Chronic cholecystitis treatment and symptoms. Penetrating into bile in fairly high concentrations. Poorly penetrating bile

An inflammatory disease of the gallbladder wall, combined with motor-tonic disorders of the biliary system. This is one of the most common gastrointestinal diseases.

The incidence is 6-7 cases per 1000 population. It occurs in all age groups, but mostly affects middle-aged people (from 40 to 60 years old). Women get sick 3-4 times more often than men. The disease is more common in economically developed countries.

Under pathological conditions, asynchronous work of sphincters and ducts occurs, which leads to difficulty in the outflow of bile into the duodenum, and therefore - to sharp increase pressure in the bile ducts (so-called hypermotor biliary dyskinesia). This causes severe pain in the right hypochondrium even in the absence of inflammatory changes in the gallbladder.

There are two types of disease - non-calculous (calculous) and calculous - they are considered transitional stages of one disease. An exacerbation most often occurs 2-4 hours after eating fatty, smoked, fried foods. An attack can also be triggered by shaking (for example, riding a tram or cycling), hypothermia, stress and prolonged physical activity.

Gallbladder

Gallbladder, shaped like a regular pear, is located in the lower lobe of the liver. The liver regularly produces bile, it accumulates in the bladder, then is excreted through the bile ducts into the duodenum.

In the ducts, bile meets pancreatic juice, which is also produced during digestion. Normally, bile does not enter the intestines, but it also happens that reflux occurs not only into it, but also into the pancreas.

More often this happens when patency is impaired biliary tract. For example, when stones occur or the proper flow of bile is blocked. Bile can destroy any organ, including itself.

This risk may arise during prolonged stagnation. The gallbladder works in close relationship with the pancreas; their ducts form the papilla of Vater, where the sphincter of Oddi is located.

The latter acts as a regulator of pancreatic juice and bile. It also protects the ducts from refluxing contents from the intestines. With him proper operation bile enters the duodenum.

Causes of chronic cholecystitis

The disease is usually caused by opportunistic microflora - Escherichia, streptococci, staphylococci, less often - Proteus, Pseudomonas aeruginosa, Enterococcus. Sometimes chronic cholecystitis is observed, caused by pathogenic bacterial microflora (Shigella, Salmonella), viral and protozoal infections. Microbes penetrate the gallbladder by hematogenous, lymphogenous and contact (most often from the intestine) route.

An important predisposing factor in the development of the disease is considered to be a violation of the outflow of bile and its stagnation; the pathology usually occurs against the background of cholelithiasis or biliary dyskinesia; on the other hand, a chronic inflammatory process in the gallbladder is always accompanied by a violation of its motor-evacuation function and contributes to the formation of stones.

The nutritional factor is of great importance in the formation of the disease. Irregular meals with long intervals between meals, large meals at night with a preference for meat, spicy, fatty foods cause spasm of the sphincter of Oddi, bile stasis. An excess of flour and sweet foods, fish, eggs, and a lack of fiber cause a decrease in the pH of bile and a violation of its colloidal stability.

Inflammation of the gallbladder develops gradually. Functional disorders of the neuromuscular system lead to hypo- or atony. The introduction of microbial flora contributes to the development and progression of inflammation of the mucous membrane of the gallbladder.

With further progression of the pathological process, inflammation spreads to the submucosal and muscular layers of the gallbladder wall, where infiltrates and connective tissue growths develop.

When the process moves to the serous membrane, adhesions are formed with the Glissonian capsule of the liver and neighboring organs (stomach, duodenum, intestines). This condition is referred to as pericholecystitis. In addition to catarrhal inflammation, a phlegmonous or even gangrenous process may occur.

Important: V severe cases Small abscesses, foci of necrosis, and ulcerations form in the wall of the gallbladder, which can cause its perforation or the development of empyema. The gangrenous form (rarely develops) occurs during an anaerobic infection and leads to putrefactive destruction of the walls of the gallbladder.

Signs and symptoms of chronic cholecystitis

The clinical picture of chronic cholecystitis is characterized by a long progressive course with periodic exacerbations.

The symptoms of the disease are due to the presence of an inflammatory process in the gallbladder and impaired flow of bile into the duodenum due to concomitant dyskinesia.

Pain

Pain syndrome is the main one in the clinic of gallbladder inflammation. The pain is localized in the right hypochondrium, less often in the epigastric region, radiating to the right scapula, collarbone, shoulder, less often - to left hypochondrium. The occurrence of pain and its intensification is usually associated with the following reasons:

• violation of diet;
• physical activity;
• stress;
• hypothermia;
• concomitant infection.

The intensity of pain depends on the degree of development and localization of the inflammatory process, the presence and type of dyskinesia. Intense paroxysmal pain is characteristic of the inflammatory process in the neck and duct of the gallbladder, constant pain is characteristic of the body and bottom of the gallbladder.

In a disease accompanied by hypotonic dyskinesia, the pain is less intense, but more constant, nagging. Aching, almost continuous pain can be observed with pericholecystitis. This pain intensifies when shaking, turning or bending the body.

With an atypical location of the gallbladder, pain can be localized in the epigastrium, at the xiphoid process, around the navel, in the right iliac region. On palpation, pain in the right hypochondrium is determined.

Positive pain symptoms of cholecystitis

Ker's symptom

Pain when pressing on the projection of the gallbladder.

Murphy's sign

A sharp increase in pain upon palpation of the gallbladder during inspiration.

Grekov-Ortner's sign

Pain in the area of ​​the gallbladder when tapping along the costal arch on the right.

Georgievsky-Mussi sign

Pain when pressing on the right phrenic nerve between the legs of the sternocleidomastoid muscle.

Dyspepsia

Dyspeptic syndrome is manifested by bitter belching or a constant bitter taste in the mouth. Patients often complain of a feeling of fullness in the upper abdomen, bloating of the intestines, and abnormal bowel movements.

Vomit

Nausea and bitter vomiting occur less frequently. When combined with hypo- and atony of the gallbladder, vomiting reduces pain and a feeling of heaviness in the right hypochondrium. With hypertensive dyskinesia, vomiting causes increased pain.

In vomit, as a rule, an admixture of bile is found. The more significant the congestion, the more bile is found in the vomit.

Important: vomiting is usually provoked by diet disorders, emotional and physical overload.

Body temperature

The exacerbation phase is characterized by an increase in body temperature. More often the fever is subfebrile (characteristic of catarrhal inflammatory processes), less often it reaches febrile values ​​(in destructive forms of cholecystitis or due to complications).

A hectic temperature curve, accompanied by severe sweating and severe chills, is always a consequence purulent inflammation(empyema of the gallbladder, liver abscess).

In weakened patients and the elderly, body temperature, even with purulent cholecystitis, may remain subfebrile, and sometimes even normal due to decreased reactivity.

Jaundice

Descriptions of symptoms of chronic cholecystitis

Forms of chronic cholecystitis

Atypical forms of the disease are observed in a third of patients.

Diagnosis of chronic cholecystitis

Blood tests in the acute phase often reveal:

• increase in ESR;
• neutrophilic leukocytosis;
• shift of the leukocyte formula to the left;
• eosinophilia.

In complicated forms, the levels of bilirubin, cholesterol, and transaminases in the blood may increase.

The severity of the inflammatory process in the gallbladder can be judged by the results of a study of bile obtained during duodenal intubation. With inflammation, the bile is cloudy with flakes, with a significant admixture of mucus, cylindrical epithelium, and cellular detritus, although these signs are not pathognomonic for cholecystitis, but mainly indicate concomitant duodenitis.

Bacteriological examination of all portions of bile allows us to establish the etiology of the inflammatory process and the sensitivity of the microflora to antibiotics. The most commonly used are ultrasound and x-ray examination methods. X-ray examination reveals numerous signs of functional or morphological changes in the gallbladder or other digestive organs.

A contrast study of the gallbladder (cholecystography, cholangiography) can reveal:

Uneven filling of the cystic duct, its tortuosity, and kinks are often detected.

To study the state of the biliary tract and the absorption and excretory function of the liver, the radioisotope method is used. For a more accurate diagnosis, it is combined with multicomponent fractional duodenal intubation.

For a more detailed study of the gallbladder and bile ducts, a radio-X-ray chromodiagnostic method has been proposed. Its essence lies in the fact that simultaneously with multicomponent sensing and radioisotope research cholecystography is performed. Comparison of the results allows us to judge changes in the position, shape, size and structure of the gallbladder shadow.

The main method for diagnosing cholecystitis is ultrasound, allows not only to establish the absence of stones, but also to assess the contractility and condition of the gallbladder wall (its thickening of more than 4 mm indicates chronic cholecystitis). In chronic cholecystitis, thickening and sclerosis of the gallbladder wall and its deformation are often detected.

Ultrasound has no contraindications and can be used during the acute phase of the disease, with increased sensitivity to contrast agents, pregnancy, obstruction of the biliary tract.

When the bilirubin level is above 51 µmol/l and clinically obvious jaundice, endoscopic retrograde cholangiopancreatography is performed to determine its causes.

Differential diagnosis

Differential diagnosis is carried out primarily with peptic ulcer duodenum, chronic duodenitis. It is necessary to take into account the peculiarities of the occurrence of pain in these diseases and the seasonality of exacerbations. Results matter endoscopic examination stomach and duodenum.

Sometimes it can be difficult to distinguish between cholecystitis and biliary dyskinesia. However, dyskinesias are not characterized by fever, neutrophilic leukocytosis and increased ESR. Ultrasound in combination with duodenal intubation helps clarify the diagnosis.

Diet for gallbladder inflammation

The diet should help prevent stagnation of bile in the gallbladder and reduce inflammation.

Small meals (5-6 times a day), low-fat varieties of meat and fish, cereals, puddings, cheesecakes, and salads are recommended. Allow weak coffee, tea, fruit, vegetable, berry juices to barely subside the exacerbation. Very helpful vegetable fats(olive, sunflower oil), containing polyunsaturated fatty acid, vitamin E.

Polyunsaturated fatty acids help normalize cholesterol metabolism, participate in the synthesis of Pg, which dilutes bile, and increase the contractility of the gallbladder. With sufficient protein and vegetable fats in the diet, the cholatesterol index increases and, thus, the lithogenicity of bile decreases.

Prohibited for use

• egg yolks;
• alcohol;
• fatty and fried foods;
• hot, spicy, sour food;
• carbonated drinks;
• baked goods;
• products with butter and butter cream;
• nuts;
• ice cream;
• raw fruits, vegetables and berries;
• legumes;
• canned food;
• chocolate and cocoa;
• fresh bread;
• tomato juice.

Treatment of chronic cholecystitis

During the period of clinically significant exacerbation, patients are indicated for hospitalization in a gastroenterological or therapeutic department.

If there is a threat of development of destructive cholecystitis, with severe pain syndrome occurring for the first time, patients are hospitalized in the surgical department. For mild cases of the disease, treatment is carried out on an outpatient basis.

Which doctors should I contact for chronic cholecystitis?

Drug treatment

Drug treatment is determined by the phase of the disease, the severity of cynical manifestations (primarily pain and dyspeptic symptoms), and the nature of dyskinesia.

