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Chronic cholecystitis

With acalculous cholecystitis, the inflammatory process is most often localized in the neck of the bladder.

What provokes / Causes of Chronic cholecystitis:

Prevalence. According to L.M. Tuchin et al. (2001), the prevalence of cholecystitis among the adult population of Moscow in 1993-1998. increased by 40.8%. During the same period of time, there was also an increase in the incidence of cholecystitis by 66.2%.

Pathogenesis (what happens?) during Chronic cholecystitis:

There are three components in the development of chronic acalculous cholecystitis (CAC): stagnation of bile, changes in its physicochemical composition and the presence of infection. An important place in the development of the disease is given to physical inactivity, nutritional factors, psycho-emotional overloads, allergic reactions. Currently, there is an increase in incidence among men. CBC occurs more often in people with normal body weight. Infectious pathogens penetrate the gallbladder by hematogenous, lymphogenous and contact (from the intestine) route. Infection from the gastrointestinal tract can enter the bladder through the common bile and cystic duct, and downward spread of infection from the intrahepatic bile ducts is also possible. At the same time, the microflora in gallbladder is found only in 35% of cases, which can be explained by the detoxification function of the liver and the bacteriostatic properties of bile. Consequently, for the development of microbial inflammation in the gallbladder, prerequisites are necessary in the form of changes in the composition of bile (stagnation due to obstruction, dyskinesia), dystrophy of the mucous membrane of the gallbladder, impaired liver function, and depression of immune mechanisms. Infection of the gallbladder is promoted by chronic duodenal stasis, duodenitis, insufficiency of the sphincters of Oddi, and the development of duodenobiliary reflux. When infection penetrates through the ascending route, E. coli and enterococci are more often found in the jellies.

Classification of chronic cholecystitis

Depending on the specific course of the disease, latent (sluggish), recurrent and purulent ulcerative forms of chronic cholecystitis are distinguished.

Based on the presence of stones, they are distinguished:

• chronic cholecystitis without cholelithiasis (calculous);
• chronic calculous cholecystitis.

There are stages:

• exacerbations;
• remission.

According to the flow, mild, moderate and severe flow are distinguished. Mild course characterized by 12 exacerbations during the year, the presence of biliary colic no more than 4 times a year. Chronic cholecystitis of moderate severity is characterized by 3-4 exacerbations during the year. Biliary colic develops up to 5-6 times or more during the year. A severe course is characterized by exacerbations of the disease up to 5 times or more per year.

Symptoms of Chronic cholecystitis:

Features of clinical manifestations. The clinical picture of chronic cholecystitis includes pain, dyspeptic, cholestatic, asthenovegetative and intoxication syndromes caused by the inflammatory process and dysfunction of the bladder. Exacerbation of chronic hepatitis is characterized by pain in the right hypochondrium. The pain can be prolonged or paroxysmal, has a wide irradiation, often oriented to the right half of the chest, back, and occurs after an error in diet, mental stress, change in body position, or physical overload. In some cases, pain syndrome occurs spontaneously, its development is accompanied by fever, symptoms of weakness, and cardialgia. Frequent but nonspecific complaints are dyspeptic disorders: severity in abdominal cavity, belching, nausea, bitterness in the mouth, flatulence, constipation.

Currently, there are several clinical variants of chronic cholecystitis:

• Cardiac variant, characterized by disturbances heart rate, electrocardiographic changes (T wave) with good tolerance to physical activity.
• Arthritic variant, manifested by arthralgia.
• Low-grade fever - prolonged low-grade fever (37-38 ° C) for about 2 weeks with periodic chills and symptoms of intoxication.
• The neurasthenic variant is manifested by symptoms of neurasthenia and vegetative-vascular dystonia in the form of weakness, malaise, irritability, and insomnia. Intoxication may occur.
• The hypothalamic (diencephalic) variant is accompanied by paroxysms of tremor, increased blood pressure, symptoms of angina pectoris, paroxysmal tachycardia, muscle weakness, hyperhidrosis.

During a physical examination, one can detect varying degrees of yellowness of the skin and mucous membranes, pain in the points of the bladder and liver area, muscle tension in the right hypochondrium, and in some cases, enlargement of the liver and gall bladder.

