Chronic cholecystitis - the inflammation of a gall bladder which is followed by violation of its motor function and in certain cases – formation of concrements. It is clinically shown by the pain and weight in the right podreberye arising often after reception of greasy food and alcohol, nausea, vomiting, dryness and bitterness in a mouth. As informative methods of diagnosis of chronic cholecystitis serve biochemical tests of blood, ultrasonography of a gall bladder, the cholecystography, duodenal sounding. Conservative treatment includes application of medicines, phytotherapies, physical therapy; at kalkulezny cholecystitis removal of a gall bladder is shown.
Chronic cholecystitis – the inflammation of a gall bladder having a chronic current and recidivous character. It is often combined with bile removal violation. Cholecystitis is often accompanied pancreatitis, gastroduodenit, enterokolit. Chronic stagnation of bile promote formation of stones in a gall bladder and to development of kalkulezny cholecystitis. Pathology occurs approximately at 0,6% of the population, mainly at persons is a female at the age of 40-60 years. Chronic cholecystitis the population of economically developed countries has more often that is explained by features of food and way of life.
In gastroenterology chronic cholecystitis is classified by several principles. On existence in a gall bladder of stones it is subdivided on kalkulyozny and beskamenny. On a current allocate: latent (subclinical), often recidivous (more than 2 attacks in a year) and seldom recidivous (no more than 1 attack a year and less often).
On weight of a current chronic cholecystitis can proceed in easy, average weight and a severe form, with complications and without.
Depending on a functional state distinguish the following forms of dyskinesia of bilious ways:
- on hyper motor type;
- on hypomotor type;
- on the mixed type;
- the disconnected gall bladder.
Etiology and pathogenesis
The pathogenesis of a disease is given up violation of motor function of a gall bladder. Normal circulation of bile is broken, there is its stagnation and jelling. Later the infection joins. There is an inflammatory process. At chronic cholecystitis the inflammation develops more slowly, proceeds inertly. Can gradually pass from walls of a gall bladder to biliary tract. At a long current solderings, deformations of a bubble, an union with the bodies (intestines) which are nearby, formation of fistulas can be formed.
Development of chronic cholecystitis is promoted by the following factors:
- congenital violation of a structure of a gall bladder, decrease in its tone a hypodynamia, omission of these or those abdominal organs, pregnancy (the factors promoting mechanically caused stagnation of bile);
- violation of a diet (overeating, obesity, regular use of spicy, greasy food, alcoholism);
- dyskinesia of biliary tract on hypotype;
- intestinal parasites (lyambliya, amoebas, ascarids, opistorkh);
- zhelchekamenny disease.
Symptoms of chronic cholecystitis
Chronic cholecystitis develops for an appreciable length of time, the periods of remission alternate with aggravations. The main symptom is painful. Pain is moderately expressed, is localized in the right podreberye, has the stupid aching character, can proceed up to several days (weeks). Irradiation can happen in a back under a right shoulder-blade, the right half of lumbar area, the right shoulder. Of chronic cholecystitis it is characteristic strengthenings of a painful symptom after reception of spicy or greasy food, carbonated drinks, alcohol. The exacerbation of chronic cholecystitis is preceded most often by similar violations in a diet, and also overcooling and stresses.
The painful symptom at kalkulyozny chronic cholecystitis can proceed as bilious colic (pain sharp, strong, skhvatkoobrazny). Besides a painful symptom at patients quite often note nausea (up to vomiting), an eructation, smack of buckwheat in a mouth. In the period of an aggravation temperature increase of a body to subfebrilny values can be noted.
Atypical displays of chronic cholecystitis: dull aches in heart, locks, an abdominal distension, a dysphagy (disorder of swallowing). Development of these signs after violations in a diet is characteristic of chronic cholecystitis.
Complications of chronic cholecystitis: development of a chronic inflammation of bilious channels (holangit), perforation of a wall of a gall bladder, a purulent inflammation of a bubble (purulent cholecystitis), jet hepatitis.
Diagnosis of chronic cholecystitis
At diagnostics reveal the factors promoting its emergence – stagnation of bile and violation of motility of a bubble, the congenital and acquired defects of bodies leading to bile circulation difficulty, a hypodynamic way of life, characteristic eating habits (addiction to spicy, spicy food, fat, to alcohol). Cholecystitis can become a complication of parasitic diseases of a liver and intestines.
At poll and a palpation of a belly wall reveal features and localization of a painful symptom. Define symptoms, characteristic of an inflammation of a gall bladder: Murphy, Myussi, Shoffara.
At laboratory blood test in the period of an aggravation signs of a nonspecific inflammation are noted (increase in SOE, ). Biochemical blood test reveals increase in activity of hepatic enzymes (ALT, NUCLEAR HEATING PLANT, G-GTP, alkaline phosphatase).
On ultrasonography of a gall bladder determine the size, wall thickness, possible deformations and existence of stones in a gall bladder. Also solderings, the inflamed bilious ways, expanded bilious channels of a liver, violation of motility of a bubble are noted.
