Cholecystitis is an inflammation of one of their internal organs organism - the gallbladder, it is acute and chronic. Among diseases of the internal organs, cholecystitis is one of the most dangerous, because it causes not only severe pain, but also inflammatory processes and the formation of calculi, during the movement of which a person needs emergency surgical care, and if it is not provided in time, a fatal outcome may occur.

Chronic and acute cholecystitis, the symptoms and treatment of which we will describe in our article, are closely related to cholelithiasis and almost 95% of cases are diagnosed simultaneously, while determining the primacy of a particular disease is much more difficult. Every year the number of these diseases increases by 15%, and the occurrence of stones annually increases by 20% among the adult population. It is noticed that men are less prone to cholecystitis than women after 50 years.

How does cholecystitis manifest itself?

Cholecystitis is catarrhal, purulent, phlegmonous, perforative, gangrenous.

• Acute cholecystitis - causes

The most dangerous is the acute form of cholecystitis, which is accompanied by the formation of stones, both in the bladder itself and in its ducts. It is stone formation that is the most dangerous in this disease, this disease is also called calculous cholecystitis. First, the accumulation of bilirubin, cholesterol, calcium salts on the walls of the gallbladder form calcifications, but then with their prolonged accumulation, the size of the deposits increases and may represent serious complications in the form of inflammation of the gallbladder. Often there are cases when stones enter the bile ducts and form serious obstacles to the outflow of bile from the gallbladder. This can lead to inflammation and peritonitis if the patient is not treated in time.

• Chronic cholecystitis- causes

Chronic cholecystitis is a longer current form of the disease. It is characterized by periods of remission and exacerbations. The development of pathology is based on damage to the walls of the bladder against the background of impaired evacuation of bile from it (hypo or hypermotor dyskinesia, pathology of the sphincter of Oddi). Secondarily, these factors are superimposed by a nonspecific bacterial infection that maintains inflammation or turns it into a purulent one.

Chronic cholecystitis can be calculous or non-calculous. In the first case, it is sand and stones that injure the mucous membrane of the bladder, clog the bile ducts or the neck of the bladder, preventing the outflow of bile.

Acalculous forms arise due to anomalies in the development of the bladder and ducts, their kinks, ischemia (in diabetes mellitus), tumors and strictures of the common cystic duct and bladder, irritation with pancreatic enzymes, obstruction of the ducts with worms, bile slugging in pregnant women, who quickly lost weight or receive full parenteral nutrition.

The most common microorganisms causing inflammation, there are streptococci and staphylococci, as well as escheria, enterococci, proteas. Emphysematous forms are associated with clostridia. Less commonly, chronic cholecystitis may be of viral origin, or be caused by a prototic infection. All types of infections penetrate into gallbladder contact (through the intestines), lymphogenous or hematogenous route.

At various types helminthic invasions, such as - with opisthorchiasis, strongyloidiasis, fasciolosis, partial obstruction of the bile duct (with ascariasis), symptoms of cholangitis (from fascioliasis), persistent dysfunction of the biliary tract is observed with giardiasis.

Common causes of cholecystitis:

• Congenital malformations of the gallbladder, pregnancy, prolapse of the abdominal organs
• Biliary dyskinesia
• Cholelithiasis
• The presence of helminthic invasion - ascariasis, giardiasis, strongyloidiasis, opisthorchiasis
• Alcoholism, obesity, an abundance of fatty, spicy food in the diet, violation of the diet

With any type of cholecystitis, the development of inflammation of the walls of the gallbladder leads to a narrowing of the lumen of the ducts, its obstruction, to stagnation of bile, which gradually thickens. Arises vicious circle, in which sooner or later a component of autoimmune or allergic inflammation appears.

When formulating the diagnosis of chronic cholecystitis, it is indicated:

• stage (exacerbation, subsiding exacerbation, remission)
• severity (mild, moderate, severe)
• the nature of the course (monotonous, recurrent often)
• state of gallbladder function (preserved, non-functioning bladder)
• nature of biliary dyskinesia
• complications.

Symptoms of acute cholecystitis

A provoking factor that gives points to the development of an acute attack of cholecystitis is powerful stress, overeating of spicy, fatty foods, and alcohol abuse. In this case, the person experiences the following symptoms acute cholecystitis:

• Acute paroxysmal pains in the upper abdomen, in the right hypochondrium, radiating to the right shoulder blade, can rarely radiate.
• Fatigue, severe weakness
• A slight increase in body temperature to subfebrile numbers 37.2 -37.8C
• There is an intense aftertaste
• Vomiting without relief persistent nausea sometimes vomiting with bile
• empty burp
• The appearance of a yellowish skin tone - jaundice

The duration of acute cholecystitis depends on the severity of the disease, it can vary from 5-10 days to a month. In not severe cases when there are no stones and does not develop purulent process the person recovers fairly quickly. But with weakened immunity, the presence of concomitant diseases, with perforation of the gallbladder wall (its rupture), severe complications and death are possible.

Symptoms of chronic cholecystitis

Chronic cholecystitis does not occur suddenly, it develops over a long time, and after exacerbations, against the background of treatment and diet, periods of remission occur, the more carefully the diet and maintenance therapy are followed, the longer the period of absence of symptoms.

The main symptom of cholecystitis is a dull pain in the right hypochondrium, which can last for several weeks, it can radiate to the right shoulder, and the right lumbar region, be aching. Increased pain occurs after taking fatty, spicy foods, carbonated drinks or alcohol, hypothermia or stress, in women, exacerbation may be associated with PMS (premenstrual syndrome).

The main symptoms of chronic cholecystitis:

• Indigestion, vomiting, nausea, lack of appetite
• Dull pain on the right under the ribs, radiating to the back, shoulder blade
• Bitterness in the mouth, belching bitterness
• Heaviness in the right hypochondrium
• subfebrile temperature
• Possible yellowing of the skin
• Very rarely, atypical symptoms of the disease occur, such as heart pain, swallowing disorder, bloating, constipation

For the diagnosis of both acute and chronic cholecystitis, the most informative methods are the following:

• cholegraphy
• duodenal sounding
• cholecystography
• Ultrasound of the abdominal organs
• scintigraphy
• A biochemical blood test shows high levels of liver enzymes - GGTP, alkaline phosphatase, AST, ALT.
• Diagnostic laparoscopy and bacteriological examination are the most modern and available methods diagnostics.