Complex therapy is carried out with antibacterial, anti-inflammatory drugs that normalize the motility of the biliary tract. Antibacterial therapy is prescribed in cases where there are clinical and laboratory data confirming the activity of the inflammatory process in the gallbladder.

The choice of drug depends on the type of pathogen identified during bile culture, its sensitivity to the antibacterial drug, as well as the ability antibacterial drug penetrate into bile and accumulate in it. The duration of antibiotic treatment is 7 days. If necessary, after a 3-day break, treatment can be administered.

It is advisable to combine antibacterial drugs with choleretic drugs, which also have an anti-inflammatory effect: cyclovalone (tsikvalon) 1 g 3-4 times a day before meals, nicodin 0.5 g 3-4 times a day before meals.

It should be remembered that according to the degree of penetration into bile, antibacterial agents can be divided into three groups.

Penetrating into bile in very high concentrations

• erythromycin (0.25 g 4 times a day);
• oleandomycin (0.5 g 4 times a day after meals);
• rifampicin (0.15 g 3 times a day);
• ampicillin (0.5 g 4-6 times a day orally or intramuscularly);
• oxacillin (0.25-0.5 g 4-6 times a day orally or intramuscularly);
• ampiox (0.5 g 4 times a day orally or intramuscularly);
• ericycline (0.25 g every 4-6 hours).

In addition, lincomycin (0.5 g orally 3 times a day 1-2 hours before meals or 1 ml of a 30% solution 3 times a day intramuscularly).

Penetrating into bile in fairly high concentrations

• benzylpenicillin (intramuscular 500,000 units 6 times a day);
• phenoxymethylpenicillin (0.25 g 6 times a day before meals);
• tetracyclines (0.25 g 4 times a day);
• metacycline (0.3 g 2 times a day);
• oletethrin (0.25 g 4 times a day).

Poorly penetrating bile

• streptomycin;
• ristomycin;
• chloramphenicol.

For giardiasis

• Metronidazole 0.25 g 3 times a day after meals for 7 days
• or tinidazole 2 g once;
• or aminoquinol 0.1 g 3 times a day for 5 days (repeated course after 10 days);
• or furazolidone 0.15 g 3-4 times a day.

With opisthorchiasis, fascioliasis, clonorchiasis

For strongyloidiasis, trichuriasis, hookworm

Choleretic drugs, physiotherapeutic treatment and mineral waters are prescribed depending on the type of concomitant dyskinesia.

Instructions for the use of drugs for chronic cholecystitis

Physiotherapeutic treatment

For physiotherapeutic treatment, mud applications are used on the right hypochondrium area (10 procedures) and mud electrophoresis on the liver area (10 procedures). It must be remembered that mud therapy for inflammatory diseases of the biliary tract is used with great caution, only for those patients who do not have signs of active infection, it is better in combination with antibiotics.

Surgery

Surgical treatment is indicated for a frequently recurrent course with the development of adhesions and the outcome of a wrinkled gallbladder (which leads to a pronounced impairment of its contractile function), a “disabled” gallbladder, and the development of complications (dropsy, empyema).

Typically, a cholecystectomy is performed. If for certain reasons (old age of the patient, concomitant diseases) cholecystectomy is impossible, cholecystotomy is performed. The essence of the operation: a tube is inserted into the gallbladder through the skin, through which the bile is drained out. Cholecystotomy helps relieve the process of inflammation in the gallbladder, which will help remove a person from a dangerous condition.

Another method is laparoscopy, which leaves no scars, is safer and the patient's recovery period after surgery takes a couple of days. Laparoscopy is completely safe for the patient and is done through a couple of small punctures in the abdominal area, this method allows you to reduce the amount of blood loss to a minimum.

Unfortunately, the laparoscopic method cannot be used in all cases. In case of anomalies, adhesions, large stones, or exacerbation of a chronic advanced stage, a conventional, open operation is performed.

Rehabilitation of the patient after open surgery is much longer than after laparoscopy from one to two months. After removal of an inflamed organ (cholecystectomy), there is a risk of developing postcholecystectomy syndrome (more about it in the link), you need to adhere to a strict diet for a long time, it is advisable to follow all the doctor’s recommendations, this will eliminate the risk of complications.

Folk remedies for the treatment of chronic cholecystitis

Important: application of funds traditional medicine must be agreed with the attending physician.

Oat infusion

We take 500 grams of raw materials per liter of boiling water. Pour in oats and leave for 1 hour. We strain and drink according to? glass three times a day - 15 minutes before main meals (breakfast, lunch, dinner).

White cabbage juice

If you don’t have a powerful juicer, use a grater to chop the cabbage and squeeze out the juice through cheesecloth. We drink 30-50 ml on an empty stomach 15 minutes before meals 3 times a day.

Oregano tea

Take 1 teaspoon of oregano for 1 cup of boiling water. Pour in and leave covered for up to 2 hours. Strain and drink a quarter glass three times a day.

Corn silk infusion

The proportion is one tablespoon of raw material per 1 glass of boiling water. Leave for up to 1 hour. We drink the strained infusion, 1 tbsp. spoon on an empty stomach - every 3 hours before meals - breakfast, second breakfast, lunch and dinner.

Infusion of medicinal sage

We need 2 teaspoons of herbs per 2 cups of boiling water. Leave for half an hour and drink the strained infusion every 2 hours, 1 tbsp. spoon.

Bay oil

We will need vegetable oil (we recommend olive oil). Add 25-30 grated leaves to one glass of oil noble laurel. Let the mixture sit for up to 7 days, until the leafy material settles to the bottom. Strain, pour into a dark glass container, and place in the refrigerator. We drink 15 drops bay oil any drink contains milk, kefir, tea.

Honey-lemon mixture with olive oil

We need: 1 glass of olive oil, 4 lemons (peel two of them), 1 kilogram of honey. Pass the lemons through a meat grinder, add butter and honey, mix well. Store in a sealed glass container, refrigerated. Stir again before each use. The course of administration is 1 month at a dose of one tablespoon half an hour before meals three times a day. There must be at least three such courses per year.

Complications of chronic cholecystitis

The chronic course is characterized by alternating periods of remission and exacerbations of cholecystitis. Purulent-destructive changes in the gallbladder (empyema, perforation) lead to the development of peritonitis and the formation of bile fistulas.

Pericholecystitis causes the development of adhesions, deformation of the gallbladder and, as a result, disruption of its functions. It is possible that neighboring organs may be involved in the inflammatory process (cholangitis, hepatitis, pancreatitis, papillitis), the development of obstructive jaundice, and the formation of hydrocele of the gallbladder.

There are not as many complications of the chronic course as in the acute form of the disease, but they all require surgical treatment:

• reactive hepatitis;
• chronic duodenitis;
• pericholecystitis;
• reactive pancreatitis;
• chronic stagnation of bile;
• cholelithiasis;
• deformation of the affected organ;
• formation of adhesions and fistulas.

Forecast and prevention of chronic cholecystitis

With infrequent exacerbations, the prognosis is satisfactory. It worsens significantly with frequent exacerbations with signs of inflammatory process activity, severe pain and the development of reactive pancreatitis.

For preventive purposes it is recommended balanced diet, active lifestyle, physical education. Timely and rational treatment is necessary acute cholecystitis, diseases of the digestive tract, focal infections, intoxications, allergies, neurotic and metabolic disorders.

Questions and answers on the topic "Chronic cholecystitis"

Question:Hello. I have a polyp in my gallbladder, a collection of viscous bile. Could this cause severe pain in the right hypochondrium? I took a course of chemotherapy, the last one was on January 17, 2018. There was inflammation of the iliac and paraortic lymph nodes. I have pain under the right rib and in the navel area, to the left. Thank you

Answer: Pain due to a polyp in the gallbladder is located on the right hypochondrium and is dull in nature. They are rarely constant and are more often of a cramping nature. Pain is provoked by fatty and rich foods, alcoholic drinks, and sometimes stressful situations.

Question:Hello, my husband has chronic cholecystitis, polyps up to 3.8 mm, catarrhal colitis of the intestine and a hyperplastic intestinal polyp, flaccid pancreas, they wanted to diagnose pancreatitis, but after treatment and diet they did not diagnose it, at the last ultrasound of the abdominal cavity they found an enlarged lymph node 17 * 5.5 Tell me, is it scary what they write about oncology on the Internet?

Answer: The cause of enlarged lymph nodes is infection, not cancer. However, it is dangerous to neglect the pathology: there is a risk of developing an abscess or peritonitis due to lymphatic suppuration.

Question:Good afternoon I did an ultrasound scan of the gall bladder and as a result, the transverse size of the gallbladder was increased to 3.1 cm with a maximum of 3 cm. There is also an enlargement of the head of the pancreas to 3.1 cm, with the norm being up to 3 cm. The walls of the gall bladder are thickened, increased echogenicity, echogenic fluid in the lumen . There are no stones. Ultrasound signs of ADHD, chronic cholecystitis and chronic pancreatitis. Tell me, how dangerous is this? The doctor prescribed only Allochol and a blood test.

Answer: Hello. Here are the possible ones. Treatment: drugs, strict diet and herbs.

Question:Hello, I get nausea when I really want to go to the toilet and it goes away when I go. I have chronic cholecystitis, is this related somehow?

Answer: Hello. Symptoms various diseases The gastrointestinal tracts are similar, so details are important. For example, pain or discomfort in the abdomen that goes away after a bowel movement is a symptom of irritable bowel syndrome. You need an in-person consultation with a gastroenterologist.

Question:Hello, I have the following question: there is aching pain in the right side opposite the navel, a bitter or acidic taste, I am pregnant, I have been diagnosed with chronic cholecystitis. They prescribed Duspatelin and Ursofalk, but the contraindication was “pregnancy”. Can they be taken during pregnancy?

Answer: Hello. Absolutely right, these drugs are contraindicated during pregnancy. Talk to your doctor about replacing them.

Question:Hello, at Lately I have abdominal pain on the right side. Keeps t 37.5. At first, my whole stomach hurt and it was unclear where exactly the pain was, now only on the right side, opposite the navel. Please tell me what this could be and what to do?

Answer: Your symptoms may indicate an exacerbation of cholecystitis or cholelithiasis. You need to visit a gastroenterologist, take a general and biochemical blood test and perform an ultrasound of the abdominal cavity. You may need to consult a surgeon; this will become clear after the examination. By the way, you did not specify exactly where on the right you have pain, because this could also be a sign of appendicitis.

Question:The attacks begin with a headache around 3-4 o'clock in the morning, then vomiting begins and continues for 10-12 hours until a bitter greenish liquid begins to flow, while the body does not accept anything, not even water - everything is vomited. Such attacks, as a rule, appear after we eat something with appetite (thirst) and are accompanied by weakness and chills. What's this?

Answer: Severe vomiting accompanied by a headache may be a sign of migraine. Persistent vomiting is not typical for cholecystitis. Be sure to see a therapist for an examination.

Question:I have the same attacks as Anna, only the greenish liquid never appears. I thought it was a migraine, but lately I have become more and more convinced that it is cholecystitis, especially since headache goes away on its own after the nausea disappears. Can spasm or inflammation of the gallbladder manifest itself with such symptoms?

