Chronic beskamenny cholecystitis
Chronic beskamenny cholecystitis – the inflammatory damage of a gall bladder proceeding without formation of bilious concrements and which is followed by motor and tonic dysfunction of biliary tract as dyskinesia and a diskholiya. Chronic beskamenny cholecystitis proceeds with pains in the right podreberye, dispepsichesky frustration, subfebrilitety. Diagnosis of nekalkulezny cholecystitis is based taking into account laboratory yielded, results of duodenal sounding, the cholecystography, a tseliakografiya, ultrasonography of a gall bladder, a holestsintigrafiya. Treatment of an exacerbation of chronic beskamenny cholecystitis includes reception of spazmolitik, antibiotics, fermental medicines, holetsistokinetik or holeretik, phytotherapy. In cases of a persistent course of cholecystitis the holetsistektomiya is made.
Chronic beskamenny cholecystitis
Chronic beskamenny cholecystitis meets the frequency of 6-7 episodes of a disease for 1000 of the population. In gastroenterology 5-10% of all cases of an inflammation of a gall bladder fall to the share of chronic nekalkulezny cholecystitis. At women the disease develops in 3-4 times, than at men. Some authors are inclined to consider chronic beskamenny cholecystitis as the physical and chemical stage of a cholesteric kalkulez preceding formation of bilious concrements and therefore demanding purpose of preventive treatment. However, as practice shows, at many patients further does not happen to chronic beskamenny cholecystitis of development of cholelithiasis.
Reasons of chronic beskamenny cholecystitis
As direct etiologichesky agents at chronic beskamenny cholecystitis infectious activators act: colibacillus, enterokokk, staphylococcus, proteas, the mixed flora. They get into a gall bladder in the ascending way from intestines (at dysbacteriosis, colitis, enterita), a gepato-pancreatic zone (at chronic pancreatitis). Less often the infection extends gematogenno or limfogenno from the remote centers of a chronic inflammation (at periodontosis, chronic tonsillitis, appendicitis, pneumonia, a piyelita, an adneksita, etc.)
Carry to the contributing factors against the background of which infectious agents can become more active and cause an inflammation of a gall bladder , hypotonic - hypokinetic dyskinesia of biliary tract, parasitic invasions (, , , ), dysfunction of sphincters of bilious ways, endokrinopatiya (obesity, ), a hypodynamia, unbalanced and irregular food, a psychological overstrain, etc.
At chronic beskamenny cholecystitis there is a thickening and deformation of walls of a gall bladder, mucous acquires mesh structure due to alternation of sites of an atrophy and a polipovidny thickening of folds. The hypertrophy of a muscular cover with development in its thickness of cicatricial and fibrous fabric is noted. Upon transition of an inflammation to a subserous and serous layer can develop perikholetsistit, solderings with the next bodies, microabscesses and pseudo-diverticulums.
Classification of chronic beskamenny cholecystitis
On severity distinguish easy, average and heavy forms of chronic beskamenny cholecystitis. During a disease allocate stages of an aggravation, subsiding of an aggravation, permanent or unstable remission. The nature of development of chronic beskamenny cholecystitis can be recidivous, monotonous and alternating. Depending on complications distinguish the complicated and uncomplicated option of chronic nekalkulezny cholecystitis.
On a clinical current allocate typical and atypical (intestinal, ezofagalgichesky, kardialgichesky) forms of chronic beskamenny cholecystitis.
Symptoms of chronic beskamenny cholecystitis
The typical form of chronic beskamenny cholecystitis develops at 2/3 patients. The clinical picture consists of painful and dispepsichesky syndromes.
Pains at nekalkulezny cholecystitis are localized in the right podreberye, sometimes – in an epigastriya; have the aching character, arise or amplify after the use of greasy and fried food, spices, alcohol. Developing of bilious colic is atypical for chronic beskamenny cholecystitis. In case of development of a perikholetsistit the pain syndrome gains constant character; pains become intensive, irradiate in a waist, the right shoulder and a shovel. Sometimes at patients with chronic beskamenny cholecystitis neurasthenia symptoms develop: sleeplessness, irritability.
Dispepsichesky frustration at chronic beskamenny cholecystitis are characterized by nausea, an eructation air, constant bitter smack in a mouth, meteorizmy, alternation of ponos and locks. At an exacerbation of chronic beskamenny cholecystitis develops subfebrilitt; high fever can demonstrate development of a holangit or empiyema of a gall bladder. Holangit it is characterized by a skin itch, at damage of a liver jaundice is noted.