Diagnosis of Chronic cholecystitis:

Diagnostic features:

IN clinical analysis blood, leukocytosis with a neutrophilic shift to the left, and an increase in ESR are observed. In the presence of obstructive syndrome, a general urine analysis indicates positive reaction for bilirubin. In a biochemical blood test, an increase in the content of bilirubin, (X2 and globulins, sialic acids, C-reactive protein, fibrinogen, blood sugar, alkaline phosphatase activity, uglutamyl transpeptidase, aminotransferases is observed.

An important place in diagnosis is given to ultrasound and X-ray methods examination of the abdominal organs, esophagogastroduodenoscopy. The diagnosis of cholecystitis is considered proven if, during an ultrasound examination, a cholecystogram or cholecystoscintegram reveals deformation, thickening of the walls and a decrease in the contractile function of the bladder, and the presence of a peri-process.

When conducting fractional duodenal intubation There is a decrease in the amount of gallbladder bile, dysfunction of the sphincter of Oddi, changes in the biochemical composition of bile, the presence of inflammatory components in it (Reactive protein, sialic acids), and bacterial contamination.

Treatment of Chronic cholecystitis:

Treatment of chronic cholecystitis without cholelithiasis (CC). The treatment program includes:

• mode;
• diet therapy;
• drug therapy during exacerbation:
• pain relief;
• use of choleretic drugs;
• antibacterial therapy;
• normalization of autonomic functions nervous system;
• immunomodulatory therapy and increasing the overall reactivity of the body;
• physiotherapy, hydrotherapy;
• Spa treatment.

During a period of severe exacerbation of the disease, the patient must be hospitalized in a therapeutic hospital. In mild cases, treatment is usually carried out in outpatient setting. During the period of exacerbation, patients with chronic cholecystitis are recommended to rest in bed for 7-10 days.

Food should be mechanically and chemically gentle and not have a cholekinetic effect. During exacerbation of the disease, therapeutic nutrition should help reduce inflammation in the gallbladder, prevent stagnation of bile, and ensure the prevention of the formation of gallstones. In the phase of sharp exacerbation in the first 1-2 days, only drinking warm liquids (weak tea, juices from fruits and berries diluted with water, rosehip decoction) is prescribed in small portions up to 3-6 glasses per day. As the condition improves, pureed food is prescribed in limited quantities : slimy soups, porridges (semolina, oatmeal, rice), jelly, mousse, jelly. In the future, lean varieties of meat, fish, dairy products, sweet vegetables and fruits, butter and vegetable fats of 30 g per day are allowed. Food is taken 46 times a day in small portions.

After eliminating signs of exacerbation of chronic cholecystitis, diet No. 5 is prescribed.

Drug therapy includes the use of drugs to relieve pain, normalize the function of the autonomic nervous system and the rational use of choleretic agents described in previous section. As an antispasmodic, it is advisable to prescribe duspatalin 200 mg (1 drop) 2 times a day.

To eliminate infection of bile, broad-spectrum antibacterial drugs are used that participate in the enterohepatic circulation and accumulate in therapeutic concentrations in the gallbladder. The drugs of choice are biseptol at a dose of 960 mg 2 times a day or doxycycline hydrochloride at a dose of 200 mg per day. In addition, ciprofloxacin 250-500 mg 4 times a day, ampicillin 500 mg 4 times a day, erythromycin 200-400 mg 4 times a day, furazolidone 100 mg 4 times a day, metronidazole 250 mg 4 times a day can be used. once a day. Antibacterial therapy is prescribed for 10-14 days. When choosing an antibacterial drug, it is necessary to take into account not only the sensitivity of microorganisms to the antibiotic, but also the ability of the antimicrobial agents to penetrate the bile.

To correct secondary immunodeficiency, preparations of the large thymus gland are used. cattle(thymalin, Taktivin, thymogen, timoptin), which are administered intramuscularly daily for 10 days. Decaris can be recommended as an immunomodulator (levamisole 50 mg once a day for the first 3 days of each week for 3 weeks, sodium nucleinate 0.2-0.3 g 3-4 times a day for a period of 2 weeks to 3 months).

To increase the body's nonspecific resistance, adaptogens can be used: saparal, 1 tablet. (0.05 g) 3 times a day for 1 month, Eleutherococcus extract, tincture of ginseng, Chinese lemongrass, pantocrine 30-40 drops. 3 times a day for 12 months.

In the treatment of chronic cholecystitis, the use of enzyme preparations (digestal, festal, panzinorm, creon) for 3 weeks during meals, as well as antacid preparations (maalox, phosphalugel, remagel, protab), used 1.5-2 hours after meals, is indicated.