Answer: Elena, headaches can occur due to gallbladder diseases, however, you should find out whether you have it. Contact a gastroenterologist.

Question:Bile does not kill bacteria; on the contrary, they develop there in the gall sac. Destroys germs? how is this?

Answer: Bile has bactericidal properties, however, often these properties are not enough to destroy a large number of bacteria. In this case, inflammation of the gallbladder develops.

Question:I have chronic cholecystitis and an ultrasound showed that there is a bend in the neck of the gallbladder. Almost every month I have an inflamed lymph node in the neck area, painkillers do not help, nausea and vomiting occur and after 3-4 days everything goes away. Is this due to illness or should I see another doctor?

Answer: Hello. You need to visit a general practitioner who will examine the lymph node and, if necessary, refer you to a more specialized specialist.

Question:I have been suffering from gallbladder dyskinesia for a very long time, now I have cholecystitis and pancreatitis. I have been undergoing treatment all my life, taking choleretic medications, and going on diets from time to time. But the relief is short-lived. Most of all I am tormented by attacks associated with unpleasant sensations in the intestines: strong heartbeat, mortal fear and then leg cramps until you take something sedative.

Answer: Hello. The symptoms you describe occur in work disorders nervous system.

Question:I was recently diagnosed with chronic cholecystitis, prescribed a diet, Ursofalk and Creon 10,000. Tell me, can these drugs cure it and how long will the treatment take on average? There is a thick stagnation of bile in the gallbladder, but there are no stones. There is another problem with the pancreas, I don’t know exactly what.

Answer: Hello. Following a diet and taking Ursofalk will improve liver function and reduce inflammation of the gallbladder. The duration of treatment is usually several months. As a rule, people experience disruption of the pancreas (usually chronic pancreatitis), since the work of these two organs is closely related. Creon is a drug that helps with the functioning of the pancreas.

Question:An ultrasound showed that I had 1 stone, 1.6 cm. The year before last I didn’t have one. Now there is an exacerbation of cholecystitis (I have had it since childhood). The doctor at our military clinic said, “when there is an attack, come for surgery” and did not prescribe any treatment to relieve the exacerbation. I don’t have any attacks, and while I didn’t know about the stone, nothing really hurt. Is it possible to take treatment according to the usual regimen, but without choleretic drugs?

Answer: Hello. Only a doctor should prescribe treatment for you. If your doctor did not pay enough attention to you, then it is better to consult another specialist.

Cholecystitis is an inflammation of the gallbladder, an organ designed to deposit bile, which, along with other digestive enzymes (stomach juice, enzymes of the small intestine and pancreas), is actively involved in the process of processing and digesting food.

The gallbladder has an oval or pear-shaped shape, its volume is small - 30-70 ml, it is located in the projection of the portal of the liver in the right hypochondrium and is connected to it by the common bile duct. The extrahepatic bile ducts ensure the delivery of bile from the gallbladder to the duodenum, where it actively enters the digestive process to process fats.

The activity of the biliary system is carried out with the help of the autonomic nervous system. Irritation of twigs vagus nerve(parasympathetic nervous system) causes an increase in the tone of the gallbladder and biliary tract and a decrease in the tone of the sphincters of the excretory system. Irritation of the sympathetic nervous system leads to the opposite effect.

Under pathological conditions, asynchronous work of sphincters and ducts occurs, which leads to difficulty in the outflow of bile into the duodenum, and consequently to a sharp increase in pressure in the bile ducts (the so-called hypermotor biliary dyskinesia). This causes severe pain in the right hypochondrium even in the absence of inflammatory changes in the gallbladder.

Hypomotor dyskinesia, which occurs with a long-term decrease in the tone of the biliary system and its sphincters, leads to the reflux of intestinal contents from the duodenum into the bile ducts, and if there is an infection in the duodenum, the bile ducts in the liver itself can become infected ascendingly (cholangitis).

Thus, there are two types of biliary dyskinesia - hypermotor and hypomotor, which is widespread functional disease among the population and is secondary in chronic cholecystitis and cholelithiasis.

Cholecystitis is a very common disease, more common in women and the elderly and old age. Stagnation of bile in the gallbladder predisposes to the occurrence of cholecystitis; its cause may be gallstones, dyskinesia of the biliary tract (under the influence of various psycho-emotional moments, disorders of the endocrine and autonomic nervous systems), anatomical features of the structure of the gallbladder and bile ducts, a sedentary lifestyle, pregnancy, rare tricks food, etc.

There are acute and chronic cholecystitis.

Acute cholecystitis, course of the disease, treatment

Acute cholecystitis is quite common in elderly and senile people suffering from severe concomitant chronic diseases, such as severe atherosclerosis in combination with obesity, coronary heart disease with frequent attacks of angina, chronic pneumonia with severe respiratory failure.

In more than half of the cases, the occurrence of acute cholecystitis is preceded by diseases such as pancreatitis, choledocholithiasis (common bile duct stone).

Acute cholecystitis begins violently: sharp pain occurs in the right hypochondrium, which spreads throughout the upper half of the abdomen, radiating to the right half of the chest, neck, and sometimes to the heart. They may resemble biliary colic (cholelithiasis), but are usually milder and last for a few days or (without treatment) a longer period of time. The pain is often accompanied by nausea and vomiting of bile. Usually there is an increase in temperature (up to 38 oC and even up to 40 oC), chills. Sometimes there is slight jaundice as a result of inflammatory swelling of the mucous membrane of the common bile duct and difficulty in the outflow of bile. The tongue is dry, covered with a white coating. The abdomen is swollen, the anterior wall has limited mobility or is excluded from breathing.

There are catarrhal and purulent forms of acute cholecystitis. In acute catarrhal cholecystitis, the gallbladder containing serous or serous-purulent exudate is slightly enlarged. With catarrhal cholecystitis, recovery occurs relatively quickly. However, a transition to a chronic form is possible.

Acute purulent cholecystitis is much more severe, with symptoms of intoxication. With gangrene of the gallbladder, a complication in the form of perforation of its wall with the development of biliary peritonitis is possible.

If acute cholecystitis occurs, hospitalization is required. For purulent and gangrenous forms, removal of the gallbladder is indicated. Patients with catarrhal cholecystitis are prescribed strict bed rest, abstaining from eating during the first two days after the attack, then diet No. 5 (according to Pevzner) with eating small portions 5-6 times a day, antibiotics wide range actions and antispasmodics (papaverine hydrochloride 2 ml of 2% solution 3 times a day, 5 ml of baralgin intramuscularly or 2 ml of no-shpa subcutaneously).

Dietary regime in acute period illness (acute cholecystitis or exacerbation of chronic cholecystitis) is based on maximum sparing of the entire digestive system. For this purpose, in the first days of illness, it is recommended to administer only liquids.

Warm drinks are prescribed (weak tea, mineral water and sweet juices mixed with boiled tap water, sweet juices from fruits and berries diluted with water, rosehip decoction) in small portions. After 1-2 days (depending on the reduction in the severity of the pain syndrome), pureed food is prescribed in limited quantities: mucous and pureed soups (rice, semolina, oatmeal), pureed porridge (rice, oatmeal, semolina), jelly, jelly, sweet mousse fruits and berries. Further in the diet you can include low-fat cottage cheese, lean, pureed, steamed meat, and low-fat boiled fish. White crackers are allowed. Food is given in small portions (5-6 times a day).

5-10 days after the onset of the disease, diet No. 5a is prescribed, which is completely complete, but with some restriction of fats. Food is prepared mainly in pureed form, cold and fried foods are excluded. Vegetarian soups (1/2 plate) with pureed vegetables and cereals, milk soup are allowed. Low-fat varieties of meat and fish in the form of soufflés, steamed cutlets, chicken can be taken in pieces, but boiled. Dairy products allowed are non-sour cottage cheese (preferably homemade), protein omelettes, milk, mild cheeses, and butter. Vegetables are prescribed raw, pureed. Ripe and sweet fruits and dishes made from them are recommended. The bread is only white, dried.

Exclude from the diet legumes (peas, lentils, beans), vegetables and herbs rich in essential oils (garlic, onions, radishes, radishes).

The transition to a more varied diet (No. 5 according to Pevzner) is carried out when all acute phenomena disappear after 3-4 weeks, the patient is in good general condition, and appetite is restored. From this moment on, the same dishes are allowed, but unprocessed. Rub only stringy meat and vegetables very rich in fiber (cabbage, carrots, beets). Fried foods are excluded. You can serve dishes made from stewed foods, as well as baked ones (after preliminary boiling). 1/3 of the fat is given in the form of vegetable oil. Vegetable oil (olive, sunflower, corn) is added to salads, vegetable and cereal side dishes. Along with white bread (200 g), small amounts of sifted rye and wholemeal flour (100 g) are allowed.

Chronic cholecystitis, clinical picture, diagnosis

Chronic cholecystitis is a disease associated with the presence of inflammatory changes in the wall of the gallbladder. Chronic cholecystitis can occur after acute cholecystitis, but more often it develops independently and gradually.

In chronic cholecystitis, the inflammatory-scarring process covers all layers of the gallbladder wall. It gradually scleroses, thickens, and in some places lime is deposited in it. The gallbladder is reduced and fused with adjacent organs by adhesions; adhesions deform the gallbladder and disrupt its function, which creates conditions for maintaining the inflammatory process and its periodic exacerbations. Two factors play a major role in the development of this disease: infection and bile stagnation. They act simultaneously.

There are chronic acalculous (non-calculous) and chronic calculous cholecystitis.

Their clinical difference from each other is due practically only to the fact that with calculous cholecystitis, a mechanical factor (migration of stones) is periodically added, which gives a more vivid picture of the disease. In practice, it can be difficult to distinguish between these two diseases. The documented division of chronic cholecystitis into calculous and non-calculous is ultrasound and X-ray examination(cholecystography, cholangiography), which detects stones in the gallbladder or bile ducts.

Chronic acalculous cholecystitis is most often caused by conditionally pathogenic microflora: Escherichia coli, streptococcus, staphylococcus, less commonly Proteus, Pseudomonas aeruginosa, enterococcus. Occasionally, chronic acalculous cholecystitis occurs, caused by pathogenic microflora (Shigella, typhoid bacilli), viral and protozoal infections. Microbes penetrate the gallbladder by hematogenous (through the blood), lymphogenous (through lymph) and contact (from the intestines) route.

The infection can enter the gallbladder through the common bile and cystic ducts from the gastrointestinal tract (ascending infection). The spread of infection from the duodenum to the biliary system is more often observed with reduced acid-forming function of the stomach, insufficiency of the sphincter of Oddi and the presence of duodenitis and duodenostasis.

Downward spread of infection from the intrahepatic bile ducts is also possible. The development of the inflammatory process in the gallbladder is facilitated by changes chemical properties bile, sensitization of the body to autoinfection. Chronic inflammatory changes in the wall of the gallbladder in the acute phase may have different character- from catarrhal to purulent (phlegmonous, phlegmonous-ulcerative and gangrenous) forms.

