and alcoholic drinks;
you need to eat fractionally and try to get rid of excess body fat;
periodically sanitize the nasopharynx and mouth (places of frequent development of infection in the body);
once every 6-12 months, examine the abdominal organs using the method of ultrasound diagnostics (pay attention to the gallbladder).

Physical activity with cholecystitis

Sports are not permitted in the aggravated stage. Exceptions are types of physical activity, in which the basis is jumping, sudden movements, jerking, lifting weights. Special remedial gymnastics is not harmful; it is recommended to consolidate the results of therapy and prevent relapses. In the state of the chronic phase of the disease, the gastroenterologist prescribes a visit to the exercise therapy room.

Lie on your back. One leg and the opposite arm go up and make movements gliding in the air. In parallel, breathing exercises are carried out. Inhale while raising your arms up.
Lying on your back, raise your head up and lower it back to the floor. Inhale is done while lifting.
Position - standing on all fours. On inhalation, roll over onto your stomach, tucking your right hand under it. Once on your stomach, exhale.
In the position on the left side, the left leg is bent and the left arm is extended. The right leg is pulled up to the stomach and extended back. Bend as you inhale, straighten as you exhale.
Lying on your back, fix your hands on your stomach. In this position, breathing exercises are carried out. Inhale and exhale slowly.

Important! Exercises are carried out slowly, without jerks and sudden movements. It is allowed to start classes only after the end of the exacerbation.

Lying on your side is the basis of therapeutic exercises, as it promotes the normal outflow of bile. Torso bends and gentle flexion improve blood flow and flush out the bladder. In addition, physiotherapy exercises have a general strengthening effect on muscle groups. The duration of training during the treatment phase is no more than 30 minutes.

As a supplement, it is recommended to use game attributes and sports equipment. This approach will diversify your activities and prolong your interest in therapeutic training. Along with gymnastics, muscle relaxation exercises are used to drain secretions from the gallbladder. The main requirement is to prevent concussion of internal organs (exclude jumping and sudden movements). Warming up is essential before exercise therapy. For this, swimming, leisurely walking, stretching are used. Massage is also suitable for warming up.

If an inflammatory disease of the organ is detected on time and adequate therapy begins, the prognosis is favorable. Strict adherence to the recommendations of the attending physician will allow a person to fully recover. It is harder and longer to fight the chronic form. During this period, the patient is able to work, he feels well.

Video

- forms of inflammatory lesions of the gallbladder, different in etiology, course and clinical manifestations. Accompanied by pain in the right hypochondrium, radiating to the right arm and collarbone, nausea, vomiting, diarrhea, flatulence. Symptoms arise against the background of emotional stress, dietary errors, and alcohol abuse. Diagnosis is based on physical examination data, ultrasound examination of the gallbladder, cholecystocholangiography, duodenal intubation, biochemical and general blood tests. Treatment includes diet therapy, physiotherapy, the appointment of analgesics, antispasmodics, choleretic drugs. Cholecystectomy is performed according to indications.

General information

Cholecystitis is an inflammatory disease of the gallbladder, which is combined with motor-tonic dysfunction of the biliary system. In 60-95% of patients, the disease is associated with the presence of gallstones. Cholecystitis is the most common pathology of the abdominal organs, accounting for 10-12% of the total number of diseases in this group. Inflammation of the organ is detected in people of all ages; middle-aged patients (40-60 years old) suffer more often. The disease is 3-5 times more likely to affect females. For children and adolescents, a stoneless form of pathology is characteristic, while calculous cholecystitis predominates among the adult population. Especially often the disease is diagnosed in civilized countries, which is due to the peculiarities of eating behavior and lifestyle.

Causes of cholecystitis

Cholelithiasis... Cholecystitis with gallstones occurs in 85-90% of cases. Concretions in the gallbladder cause bile stasis. They clog the lumen of the outlet, injure the mucous membrane, cause ulceration and adhesions, supporting the process of inflammation.
Biliary dyskinesia . The development of pathology is facilitated by functional impairment of motility and tone of the biliary system. Motor-tonic dysfunction leads to insufficient emptying of the organ, stone formation, inflammation in the gallbladder and ducts, and provokes cholestasis.
Congenital anomalies... The risk of cholecystitis increases with congenital curvatures, scars and constrictions of the organ, doubling or narrowing of the bladder and ducts. The above conditions provoke a violation of the drainage function of the gallbladder, stagnation of bile.
Other diseases of the biliary system... The occurrence of cholecystitis is influenced by tumors, cysts of the gallbladder and bile ducts, dysfunction of the valve system of the biliary tract (sphincters of Oddi, Lutkens), Mirizzi syndrome. These conditions can cause deformation of the bladder, compression of the ducts and the formation of bile stasis.