Of course, any disease is easier to prevent than to treat, and an early study can reveal early violations, deviations in the chemical composition of bile. And if you follow a strict diet, it will be enough for for a long time prolong the period of remission of this disease and prevent serious complications.

Treatment of chronic cholecystitis

Treatment of a chronic process without the formation of stones is always carried out conservative methods, the main of which is dietary nutrition (diet 5 - fractional nutrition with a sufficient volume of liquid, mineral water). In the presence of gallstones - limitation of hard work, physical overload, bumpy ride.

The following medicines are used:

• Antibiotics, most often broad-spectrum or cephalosporins
• Enzyme preparations - Pancreatin, Mezim, Creon
• Detoxification - intravenous infusion of sodium chloride, glucose solutions
• NSAIDs - sometimes used to relieve inflammation and pain

Choleretic drugs are usually divided into:

• Choleretics are drugs that increase the production of bile. Preparations containing bile and bile acids: allochol, lyobil, vigeratin, cholenzyme, dihydrocholic acid - holagon, sodium salt dehydrocholic acid - decholine. Herbal preparations increase the secretion of bile: Flacumin, corn stigmas, berberine, convaflavin. Synthetic drugs: osalmide (oxafenamide), hydroxymethylnic otinamide (nikodin), tsikvalon, hymecromon (odeston, cholonerton, cholestyl).
• Cholekinetics are divided into: promoting the release of bile and increasing the tone of the gallbladder (magnesium sulfate, pituitrin, choleretin, cholecystokinin, sorbitol, mannitol, xylitol) and cholespasmolytic and reducing the tone of the biliary tract and the sphincter of Oddi: drotaverine hydrochloride, olimethin, atropine, platifillin, eufillin , mebeverine (Duspatalin).

During periods of exacerbation, phytotherapy is very widely used, in the absence of allergies to it - decoctions of chamomile, dandelion, peppermint, valerian, calendula. And during periods of remission, it is possible to prescribe homeopathic treatment or herbal medicine, but with other herbs - yarrow, marshmallow, tansy, buckthorn.

It is very important to follow a strict diet after an exacerbation of cholecystitis, then the symptoms gradually subside. In addition, it is also recommended to periodically carry out tubages with xylitol, mineral water or magnesia, physiotherapy is effective - reflexology, SMT therapy.

In case of calculous chronic cholecystitis with pronounced symptoms, it is recommended to remove the gallbladder, the source of the growth of stones, which can pose a threat to life when they move. The advantage of chronic cholecystitis with stones from acute calculous cholecystitis, is that this operation is planned, it is not an emergency measure and you can safely prepare for it. In this case, both laparoscopic surgery and cholecystectomy from a mini-access are used.

When surgery is contraindicated, sometimes in chronic cholecystitis, the treatment may be to crush the stones with shock wave lithotripsy, this extracorporeal procedure does not remove the stones, but simply crushes, destroys them, and often their re-growth occurs. There is also a method for destroying stones with the help of ursodeoxycholic and chenodeoxycholic acid salts, in addition to the fact that this therapy does not lead to complete cure, it is also quite long in time and last up to 2 years.

Treatment of acute cholecystitis

If acute cholecystitis is recorded for the first time, stones and severe clinical picture, No purulent complications, then it is enough to carry out standard medical conservative therapy - antibiotics, antispasmodics, NSAIDs, detoxification and enzyme therapy, choleretic agents.

At severe forms destructive cholecystitis, cholecystotomy or removal of the gallbladder is mandatory (see. Most often, cholecystectomy is performed from a mini-access. If the patient refuses the operation, an acute attack can also be removed with medication, but it should be remembered that large stones necessarily lead to relapses and transition to chronic cholecystitis, the treatment of which may still end in surgery or cause complications.

To date, 3 types of surgical interventions are used to treat cholecystitis - open cholecystotomy, laparoscopic cholecystotomy, for weakened people - percutaneous cholecystostomy.

Without exception, all patients with acute cholecystitis are shown a strict diet - in the first 2 days you can only drink tea, then you are allowed to switch to a diet table 5A, where food is only steamed or boiled, a minimum of fat is used, fried, smoked, seasonings, carbonated and alcoholic drinks. More about that in our article.

Inflammation of the walls of the gallbladder is called cholecystitis. The disease is considered one of the most common among other pathologies of organs localized in the abdominal cavity. According to statistics, about 2 out of ten people have a history of this disease. Women get sick several times more often.

What is a gallbladder? It is a hollow, muscular organ, small in size, sac-shaped, which is adjacent to the liver and is the place of storage of bile constantly secreted by the liver. When a person eats food, the walls of the bladder contract and secrete a cystic portion of bile into the lumen of the duodenum 12. One of the functions of bile is to emulsify fats.

Causes of inflammation of the gallbladder

Very often, the disease is preceded by the following changes in the body:

• dyskinesia by hypertonic or hypotonic type;
• formation of sand and/or stones.

The following factors contribute to the disease:

• malnutrition;
• limitation of physical activity;
• constant stress;
• some endocrine diseases;
• hormonal changes in women during pregnancy or taking hormonal drugs as contraceptives.

Classification of cholecystitis

Depending on the presence of stones, cholecystitis can be acalculous and calculous (that is, with the formation of stones).

The mechanism of the pathological process has several phases:

1. Motility disorder, which is accompanied by congestion of bile in the cavity of the bladder. Dyskinesia can be of a hypotonic type, when the gallbladder is “lazy” and does not contract well. As a result, bile stagnates, which is favorable condition formation of sand and stones. With dyskinesia hypertonic type the muscular layer of the gallbladder is in hypertonicity ( constant voltage), which also leads to a violation of the evacuation of bile and congestion.
2. Accession inflammatory process , against the background of which cholecystitis is first formed without sand and stones.
3. Cholelithiasis or calculous cholecystitis - as a result of the two processes listed above.

Symptoms and course of the disease

The disease can have an acute and chronic course. Acute cholecystitis without stone formation is the most favorable in terms of prognosis for health.