Outside of severe exacerbation, cholecystitis can be represented by sluggish inflammation in the wall of the gallbladder. The outcome of the inflammatory process in the gallbladder can be dropsy and empyema, pericholecystitis with a constant focus of infection. Chronic cholecystitis is often accompanied by involvement in pathological process other digestive organs (liver, stomach, pancreas, intestines), nervous and cardiovascular disorders. Inflammatory diseases of the gallbladder are often accompanied by the formation of stones in it.

The clinical picture of chronic acalculous cholecystitis is characterized by a long progressive course with periodic exacerbations. The picture of the disease is dominated by pain, which occurs in the area of ​​the right hypochondrium, less often - simultaneously or even predominantly in the epigastric region.

The pain most often radiates to the right scapula, collarbone, shoulder joint and shoulder, less often to the left hypochondrium, has aching character, continues for many hours, days, sometimes weeks. Often, against this background, acute cramping pain occurs due to exacerbation of inflammation in the gallbladder. The occurrence of pain and its intensification is often associated with a violation of diet, physical stress, cooling, and intercurrent infection.

Particularly characteristic is the occurrence or intensification of pain after eating fatty and fried foods, eggs, cold and carbonated drinks, wine, beer, spicy snacks, as well as under the influence of neuropsychic stress. An exacerbation of a painful attack is usually accompanied by increased body temperature, nausea, vomiting, belching, diarrhea or alternating diarrhea and constipation, bloating, a feeling of bitterness in the mouth, and general neurotic disorders.

Pain in chronic acalculous cholecystitis can be intense, paroxysmal (hepatic colic); less intense, constant, aching; paroxysmal pain can be combined with constant pain. Many have an exacerbation constant feeling heaviness in the upper abdomen. Sometimes pain occurs in the epigastric region, around the navel, in the right iliac region.

The intensity of pain depends on the degree of development and localization of the inflammatory process, the presence of spasm of the gallbladder muscles, and concomitant diseases. For example, in chronic acalculous cholecystitis, manifested by hypertensive dyskinesia, the pain is usually intense, paroxysmal, and in hypotonic dyskinesia it is less intense, but more constant, nagging. Aching, almost continuous pain can be observed with pericholecystitis.

Pain in chronic acalculous cholecystitis is usually less intense than in chronic calculous cholecystitis, and is relieved or disappears after the use of antispasmodics and analgesics. Sometimes the nature of the pain helps to recognize concomitant diseases of adjacent organs. Thus, irradiation of pain to the left hypochondrium can be observed with pathological changes in the pancreas; pain in the area corresponding to the projection of the duodenum is characteristic of periduodenitis developing due to chronic cholecystitis.

Vomiting is not an obligatory symptom of chronic acalculous cholecystitis and, along with others dyspeptic disorders(nausea, bitter belching or constant bitter taste in the mouth) can be associated not only with the underlying disease, but also with concomitant pathology - gastritis, pancreatitis, periduodenitis, hepatitis. Often an admixture of bile is found in the vomit, and it turns green or yellow-green. Outside of an exacerbation, vomiting occurs when the diet is violated, after consuming fatty foods, smoked meats, spicy seasonings, alcohol, sometimes after smoking, strong excitement.

Weakness, lethargy, increased irritability, excitability, and sleep disturbance are observed. Sometimes, when the temperature rises, chills occur, which, however, is more often a sign of cholangitis or acute cholecystitis.

A typical palpation symptom of chronic cholecystitis is pain in the gallbladder area, especially on inspiration. Pain is also often observed when tapping in the right hypochondrium, especially at the height of inspiration, when the abdomen protrudes.

Often, pain during palpation of the gallbladder area is detected more when the patient is sitting. However, palpation of the gallbladder may be hampered by an excessively thick fat layer on the anterior wall of the abdomen, or significantly developed abdominal muscles, or an atypical location of the gallbladder. With long-term chronic cholecystitis, the gallbladder may shrink due to the development of connective tissue, and in this case, even with purulent cholecystitis, it cannot be palpated.

In general, the clinical picture of chronic acalculous cholecystitis does not have specific features and does not allow one to confidently differentiate calculous and acalculous lesions without special research methods.

The clinical and radiological method is most often used to diagnose chronic cholecystitis.

In chronic cholecystitis, in the acute phase, the ESR often increases, an excessive number of leukocytes is detected with a shift in the leukocyte formula to the left (a clear sign of inflammation), and a large number of eosinophils. Dynamic blood testing is important. For the diagnosis of complicated forms of chronic cholecystitis, biochemical studies of venous blood are of significant interest, in particular the determination of bilirubin, cholesterol, alkaline phosphatase, liver cytolytic enzymes, C-reactive protein, etc. in the blood serum.

Duodenal intubation in chronic acalculous cholecystitis often reveals dyskinetic disorders. Normally, the gallbladder usually contains 30-50 ml of bile, and with hypodynamic dyskinesia of the gallbladder, its amount reaches 150-200 ml or more, but it is released much more slowly than normal. Often, even with repeated probing, gallbladder bile (portion B) cannot be obtained, which may be due to obliteration and shrinkage of the gallbladder, with pericholecystitis, in which its contractility is always impaired. Cloudy, flocculent gallbladder bile (portion B) with an admixture of mucus and cellular elements indirectly indicates an inflammatory process.

X-ray examination methods include cholegraphy, which is carried out after oral or intravenous administration of a contrast agent. The gallbladder and ducts in this case are well contrasted and are revealed on x-ray films various symptoms gallbladder lesions: elongation, tortuosity, uneven filling (fragmentation) of the cystic duct, its kinks, etc.

However, the use of traditional methods does not always make it possible to identify certain forms of chronic cholecystitis. Thus, in some forms of cholecystitis in the remission phase of the disease, radiological signs of damage to the gallbladder may be absent or minimal.

Thus, the clinical and radiological method cannot be considered absolutely reliable. In recent years, a complex technique has increasingly begun to be used, which, in addition to conventional cholecystography, includes cholecystocholangiography, ultrasound and radionuclide scanning, computed tomography, laparoscopy, as well as the study of other organs and systems. In some cases, laparoscopic cholecystography is performed for special indications. The use of this method allows you to examine various parts of the gallbladder, note the degree of its filling, the presence of adhesions and adhesions, deformations, and the condition of the gallbladder wall. Despite the fact that there are practically no complications when using this method, non-invasive methods are preferred in the diagnosis of chronic cholecystitis.

Non-invasive methods for studying the biliary tract include ultrasound scanning and thermography.

Ultrasound scanning has no contraindications and can be used in cases where X-ray examination cannot be performed: in the acute phase of the disease, with increased sensitivity to contrast agents, pregnancy, liver failure, obstruction of the main bile ducts or cystic duct. Ultrasound examination allows not only to determine the absence of stones, but also to assess the contractility and condition of the gallbladder wall (thickening and sclerosis).

The thermography method for the diagnosis of chronic cholecystitis is not of significant importance, but with its help it is possible to identify a number of features in acute and destructive forms of cholecystitis. In chronic cholecystitis, thermography data usually turns out to be negative, and only when there is an exacerbation in the thermogram of the right hypochondrium area, a light spot is sometimes observed, the size and intensity of which depends on the nature and severity of inflammation of the gallbladder. Thermography in chronic acalculous cholecystitis can be used mainly for dynamic monitoring of the state of the inflammatory process and identification of complications. Thermography can be used for any condition of the patient; the method is harmless and simple.

When examining patients with chronic cholecystitis, it is necessary to examine the systems and organs associated with the biliary tract anatomically and functionally. This allows us to judge the condition of the gallbladder by indirect signs, and also exclude diseases with similar clinical symptoms. If necessary, fluoroscopy and endoscopy of the esophagus, stomach, duodenum, colon, echography of the liver and pancreas, laparoscopy, and excretory urography are performed.

Treatment of chronic cholecystitis

In case of exacerbation of chronic cholecystitis and a protracted course, treatment is usually carried out in a hospital; in the remission phase - in a clinic, dispensary, or sanatorium. Treatment is aimed at eliminating pain and dyskinetic disorders, suppressing infection and inflammation, eliminating digestive and metabolic disorders.

Diet therapy is important both during exacerbation and in remission of chronic cholecystitis. In the acute phase, the volume and calorie content of food should be reduced. Frequent split meals at the same hours are recommended, which promotes better outflow of bile. Exclude fried, salted and smoked foods, egg yolks, beer, wine, syrups, carbonated drinks, pork, lamb, goose, duck, mushrooms, baked goods, sour cream, chocolate, ice cream, canned juices, nuts, cream, cold dishes ( diet No. 5a and 5, discussed above).

Patients are allowed white stale bread, vegetable, milk and fruit soups, boiled meat (lean beef, chicken, rabbit), lean boiled fish (cod, hake, etc.), milk and dairy products, fruits, berries, vegetables, various dishes from cereals

In therapeutic nutrition for diseases of the biliary tract great importance have vegetables and fruits. Of these, only eating plums, sour varieties of apples, white cabbage, radishes, radishes, onions, garlic, cranberries. At the same time, there is no justification for prohibiting patients with liver and biliary tract pathologies from eating fresh ripe tomatoes. Vegetables and fruits are a source of vitamins, have a choleretic effect, and are rich in fiber, which helps normalize the metabolism of bile acids.

It is necessary to take into account individual tolerance of dishes, as well as the presence of concomitant diseases. Often, patients with chronic acalculous cholecystitis, even in the remission phase, experience intolerance to milk, raw vegetables and fruits due to disturbances in intestinal digestion or food allergies. When prescribing food for patients, it is necessary to take into account the course of cholecystitis, the functional state of the liver, stomach and pancreas, concomitant diseases, including duodenitis, enteritis, colitis, etc. Food should be consumed freshly prepared and warm. All dishes are prepared boiled or steamed; vegetable and cereal dishes can also be baked in the oven.

The nutrition of patients with chronic cholecystitis outside of exacerbation should be complete and balanced. Food should correspond to physical needs depending on age and labor activity. The amount of foods containing lipotropic substances (cottage cheese, cheese, legumes, cod and others) should be increased.

To eliminate pain from the first days, antispasmodics are used parenterally (that is, intramuscularly or intravenously): no-shpu, papaverine, halidor, atropine, metacin, platifillin.

In case of severe pain, analgin or promedol is administered. The combination drug baralgin is often used for this purpose. In some cases, for special reasons, the combined drug talomanal is used to relieve pain. Nitroglycerin-type drugs have a good antispasmodic effect on the Lütkens and Oddi sphincters, therefore, for severe hepatic colic, the use of nitroglycerin (under the tongue, 1 capsule or tablet), debridate 100-200 mg 3 times a day, as well as hepatofalkplant 2 capsules 3 times is indicated in a day.

The listed drugs are administered 3-4 times a day; as the pain decreases, they switch to taking drugs with a similar effect orally, some of them are used in the form of suppositories. Of the drugs in this group, the following are often prescribed orally for prolonged treatment:

• baralgin (1-2 tablets 3 times a day);
• debridate (100-200 mg 3 times a day);
• andipal (1 tablet 3-4 times a day);
• Rovahol (3-5 drops per piece of sugar 30 minutes before meals 4-5 times a day);
• papaverine (0.04-0.06 g 3 times a day);
• hepatofalkplant (1 capsule 3 times a day).