For physiotherapeutic treatment of chronic cholecystitis, 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.

Forecast. Depends on predisposing factors, timely treatment, and severity.

Which doctors should you contact if you have Chronic cholecystitis:

Gastroenterologist

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Other diseases from the group Gastrointestinal tract diseases:

Cholecystitis- This is an inflammation of the gallbladder. Like most inflammatory diseases, it can be acute or chronic.

It is also classified into non-calculous and calculous (that is, accompanied by the formation of stones).

Term "cholecystitis" translated from Greek means inflammation of the gallbladder.

The main purpose of the gallbladder is to deposit bile. The gallbladder is most often pear-shaped, located on the lower surface of the right lobe of the liver, projected onto the anterior abdominal wall under the right hypochondrium.

Inflammation of the gallbladder develops as a result of infection from the intestines, its transfer through the blood and stagnation of bile in the bladder. With this disease, less bile is secreted into the intestines than in a healthy person, which makes it difficult to digest and absorb fats.

Causes

Stagnation of bile due to cholelithiasis or kinks of the bile ducts.

Bacterial infections.

Pregnancy.

Physical inactivity, that is, a sedentary lifestyle.

Overeating, especially abuse of fatty, spicy and fried foods.

Excessive consumption of alcoholic beverages.

The most common cause of cholecystitis is the presence of gallstones, which block the flow of bile from the gallbladder. This leads to acute cholecystitis, which causes the gallbladder to become irritated and inflamed. Other causes of cholecystitis include previous infection or trauma, for example after a car accident. Acute cholecystitis also occurs in people with serious illnesses, such as diabetes. In this case, stones are not the cause of cholecystitis; rather, it is a complication of other diseases. Inflammation of the gallbladder largely depends on nutrition, on the lack of foods containing plant fibers in the diet - vegetables, fruits, wholemeal bread, when the diet contains an excess of animal fats, various sweets, a sedentary lifestyle, and lack of physical activity as well. promotes stagnation of bile and the development of the inflammatory process in them.

Exacerbation of cholecystitis occurs when bile stagnates in the bile ducts. Therefore, you need to increase physical activity, move more, but avoid sudden movements so as not to provoke an attack of hepatic colic.

The immediate impetus for an outbreak of the inflammatory process in the gallbladder is often overeating, especially eating very fatty and spicy food, drinking alcoholic beverages, acute inflammatory process in another organ (tonsillitis, pneumonia, adnexitis, etc.).

Chronic cholecystitis can occur after acute cholecystitis, but more often it develops independently and gradually, against the background of cholelithiasis, gastritis with secretory insufficiency, chronic pancreatitis and other diseases of the digestive system, obesity.

Chronic cholecystitis occurs when inflammation of the gallbladder occurs over a long period of time, causing the walls of the gallbladder to thicken.

This disease is common and is more common in women.

Pathogenic bacterial flora (Escherichia coli, streptococci, staphylococci, etc.), more in rare cases- anaerobic infection, worms and fungi, hepatitis viruses can cause cholecystitis.

The main factor in the occurrence of the disease is stagnation of bile in the gallbladder, which can be caused by gallstones, compression and kinks of the bile ducts, dyskinesia of the gallbladder and biliary tract, violation of their tone and motor function under the influence of various emotional stress, endocrine and nervous disorders.

Stagnation of bile in the gallbladder is also facilitated by prolapse of internal organs, pregnancy, sedentary lifestyle, rare meals, etc.

The direct impetus for an outbreak of the inflammatory process in the gallbladder is often overeating, eating very fatty and spicy foods, drinking alcoholic beverages, an acute inflammatory process in the body (sore throat, pneumonia, adnexitis, and so on).

Chronic cholecystitis can occur after acute cholecystitis, but more often it develops independently and gradually against the background of cholelithiasis, gastritis, chronic pancreatitis and other diseases digestive tract, as well as obesity.

Symptoms

Noncalculous cholecystitis, that is, cholecystitis without stones, is characterized by a dull pain in the right hypochondrium, which usually occurs some time after eating. As well as bloating, belching of air, unpleasant taste in the mouth, abnormal bowel movements and nausea.

In addition to all the above symptoms, calculous cholecystitis is characterized by colic, that is, attacks of acute pain.