It does not occur frequently and proper treatment ends with absolute health. Basically, specialists have to deal with calculous cholecystitis. Its symptoms, in most cases without additional examination methods, indicate a disease. During the period of exacerbation both with cholecystitis with stones, and without them occurs intense pain in the area of ​​localization of the liver (in the right side). It may have a girdle character, give into the shoulder blade, but still its source is the place of the projection of the gallbladder. Along with the pain, appetite disappears, there is a feeling of nausea and sometimes vomiting.

Body temperature (not always) can rise to subfebrile (37-38 degrees) or less often febrile (38-39 degrees) values. There is flatulence, stool retention. During an exacerbation, the inflammatory process may affect other organs. gastrointestinal tract. Often the pancreas suffers from the disease.

Dangerous conditions that occur against the background of acute cholecystitis and lead to emergency hospitalization - peritonitis, pancreatitis, liver abscess.

Chronic cholecystitis may occur due to acute illness, and may develop gradually from childhood. Errors in nutrition, irrational composition of food, large intervals between meals - all this gradually leads to dyskinesia, and then to chronic cholecystitis. A chronic disease is accompanied by a change in periods of remission and exacerbation. Errors in nutrition, stress, alcohol, exacerbation of chronic diseases, etc. help to “wake up” the symptoms of the disease.

Most clear sign cholecystitis is pain. Its epicenter is located in the region of the right hypochondrium. Sometimes she gives in upper part belly. Along with pain, there is a burning sensation, heaviness.

The attack reduces performance, significantly worsens general well-being, brings obvious suffering. As a rule, the pain occurs at night. IN in some cases, pain can be localized not only in the right hypochondrium, but also in the region of the heart. In this case, they talk about cholecystocardial syndrome.

Why does nausea occur? This condition is associated with a violation of the muscle tone of the bladder, as well as concomitant inflammation of the pancreas and duodenum 12. Another symptom that is common is bitterness in the mouth.

Diagnostics

In addition to symptoms, additional research methods help to clarify the diagnosis. In a general blood test, signs of inflammation are revealed. IN biochemical analysis blood in calculous cholecystitis is likely to increase total bilirubin. microscopic examination bile will help identify protozoa (such as giardia) that may be causing the inflammation.

From instrumental methods research is most often assigned to ultrasound. With its help, the thickness of the walls of the bladder, the consistency of bile, its deformation and the presence of foreign substances (sand, stones) are determined. Duodenal sounding is used somewhat less frequently. With this method, portions of bile are taken and examined. In addition, the contractility of the bladder, the presence of inflammation, etc. are determined. From modern methods In order to clarify the diagnosis, computed tomography is prescribed.

Acute cholecystitis without stones is treated by a general practitioner or gastroenterologist. The surgeon deals with the treatment of calculous cholecystitis.

Complications

If the disease is not treated, then sooner or later the following complications are likely:

• cholangitis - inflammation of not only the bladder, but also the bile ducts;
• involvement in the pathological process of other abdominal organs;
• rupture of the walls of the bladder with the development of peritonitis;
• inflammation of the liver tissue;
• blockage of ducts with stones, etc.

Some of the above complications are life threatening.

Treatment or removal? What is laparoscopic cholecystectomy?

Therapy of the disease largely depends on the presence or absence of stones in the bladder.

1. Inflammation is eliminated with antibacterial drugs, the choice of which is determined by the doctor.
2. Painkillers ("Baralgin"), antispasmodics ("No-shpa"), etc. help to eliminate pain.
3. If there are no stones in the bladder, and the cause of cholecystitis is associated with hypotension of the muscles of the bladder, then drugs with choleretic properties ("Allohol") are prescribed.
4. Mineral waters and various dosage forms herbs (tansy, immortelle, corn stigmas, wild rose, etc.).
5. Tubage will help improve the evacuation of bile. This procedure can be done no more than once a week. In the morning, on an empty stomach, you need to drink a glass of mineral water heated to 40 degrees, to which you should add a tablespoon of xylitol. In this case, you need to lie on your right side, placing a heating pad. It is recommended to stay in this position for one hour. You can eat only 1.5 hours after the procedure.
6. Hepatoprotectors and choleretic agents will help normalize the function of bile secretion.

If the examination reveals cholecystolithiasis or chronic calculous cholecystitis (both diagnoses are associated with the presence of gallstones), then instead of therapeutic treatment The patient is indicated for surgery. The operation is performed under general anesthesia, during which the gallbladder is removed.

One way to remove the gallbladder is laparoscopic cholecystectomy. which has been practiced in Russia since 1991. This method has a number of advantages over conventional laparotomy (dissection of the anterior abdominal wall), namely:
- the period of stay of the patient in the hospital after the operation is reduced;
- ability to work is restored faster;
- after the healing of small incisions, almost imperceptible scars remain;
- frequency postoperative complications decreases significantly.

What happens after the operation? Bile continues to be secreted and enters directly into the lumen of the duodenum.

Diet

Except medications special importance is attached to therapeutic nutrition. During exacerbation, it is recommended to eat food in a warm, semi-liquid state in small portions. Permitted foods and drinks include: weak tea, juices, kissels, vegetable puree, cereals, lean varieties boiled and mashed meat. Products on the "F" are excluded: fatty, fried and yolks.

As soon as the symptoms subside a little, it is allowed to arrange fasting days once a week, for example, curd-kefir, rice, etc. On the remaining days, the Pevzner diet No. 5 is recommended.

Allowed products include:

• low-fat dairy products;
• lean meat and fish;
• vegetables and fruits;
• cereals;
• sweet dishes;
• yesterday's pastries.

Products are recommended to be steamed, baked or boiled. It is recommended to consume at least 5-6 servings per day in a small amount. Large time intervals between meals lead to stagnation of bile and provocation of an attack.

Exclude from the diet:

• fried foods;
• fatty meats, fish;
• high-fat dairy products;
• fresh pastries;
• cold drinks;
• spicy dishes containing pepper, onion, garlic;
• alcoholic drinks.

Prevention

Primary prevention (prevention of the onset of the disease for the first time) is aimed at preventing stress, observing the rules of a healthy lifestyle, rational nutrition, prevention of infectious diseases and timely elimination of foci of infection. Secondary prevention (aimed at preventing exacerbations) is diet. Patients with cholecystitis are registered in the dispensary and are examined annually.