As a rule, the pain syndrome in chronic acalculous cholecystitis is relieved in the first 1-2 weeks from the start of complex treatment and does not recur during prolonged therapy. Typically, therapy with these drugs lasts at least 3-4 weeks. Pain syndrome with cholecystitis, as is known, depends not only on the severity of dyskinetic disorders of the gallbladder and biliary tract sphincters, but also on the nature and intensity of the inflammatory process in the biliary tract.

Treatment with antibacterial agents lasts an average of 8-10 days. After a 2-3-day break, taking into account the isolated microflora (during duodenal intubation), it is advisable to repeat treatment with antibacterial agents for another 8-10 days. Some drugs (erythromycin, furazolidone) also have an antigiardiasis effect.

In the treatment of patients with chronic acalculous cholecystitis, it is widely used choleretic agents. They are divided into two groups:

• choleretics (drugs that stimulate bile formation);
• cholekinetics (drugs that enhance muscle contraction of the gallbladder and thereby promote the release of bile into the intestines).

Choleretics include drugs containing bile or bile acids (allochol, dehydrocholic acid, decholin, lyobil, cholenzyme), a number of synthetic substances (oxaphenamide, cyqualom, nicodin), herbal preparations (flamin, holagon, corn silk, etc.), and also conditionally some enzyme preparations containing bile acids - festal, digestal.

Cholekinetic agents include cholecystokinin, magnesium sulfate, Carlsbad salt, sea buckthorn and olive oil, sorbitol, xylitol, maniitis, holosas.

Most choleretic drugs have a combined effect, increasing the secretion of bile and facilitating its entry into the intestines. Some drugs provide both anti-inflammatory (cyqualone) and antibacterial (nicodine) effects.

The use of choleretics is contraindicated in cases of severe inflammatory processes in the gallbladder and bile ducts, hepatitis and hepatosis, and cholekinetics are also contraindicated in cases of liver failure. Taking into account the listed contraindications, it is advisable to use choleretics only in the remission phase of chronic cholecystitis and then in combination with enzymes, and in case of hypotension of the gallbladder - with cholekinetics.

IN similar cases the use of allochol (1-2 tablets 3 times a day after meals), nicodine (0.5 - 1 g 3-4 times a day before meals), cyqualon (1 tablet 3 times a day after meals), flamin is indicated (1 tablet 3 times a day 30 minutes before meals), as well as festal or degistal (1-2 tablets 3 times a day with meals) and other remedies. The course of treatment is from 10 to 30 days, depending on the course of the disease.

Active therapy in the initial stage of the disease contributes not only to improvement of the patient’s condition, but also to cure with persistent inpatient and sanatorium treatment. However, for patients with convincing clinical symptoms of chronic recurrent cholecystitis, subject to previously unsuccessful conservative treatment surgery to remove the gallbladder is indicated.

Therapeutic and surgical methods of treatment do not oppose, but complement each other at a certain stage of the disease.

In the phase of fading exacerbation of chronic acalculous cholecystitis, a heating pad, hot poultices of flaxseed or oats, applications of paraffin, ozokerite, peat are recommended for the area of ​​the right hypochondrium; diathermy, inductothermy, and UHF currents are prescribed. For persistent pain syndrome, diadynamic therapy or amplipulse is used. Microwave therapy and ultrasound are also indicated.

In complex therapeutic measures In the remission phase of chronic cholecystitis, a significant place is occupied by the streamlining of work activity and the rhythmic alternation of work and rest. Physical therapy plays an important role, especially with hypokinesia of the gallbladder. Highest value have morning exercises and dosed walking. The complex of therapeutic exercises includes exercises for the trunk muscles in a standing, sitting and lying position on the back, right side, with a gradual increase in the range of movements and load on the abdominal press. When using abdominal exercises, static tension should be avoided. You should also pay attention to the development of diaphragmatic breathing.

To enhance the effect of breathing exercises on blood circulation in the liver and gall bladder, it is recommended to start in a lying position on the right side. As special exercises for the abdominal press, alternating with breathing exercises, exercises with a ball in different starting positions (lying on your back, on your side, on all fours, on your knees, etc.), as well as exercises on a gymnastic wall, are shown.

Approximate scheme of therapeutic exercises for chronic cholecystitis.

Introductory part 5-7 minutes.

1. Walking is simple and complicated. Simple active exercises for arms and legs in a standing position, alternating with breathing exercises.

2. Attention exercises.

The main part is 25-30 minutes.

1. In a standing position, raise your arms up to the sides; bending the body forward, backward; turns the body to the sides; spring squats; alternate leg bending. Includes exercises with objects - sticks, clubs, dumbbells with low mass.

2. Lying on your back - raising your arms and legs with pressing bent legs to the stomach, “bicycle”, “scissors”.

3. In a position lying on your side - raising your arms and legs with bending of the torso, abducting and adducting your legs, alternating with breathing exercises.

4. While lying on your stomach - “swimming”, moving to a position on all fours, sitting on your heels, left, right, etc.

5. Exercise on a gymnastic wall in alternation with exercises on a chair astride and breathing exercises.

6. Elements of outdoor games, dancing, relay races with objects, etc.

The final part is 3-5 minutes.

1. Simple walking.

2. Breathing exercises.

3. Attention exercises.

The duration of therapeutic exercises is up to 30-40 minutes with a physical therapy instructor or independent exercises for 10-15 minutes 1-2 times a day (simpler and easier exercises are performed).

Required daily walks in the fresh air for 2-3 hours a day. To increase the effect, physical therapy is combined with water treatments- morning wet wiping or dousing with water, followed by rubbing the body with a hard towel, a warm rain shower after the procedure, regardless of it - a circular shower (33-35 oC, for 3-5 minutes, every other day, for a course of treatment 8-10 procedures) .

Spa treatment

Sanatorium-resort treatment of patients with chronic acalculous cholecystitis in the remission phase is carried out in Essentuki, Zheleznovodsk, Pyatigorsk, Truskavets, Borjomi, Jermuk, Belokurikha, Morshyn, etc. It is an important part of the step-by-step treatment of patients with diseases of the digestive system. The effectiveness of treatment outside the acute stage at a resort is higher than in a hospital. This is due to the influence of resort medicinal factors on the main mechanisms of development of diseases of the digestive system.

It has been proven that natural healing factors (mineral waters, baths, mud therapy, climatotherapy, therapeutic nutrition and physical therapy) have a beneficial effect on the functional state of the nervous system and glands internal secretion, help restore immunity, improve metabolism, and provide an anti-inflammatory effect. A special role in the treatment of pathologies of the digestive organs is played by the elimination of neuropsychic disorders.

For patients with chronic cholecystitis in the phase of stable and unstable remission, a gentle and then a training regimen is recommended in the first 3-5 days after admission to the sanatorium. Of the various methods of spa treatment of diseases of the biliary system, treatment with mineral waters is of primary importance. For internal use, mineral waters of low and medium mineralization, in which sulfate anions predominate (sulfate, sulfate-chloride). Sulfate mineral waters enhance bile formation and secretion, reduce the level of total cholesterol in the blood, and help normalize liver function.

In case of chronic cholecystitis, especially with concomitant hyperkinetic dyskinesia of the biliary tract, it is recommended to drink thermal (t = 40-42 oC) and high-thermal (more than 42 oC - 46-50 oC) water in small sips, slowly 1.5 hours before meals at the rate of 3 ml per 1 kg of weight (but not more than 250 ml). The optimal course of drinking treatment with mineral water is 3-4 weeks. To consolidate the results of treatment, repeated courses of drinking treatment with bottled mineral waters should be carried out at home after 3-6 months.

Patients with chronic cholecystitis are widely prescribed tubage (probeless drainage). For hypertensive dyskinesia, use 200 ml of low- or medium-mineralized water at a temperature of 40-44 °C using a heating pad. For hypotonic dyskinesia and chronic non-calculous cholecystitis, it is recommended to use choleretic agents (magnesium sulfate, olive oil, 100 ml of a 20% solution of xylitol or sorbitol, 1 tsp of Carlsbad salt per 100 ml of water). 30-40 minutes after the first intake of the stimulus, the patient again drinks 1 glass of mineral water and continues to lie down for another 30 minutes. The course of treatment consists of 4-7 procedures, which are carried out 2 times a week.

For chronic cholecystitis and accompanying intestinal lesions, microenemas from warm mineral water (100-120 ml each), infusions or decoctions of medicinal herbs (chamomile, sage, St. John's wort, oak bark), medications (collargol, potassium permanganate, Shostakovsky balm, rosehip oil, etc.), which have a local anti-inflammatory effect and also relieve spasm of smooth muscles not only of the intestines, but also of the gallbladder and stomach. Microclysters are prescribed in the morning or before bedtime, daily or every other day, for a course of treatment of 10-20 procedures.

In the complex of sanatorium-resort treatment of patients with chronic biliary tract disease, baths of various chemical compositions, both gas and not containing free gas, are successfully used. It should be emphasized once again that baths are a procedure with a pronounced active action. Mineral baths are successfully used. For hypotonic dyskinesias, preference should be given to carbon dioxide, hydrogen sulfide, and radon baths; for hypertonic dyskinesias, preference should be given to mineral baths with the addition of pine extract, oxygen and nitrogen baths.

Baths are prescribed every other day, at an indifferent temperature (35-37 oC), exposure 10-15 minutes, 10-12 baths per course of treatment. For chronic cholecystitis in the stage of unstable remission, hypotonic dyskinesias, a rain shower of decreasing temperature (from 34 to 32 oC) for 3-5 minutes, every other day, is recommended for a course of treatment of 10-12 procedures. For chronic cholecystitis in the stage of stable remission with symptoms of hypotonic dyskinesia, as well as with concomitant intestinal atony - underwater shower massage. Dousing and rubbing are recommended.

Along with the use of mineral waters, mud therapy (peat, silt and hill mud) and ozokerite therapy are important in the complex treatment of patients with diseases of the biliary system.

In the mechanism therapeutic effect In mud therapy, the thermal and chemical factors are of primary importance. Mud therapy has an anti-inflammatory, antispasmodic, absorbable effect, enhances reparative processes, improves blood circulation in the digestive organs.

In case of chronic non-calculous cholecystitis in the remission phase, especially accompanied by hyperkinetic dyskinesia, mud therapy (mud temperature 40-42 °C) or ozokerite treatment (ozokerite temperature 44-46 °C) in the form of applications only to the area of ​​the right hypochondrium and lumbar are indicated. In case of concomitant diseases of other digestive organs and the absence of liver pathology, applications in the form of a wide belt are recommended (on the anterior abdominal wall and lumbar region).

The effectiveness of treatment of patients with biliary tract pathology increases significantly when climatic factors are included in the treatment complex. Biliary dyskinesia is one of the manifestations of general neurosis, so patients with this pathology can also be treated at climatic resorts. Climatic factors have a diverse effect on the body of patients with this pathology, normalize its reactivity and the functional state of the nervous system, train the body’s protective and adaptive forces, and increase the effectiveness of other treatment methods.