Most often, the first signs of cholecystitis are pain in the right hypochondrium (upper right part of the abdomen), which can sometimes radiate to the back or right shoulder blade. The person may also feel nausea and vomiting and tenderness in the right side of the abdomen. There is also an increase in temperature, pain that intensifies with a deep breath, or lasts more than 6 hours, especially after eating.

Inflammation of the gallbladder is registered in almost 10% of the world's population, and women are 3-4 times more likely to suffer from cholecystitis. The possibility of developing cholecystitis is influenced by age and body weight: the older a person is and the more he weighs, the higher the risk of the occurrence and development of chronic cholecystitis.

Cholecystitis is characterized by dull, It's a dull pain in the area of ​​the right hypochondrium of a permanent nature or occurring 1-3 hours after eating a large and especially fatty and fried meal. The pain can radiate to the area of ​​the right shoulder and neck, right shoulder blade. However, sharp pain reminiscent of biliary colic may also occur periodically.

A feeling of bitterness and a metallic taste appears in the mouth, belching of air occurs, nausea, which is accompanied by flatulence and impaired bowel movements (often alternating constipation and diarrhea). The person becomes irritable and suffers from insomnia.

Jaundice is not typical for cholecystitis.

Diagnostics

The disease is diagnosed using ultrasound or computed tomography. To diagnose acalculous cholecystitis, duodenal intubation and bacteriological examination of bile can be used (this is what often helps to identify the causative agent of cholecystitis).

Upon examination, the doctor notes that the patient has an enlarged liver. In most cases, the gallbladder cannot be palpated, since it is usually wrinkled due to a chronic scar-sclerosing process.

Bacteriological examination of bile allows you to determine the causative agent of cholecystitis.

During cholecystography, a change in the shape of the gallbladder is noted, sometimes stones are found in it: the inflammatory process is the impetus for their formation.

Signs of chronic cholecystitis are also determined by echography - in the form of thickening of the walls of the bladder, its deformation.

Course of the disease

In most cases, it is long-term and is characterized by alternating periods of remission and exacerbations. Exacerbations often occur as a result of dietary disturbances, after drinking alcoholic beverages, severe physical work. The process can be triggered by an acute intestinal infection or general hypothermia of the body.

Treatment

Treatment for cholecystitis depends on the symptoms of the disease and the person's general health. In some cases, people who develop gallstones may not need treatment. With a mild form of cholecystitis, sometimes it is enough to have a gentle regime of the digestive system, a course of antibiotics and painkillers.

In other cases, especially with chronic cholecystitis, the gallbladder is removed surgically. Removing the gallbladder usually does not impair digestion.

In case of exacerbation of chronic cholecystitis, patients are hospitalized in a surgical or therapeutic hospital.

In this case, bed rest, dietary nutrition (diet No. 5a), antibiotics and sulfonamide drugs are prescribed.

To eliminate biliary dyskinesia, pain, and improve the outflow of bile, antispasmodic and choleretic agents are prescribed.

During the period of subsidence of the inflammatory process, thermal physiotherapeutic procedures are performed on the area of ​​the right hypochondrium.

Among medicinal herbs, decoctions of immortelle flowers (0.5 cups 2-3 times a day before meals), corn silk (1-3 tablespoons 3 times a day) or liquid extract these herbs (30-40 drops 3 times a day).

After returning home from the hospital, it is useful for the patient to drink choleretic tea (sold at the pharmacy): 1 tbsp. Brew a spoonful of tea with 2 cups of boiling water, take the strained infusion 0.5 cup 3 times a day 30 minutes before meals.

Treatment with mineral water (“Essentuki” No. 4 and No. 17, “Slavyanovskaya”, “Smirnovskaya”, “Mirgorodskaya”, “Naftusya”, etc.), as well as magnesium sulfate (1 tablespoon of 25% solution 2) is useful. times a day) or Carlsbad salt (1 teaspoon per glass of warm water 3 times a day).

If conservative treatment is not successful, which often happens when there are large stones in the gallbladder, as well as with frequent exacerbations of cholecystitis, surgical intervention is performed - usually cholecystectomy (surgery to remove the gallbladder).

Calculous cholecystitis

Cholecystitis is an inflammation of the gallbladder. If there are also stones in the bladder, then they speak of calculous, stone cholecystitis.

Causes

Inflammation is most often caused by bacterial infection and bile stagnation.

Infectious agents can enter the gallbladder in three ways: from the duodenum, through the blood and through the lymph.