The gallbladder is a rather inconspicuous organ of our body. Most people have absolutely no idea about its location and its functions. But if this organ is affected by inflammation, it gives the patient a lot of inconvenience and discomfort. So a fairly common pathological condition is chronic inflammation gallbladder, which doctors classify as cholecystitis. Let's clarify what to do if an exacerbation of chronic cholecystitis occurs, we will discuss the symptoms and treatment of this condition, as well as what kind of nutrition patients with such a diagnosis need.

The chronic form of cholecystitis in most cases occurs against the background of cholelithiasis. Also similar condition can be caused by pancreatitis, helminthic invasions and other pathological conditions.

Symptoms of exacerbation of chronic cholecystitis

The main manifestation of chronic cholecystitis is pain. They are moderate in severity, localized in the right hypochondrium, characterized by a dull aching character and can last up to several days (weeks). Pain may well radiate to the back, under the right shoulder blade or in the region of the right half lumbar region and even in the right shoulder.

Increased pain syndrome can be triggered by the consumption of acute or fatty foods, alcoholic or carbonated drinks.

An exacerbation of the disease most often occurs after such violations in the diet, in addition, it can happen as a result of hypothermia and stress.

The pain syndrome in patients with exacerbated chronic calculous cholecystitis often resembles biliary colic (sharp pains, strong cramping character). In addition to pain, patients often complain of a feeling of nausea (up to vomiting), they experience belching and an unpleasant taste of bitterness in the mouth. At the stage of exacerbation, the temperature of the human body often rises - up to 37C.

Sometimes exacerbation of chronic cholecystitis is manifested by rather atypical symptoms: dull pains in the region of the heart, constipation, bloating, dysphagia (swallowing disorder). These manifestations often occur after violations in the diet.

How is the exacerbation of chronic cholecystitis corrected, what is its effective treatment?

Therapy of the non-calculous form of chronic cholecystitis is carried out by a gastroenterologist and is usually conservative. In case of exacerbation, treatment is aimed at eliminating unpleasant symptoms, sanitation of foci bacterial infection using antibacterial drugs(in most cases, medicines with a wide spectrum of action are used, for example, from the group of Cephalosporins). Patients are also detoxified by injecting glucose solution and sodium chloride solution. To restore digestive functions, the drug Creon, Panzinorm and others are used.

To achieve an analgesic effect and eliminate inflammation, drugs from the group of non-steroidal anti-inflammatory drugs are used. Antispasmodics are also used - they effectively relieve spasm of smooth muscles, both the bladder and the ducts.

To eliminate the stagnation of bile, drugs are used that can increase the peristalsis of the biliary tract. An excellent effect is given by olive oil (refined or unrefined - it does not matter), sea buckthorn and magnesia. In some cases, choleritics are used, which increase the production of bile. But they can only be used with caution in order to avoid increasing soreness and aggravating congestion.

Therapy for chronic uncomplicated cholecystitis may involve the use of herbal medicine methods. So a good effect is given by the leaves of peppermint, valerian, dandelion, chamomile, calendula.

If an exacerbation of calculous cholecystitis occurs, an operation is required (removal of the gallbladder).

Nutrition during exacerbation of chronic cholecystitis

All patients with chronic cholecystitis should use Pevzner's treatment tables. At the stage of remission, they need to adhere to diet No. 5, and during an exacerbation - diet No. 5a.

So, with an exacerbation of chronic cholecystitis, it is worth eating five times a day in small portions. Food must be warm.

The patient can eat dried or yesterday's White bread and bad cookies. It is allowed to eat lean and lean beef, turkey, skinless chicken and rabbit (in the form of cutlet mass), you can eat lean steam fish, fish puree and soufflé. A protein steam omelette may be present in the diet; half a yolk can be eaten per day, adding it to other dishes. It is allowed to eat milk, sour-milk drinks, low-fat and non-acidic cottage cheese. Small amounts of butter and vegetable oil can be added to dishes.

Vegetables should be steamed or eaten raw. You can eat zucchini and pumpkin, boiled or stewed in pieces. Porridge should be cooked in water or milk, diluting it in half with water, with semolina, oatmeal (mashed porridge), buckwheat and rice. You can also cook semolina, rice or buckwheat soufflé and boiled vermicelli.

Soups can be dairy (half with water), vegetarian with cereals (vegetables are rubbed) and puree soups. You can fill such dishes with sour cream or butter.

From fruits you can eat sweet and ripe, for dessert you can eat jelly, marshmallows, jelly, mousse, marshmallow, honey, jam. Sugar is allowed. Drinks to choose from green tea with milk and lemon, coffee substitute with milk, rosehip decoction, tomato juice, sweet berry and fruit juices.

Exacerbation of chronic cholecystitis - folk remedies

Patients with exacerbation of chronic cholecystitis can be used different means folk medicine.

So a good effect is given by treatment with the rhizome of calamus. Brew a teaspoon of crushed raw materials with a glass of only boiled water. Infuse the medicine under the lid for twenty minutes, then strain. Take it in half a glass four times a day.

The feasibility of using traditional medicine must be agreed with the attending physician.

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Moments of exacerbation of chronic cholecystitis: symptoms

Exacerbation of chronic cholecystitis symptoms are severe for the human body. The occurrence of such a disease is due to malfunctions in the gastrointestinal tract and liver. Violation of the diet, poor quality and harmful products, sedentary lifestyle, heredity, poor ecology lead to the appearance of the disease. Chronic cholecystitis is a consequence of poor patency of the bile ducts. When bile does not accumulate in the liver and gallbladder and is not excreted from the organs, an attack of cholecystitis begins.

Chronic cholecystitis affects more than 15% of young people and more than 25% of the middle-aged people of the Earth's population. The causes of chronic cholecystitis are weight gain, sedentary lifestyle, unbalanced diet, which is rich in animal fats, hormonal disorders in the body and disorders in the gastrointestinal tract and liver. Some medications cause the appearance this disease. The disease is exacerbated if the body is affected by some of these factors.