Among climatotherapeutic procedures, patients with chronic diseases of the biliary tract are widely prescribed stay in the fresh air (in warm time of the year). Depending on the temperature and humidity of the air, the forces of the wind are used to apply air baths in tents or solariums. Indifferent (21-22 °C) or warm (23-25 ​​°C) air baths are prescribed to patients after acclimatization for 2-5 days, first in a tent, and then in an aerosolium (the patient is partially or completely undressed). The duration of the bath is on average from 15-25 to 30-80 minutes, daily.

Swimming is carried out in fresh water bodies or in the sea at an air temperature of not lower than 20-22 ° C and water temperature of not lower than 22-24 ° C in a low cold load mode. The duration of swimming is from 2 to 15-20 minutes, the swimming pace is slow.

In order to prevent chronic cholecystitis and prevent repeated exacerbations, measures are recommended to prevent stagnation of bile in the gallbladder - exercises, walks, regular and frequent meals with known restrictions, herbal medicine.

Herbal medicine for chronic cholecystitis

Herbal medicine (or treatment with medicinal plants) at this stage of development therapeutic medicine is an indispensable, harmless and effective method of anti-relapse therapy. Interest in medicinal plants not accidental.

With the increasing flow of pharmacological drugs, their quantity is also increasing. side effects: from allergic reactions and severe complications to changes in the genetic apparatus. On the contrary, herbal medicine is practically devoid of the disadvantages of pharmacotherapy.

For diseases of the biliary tract (dyskinesia, cholecystitis, cholelithiasis), herbal preparations are used quite widely. Herbal medicine for chronic cholecystitis can be used only after a thorough examination of the patient to clarify the diagnosis, exclude stones and other diseases of the biliary system. The following plants are used: anise (fruit), birch (buds, leaves), immortelle (flowers), elecampane (root), wild strawberry (fruit), calendula (flowers), cabbage (juice), mullein (flowers), burnet (root), corn (herb), agrimony (herb), knotweed (herb), hops (cones), chicory (root), rose hips (fruit), eucalyptus (leaves).

For chronic cholecystitis, the following plants are also used as “choleretic”: calamus (root), black elderberry (flowers, fruits), angelica (root), juniper (fruits), mint (leaves), dandelion (root), rhubarb (root), chamomile (flowers), pine (buds), caraway (fruits), trifol (leaves), dill (fruits), fennel (fruits).

When compiling medicinal mixtures Some other plants can also be used.

M.A. Nosal and I.M. Nosal for chronic cholecystitis recommend collecting plants from three components: centaury grass, calamus roots, immortelle flowers, 1 part each (5 g of the mixture is poured into 2 glasses of cold water, infused for 8-10 hours, boiled for 5 minutes, take 100 ml 4 times a day 1 hour after meals).

Collection of St. John's wort herb, immortelle and calendula flowers - 4 parts each, knotweed herb, chamomile flowers - 2 parts each, chicory roots - 3 parts, buckthorn bark - 1 part. 20 g of mixture per 300 ml of water. The preparation method is the same as the above collection. Take 300 ml throughout the day in sips.

Collection of St. John's wort herb, buckthorn bark - 1 part each, knotweed herb - 3 parts, immortelle flowers - 4 parts, chamomile flowers - 2 parts. 20 g of mixture per 1000 ml of water. The cooking method is similar to the first. Take 200 ml 5 times a day 1 hour after meals.

N.P. Kovaleva successfully used a multicomponent mixture for chronic cholecystitis:

Collection of calendula flowers, dill fruits, birch leaves, juniper fruits - 1 part each, chamomile flowers, strawberry fruits - 2 parts each, horsetail grass, corn silk, rose hips, dandelion roots - 3 parts each, immortelle flowers - 4 parts. 5 g of the mixture is poured into 500 ml of boiling water, infused for 30 minutes, and taken 150 ml 3 times a day before meals.

Collection of mint leaves - 2 parts, valerian roots, St. John's wort herb, hop cones - 1 part each. 5 g of the mixture is poured into 1 glass of boiling water, infused for 30 minutes, and taken 100 ml 2 times a day before meals.

Collection of St. John's wort and centaury herbs, mullein flowers - 1 part each, dandelion roots, immortelle and chamomile flowers - 3 parts each, triphol leaves - 2 parts. Methods of preparation and use are the same as for the above collection.

It is also advisable to use official choleretic teas.

Choleretic tea No. 1: immortelle flowers, coriander fruits - 1 part each, triphol leaves - 3 parts, mint leaves - 2 parts. Pour 10 g of the mixture into 2 cups of boiling water, boil for 10 minutes, take 100 ml 3 times a day before meals.

Choleretic tea No. 2: immortelle flowers - 3 parts, yarrow and wormwood herbs, fennel fruits, mint leaves - 2 parts each. 10 g of the mixture is poured into 2 glasses of cold water, infused for 8 hours, cooled (do not boil), and taken in 400 ml sips throughout the day.

Choleretic tea No. 3: triphol leaves - 3 parts, coriander fruits, mint leaves - 2 parts each, immortelle flowers - 4 parts. 10 g of the mixture is poured into 1 glass of boiling water, infused for 30 minutes, and taken 100 ml 3 times a day before meals.

During treatment with herbal mixtures, exacerbations of the process are possible. It is recommended to continue herbal medicine without changing the composition of the prescribed collection and dosage, and it is advisable to relieve the pain syndrome with fast-acting analgesic antispasmodic drugs (analgin, papaverine, no-spa, etc.). Herbal medicine for chronic cholecystitis should be carried out in courses of 1 to 1.5 months, with breaks of 2 weeks. If you are pregnant, it is advisable to stop herbal medicine.

Against the background of herbal medicine, exacerbations of chronic cholecystitis occur less frequently, become less intense, and in many patients completely stop.

Chronic cholecystitis lasts for many years or decades, characterized by alternating exacerbations with periods of remission. The nature of its course and the frequency of exacerbations depend primarily on the person himself, his desire to defeat the disease with all possible methods and means of treatment.

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Cholecystitis occurs as a result of irritation and inflammation of the gallbladder (an organ located near the liver and involved in digestion). Bile is excreted from the body primarily through the small intestine, but sometimes problems with its release can occur, causing it to accumulate in the gallbladder. This leads to pain and infection.

Function of the gallbladder in the body

What is the function of the gallbladder? This organ secretes a secretion that dilutes the processed gastric juice food, changing gastric digestion to intestinal digestion. Activates small intestinal peristalsis and the production of physiological mucus, which plays a protective role. At the same time, it neutralizes cholesterol, bilirubin and some other substances, and also stimulates the production of enzymes.

Who is at risk?

As a rule, cholecystitis occurs in parallel with inflammation of the ducts. The disease is quite common. Most often, chronic cholecystitis is required for women. In the fairer sex, this disease occurs 3-8 times more often than in men of the same age.

Why are women more predisposed to this disease? Most often it develops during pregnancy due to chronic compression of the gallbladder by the fetus. The result is an imbalance and stagnation of bile.

Progesterone, which is produced in large quantities during pregnancy and menopause, along with other female hormones, negatively affects the functioning of the gallbladder. In addition, women like to go on diets that lead to disruption of his motor skills.

These reasons are due to either a violation of obstruction (patency) or impaired motility of the gallbladder.

Types of disease

According to the course of the disease, cholecystitis of the liver can be acute or chronic. The physiology of the gallbladder is close to that of which it is quite diverse. The main one is the constant production of bile and excretion into the duodenum. Excess bile accumulates in the gallbladder and is consumed gradually.

The disease cholecystitis can be divided according to etiology into 2 groups: calculous (translated from Latin Calculus means “stone”) and non-calculous (stoneless).

Inflammation can be of a different nature, depending on which cholecystitis is divided into catarrhal, purulent, mixed, gangrenous and phlegmonous. The last two types of cholecystitis are included in one group - destructive cholecystitis. An exacerbation of the disease most often gives the patient a lot of unpleasant sensations. Therefore, it is important to identify the disease at an early stage and begin its treatment in time. Correct treatment allows you to avoid possible complications.

Causes of inflammation

Treatment of cholecystitis and chronic cholecystitis should begin with examination by a specialist. But first it’s worth finding out why this disease occurred. The reasons for the development of the disease can be very different. However, most often it occurs as a result of the accumulation of stones in the gall bladder, which significantly impede the removal of bile from the body. Another common cause of the disease is infection or injury. Also biliary cholecystitis may occur as a complication of serious diseases, such as diabetes. In this case, the treatment method is prescribed to the patient individually.

As a result of these circumstances, inflammation of the gallbladder may develop. Chr. cholecystitis, as a rule, develops in cases where inflammation does not go away over a long period and is protracted. This leads to the fact that the walls of the gallbladder begin to thicken.

Symptoms and diagnosis of cholecystitis

In the early stages, the main symptom of cholecystitis is usually a sharp pain in the right side, which a person feels just below the ribs. Pain always comes unexpectedly. The main reason painful symptoms is a stone blocking the duct in the bladder. This leads to irritation and inflammation.

The pain goes away after some time on its own or after painkillers. However, in the future there is a gradual increase in pain, which becomes systematic over time. The development of cholecystitis is accompanied by fever, nausea and vomiting, and the person’s condition gradually worsens.

Soon the patient develops jaundice, as a result of which the skin and sclera become yellowish color. This is due to a violation of the flow of bile into the intestines. The main prerequisite for this is the presence of stones blocking the ducts in the bladder. allows you to determine the degree of infection and development of the disease. It should be measured by every patient diagnosed with cholecystitis. Exacerbation of the disease can lead to complications. Therefore, if a patient has a pulse of 80 to 130 beats per minute or higher, you should be wary. Since this is serious sign, which indicates that dangerous changes are occurring in the body.

In the chronic course of the disease, symptoms may not manifest themselves strongly, but in the future the disease may make itself felt in a more advanced form or become acute. In this case, treatment should be carried out in a medical facility - this will avoid complications.

Symptoms are detected during examination, as well as in laboratory tests and Based on the patient’s complaints, diseases of the liver, gastrointestinal tract and other organs that the person has suffered previously are determined. Once the diagnosis is confirmed, certain medications are prescribed. Treatment of cholecystitis and chronic cholecystitis begins only after consultation with the doctor.

Most often, patients complain of severe pain in the area below the ribs, indigestion, nausea, vomiting, diarrhea, constipation or bloating. Other symptoms include a coated tongue, which is a sign of stagnation of bile in the bladder. The main symptom of cholecystitis is pain, which can be determined by palpation. It usually appears regardless of body position.

A fairly common symptom of this disease is nausea, which often leads to vomiting. In certain cases, these symptoms serve as a protective reaction of the body to intoxication. With cholecystitis, they are always part of the course of the disease. A feeling of nausea can be observed not only with cholecystitis, but also with appendicitis, poisoning, renal colic, ulcer, pancreatitis or ectopic pregnancy.

To accurately determine the cause of nausea and vomiting, you should pay attention to what time of day these symptoms appear, as well as when they occur after eating. It is important to pay attention to the duration of nausea and whether it ends with a gag reflex. It is necessary to study the composition of the vomit (whether food has been digested or not, whether there are blood clots and foreign impurities), whether relief occurs after vomiting.