The atypical ezofagalgichesky form of chronic beskamenny cholecystitis proceeds with persistent heartburn, weight and pains behind a breast, an easy changeable dysphagy. At an intestinal form of chronic beskamenny cholecystitis intestines pains, a meteorizm, tendency to locks prevail. The Kardialgichesky form is characterized by arrhythmias (more often premature ventricular contraction), zagrudinny pains, changes of the ECG (flattening, inversion of a tooth of T).
The course of chronic beskamenny cholecystitis can be complicated by jet hepatitis, a chronic holangit, kalkulezny cholecystitis, empiyemy a gall bladder, perforation of a wall of a gall bladder and development of peritonitis.
Diagnosis of chronic beskamenny cholecystitis
At fizikalny inspection the stomach palpation in a projection of a gall bladder is painful; morbidity amplifies on a breath (Kerr's symptom) and at a pokolachivaniye on the right costal arch a palm edge (Ortner's symptom), etc. At biochemical blood test the increased levels , alkaline phosphatase, a γ-glutamiltranspeptidaza are defined.
To the major visualizing and tool methods of diagnosis of chronic beskamenny cholecystitis ultrasonography of a gall bladder possesses, the cholecystography, a tseliakografiya, a holestsintigrafiya, duodenal sounding.
On the basis of duodenal sounding it is possible to judge extent of inflammatory damage of a gall bladder. As typical macroscopic changes of a portion In (puzyrny bile) serve its turbidity, existence of flakes and slime; at microscopy of bile a large number of leukocytes and a deskvamirovanny epithelium, the increased content of bilirubin, protein, cholesterol crystals and so forth is found. At a bakposeva of bile microbic flora comes to light.
By means of the cholecystography at patients with chronic beskamenny cholecystitis motor and concentration function of a gall bladder, its form and situation is estimated.
Deformation of a gall bladder, change of its sizes, thickening or atrophy of walls, roughness of an internal contour, existence of not homogeneous contents with inclusions of non-uniform bile are Ekhografichesky signs of chronic beskamenny cholecystitis. After reception of a bile-expelling breakfast the lowered sokratimost of a gall bladder is traced.
Differential diagnosis of chronic beskamenny cholecystitis is carried out with diskineziya of biliary tract, ZhKB, a chronic holangit, nonspecific ulcer colitis, a disease Krone.
Treatment of chronic beskamenny cholecystitis
In most cases treatment of chronic beskamenny cholecystitis conservative. Dietary food is recommended: frequent fractional meal with an exception of fat, fried, hot dishes, carbonated drinks and alcohol.
At abdominal pains spazmolitik are appointed (, , a papaverine, etc.). At an exacerbation of chronic beskamenny cholecystitis and its combination with holangity antibacterial therapy by medicines of a broad spectrum of activity (cefazolin, amoxicillin, erythromycin, ampicillin, furasolidone, etc.) taking into account the microflora sowed from bile is shown.
For normalization of digestion reception of fermental medicines (Pancreatinum) is recommended. For the purpose of strengthening of secretion of bile reception of holeretik can be required (dry bile, phytomedicines); for stimulation of reduction of a gall bladder – holetsistokinetik (magnesium sulfate, ).
During the periods of aggravations and remission of chronic beskamenny cholecystitis phytotherapy courses – reception of broths of a camomile, mint, flowers of a calendula, dogrose, a glycyrrhiza, etc. are expedient. Out of an aggravation blind tyubazh, treatment are recommended by mineral waters, LFK.
Serve as indications to surgical treatment of chronic beskamenny cholecystitis the persistent course of a disease, the expressed deformation of a gall bladder, perikholetsistit, the "disconnected" gall bladder, accession resistant to treatment of a holangit and pancreatitis. In these cases the holetsistektomiya is carried out (open, laparoscopic or from mini-access).
Forecast and prevention of chronic beskamenny cholecystitis
Easy degree of chronic beskamenny cholecystitis with infrequent aggravations has a favorable current. The forecast worsens in case of frequent aggravations, a medium-weight current, development of complications.
As prevention of chronic beskamenny cholecystitis serves timely therapy of sharp cholecystitis, sanitation of the infectious centers, elimination of exchange and neurotic violations, observance of the correct diet, prevention of intestinal infections and helminthic invasions.