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Symptoms during exacerbation of chronic cholecystitis

In people suffering from chronic cholecystitis, periods of exacerbation of the disease are periodically observed. They can be caused by seasonal factors, or exposure to certain foods, drugs, or exercise. An exacerbation has the following symptoms:

• sharp and prolonged pain in the abdomen, in its right side;
• increased salivation, nausea and vomiting;
• heaviness in the abdomen, bloating, flatulence;
• stool disorder, which is accompanied by severe constipation or diarrhea;
• bitterness in the mouth, bad breath;
• metallic taste in the mouth;
• yellowness of the eyeballs.

These symptoms indicate that bile stagnation occurs in the liver and gallbladder, some bile ducts cease to function and conduct fluid. What is the danger of an attack of chronic cholecystitis? It indicates, as a rule, a chronic form of the disease that needs to be treated.

In such cases, please contact medical institution, examine the body and pass special treatment, which can only be prescribed after careful and complete examination sick.

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Diagnosis of the patient

An exacerbation of chronic cholecystitis indicates a general deterioration in the human condition and disturbances in the functioning of internal organs, therefore, upon admission of a patient with such a disease, a complete and accurate examination of the body is necessary. The first step in examining the patient's condition is to check the condition of the stomach using endoscopy. A tube is inserted into the patient's stomach through oral cavity and the esophagus and the echostructure of the organ, the condition of the gastric mucosa, the presence or absence of ulcerative foci, the level of acidity is determined, the gastric juice, bile and gastric secretion are examined.

Next, the patient undergoes an ultrasound diagnosis of the abdominal cavity. Thus, the state of the liver, gallbladder, pancreas is determined. The sizes of organs are determined, the presence of stones or other formations in the gallbladder is excluded or, conversely, confirmed. In addition, the patient takes a blood test, a general urine test and a stool test. When the doctor compared the symptoms of the patient's illness and the results of laboratory and diagnostic studies, the tactics of treating the patient is determined.

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Treatment of the disease

Treatment of the disease in the acute stage occurs with the help of antibiotics, antispasmodics, cholagogues, vitamins and dietary nutrition. If complications of chronic cholecystitis affect the liver and stomach and there is a violation of the pancreas, then the patient is shown resection of the gallbladder and postoperative therapy. In the usual case, antibiotic therapy is prescribed to relieve the inflammatory process and prevent the occurrence of infectious diseases of the gastrointestinal tract caused by microorganisms.

Antibiotic drugs such as Ampicillin, Metronidazole, Ciprofloxacin relieve inflammation in the liver and gallbladder, destroy pathogens in the accumulated fluid of the gallbladder. Treatment with such drugs lasts the entire period of stay in the hospital, until the onset of remission. The patient in the first hours of admission to a medical institution with pain syndrome a double dose of antispasmodics is administered to relieve pain sensitivity internal organs and improve the general condition of the patient.

Choleretic drugs are prescribed, which contribute to the outflow of stagnant bile and establish a normal process of its excretion. It can be Allochol, Holamid, Vigeratin and others. Complex purpose medications relieves symptoms of the disease, dulls pain and restores normal functioning digestive organs. Chronic cholecystitis in the acute stage involves treatment with a diet. Diet therapy is to create balanced diet and dietary compliance. Food should be moderately warm and steamed or boiled. Fried, smoked, sour and salty foods are excluded. Alcohol is prohibited, which provokes stagnation of bile in the bladder. You can fry food, but then it needs to be well stewed. You can not overeat, a portion should not exceed 200-300 grams at a time. Products for cooking must be fresh. Need to consume as much as possible plant food excluding heavy protein foods.

The diet should last the entire period of treatment, then you can gradually return to the usual diet, but you should still stick to healthy eating. For people with chronic cholecystitis, herbs and herbal preparations. The attending physician will help determine the necessary collection of herbs and the duration of the decoction.

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Exacerbation of chronic cholecystitis: symptoms and treatment

Chronic cholecystitis - this disease occurs due to the appearance in the body of an infection that has entered the gallbladder. It is not uncommon to observe an exacerbation of chronic cholecystitis, which occurs due to improper and untimely treatment.

Although cholecystitis is a dangerous disease, it is treatable, it is only important to know which method is right for you personally. Knowing the symptoms of exacerbation, with cholecystitis, you can correct the situation in a timely manner, avoiding serious consequences.

How does exacerbation of cholecystitis manifest itself?

During the period of exacerbation, the patient shows the main symptoms:

1. Dyspepsia is manifested by vomiting, nausea, unpleasant belching, diarrhea and diarrhea.
2. Itching occurs when bile stagnates and its acids enter the bloodstream.
3. Heat.
4. Lethargy.
5. Discomfort and pain in the abdomen is the most obvious sign of a complication. The strength of pain, its duration and location depends on the characteristics of the human body. Most often, the pain manifests itself in the right side or in the gallbladder area.

Every patient has different symptoms exacerbations, however, when you notice that something incomprehensible is happening to you, contact your doctor immediately. The doctor will prescribe a new treatment, in the acute stage, it has its own characteristics.

What can cause an exacerbation?

Chronic cholecystitis can be calculous or without stones. The appearance of acalculous cholecystitis can be provoked by such factors:

1. Alcohol consumption,
2. Inappropriate consumption of food
3. Regular or severe stress,
4. Eating smoked, fried, fatty or pickled foods
5. The use of incompatible products,
6. food allergy.

With stone cholecystitis, exacerbation can cause:

1. Excessive physical activity
2. Sudden change in body position
3. Restless ride.

In addition, exacerbation can occur during pregnancy, due to hypothermia and obesity.

Important! If you know you have gallbladder problems, try to follow a diet that will help you avoid complications.

Possible consequences

Chronic cholecystitis is dangerous because it can affect other organs besides the gallbladder. Its exacerbation provokes the appearance of biliary fistulas, gangrene, jaundice, sepsis, abscess and exacerbation of pancreatitis.

With stone cholecystitis, it is easier to get rid of the disease, as well as complications, than with non-calculous cholecystitis. May appear purulent inflammation and subsequently lead to lethal outcome.

Treatment of cholecystitis in the acute stage

An exacerbation of the disease can occur at any time, so it is important to know how to provide first aid to the patient. After the patient is taken to the hospital, he undergoes diagnostics so that the specialist understands exactly what complications the patient has.

Having made a diagnosis, the patient is assigned special course treatment, but let's take a closer look at how first aid works and then see how to treat an exacerbation.