Diarrhea, constipation and bloating are symptoms various diseases Gastrointestinal tract, including cholecystitis. If the disorder occurs suddenly, this indicates a complication of the disease.

Diarrhea most often appears due to dysbacteriosis while taking antibiotics to treat cholecystitis. It can also appear when various disorders intestines, when other digestive organs are involved in the pathogenesis of the disease.

Constipation and bloating usually occur with peritonitis and acute cholecystitis. They often occur in sedentary patients who are on bed rest for a long time.

Diagnostics

If these symptoms are present, a person should seek medical attention. medical care. The doctor finds out the patients’ complaints, on the basis of which a medical history is compiled. Cholecystitis is diagnosed by various laboratory and instrumental methods. Basically, to determine cholecystitis, specialists use duodenal probing, X-rays and ultrasound. With the help of these studies, peristalsis and the passage of bile into the duodenum, as well as other important indicators of this organ, are determined.

Non-calculous cholecystitis

6-7 people out of 1000 experience an acalculous form of cholecystitis, most often chronic. It occurs more often in women than in men. Some doctors believe that this type of disease can subsequently develop into calculous. Therefore, it is important to start treatment of cholecystitis and chronic cholecystitis in a timely manner. Patients need to understand that this is not something to joke about.

Why does acalculous cholecystitis occur? The main causative agents of this disease are: coli, enterococcus, staphylococcus, proteus or mixed flora. If the patient has dysbiosis, colitis or enteritis, the infection can spread from the intestines to the gallbladder, or from the hepatopancreatic zone if the patient suffered from chronic pancreatitis. IN in rare cases there is a development of infection from more distant foci in which there was chronic inflammation. Such diseases include: chronic tonsillitis, periodontal disease, appendicitis, pneumonia and others.

The disease is usually treated with traditional methods. The patient must be prescribed a special diet. It is very important that the patient eats small and often. It is necessary to completely exclude fatty, fried, spicy foods, as well as carbonated and alcoholic drinks from the diet.

Currently, acalculous cholecystitis is treated with drugs such as Amoxicillin, Cefazolin, Erythromycin and some others. To normalize the digestion process, taking these drugs is usually combined with enzyme preparations, for example, Festal, Mezim Forte, Pancreatin. To stimulate bile secretion, the patient is prescribed choleretics (“Cholenzim”, “Allohol” and others). To contract the gallbladder, sorbitol is prescribed.

Chronic form of the disease

Chr. cholecystitis is characterized by the presence of stones in the gallbladder, a mild inflammatory process and the periodic manifestation of symptoms of the disease. The disease can be almost asymptomatic or manifest itself with hepatic colic. If the disease occurs in a latent form, the patient may experience a feeling of heaviness on the right side in the hypochondrium. Along with this, he is tormented by flatulence, diarrhea, heartburn, and belching. These symptoms are accompanied by bitterness in the mouth. When overeating or after eating fatty foods, these unpleasant sensations worsen.

Sudden hepatic colic usually occurs with diseases such as cholecystitis, pancreatitis, the treatment of which should be carried out under the supervision of a doctor. As a rule, colic is preceded by poor diet, heavy physical activity, or some kind of emotional stress. The attack is provoked by contractions of the gallbladder and its ducts, which occur as a result of irritation of the mucous membrane by stones. In this case, the person experiences acute stabbing pain, localized in the right hypochondrium, flowing into the neck, right shoulder and scapula. The duration of the attack varies from several minutes to 2 days.

Colic is accompanied by high fever and vomiting, which does not bring relief. The patient feels excited, and his pulse becomes arrhythmic. On arterial pressure the disease has little effect. Older patients often develop reflex angina.

During an attack, the tongue becomes very wet, and a coating often appears on it. Along with this, the patient may experience bloating and painful sensations in the hypochondrium on the right side. It is noteworthy that in this case, a blood test does not show any abnormalities, and the gallbladder and liver do not enlarge, and there are no signs of irritation. The attacks of colic stop as suddenly as they began, while the patient feels some relief and weakness.

Prevention of cholecystitis

How to prevent yourself from developing of this disease? To do this, it is necessary to try to maintain optimal body weight and level of physical activity, because due to sedentary lifestyle During life, bile stagnates and stones form in the bladder. The patient is advised to adhere to a special diet. Drinks allowed include compotes and weakly brewed tea. The list of permitted dishes and products includes: wheat bread, low-fat cottage cheese, vegetable soups, beef (lean), chicken, crumbly cereals and non-acidic vegetables and fruits.

It is forbidden to eat: fresh baked goods, lard, spinach, sorrel, fried meat, fatty fish and meat, mustard, pepper, coffee, ice cream, alcoholic drinks, semi-finished products.

For the purpose of prevention, experts prescribe ursodeoxycholic acid to patients, which prevents the appearance of stones during sudden weight loss (from 2 kg per week).

At existing disease preventive measures are aimed at preventing the occurrence of relapses of inflammation and associated complications. It should be noted that they may appear even after treatment. In such a situation, the patient requires surgery. Cholecystitis cannot be ignored; at the first signs of the disease, you should undergo examination.

Traditional medicine recipes for the treatment of cholecystitis

Treatment of cholecystitis, based on the use of various herbs and infusions, must be agreed with the attending physician. This is necessary in order to avoid possible deterioration in health and well-being. Among the well-known folk remedies, good results are shown medicinal fees herbs based on immortelle, which have a choleretic effect.

Before starting treatment, it is important to accurately determine the type of disease, since taking any choleretic drug is not allowed for calculous cholecystitis. Alternative treatment for cholecystitis can only be used if the patient suffers from non-calculous cholecystitis. In the presence of a calculous form of the disease, it is possible to stimulate the release of bile with the help of herbs and medications only on the individual prescription of a doctor.

The patient can drink herbal infusions that improve intestinal motility and blood circulation. Various soothing infusions and herbal teas, as well as fresh carrot and pumpkin juices, are very useful in this case.

Many people treat noncalculous cholecystitis with homeopathy, which in some cases improves overall health. Only the attending physician can prescribe the use of certain homeopathic medicines.

• For cholecystitis, drinking rowan juice is very useful. It should be taken 50 ml 3 times a day 30 minutes before meals.
• Diseases such as chronic cholecystitis and pancreatitis can be treated with a decoction of St. John's wort. It has not only a choleretic effect, but also an anti-inflammatory effect. To prepare it, you will need 1 tablespoon of St. John's wort and 1 glass of hot water. The broth is boiled for 15 minutes and filtered. Take 50 ml three times a day.
• A decoction of birch leaves is also quite effective in combating the disease. For it, take 1 tablespoon of leaves and pour 200 ml of boiling water over them. The broth should be boiled for 30 minutes, after which it should be cooled to room temperature. During cooking, the amount of broth will decrease, so you will need to add water to the volume of one glass. You should drink the decoction 3 times a day, 50 ml before meals. This recipe is used to treat giardia cholecystitis.
• You can make another decoction of St. John's wort, but with the addition of immortelle and corn silk. All ingredients are mixed in equal quantities to make 1 tablespoon of herbal mixture. Then this mixture is poured with 200 ml of boiling water and boiled for 30 minutes. After which the broth will need to be cooled to room temperature and diluted slightly with boiled water. You need to take this remedy 1/3 cup half an hour before meals three times a day.
• Chamomile decoction helps treat non-calculous cholecystitis. For this you will need 15 g of chamomile per 1 cup of boiling water. The decoction should be drunk warm. It can also be used for enemas, which should be done no more than 2-3 times a week.

It is important to remember that in human body everything matters, each organ is important in its own way and affects the length and fullness of life. Traditional methods are part of maintenance therapy. Since traditional recipes cannot replace antibacterial and other drugs, the patient must follow all the doctor’s instructions and not neglect taking medications. It is not recommended to treat the disease cholecystitis only with herbs. It is important to monitor your health and not ignore the symptoms of cholecystitis, even if they are minor.

Chronic cholecystitis is a recurrent inflammatory disease of the gallbladder, characterized by fibrosis and thickening of its walls.

In the pathogenesis of cholecystitis, the main role belongs to changes in the physicochemical properties of bile and disruption of the motor function of the biliary tract.

Classification

According to the frequency of exacerbations, cholecystitis can be:

• often recurrent (more than 2 exacerbations per year);
• rarely recurrent (no more than 1 exacerbation per year);
• latent (with a minimum of symptoms, without clear exacerbations).

There are other classifications of chronic cholecystitis. Thus, when making a diagnosis, the presence of complications (cholecystitis with and without complications), severity (mild, moderate and severe), cause, and pathological picture (catarrhal, purulent, gangrenous forms) are taken into account.

Etiology

The following microorganisms can be the direct cause of cholecystitis:

• coli,
• staphylococcus,
• streptococcus,
• salmonella,
• Proteus,
• enterococcus,
• mixed infection.

• structural anomalies (kinks, narrowing of the organ);
• cholelithiasis;
• errors in nutrition (overeating, frequent consumption of fatty, spicy, fried foods, alcohol);
• insufficient physical activity(hypodynamia);
• obesity or rapid weight loss;
• pregnancy;
• endocrine diseases;
• violations nervous regulation internal organs.

All of these conditions help slow down bile secretion. As a result, favorable conditions for the development of infection appear.

Important: if you have any risk factors, you should be more careful about your health and consult a doctor at the first signs of illness.

Symptoms of the disease

For chronic cholecystitis characteristic symptom is pain in the right hypochondrium. It is most often dull and unclear. There is a connection between the pain syndrome and the consumption of fatty or spicy foods and psycho-emotional stress. Painful sensations can reflexively spread to the heart area, lumbar area, under the right shoulder blade and to the right half of the neck. The pain becomes more intense after physical activity, jolting driving, or taking a deep breath.

Pain syndrome is often accompanied by other signs of chronic cholecystitis:

• slight rise in temperature;
• nausea;
• heartburn and bitter belching;
• vomiting bile;
• bitter or metallic taste, dry mouth;
• bowel dysfunction (usually constipation type).

With calculous chronic cholecystitis there may be biliary colic. They are characterized by sharp, cramping pain in the right hypochondrium, accompanied by vomiting, chills, and high fever. Impaired bile outflow contributes to the development of obstructive jaundice, which is manifested by itchy skin, yellowness of the skin, sclera and mucous membranes.

Symptoms of chronic cholecystitis in women can worsen during menstruation and pregnancy, when the body's defenses decrease.

Diagnostics

Laboratory and instrumental methods are used as diagnostic studies:

• general blood test (increased leukocyte level, increased ESR);
• biochemical blood test (appearance of inflammatory proteins - CRP, seromucoid);
• followed by bile analysis;
• microbiological examination of bile;
• cholecystography (x-ray contrast study);

Ultrasound examination is one of the main methods for diagnosing the disease

The following echo signs of chronic cholecystitis are distinguished:

• change in bubble size (increase or decrease);
• deformation;
• wall thickening more than 3 mm;
• uneven internal contour;
• heterogeneous free-floating or fixed inclusions;
• three-layer nature of the wall (with severe exacerbation).

