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Sharp cholecystitis

Sharp cholecystitis — the inflammation of a gall bladder which is characterized by suddenly arising violation of the movement of bile as a result of blockade of its outflow. Development of pathological destruction of walls of a gall bladder is possible. In most cases (85-95%) development of sharp cholecystitis is combined with concrements (stones), more than at a half (60%) of patients bacterial infection of bile is defined (colibacilli, cocci, salmonellas and t of the item). At sharp cholecystitis the symptomatology arises once, develops and, at adequate treatment, stukhat, without leaving the expressed consequences. At repeated repetition of bad attacks of an inflammation of a gall bladder speak about chronic cholecystitis.

    Sharp cholecystitis

    Sharp cholecystitis — the inflammation of a gall bladder which is characterized by suddenly arising violation of the movement of bile as a result of blockade of its outflow. Development of pathological destruction of walls of a gall bladder is possible. In most cases (85-95%) development of sharp cholecystitis is combined with concrements (stones), more than at a half (60%) of patients bacterial infection of bile is defined (colibacilli, cocci, salmonellas and t of the item). At sharp cholecystitis the symptomatology arises once, develops and, at adequate treatment, stukhat, without leaving the expressed consequences. At repeated repetition of bad attacks of an inflammation of a gall bladder speak about chronic cholecystitis.

    Sharp cholecystitis develops at women more often, the risk of its emergence increases with age. There are assumptions of influence of a hormonal background on development of cholecystitis.

    Classification

    Sharp cholecystitis is subdivided in a form on catarrhal and destructive (purulent).

    In turn, distinguish from destructive forms flegmonozny, flegmonozno-ulcer, gangrenous and perforative, depending on a stage of inflammatory process.

    Etiology and pathogenesis

    Cholecystitis reasons:

    • damage of walls of a bubble by firm educations (stones), obstruction by stones of a bilious channel (kalkulezny cholecystitis);
    • bile infection with bacterial flora, development of an infection (bacterial cholecystitis);
    • throwing of enzymes of a pancreas in a gall bladder (enzymatic cholecystitis).

    In all cases development of an inflammation in walls of a gall bladder causes narrowing of a gleam of a bilious channel (or its obturation a concrement) and stagnation of bile which gradually gets thick.

    Symptoms of sharp cholecystitis

    The main symptom is bilious colic – the acute expressed pain in the right podreberye, the top part of a stomach which is perhaps irradiating in a back (under a right shoulder-blade). Less often irradiation happens in the left half of a body. Alcohol intake, spicy, greasy food, a severe stress can precede developing of bilious colic.

    Besides a pain syndrome, sharp cholecystitis can be followed by nausea (up to vomiting with bile), subfebrilny temperature.

    In mild cases (without existence of stones in a gall bladder) sharp cholecystitis proceeds quickly (5-10 days) and comes to the end with recovery. At accession of an infection purulent cholecystitis, at persons with the weakened protective forces of an organism capable to pass (proryvany) walls of a gall bladder into gangrene and perforation develops. These states are fraught with a lethal outcome and demand immediate expeditious treatment.

    Diagnosis of sharp cholecystitis

      ()For diagnostics identification of violations in a diet or stressful states matters at poll, presence of symptomatology of bilious colic, a palpation of a belly wall. At suspicion ultrasonography of abdominal organs is surely appointed to an acute inflammation of a gall bladder. It shows increase in body, existence or absence in a gall bladder and a bilious channel of stones.

    At ultrasonic inspection the inflamed gall bladder has thickened (more than 4 mm) walls with a double contour, expansion of bilious channels, a positive symptom of Murphy can be noted (bubble tension under the ultrasonic sensor).

    The computer tomography gives a detailed picture of abdominal organs. Apply ERHPG technique (an endoscopic retrograde holangiopankreatografiya) to a detailed research of bilious channels.

    Blood test shows inflammation signs (, high SOE), a disproteinemiya and a bilirubinemiya, increase in activity of enzymes (amylase, aminotransferases) at biochemical blood test and urine.