First aid

The very first thing to do with exacerbations of pathology is to call ambulance. When you noticed the first signs of an exacerbation of the disease, namely, severe cutting pain, you need to do the following:

• Lay the patient on his right side and make sure that he is completely at rest.
• Do not give the sick person any food, even if he asks hard.
• So that the patient does not have signs of nausea, let him drink mineral, but not carbonated water.
• If the patient feels that he will vomit, make sure that his tongue does not sunk. After vomiting, give the patient some mineral water.
• Offer a cold heating pad or put it yourself under his right side. If the pain gets worse, remove the heating pad.

It is strictly forbidden to give the patient alcoholic beverages or painkillers. Moreover, you can not do an enema, but rather wait for the arrival of the doctor. If the patient is given painkillers, then the pain and other symptoms of exacerbation may disappear for a while, but they will appear and cause more more harm.

Medicines and doctors

When the doctors pick up the patient, they will give him needed help in a medical institution. They act according to the algorithm, namely:

• A deep examination of the patient is carried out to determine the state of his disease.
• Eliminate pain using painkillers.
• Trying to prevent stagnation of bile.
• Apply detoxification therapy using saline solutions.

After these steps, the doctor can begin treatment with medications. IN extreme cases may need surgery to save a person's life. While in the hospital, the patient is prescribed the following drugs:

1. Antibiotics.
2. Antispasmodics relieve acute pain.
3. To improve the flow of bile and its dilution, choleretic drugs are prescribed, such as Allochol, Liobil and Tsikvalo.
4. Hepatoprotectors protect the liver.

Of course, an individual course of treatment is chosen for each patient, so even if you are being treated at home, never take drugs without obtaining the consent of the doctor.

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Often you can meet patients who are treated at home using folk methods treatment. There are many prescription drugs that help cure cholecystitis and even relieve pain symptoms. Eg:

1. A decoction of calamus root.
2. Volodya tea.
3. A mixture of honey, lemon and olive oil.
4. Plantain decoction.
5. Yarrow tincture.
6. Sage tea.

Very effective method treatment, is the use of juices. There is a very good recipe that cures cholecystitis. Mix the juices of beets, radishes, carrots, aloe, each juice should be 0.5 liters. Combine the resulting liquid with 0.5 liters of vodka and honey. After mixing the resulting mixture, close it with a lid and drop a container of medicine into the ground for 14 days.

After the elapsed time, remove the liquid from the earth and store it in a cool place where the rays of the sun do not fall. You need to take the medicine before meals, thirty minutes in advance, one tablespoon.

Traditional medicine also suggests drinking a lot of different herbs, as they enrich the body with vitamins and relieve inflammation. You can drink such herbs as:

• Mint,
• Barberry,
• Immortelle,
• centaury,
• birch leaves,
• Amur velvet.

In addition to eating herbs, doctors advise drinking plenty of clean water. It is water that removes from the body all the toxins that do not allow vital important bodies work fine.

Features of diet and nutrition

Almost always, with some kind of disease, doctors prescribe the patient to follow a diet in order to facilitate the work of the body and help the diseased organ recover. With exacerbation of cholecystitis, you need to eat often, namely five times a day, but in small portions.

Advice! It is advisable to eat at the same time, so that the body gets used to such a diet and recovers faster.

The main purpose of such a meal is that bile does not stagnate and does not load work. digestive system. Try to never overeat, as this can cause severe abdominal pain.

Some foods need to be excluded from your diet for a while, for example:

• Garlic,
• Sorrel,
• Beans,
• Peas,
• Spinach,
• Fat meat,
• Fat bird and fish
• Meat broths,
• spices,
• Chocolate,
• Cocoa.

All of the listed products can not be eaten, as they will only aggravate the situation. In addition, it is important to remember the method of preparation, it is forbidden to eat fried and smoked food, boil, steam and stew your food.

The food that the patient must eat must not contain cholesterol. It is welcome to use different cereals, simple oily fish, nuts and vegetable oils.

Not everyone knows that such a seasoning as turmeric helps to restore the processes in the gallbladder and it enhances the outflow of blood. In addition to this spice, it is allowed to eat:

1. Dried bread or flour products,
2. Fruits and berries that do not have bitterness and sourness,
3. Lots of vegetables
4. Lean meat or poultry
5. Chicken eggs no more than two per week
6. In small quantities, you can eat sour cream and butter.

Although doctors allow the patient, in limited quantities, to consume sugar, the medical history of many patients has shown that if it is completely abandoned, then the person recovers faster.

Nutrition during the progression of the disease

If cholecystitis does not want to recede, then doctors recommend drinking plenty of fluids, but what kind? Rosehip teas or dried fruit teas are most often helpful. Then try to ease the work of the stomach by eating only cereals. After the patient is better, he needs to stick to diet number 5. sample menu might look like this:

1. Breakfast: semolina with scrambled eggs and green tea. Remember that eggs can be eaten once a week.
2. Second breakfast: cottage cheese without any additives with rosehip broth.
3. Dinner: vegetable soup, mashed potatoes and stewed meatballs, as a dessert, you can eat fruit jelly.
4. Afternoon snack: Baked apples.
5. Dinner: Mashed potatoes and tea.

If you want to eat before going to bed, then drink kefir or jelly. Remember to eat little but often and try not to indulge yourself, as the wrong food can cause exacerbations.

It is also very important to eat a lot of vegetables, because they are easily and quickly absorbed by the body and saturate it with vitamins. Moreover, there are much more in berries beneficial trace elements than in large fruits.

Signals not to be ignored

Exacerbation of chronic cholecystitis requires special close attention, so it is very important to remember the first aid for exacerbation and follow a diet, thanks to which complications will not appear.

In addition, when you notice the first signs of a complication, do not think that they will pass by themselves, if the disease has begun to progress, it must be stopped and not allowed to progress, and not endured.

Another important point is the importance of nutrition, take this issue seriously, because, like pills, food can either harm or improve the condition of the gallbladder. In addition to products, take extra nutritional supplements which are enriched with natural minerals and vitamins. Since the gallbladder is damaged in cholecystitis, try to restore it in every possible way.