More information about the symptoms and diagnosis of gallbladder inflammation can be found in the video at the end of the article.

Treatment of cholecystitis

For chronic cholecystitis, treatment includes diet (table No. 5 according to Pevzner) and drug therapy. During an exacerbation, spicy foods, fried and fatty foods, smoked foods, and alcohol are excluded from the diet. You should eat small portions 4 times a day.

Medicines used:

• antibacterial agents,
• (in the absence of cholelithiasis).

When the exacerbation subsides, physiotherapy is prescribed - UHF therapy, acupuncture and other procedures. Useful for chronic cholecystitis in the remission phase Spa treatment. Good results can be achieved with the help of herbal remedies. They use decoctions and infusions from, which have antimicrobial, anti-inflammatory and choleretic properties (yarrow, buckthorn, tansy).

Important: the question of how to treat chronic cholecystitis must be decided by a gastroenterologist based on the examination results. You cannot self-medicate.

In the case of calculous cholecystitis and when complications develop, they resort to surgical intervention - cholecystectomy.

Surgery to remove the gallbladder is often performed by laparoscopy

IN abdominal wall Several punctures are made through which the necessary instruments and video equipment are inserted. Open laparotomy is performed for complications of the disease such as empyema and peritonitis.

Complications of the disease

The most dangerous complications chronic cholecystitis are empyema, perforation of the bladder wall and peritonitis. Empyema is an accumulation of pus in the cavity of the gallbladder with stretching of its walls. Perforation of the organ develops with purulent melting of the membranes. Without treatment, this condition ends in peritonitis - inflammation of the peritoneum.

Prevention of chronic cholecystitis

To prevent the onset of the disease or avoid its exacerbation, you should follow the general hygiene rules. Nutrition plays an important role. You need to eat food 3-4 times a day at approximately the same time. Dinner should be light and you should not overeat. Especially to be avoided overuse fatty foods combined with alcohol. It is important that the body receives a sufficient amount of fluid (at least 1.5-2 liters per day).

is an acute inflammatory process occurring in the human gallbladder.

Normally, the gallbladder has a volume of 40–70 cm3. Produced in the human liver , which is necessary to ensure the digestion process. It is stored in the gallbladder. If a disorder occurs in the body metabolic processes, then stones may appear in the lumen of the gallbladder, and with the simultaneous occurrence of an infectious inflammatory process, acute cholecystitis develops.

Causes of cholecystitis

Most common cause The development of cholecystitis is the entry of microbes into the body and their subsequent development. Cholecystitis can be caused by streptococci , enterococci , staphylococci . That is why for treatment acute or chronic cholecystitis technique is often used . As a rule, the penetration of microorganisms into the gallbladder occurs through the bile ducts from the intestine. This phenomenon occurs as a consequence of insufficient function of the muscle fibers that separate the common intestine from the intestine. bile duct. This is often seen as a consequence gallbladder dyskinesia And biliary tract , too low secretory activity of the stomach, high pressure in the duodenum.

Very often, the development of cholecystitis occurs as a consequence of impaired bile outflow. This may occur in a person who suffers from . If there are fireplaces in a person’s gallbladder, they not only create a mechanical barrier to the outflow of bile, but also irritate the walls of the gallbladder. As a result, it initially develops in the gallbladder aseptic , and later - microbial inflammation of the gallbladder. Thus, the patient develops chronic cholecystitis, which periodically worsens.

However, microbes can end up in the gallbladder, getting there with the flow of blood and lymph, because the gallbladder has a developed vascular network. In this regard, symptoms of cholecystitis often appear in people who suffer from ailments of the intestines, organs genitourinary system or the presence of other foci of inflammation.

Sometimes cholecystitis is provoked roundworms , Giardia , Availability liver injuries And gallbladder and etc.

Symptoms of cholecystitis

Symptoms of cholecystitis clearly appear at the very early stages of the development of the disease. The early manifestations of this disease are very diverse. As a rule, they occur after a person has noticeably violated his usual diet, for example, ate a lot of spicy or very fatty foods, drank a fairly large amount of alcohol, etc. In this case, initially the pain occurs in the upper abdomen and radiates to the right hypochondrium. The pain can be either constant or increasing periodically. Sometimes with cholecystitis there is a very sharp pain that resembles biliary colic . Dyspeptic symptoms may also occur as symptoms of acute cholecystitis. This is a bitter and metallic taste in the mouth, constant nausea, belching, . The person becomes very irritable and often suffers from insomnia.

A patient with cholecystitis vomits bile from time to time, but after such vomiting he does not feel better. In addition, the symptoms of cholecystitis are often manifested by an increase in body temperature, increased heart rate, and the patient's skin may turn slightly yellow. There is a dry tongue.

If the disease is not treated immediately after the symptoms described appear, it may subsequently develop peritonitis , which is a very dangerous condition.

Chronic cholecystitis generally occurs over a long period of time, sometimes it can last for many years. Chronic cholecystitis is usually divided into several types. At acalculous cholecystitis Stones do not form in the lumen of the gallbladder. In the same time calculous cholecystitis characterized by the appearance of stones in the lumen of the bladder. Consequently, calculous cholecystitis is a manifestation of cholelithiasis.

In this case, a person periodically develops exacerbations, alternating with remissions. Exacerbations of the chronic form of the disease, as a rule, are the result of overeating heavy foods, alcohol abuse, physical overexertion, hypothermia, and intestinal infections. In chronic cholecystitis, symptoms similar to those of acute form diseases. However, their intensity is less pronounced, and the patient’s condition is not so severe.

Diagnosis of cholecystitis

Diagnosis of cholecystitis is carried out by a specialist, first of all, by interviewing the patient and getting to know his medical history. Analysis of the anamnesis and clinical course of the disease gives necessary information for further research. Next, the patient is prescribed special method research, which is used for cholecystitis - duodenal intubation . This method is used in the morning, because it is important to conduct such a study on an empty stomach.

It is also important to conduct a thorough bacteriological examination (for this, bile culture is performed). This is especially important if the patient has reduced acid-forming function of the stomach. In the process of diagnosing cholecystitis, it is necessary to determine physicochemical characteristics bile.

It is important to differentiate the chronic form of the disease from chronic cholangitis , cholelithiasis .

Treatment of cholecystitis

If a patient develops acute cholecystitis, then in most cases he is immediately hospitalized in a surgical hospital. Basically, treatment of cholecystitis begins with the use of conservative therapy. It is important that the patient remains in a state of complete rest at all times. Initially, the patient is prohibited from eating food: his nutrition is provided by intravenous administration of nutritional mixtures.

If there is severe inflammation with corresponding symptoms and surges in body temperature, then in complex treatment cholecystitis may also include taking broad-spectrum antibiotics. It is especially important to prescribe antibiotic therapy to elderly patients, as well as people who have diabetes.

At the stage of exacerbation, treatment of cholecystitis is primarily aimed at removing severe pain, reducing inflammation, as well as eliminating manifestations of general intoxication. During the application of conservative treatment, the patient's condition is carefully monitored. And if improvement occurs, the patient continues to be treated using conservative methods.

However, if there is no effect from similar treatment The attending physician often decides on surgical intervention. If there is a suspicion of phlegmon of the gallbladder , , perforation , peritonitis , then the operation is performed urgently.

If a person is diagnosed with calculous cholecystitis and, therefore, there is fire in the gallbladder, then treating the disease is a more difficult task. Accordingly, the prognosis of the disease worsens.

With the calculous form of cholecystitis, very painful hepatic colic . This phenomenon in some ways resembles the symptoms of acute cholecystitis, but the patient suffers from more intense pain. As a rule, such attacks begin at night or in the morning. A little later, the patient shows signs of jaundice: the shade of the skin, urine, and mucous membranes changes. In this case, a person’s stool becomes light-colored, sometimes White color. At similar symptoms hospitalization must be carried out immediately.

Treatment of chronic cholecystitis is primarily aimed at stimulating the process of bile discharge and eliminating spasmodic phenomena in the biliary tract and gallbladder. A set of measures is also being carried out that are designed to destroy the causative agent of inflammation. For calculous cholecystitis, stones are also crushed using different methods. Subsequent treatment measures are aimed at preventing the appearance of new stones.

The doctors

Medicines

Prevention of cholecystitis

As preventive measures that are used to prevent the manifestation of acute cholecystitis, it is important to adhere to all hygiene measures general. An important point in this case is to follow the norms of proper nutrition: you need to eat at the same time, at least four times a day, and the calorie content of the daily amount of food should not be exceeded. You should not take large amounts of food at night; such meals have a particularly negative effect if alcohol is consumed at the same time. An important preventative measure is to drink enough fluids every day. You need to drink at least one and a half to two liters of water or other drinks, and the drink should be distributed evenly throughout the day.

Another important point– ensuring regular bowel movements. This process must be controlled to prevent the occurrence of biliary dyskinesia, as well as excretion .

Experts recommend periodically holding fasting days, during which one type of food should be consumed (for example, milk, apples, cottage cheese, fruits, meat, etc.). Every person should know which foods cause an allergic reaction and exclude them from the diet.

To stimulate the passage of bile, it is important to do gymnastic exercises every day and maintain an active lifestyle in general.

In addition, it is important to take all measures in a timely manner to cure the manifested inflammation of the abdominal organs.

Diet, nutrition for cholecystitis

In addition, your diet should include products containing large amounts of magnesium salts. These are fruits, vegetables, buckwheat. They not only accelerate the secretion of bile, but also relieve pain and spasms.

The diet for cholecystitis should not contain foods that are irritating: broths from meat and fish, sauces, smoked, fatty foods, too sour and spicy dishes. Do not drink alcohol, very cold food or drinks. Fried foods excluded. It is important to adhere to a proper diet, eating food five times a day.

The diet for cholecystitis includes soups, lean meat and fish, crackers from wheat bread, omelet, boiled vegetables, cereals, dairy products. Fruit juices are also included in the diet, and it is recommended to consume jelly, gingerbread, jelly, jam, and honey as sweets.

Complications of cholecystitis

As complications of this disease, some ailments are defined that occur in parallel with cholecystitis, joining it. This chronic cholangitis , hepatitis . Often cholecystitis is the initial cause of gallstones .

In addition, the patient may develop secondary inflammation of the pancreas. In this case, the person also feels pain in the left hypochondrium. This inflammation is diagnosed by ultrasound.

In patients with calculous cholecystitis, due to blockage of the common bile duct, subhepatic jaundice followed by cholestasis . Also, complications of cholecystitis are often dropsy And gallbladder perforation . The latter disease is very dangerous and difficult to treat.

List of sources

• Bolotovsky G.V. Cholecystitis and other gallbladder diseases. St. Petersburg: Nevsky Prospekt, 2003;
• Kuchanskaya A.V. Cholelithiasis. Modern look for treatment and prevention: IG "Ves", 2007;
• Dadvani S.A., Vetshev P.S., Shuludko A.M., Prudkov M.I. Cholelithiasis. M.: Vidar-M, 2000;
• Gallbladder diseases. Cholecystitis, cholangitis; AST, Poligrafizdat, Sova - Moscow, 2010.