    Differential diagnosis

    In case of suspicion of sharp cholecystitis carry out differential diagnostics with sharp inflammatory diseases of abdominal organs: acute appendicitis, pancreatitis, liver abscess, probodny stomach ulcer or 12 items of a gut. And also with an attack of an urolithic disease, pyelonephritis, right-hand pleurisy.

    Important criterion in differential diagnosis of sharp cholecystitis is functional diagnostics.

    Complications

    Often complications of sharp cholecystitis are a consequence of development of an infection: empiyema of a gall bladder (purulent inflammation) and emphysema (gas congestion) of a gall bladder, sepsis (generalization of an infection).

    Also sharp cholecystitis can lead to a perforation of a gall bladder, the inflammation of a peritoneum (peritonitis) will turn out to be consequence of what, puzyrno-intestinal fistula can be created. Often cholecystitis is complicated by a pancreas inflammation.

    Treatment of sharp cholecystitis

    ё  ё In case of primary diagnosing of sharp cholecystitis if existence of stones is not revealed, the current not heavy, without purulent complications – treatment is carried out conservatively under observation of the gastroenterologist. Apply antibiotic treatment to suppression of bacterial flora and prevention of possible infection of bile, a spazmolitika for removal of a pain syndrome and expansion of bilious channels, dezintoksikatsionny therapy at the expressed organism intoxication.

    In case of development of severe forms of destructive cholecystitis – surgical treatment (holetsistotomiya).

    In case of identification of stones in a gall bladder, most often removal of a gall bladder is also offered. Operation of the choice is the holetsistektomiya from miniaccess. At contraindications to carrying out operation and lack of purulent complications it is possible to use methods of conservative therapy, but it is worth meaning that the refusal of expeditious removal of a gall bladder with large concrements is fraught with development of repeated attacks, transition of process to chronic cholecystitis and development of complications.

    All sick sharp cholecystitis showed a dietotherapy: 1-2 days water (it is possible sweet tea), then a diet No. 5A. The patient of a rekomenovan food, freshly cooked on couple or boiled in a warm look. The refusal of the products containing a large amount of fats of hot spices, fancy bread, fried, smoked is obligatory. For prevention of locks the refusal of the food rich with cellulose (fresh vegetables and fruit), nuts is recommended. Alcohol-containing and carbonated drinks are strictly forbidden.

    Options of surgical interventions at sharp cholecystitis:

    • laparoscopic holetsistotomiya;
    • open holetsistotomiya;
    • chrezkozhny holetsistostomiya (it is recommended for the elderly and weakened patients).

    Prevention

    Prevention consists in respect for norms of healthy food, restriction of alcohol intake, large numbers of spicy, greasy food. Also physical activity is welcomed – the hypodynamia is one of the factors promoting stagnation of bile and formation of concrements.

    It is better to carry out meal according to the mode, at least, than each 4 hours. It is obligatory to use enough liquid (from one and a half liters), not to overeat for the night. For health of a gall bladder obesity, intestinal parasites (ascarids, lyambliya), severe stresses also are adverse.

    Forecast

    Easy forms of sharp cholecystitis without complications, as a rule, come to an end with fast recovery without noticeable consequences. At insufficiently adequate treatment sharp cholecystitis can become chronic. In case of development of complications the probability of a lethal outcome is very high – the complicated sharp cholecystitis mortality reaches nearly a half of cases. In the absence of timely medical assistance development of gangrene, perforation, empiyema of a gall bladder happens very quickly and is fraught with a lethal outcome.

    Removal of a gall bladder does not lead to noticeable deterioration of life of patients. The liver continues to develop necessary amount of bile which comes directly to a duodenum. However after removal of a gall bladder the postkholetsistektomichesky syndrome can develop. At first at patients after a holetsistotomiya more frequent and soft chair can be noted, but, as a rule, over time these phenomena disappear. Only seldom or never (1%) operated note persistent diarrhea. In that case it is recommended to exclude dairy products from a diet, and also to limit itself in fat and sharp, having increased quantity of the used vegetables and others, rich with cellulose, products.

    If dietary correction does not bring desirable result, appoint drug treatment of diarrhea.

    Sharp cholecystitis - treatment

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