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Treatment of chronic cholecystitis in the acute stage

In an acute attack of cholecystitis, 1 ml of a 1% solution of morphine or pantopon is injected under the skin, a heating pad is prescribed to the gallbladder area and rest. In more severe forms, penicillin is indicated. Penicillin significantly improves the course of the process, but does not always lead to a complete cure.

Treatment of chronic cholecystitis in the acute stage consists in prescribing a diet, systematic local application of heat (hot water heaters, mud cakes, diathermy), repeated duodenal sounding with an introduction to duodenum magnesium sulphate solution, spa treatment. In the presence of lamblia in the bile, akrikhin is prescribed.

Since there is no reason to rely on the dissolution or disintegration of stones into small fragments that can pass through the biliary tract unhindered under the influence of therapeutic treatment, in the case of ongoing attacks with stone and stoneless cholecystitis, surgical intervention is often inevitable.

Since the time of S. P. Fedorov, it has been considered that an acute attack of cholecystitis in itself is not a mandatory indication for surgery. An urgent operation was considered and considered by many to be necessary only in case of very high temperature, chills, high leukocytosis, with a large, painful gallbladder threatening to perforate, with a progressive deterioration in the general condition, in short, with symptoms of empyema of the gallbladder.

Perforation of the gallbladder is an absolute indication for immediate laparotomy. This course of action was based on the fact that after operations in the acute period, mortality was significantly higher than after operations in the intermediate period. However, this did not take into account that only the most severe patients were operated on in the acute period.

Stoneless cholecystitis is subject to surgical treatment only in the phlegmonous form.

Concerning common tactics in the treatment of cholelithiasis and its complications, most surgeons adhere to the principle of early surgery, i.e., consider it necessary to perform the operation before the onset of severe complications and deterioration general states sick.

The advantages of an early operation, i.e. an operation performed at an earlier stage of the disease and more young age, are obvious. However, it is at a younger age that biliary dyskinesia often occurs, which does not require surgical intervention but difficult to distinguish from cholecystitis. Early operation desirable, but it is acceptable only with a firmly established diagnosis of cholecystitis.

In a special preoperative preparation icteric and febrile patients need. To weaken the bleeding inherent in patients with jaundice, blood is retransfused (100-150 ml each) for 6-8 days and vitamin K is prescribed. Febrile patients are preliminarily given penicillin therapy. The operation is done under ether anesthesia orityude local anesthesia.

In some severe cases, the treatment of chronic cholecystitis in the acute stage consists in the appointment of an operation - cholecystectomy. By removing the gallbladder, the main reservoir and source of stones, the collector of infection, as well as the source of constant pathological impulses to the cerebral cortex, are removed. If it is impossible to remove the gallbladder, for example, due to powerful adhesions, the bladder mucosa or the entire bladder is electrocoagulated.

A gauze swab (not too large) or several strips of rubber tissue are brought to the stump of the cystic duct. Under the condition of complete hemostasis, careful peritonization, checked patency of the common bile duct, the abdominal cavity is closed tightly.

Cholecystostomy is rarely done, almost exclusively in the acute period with a large infiltrate, powerful adhesions and general weakening of the patient, when cholecystectomy is risky. Cholecystotomy, more precisely, cholecystolithotomy, i.e., an incision in the gallbladder to remove stones from it, is performed as a rare exception, since the cause of the painful phenomena is not the stones, but the infection. In all types of gallbladder surgery, a thorough examination of the common bile duct in relation to its patency is necessary.

IN postoperative period in the treatment of chronic cholecystitis in the acute stage, penicillin is prescribed; in case of persistent vomiting or acute expansion of the stomach, repeated gastric lavage is performed or a constant suction of its contents is established through a thin probe. Of the other postoperative complications observed local, occasionally general peritonitis, intestinal obstruction. If patients with jaundice experience postoperative bleeding, which can be fatal, blood is transfused, vitamin K is prescribed.

What is chronic cholecystitis and why is it dangerous

Chronic cholecystitis is characterized by the occurrence of a prolonged inflammatory process affecting the gallbladder. The occurrence of inflammation is associated with the activity of pathogenic flora of bacterial and viral origin.

Chronic cholecystitis is a sluggish disease. The disease is paroxysmal. An exacerbation of chronic cholecystitis can be triggered by a number of causes and factors, so patients suffering from this pathology should know what to do with an exacerbation of cholecystitis.

What provokes exacerbation of cholecystitis?

Chronic cholecystitis can be of two varieties - calculous, accompanied by the formation of stones and acalculous.

The main reasons for the appearance chronic form pathology is the development infectious process and congestion of bile. These factors are interrelated, any of them can become an impetus for the formation of the disease.

The accumulation of bile secretion leads to an increased risk of an infectious process, and infection and inflammation contribute to a narrowing of the excretory duct and a decrease in the rate of excretion of bile secretion into the intestinal lumen.

Exacerbation of chronic cholecystitis provokes the presence of the following factors:

• being overweight and obese, increased amount cholesterol in the composition of bile is one of the causes of the development of gallstone disease;
• diabetes;
• starvation;
• the presence of a hereditary predisposition;
• the period of bearing a child;
• reception hormonal drugs contraception, certain antibiotics and other medicines;
• rare meals, when meals are made 1-2 times a day.

In addition, exacerbation of calculous cholecystitis can be triggered by:

1. Strong shaking while driving.
2. Excessive physical exertion, especially after the onset of prolonged physical inactivity.
3. Abrupt changes in body position after a heavy meal.

Exacerbation during the acalculous form of chronic cholecystitis can provoke:

• use a large number fatty, smoked and pickled foods;
• binge eating;
• taking excessive amounts of alcohol;
• impact on the body of stress;
• development allergic reaction, especially on foodstuffs;
• a diet in which for a long time there were no foods containing fiber.

The pathology can worsen in a person who is exposed to hypothermia, has anomalies in the development of the biliary tract, and suffers from dyskinesia.

Cholecystitis can worsen from once a month to 3-4 times a year, the exacerbation stage can last a different amount of time, so doctors distinguish mild, moderate and severe exacerbations. Depending on the course of the pathology, different treatment tactics should be used.

The main signs of exacerbation of pathology

The main symptoms of an attack of the disease are abdominal pain, disorders in the gastrointestinal tract, weakness and fever.

The first symptom indicating the presence of an exacerbation of cholecystitis and the need for treatment is the appearance of severe pain in the abdomen.