At duodenal sounding note violation of motility of a gall bladder, take the analysis of bile. At crops of bile detection of bacterial infection, definition of the causative agent of an infection is possible, it is also possible to hold testing of culture for sensitivity to antibiotics for the optimum choice of therapeutic means. Decrease in amount of bilious acids in the bile received from a bubble is characteristic of chronic beskamenny cholecystitis and concentration of litokholiyevy acid is increased. Also at an aggravation in bile the amount of protein, bilirubin (more than twice), free amino acids increases. Often in bile find cholesterol crystals.
The cholecystography, holegrafiya can be applied to definition of motility and a shape of a gall bladder. Arteriography reveals a thickening of a wall of a gall bladder and growth of vascular network in the field of DPK and adjacent departments of a liver.
Treatment of chronic cholecystitis
Treatment of nekalkulezny chronic cholecystitis is practically always performed by the gastroenterologist conservatively. Treatment in the period of an aggravation is directed to removal of sharp symptoms, sanitation of the center of a bacterial infection by means of antibiotic treatment (medicines of a broad spectrum of activity, as a rule, of group of tsefalosporin are applied), desintoxication of an organism (infusional introduction of solutions of glucose, sodium chloride), restoration of digestive function (fermental medicines).
To anesthesia and removal of an inflammation apply medicines of group of nonsteroid resolvents, removal of a spasm of smooth muscles of a bubble and channels carry out spazmolitikam.
Apply the medicines promoting strengthening of a vermicular movement of bilious ways (olive oil, a sea-buckthorn, magnesia) of Holeretiki (the medicines increasing bile secretion) to elimination of stagnation of bile apply with care not to cause strengthening of morbidity and aggravation of developments of stagnation.
In the period of an exacerbation of chronic uncomplicated cholecystitis apply phytotherapy methods to treatment: broths of herbs (peppermint, valerian, dandelion, camomile), calendula flowers.
After subsiding of symptoms of an aggravation and transition of a disease to a stage of remission observance of a diet, tyubazha with magnesia, xylitol or sorbite is recommended. Phytotherapeutic therapy of chronic cholecystitis consists in reception of broths of a tansy, buckthorn, , a yarrow. Physiotherapeutic treatment is applied: reflexotherapy, electrophoresis, SMT-therapy, mud cure, etc. Sanatorium treatment in balneological resorts is shown.
At chronic kalkulyozny cholecystitis surgical removal of a gall bladder – a source of formation of concrements is shown. Unlike treatment of sharp kalkulyozny cholecystitis, operation on removal of a gall bladder (a holetsistotomiya laparoscopic or open) at chronic cholecystitis is not an emergency measure, is appointed according to plan. The same surgical techniques are applied, as well as at sharp cholecystitis – laparoscopic operation of removal of a gall bladder, a holetsistektomiya from miniaccess. For the weakened and elderly patients – a chreskozhny holetsistostomiya for formation of an alternative way of outflow of bile.
At chronic cholecystitis in case of contraindications to surgery it is possible to try a technique of not surgical crushing of stones by means of an extracorporal shock and wave tsistolitotripsiya, however it is worth remembering that destruction of stones does not lead to treatment and quite often there is their repeated formation.
Also there is a technique of medicamentous destruction of stones by means of medicines of salts of ursodezoksikholiyevy and henodezoksikholiyevy acids, but this treatment takes very long time (to 2kh years) and also does not lead to full treatment, and does not guarantee that stones will not be created over time again.
Food at chronic cholecystitis
All sick chronic cholecystitis ordered a special diet and strict observance of a certain diet is necessary. At chronic cholecystitis the patient appoints a diet No. 5 in a stage of remission and a diet No. 5A at an exacerbation of a disease.
First, meals make each 3-4 hours in the small portions (fractional food), in - the second, adhere to restrictions in the use of certain products: fat, fried, hot, spicy dishes, carbonated drinks, alkogolesoderzhashchy products.
Egg yolks, crude vegetables and fruit, products from fancy pastry, oil and butter creams, nuts, ice cream are also forbidden to the use. At an aggravation are recommended freshly cooked for couple or boiled products in a warm look. The vegetables and fruit allowed patients during the period out of an aggravation: dried apricots, carrots, water-melon and melon, raisin, prunes. These products normalize motility of a gall bladder and save from locks.
Violation by patients of the principles of clinical nutrition leads to development of an exacerbation of a disease and progressing of destructive processes in a wall of a gall bladder.
Primary prevention of cholecystitis is observance of a healthy lifestyle, restriction in alcohol intake, lack of harmful eating habits (an overeating, addiction to spicy and greasy food), physically active life. In the presence of congenital anomalies of internals – timely identification and correction of developments of stagnation in a gall bladder. Avoiding of stresses and timely treatment of a zhelchekamenny disease and parasitic infections of intestines and liver.
For prevention of aggravations by the patient it is necessary to follow strictly a diet and the principles of fractional food, to avoid a hypodynamia, stresses and overcooling, heavy physical activity. Patients with chronic cholecystitis stay on the dispensary registry and twice a year have to undergo inspection. Regular sanatorium treatment is shown them.