In most cases, inflammation of the gall caused by the presence in it of stones - chronic calculous cholecystitis. Less common nekalkulezny cholecystitis caused by the infectious process can act.
What it is?
Chronic cholecystitis calculary - persistent inflammation of the mucosa of the gallbladder, the conjugate to the presence of stones. Gastroenterologists say that this pathology is associated with a secondary infection of the bile. The disease is clinically manifested by pain in his right side, nausea, mood swings.
Types of gallstones
Homogeneous (uniform) stones. This group includes cholesterol calculi formed due to metabolic disorders. These rentgenoaktivnye education do not cause inflammatory changes in the gallbladder, are the most common in obese patients.
Bilirubin (pigment) stones, arising due to the enhanced decay of erythrocytes, characteristic of patients suffering from congenital hemolytic anemia, thalassemia, sickle anemia. They also formed in an aseptic environment. Calcareous concretions (very rare formation) occur due to complications of acute inflammatory processes in the biliary tract.
Mixed concrements (this group is 80% of the total number of gallstones). The core of such a stone is presented in the form of organic material, around which the layers located cholesterol, bilirubin and calcium salts.
Sophisticated concrements (10% of total). They are a combination of both forms. The core consists of cholesterol, and the shell - of a mixture of bilirubin, cholesterol and calcium. As a rule, complex rocks observed in inflammation in the gallbladder and biliary tract.
Causes of
A major role in the development of stone formation plays a metabolic disorder of bilirubin and cholesterol. It is poorly soluble components of bile is retained in the solution due to the emulsifying action of bile acids. In the case of increasing the concentration of cholesterol and bilirubin in the bile is a risk of stone formation. Such a condition occurs in atherosclerosis, obesity, gout, diabetes, hyperlipoproteinemia.
Risk factors that promote stone formation
- irregular eating (overeating, starvation, sparse meals);
- compromised immune status;
- pregnancy;
- vitamin A deficiency;
- prolapse of internal organs;
- lack of exercise;
- genetic predisposition;
- adhesions, scarring, kinks bile ducts;
- pathology of the pancreas;
- persistent constipation;
- hormonal contraceptives;
- violation of neurohumoral regulation of the contractile function of the gallbladder and bile ducts.
However, an important role in the development of calculous cholecystitis plays a poor diet (excessive consumption of refined carbohydrates, fat containing a high percentage of food cholesterol, flour and cereal foods) leads to a shift of pH to the acid side of bile and solubility reduction cholesterol.
Classification
Allocate acute and chronic form, wherein for each of them may be smooth and complicated.
- In chronic calculous cholecystitis inflammation develops slowly and manifests itself in periods of exacerbation, the infectious factor is not so significant role. In the development of calculous cholecystitis are the leading disorders in the composition of bile, its thickening and congestion, irritation of the bladder wall. This usually occurs due to errors in the diet, obesity, diabetes, endocrine shifts and frequent infections. Predisposing factors include biliary dyskinesia, liver disease, chronic gastritis and duodenitis.
- The acute form of calculous cholecystitis is rare, it usually manifests itself as a result of long-term asymptomatic cholelithiasis, whereby due to the blockage of the bile duct stone general inflamed bladder wall. This happens when the penetration into the region of the bladder infection to surrounding organs due to violations of the antiseptic properties of bile. As a result, it developed rapidly thickening of the walls and their degradation (destruction), which may lead to accumulation of pus inside the bubble and the formation of bile peritonitis.
symptoms
The presence of stones in the gallbladder can not affect the human condition, so at the initial stage of the disease is often asymptomatic, latent.
Symptomatology depends on the stage of the disease, however calculary acute cholecystitis, characterized by the following features presence biliary colic:
- a sharp decrease in blood pressure;
- the appearance of weakness and cold sweat;
- nausea, vomiting, stomach contents and bile;
- elevated temperature, which is particularly characteristic of suppurative inflammation;
- acute pain, localized in the right side and smack in the shoulder area and right scapula caused by violations of diet, alcohol, physical activity or stress;
- individual manifestations of jaundice with a change in color of stool: stool contains a lot of fat and has a bleached appearance, and urine is darker than usual.
Manifestations of chronic calculous cholecystitis are smoother:
- often arising aching pain in the area of the right hypochondrium;
- nausea and regurgitation with a bitter aftertaste;
- violation of the right to food can cause sporadic vomiting with bile;
- occurrence of acute pain caused by poor diet, which gradually subsides itself;
- paroxysmal pain arising after 3 hours after eating a fat, salt or fried foods.
Chronic calculous cholecystitis stage of development characterized by the presence of gallstones, inflammation faint and periodic manifestations of the disease.
Chronic period can occur almost asymptomatic or declare themselves bouts of biliary colic. When the latent form of the disease the person feels a sense of gravity to the right costal margin. Suffering from bloating, diarrhea, heartburn, eructation, bitter taste in mouth feel. After eating fatty foods or unpleasant symptoms worse.
Hepatic colic can occur suddenly, in most cases it is preceded by a violation of the diet, heavy physical labor, transferred psycho-emotional stress. Attack of colic causes spastic reduction of the gall bladder and tract caused by irritation of the stones. There is a sharp pain stabbing nature of different intensity, localized in the right upper quadrant and of referred to the right of the shoulder blade and neck. attack time can vary from a few minutes to a couple of days.