Also, cholecystitis can occur with acute pancreatitis, when pancreatic enzymes enter the lumen of the gallbladder.

Matter hereditary predisposition, poor nutrition, allergies, metabolic disorders in the body and disruptions in the blood supply to the gallbladder.

Symptoms

With calculous cholecystitis, the patient experiences a feeling of heaviness in the right hypochondrium, as well as paroxysmal or constant dull pain. There is often a bitterness in the mouth and nausea.

Treatment

The necessary drug therapy is prescribed by the attending physician. The patient must strictly follow the instructions to avoid exacerbations of the disease.

Treatment also includes constant dieting.

For calculous cholecystitis, fruit, milk, and cereal soups, boiled meat, low-fat fish, milk, fresh curdled milk, kefir, acidophilus milk, cottage cheese (up to 200 g per day), porridge, white and black stale bread, ripe fruits, berries (except sour varieties), vegetables, herbs.

For sweets, you can consume jam, honey, sugar (up to 70 g per day), for drinks - vegetable, fruit juices, weak tea with milk.

But foods rich in fats must be limited: cream, butter - up to 10 g per day, vegetable oil - up to 20-30 g per day. You can eat one egg daily.

The exception here is chronic lesions of the gallbladder, which occur with stagnation of bile.

Table salt should be consumed no more than 10 g per day.

Meals should be five times a day.

It is necessary to completely exclude from the diet lard, fatty meats, fish, fried, spicy, smoked foods, canned food, spices, legumes, mushrooms, spinach, sorrel, onions, baked goods, vinegar, ice cream, cocoa, carbonated drinks, alcoholic drinks, chocolate, creams.

Self-help available

Among the folk remedies for cholecystitis, we can recommend the use of decoctions and infusions that have antimicrobial and astringent effects. They can be prepared from snakeweed, St. John's wort, nettle, tansy, chamomile, chicory, and rose hips. Spasms from the smooth muscles of the biliary tract are relieved (and thereby reduce pain) by immortelle, corn silk, and mint.

Of the medicinal preparations made from plants, allohol and holagol are indicated.

Large gallstones cannot be eliminated using herbal medicine.

Also, in case of chronic cholecystitis, it is advisable to carry out tubeless tubing 2-3 times a week for a month. It is best to perform this procedure in the morning.

To do this, you need to drink a glass of decoction of choleretic herbs on an empty stomach or, at worst, warm water. After half an hour, take allohol or holagol and wash it down with warm sweet tea (a glass or half a glass) or again herbal decoction. Then lie on your left side, and on your right side - on the liver area - put a warm heating pad. Cover yourself with a blanket and lie there for 1.5-2 hours.

After this, do a few deep breaths and squats and then you can have breakfast.

For cholecystitis, you can treat with mineral waters for 3-4 weeks several times a year.

At increased acidity gastric juice drink water 1.5 hours before meals, with normal acidity - half an hour. The norm is 0.5-0.75 glasses 2-3 times a day.

Physiotherapeutic procedures are indicated for chronic cholecystitis during remission. The most effective are diathermy and inductothermy (heating the organ with high-frequency currents), UHF (magnetic field treatment), ultrasound, mud, ozokerite or paraffin applications to the gallbladder area, radon and hydrogen sulfide baths.

To prevent exacerbations, it is necessary to follow a diet, a gentle work schedule, promptly sanitize foci of infection, and also carry out preventive treatment 2-3 times a year.

Prevention of cholecystitis consists of proper nutrition and regimen, combating a sedentary lifestyle, obesity, and diseases of the abdominal organs.

Acute cholecystitis: features of clinical manifestations

The disease begins rapidly. The leading symptom is biliary colic. The pain syndrome is caused by stretching of the gallbladder, a significant increase in pressure in it, disruption of the flow of bile through the cystic duct, inflammatory edema gallbladder, adjacent peritoneum.

Pain occurs in the right hypochondrium and radiates to right shoulder, right shoulder blade, right half of the chest, sometimes in the left half of the chest, lumbar or iliac region.

Over the course of several hours, the pain intensifies, but rarely reaches pronounced intensity. Often the patient takes a forced position on the right side or on the back.

Patients' body temperature rises and chills appear. High fever and chills are more typical for purulent or phlegmonous cholecystitis. The patient is often bothered by thirst, nausea, vomiting, constipation, and flatulence. The tongue is dry and coated. The stomach is swollen and the abdominal muscles are tense. Percussion and light tapping in the liver area cause severe pain.