The area of ​​localization of pain sensations, their intensity and duration depend on a large number of individual characteristics body of an adult.

The main features of the patient's body that affect the intensity and localization of pain are the following:

1. A type of biliary dyskinesia.
2. The presence of complications accompanying the inflammatory process in the gallbladder.
3. The presence of concomitant diseases of the gastrointestinal tract.

The last of these features can have a significant impact on the choice of therapy used. This feature has a significant impact on the choice of diet in the event of exacerbations of chronic cholecystitis.

Most often, pain during an exacerbation of the disease is localized in the right hypochondrium, it can be constant and mild. Pain can be aching in nature, in some cases they can be felt as heaviness under the right rib. Such pains are characteristic of a situation in which there is a decrease in the tone of the walls of the gallbladder.

If the tone is above normal or the stone moves in the bladder, the pain is in the nature of biliary colic.

Characteristic signs in such a situation are:

• severe pain in the right hypochondrium;
• pains are paroxysmal in nature;
• pain radiates to the region of the right shoulder blade, collarbone or shoulder.

The pain is relieved by applying a warm heating pad. When vomiting occurs, after its completion, the pain sensations increase significantly.

With the spread of the inflammatory process to adjacent tissues, the pain becomes constant and increases with movement. right hand, as well as when tilting and turning the torso.

Signs of the development of dyspeptic disorders are:

1. The appearance of bitterness in the oral cavity.
2. Vomiting with an admixture of bitterness.
3. Attacks of nausea.
4. Bitter burp.
5. The appearance of bloating.
6. The appearance of diarrhea.

The patient has a feeling of itching, if there is a stagnation of bile in the excretory tract, this leads to an increase in its pressure and partially bile acids enter the bloodstream. The feeling of itching can spread both to the whole body and to its individual parts.

The appearance of itching is characteristic of the calculous form of the pathology, but even with non-calculous chronic cholecystitis, such a symptom may appear, which indicates the need for medical treatment in a hospital, and not at home.

Methods of treatment and diagnosis of exacerbations of cholecystitis

When conducting a diagnosis, the doctor examines the patient's medical history and identifies concomitant diseases that can lead to an exacerbation, such as pancreatitis. During palpation on the right side of the body in the hypochondrium, the patient experiences pain.

To confirm the diagnosis, a complex of laboratory, instrumental and hardware studies is carried out.

Laboratory tests reveal increased value ESR and high values ​​of the activity of liver enzymes such as phosphatase, GGTP, ALT and AST. In the composition of bile, in the absence of calculi, a low content of bile acids and an increased amount of lithocholic acid are detected, cholesterol crystals and an increased amount of bilirubin are also found. In addition, the presence of bacteria that provoked the inflammatory process is detected in the composition of bile.

As instrumental and hardware diagnostic methods, the following are used:

• cholegraphy;
• scintigraphy;
• duodenal sounding;
• arteriography.

Treatment of exacerbation of cholecystitis

Operative methods of treatment are used only for the treatment of the calculous form of pathology, as well as non-calculous in the acute form.

In other cases, conservative treatment is indicated. Conducting conservative treatment involves the use of a whole range of medications.

Antibacterial agents are used to carry out the sanitation of the focus of the inflammatory process. Enzyme preparations - Panzinorm, Mezim and Creon are used to normalize digestion processes. NSAIDs and antispasmodics are used to relieve pain and reduce the intensity of the inflammatory process. Means to enhance the outflow of bile help to normalize the functioning of the organ.

Such drugs are

1. Liobil.
2. Allohol.
3. Holosas.

In addition, you can use a decoction of corn stigmas to normalize the outflow of bile.

To reduce the degree of intoxication of the body, droppers with sodium chloride and glucose are used.

• electrophoresis;
• SMT therapy;
• reflexology;
• installation of applications with therapeutic mud.

If there is a need for surgical intervention, but the presence of contraindications has been identified, then, as an alternative, can be used shock wave lithotripsy. The technique is used to crush stones in the calculous form of pathology.

The disadvantage of the technique is the high probability of further formation of stones in the biliary tract in the future.

The use of diet in the treatment of exacerbation of chronic cholecystitis

Dietary nutrition in the event of exacerbations of the chronic form of cholecystitis involves the introduction of a number of restrictions in the diet. At the stage of exacerbation, it is recommended to adhere to diet No. 5a.

In addition, certain principles of nutrition should be observed. You need to switch to fractional nutrition. There should be 5-6 meals per day, while the one-time amount of food consumed should be small. It is recommended to eat at the same time.

Doctors advise to reduce to a minimum the amount of simple carbohydrates consumed, such as sweets, honey, and sweet pastries. It is necessary to abandon the consumption of carbonated drinks, alcohol and coffee. It is better to replace these components of the diet with weak tea, compotes, natural juices, herbal decoctions and mineral water.

The use of vegetable oils is allowed, lean meat, low-fat dairy products, oatmeal and buckwheat, vegetables and fruits.

It is forbidden to use at the stage of exacerbation fatty meat and broths prepared on its basis, nuts, fried foods, egg yolks, sour cream, cottage cheese and milk with a high fat content. In addition, sausages and ice cream should be excluded from the diet.

Prevention of exacerbations of cholecystitis

The risk of exacerbations is significantly reduced with the observance of preventive measures. To prevent exacerbations, it is recommended to follow a dietary diet and strictly follow the recommendations received from the attending physician. The most optimal diet during the period of remission of the pathology is dietary table No. 5. The main requirement is the preparation of a diet using permitted products and methods of cooking.

A patient who is at risk must necessarily control his body weight. It is forbidden to overeat and starve. Doctors advise regular rehabilitation with the use of spa treatment. During the period of remission of the pathology, it is necessary to do exercises to prevent the occurrence of exacerbations. therapeutic gymnastics recommended by the attending physician.

IN preventive purposes you can use Essentuki mineral water No. 4 and 17, Smirnovskaya and Mirgorodskaya. The recommended amount is one glass three times a day.

To improve the body, after agreement with the attending physician, you can drink infusions prepared on the basis of which include corn stigmas, helichrysum and mint. As antimicrobial agents you can use infusions based on chamomile, rose hips, St. John's wort, tansy, celandine and calendula.