Diagnostics
The main purpose of diagnostic examination of a patient is possible detection of the disease, and its complications, as well as the appointment of therapeutic regimen, the most appropriate existing situation.
At external examination and palpation of the abdomen - symptoms:
- Kera - the appearance of pain in the maximum inspiratory while of clicking in the right zone of ribs;
- Murphy - holding your breath when pressing your fingers under the ribs on the right;
- Ortner - the appearance of pain during tapping in the right zone of ribs;
- Frenikus-symptom - the emergence of pain when pressing in a certain area.
The results of MRI and CT gallbladder observed:
- in the presence of liquid paravesical tissue;
- thickening body wall;
- rejection mucosa;
- gas in the interior or lumen of the body wall.
On the overview x-ray of the gallbladder are observed:
- gas into lumen or thicker body walls during the development of anaerobic infections;
- stones - one in ten patients;
- partial or complete calcification of the body wall.
The results of the blood tests and biochemical liver function tests observed exceedances:
- alkaline phosphatase;
- alanine aminotransferase (ALT);
- total bilirubin;
- aspartate aminotransferase (AST).
The appointment of a particular treatment regimen is based upon the history of the patient.
Treatment of calculous cholecystitis
When the diagnosis of chronic cholecystitis calculary treatment can be both conservative and surgical. The choice of method depends on the severity of the symptoms, the frequency of exacerbations, composition, size and number of stones, as well as the presence of complications.
Non-surgical treatment includes:
- dieting,
- medications.
Of Medicine physician may prescribe antispasmodics, hepatoprotectors, phytochemicals, enzymes, antibiotics (if the infection is now). When calculous cholecystitis treatment without operation is possible if the stones have small dimensions (15 mm) and composed of cholesterol.
Cholecystitis on the background of gallstone disease are contraindicated any cholagogue preparations, as they may cause blockage of the bladder and the development of dangerous complications.
For their use preparations dissolving bile acids. Another important condition for conservative treatment - normal motor activity of the gall bladder. If these details are not taken into account, then litholytic therapy may worsen the patient's condition and even cause complications.
Surgery
The main method of treatment in chronic calculous cholecystitis is surgical.
There are some types of operations:
| open cholecystectomy | This operation to remove the bladder through the abdominal incision. This type is used in severe complications, such as adhesions or infections; |
| Laparoscopy | This removal of the gallbladder using a laparoscope through a small incision. This operation is very widespread, since post-operative recovery is much faster and with fewer complications; |
| percutaneous cholecystectomy | It is due to the introduction of drainage into the gallbladder. Apply this type of surgery for elderly patients, patients with obstructive cholecystitis and prolonged obstructive jaundice. |
Before surgery, you can try the method of crushing stones waves with their large sizes. In some cases, after such a procedure possible to avoid surgery. To prevent gallstone symptoms and prevention of stone formation is very important to adjust the power and stick low-calorie diet, cure all diseases of the gastrointestinal tract, try to avoid stress and physically overwork.
Immediately after the discovery of calculous cholecystitis need to start treatment, it helps to avoid complications that may lead to cholecystectomy. Chronic calculous cholecystitis treatment provided under the guidance of a doctor.
Diet after cholecystectomy
Operated for calculous cholecystitis patients assigned diet after surgery. In the absence of the gallbladder, which serves as a physiological tank requires frequent discharge of the biliary tract. Therefore, the patient throughout later life is forced to comply with a fractional power. Otherwise, the stones can be formed again in the cult bladder or passages themselves. meals should be at least 5-6 times a day.
After cholecystectomy, there is a shortage of bile acids are responsible for the digestion of fats. Therefore, the menu should be excluded lard, mutton and beef fat. The use of high-fat dairy products and butter should be restricted. To compensate for the lack of lipids in the diet include more vegetable oil. They can be refilled cereals, salads, vegetable purees.
Diet for chronic calculous cholecystitis
Diet for chronic calculous cholecystitis, as well as the diet for GSD is based on compliance with a certain diet (eat food It requires four - five times a day so that the maximum amount of calories should not exceed 2000), and to exclude the following products drinks and meals:
- soft drinks;
- chocolates;
- alcohol;
- fatty, spicy, sweet and savory;
- fast food;
- margarine;
- of sugar in its natural form.
The recommended same products, drinks and meals in this case are:
- boiled chicken or rabbit;
- fresh and steamed vegetables;
- boiled or braised sea fish;
- any fruit;
- vegetable oil;
- beet juice;
- nenavaristy broth;
- cereals;
- doctor recommended mineral water.
prevention
As a preventive measure:
- eliminated the factors that lead to stone formation;
- appointed prolonged low-calorie diet;
- unload the digestive system 1 time per week;
- limit the physical and emotional overloads;
- reduce the weight;
- take prescription medications a doctor;
- drink broth of herbs, cooked folk ways.
Forecast
Forecasts for the cure of the disease is largely dependent on how it proceeds.
Thus, no complicated course cholecystitis usually has favorable prognoses. Complicated same form of the disease, as well as the presence of severe concomitant diseases, leads to significant deterioration projections cure - mortality of patients with these pathologies is 50-60%.
This is explained by the fact that the complicated forms of the disease are accompanied by the rapid development of empyema and gangrene body, liver abscesses, fistulas, peritonitis.