It is not always possible to palpate an enlarged, tense, sharply painful gallbladder. In older people, there is often a discrepancy between the clinical manifestations of acute cholecystitis and the severity of inflammatory changes in the gallbladder. Moreover, the development of gangrenous changes in the wall of the gallbladder can be clinically manifested by the so-called period of imaginary well-being - a decrease in pain due to necrosis of the receptors of the sensitive apparatus.

The catarrhal form of acute cholecystitis with timely antibiotic therapy ends in recovery.

With the phlegmonous form of acute cholecystitis, the process is more difficult. Characterized by fever with severe chills. Symptoms of intoxication quickly increase: dry mouth, thirst, nausea. Pain in the abdominal cavity reaches great intensity. The abdomen becomes bloated and symptoms of peritoneal irritation appear.

With a favorable course, the febrile state, having reached its greatest severity by the 2-4th day of the disease, persists for several days, then recovery may occur. In some cases, the disease becomes chronic.

Dangerous complications of acute cholecystitis include pancreatic necrosis, pancreatitis, gallbladder perforation, and biliary peritonitis.

The main symptoms of gallbladder perforation are sudden strong pain in the right hypochondrium, hiccups, bloating, cessation of gas discharge, disruption of the bowel movement, hypotension.

At acute cholecystitis adhesions may appear between the bladder and other organs - pericholecystitis with deformation of the bladder.

Cholecystitis: maintenance therapy during remission

After inpatient treatment and after the acute period subsides, patients with cholecystitis are prescribed maintenance therapy.

Nutrition should contribute to stable remission of the disease and prevent the thickening of bile. It is necessary to have scales and strictly monitor the stability of body weight. Nutrition should not be excessive. Food should be taken in small portions, at least 4 times a day. It is advisable to enrich the diet with vegetables and vegetable oil. Refractory fats, cold fizzy drinks, spicy seasonings, fried foods are prohibited; large meals at night are especially undesirable.

If the feeling of heaviness in the right hypochondrium increases or heartburn occurs, a course of treatment with choleretic agents is administered 2-3 times a year for a month.

Patients with prolonged pain and dyspeptic syndromes should undergo blind duodenal intubation, that is, tubage, once every 7-10 days. For this purpose, the patient on an empty stomach drinks 1-2 glasses of a hot solution of Carlsbad salt (2 sachets) or xylitol (15 g) dissolved in water in small sips. After this, for 40-60 minutes you need to lie comfortably on your right side, placing a warm heating pad on the liver area. These same patients sometimes almost constantly have to take choleretic drugs - 5-6 drops of Cholagol after breakfast.

Drug therapy

basis drug treatment chronic cholecystitis is anti-inflammatory therapy.

Antibiotics are widely used to suppress infection in the biliary tract. The choice of antibacterial drug depends on individual tolerance and the sensitivity of the bile microflora to the antibiotic.

Correction of antibacterial therapy is carried out after receiving the results, analyzing the culture of bile for microflora and determining its sensitivity to the antibiotic.

The most effective are:

• Antimicrobial drugs of the fluoroquinolone group: norfloxacin (nolicin, norbactin, girablok) - 0.4 g 2 times a day; ofloxacin (tarivid, zanocin) - 0.2 g 2 times a day; ciprofloxacin (tsiprobay, ciprolet, tsifran) - 0.5 g 2 times a day; levofloxacin (tavanic, lefoccin) - 0.5 g 2 times a day; macrolides: erythromycin - 0.25 g 4 times a day; azithromycin (sumamed, azitrox, azitral) - 0.5 g 1 time per day; clarithromycin (klatsid, clubaks, klerimed) - 0.5 g 2 times a day; roxithromycin (rulid, roxide, roxolid) - 0.1 g 2 times a day; midecamycin (macropen) - 0.4 g 2 times a day;
• Semi-synthetic tetracyclines: doxacycline (vibramycin, unidox solutab, medomycin) - 0.1 g 2 times a day; metacycline - 0.15 g 4 times a day.

You can use semi-synthetic penicillins: ampicillin - 0.5 g 4 times a day; oxacillin - 0.5 g 4 times a day; ampiox - 0.5 g 4 times a day, although they are less active.

In severe cases, the doctor prescribes cephalosporins (ketocef, cefobid, claforan, cefepime, rocephin).