In addition to the main etiological factors, there are a number of conditions, the presence of which increases the likelihood of symptoms of cholecystitis, influencing both the utilization of bile and a change in its qualitative composition. These conditions include dyscholia (violation of the normal composition and consistency of gallbladder bile), hormonal changes during pregnancy, menopause. The development of enzymatic cholecystitis is facilitated by the regular reflux of pancreatic enzymes into the bladder cavity (pancreatobiliary reflux). Cholecystitis often occurs against the background of malnutrition, alcohol abuse, tobacco smoking, adynamia, sedentary work, hereditary dyslipidemia.

Pathogenesis

The main pathogenetic link of cholecystitis is considered to be stasis of gallbladder bile. Due to dyskinesia of the biliary tract, obstruction of the bile duct, the barrier function of the epithelium of the mucous membrane of the bladder decreases, the resistance of its wall to the effects of pathogenic flora. Stagnant bile becomes a favorable environment for the reproduction of microbes, which form toxins and promote the migration of histamine-like substances to the inflammation focus. With catarrhal cholecystitis, edema occurs in the mucous layer, thickening of the organ wall due to its infiltration by macrophages and leukocytes.

The progression of the pathological process leads to the spread of inflammation to the submucosal and muscle layers. The contractile ability of the organ decreases up to paresis, its drainage function worsens even more. An admixture of pus, fibrin, mucus appears in the infected bile. The transition of the inflammatory process to neighboring tissues contributes to the formation of a perivesical abscess, and the formation of purulent exudate leads to the development of phlegmonous cholecystitis. As a result of circulatory disorders, foci of hemorrhage appear in the wall of the organ, areas of ischemia appear, and then necrosis. These changes are characteristic of gangrenous cholecystitis.

Classification

Diagnostics

The main difficulty in verifying the diagnosis is considered to be the determination of the type and nature of the disease. The first stage of diagnosis is a consultation with a gastroenterologist. A specialist, on the basis of complaints, studying the medical history, conducting a physical examination, can establish a preliminary diagnosis. On examination, positive symptoms of Murphy, Kera, Mussey, Ortner-Grekov are revealed. To determine the type and severity of the disease, the following examinations are carried out:

Ultrasound of the gallbladder... It is the main diagnostic method that allows you to establish the size and shape of the organ, the thickness of its wall, contractile function, the presence of calculi. In patients with chronic cholecystitis, thickened sclerosed walls of the deformed gallbladder are visualized.
Fractional duodenal intubation... During the procedure, three portions of bile (A, B, C) are taken for microscopic examination. With this method, you can assess the motor skills, color and consistency of bile. In order to detect the pathogen that caused the bacterial inflammation, the sensitivity of the flora to antibiotics is determined.
Cholecystocholangiography. Allows you to get information about the work of the gallbladder, biliary tract in dynamics. Using the X-ray contrast method, a violation of the motor function of the biliary system, calculi and organ deformation are detected.
Laboratory blood test. In the acute period, neutrophilic leukocytosis and ESR acceleration are detected in the KLA. In the biochemical analysis of blood, an increase in the level of ALT, AST, cholesterolemia, bilirubinemia, etc. is noted.

In doubtful cases, to study the work of the biliary tract, hepatobiliscintigraphy is additionally performed,

Diet therapy... The diet is indicated at all stages of the disease. Fractional meals are recommended 5-6 times a day in boiled, stewed and baked form. Long breaks between meals (more than 4-6 hours) should be avoided. Patients are advised to exclude alcohol, legumes, mushrooms, fatty meats, mayonnaise, cakes.
Drug therapy. In acute cholecystitis, pain relievers, antispasmodics are prescribed. When pathogenic bacteria are detected in the bile, antibacterial agents are used, based on the type of pathogen. During remission, choleretic drugs are used that stimulate bile formation (choleretics) and improve the outflow of bile from the organ (cholekinetics).
Physiotherapy... It is recommended at all stages of the disease in order to relieve pain, reduce signs of inflammation, and restore the tone of the gallbladder. With cholecystitis, inductothermia, UHF, electrophoresis are prescribed.

Removal of the gallbladder is carried out with advanced cholecystitis, ineffectiveness of conservative treatment methods, calculous form of the disease. Two techniques of organ removal are widely used: open and laparoscopic cholecystectomy. Open surgery is performed for complicated forms, obstructive jaundice and obesity. Video laparoscopic cholecystectomy is a modern, low-traumatic technique, the use of which can reduce the risk of postoperative complications and shorten the rehabilitation period. In the presence of calculi, non-surgical stone crushing is possible using extracorporeal shock wave lithotripsy.

Forecast and prevention

The prognosis of the disease depends on the severity of cholecystitis, timely diagnosis and competent treatment. With regular medication, adherence to diet and control of exacerbations, the prognosis is favorable. The development of complications (phlegmon, cholangitis) significantly worsens the prognosis of the disease, can cause serious consequences (peritonitis, sepsis). For the prevention of exacerbations, one should adhere to the foundations of a balanced diet, exclude alcoholic beverages, lead an active lifestyle, and rehabilitate foci of inflammation (sinusitis, tonsillitis). Patients with chronic cholecystitis are recommended to undergo an ultrasound scan of the hepatobiliary system annually.