It is preferable to take the antibiotic orally (through the mouth) at the usual therapeutic dose. The course of treatment is 7-8 days. It is possible to repeat the course with other antibiotics after 3-4 days.

If the bile microflora is not sensitive to antibiotics or is allergic to them, cotrimaxozole (Biseptol, Bactrim) is recommended - 2 tablets each

2 times a day, although its effectiveness is significantly lower than that of antibiotics, and the adverse effect on the liver is higher. A good effect is achieved by using nitrofuran drugs - furazolidone, furadonin, and metronidozole - 0.5 g 3 times a day for 7-10 days.

In case of severe pain syndrome, in order to reduce spasm of the Odzi sphincter, in case of hypermotor type gallbladder dysfunction, antispasmodics are indicated.

There are several groups of antispasmodics, differing in their mechanism of action.

Metacin, gastrocepin, buscopan, and platifillin are used as antispasmodics. However, when taking this group of drugs, a number of side effects(dry mouth, urinary retention, visual disturbances, tachycardia, constipation). The combination of the rather low effectiveness of this group of drugs with a wide range of side effects limits the use of this group of drugs.

Direct-acting antispasmodics, such as papaverine, drotaverine (no-spa), are effective in relieving spasms. However, they are not characterized by selectivity of action and they affect all tissues where smooth muscles are present.

Mebeverine hydrochloride (duspatalin) has a much more pronounced antispastic activity, which also has a direct effect, but it has a number of advantages over other antispasmodics. It relaxes the smooth muscles of the digestive tract, does not affect the smooth muscle wall of blood vessels and does not have the systemic effects characteristic of anticholinergics. The drug has a prolonged effect and should be taken no more than 2 times a day in the form of 200 mg capsules.

Pinaveria bromide (dicetel) also belongs to antispasmodics. The main mechanism of its action is the blockade of calcium channels located in the smooth muscle cells of the intestine, bile ducts and peripheral nerve endings. Dicetel is prescribed 100 mg 3 times a day for pain.

A drug that has a selective antispasmodic effect on the sphincter of Oddi is hymecromone (odeston). This drug combines antispasmodic and choleretic properties, ensuring harmonious emptying of intra- and extrahepatic bile ducts. Odeston does not have a direct choleretic effect, but it facilitates the flow of bile into the digestive tract, thereby increasing the circulation of bile acids. The advantage of odeston is that it has virtually no effect on other smooth muscles, in particular circulatory system and intestinal muscles. Odeston is used 200-400 mg 3 times a day 30 minutes before meals. All antispasmodics are prescribed for a course of 2-3 weeks.

In the future, they can be used if necessary or in repeated courses. For acute pain syndrome, drugs can be used once or in short courses.

In case of gallbladder dysfunction caused by hypomotor dyskinesia, prokinetics are used to increase contractile function for 10-14 days: domperidone (Motilium, Motonium, Motilac) or metoclopramide (Cerucal)

- 10 mg 3 times a day 20 minutes before meals.

The prescription of choleretic drugs requires a differentiated approach depending on the presence of inflammation and the type of dysfunction. They are indicated only after the inflammatory process has subsided. All choleretic drugs are divided into two large groups: agents that stimulate bile formation and agents that stimulate bile secretion.

The first includes drugs that increase the secretion of bile and stimulate the formation of bile acids (true choleretics), which are divided into:

• on drugs containing bile acids - decholin, allochol, cholenzyme;
• drugs plant origin- hofitol, tanacechol, holagol, livamine (Liv 52), hepabene, hepatofalk, silymar;
• drugs that increase bile secretion due to the water component (hydrocholeretics) - mineral waters.

The second group of drugs that stimulate bile secretion include:

• cholekinetics - drugs that cause an increase in the tone of the sphincters of the biliary tract and gallbladder - magnesium sulfate, Carlsbad salt, sorbitol, xylitol, holagogum, olimethin, rovahol;
• preparations containing oil solutions - pumpkinol;
• drugs that cause relaxation of the biliary tract (cholespasmolytics)

- platifillin, no-spa, duspatalin, odeston, dicetel.

The doctor prescribes drugs from these groups to patients differentially, depending on the type of dyskinesia accompanying chronic cholecystitis.

During the period of exacerbation of chronic acalculous cholecystitis, physiotherapeutic procedures are indicated: electrophoresis with antispasmodics for hypermotor type dysfunctions and with magnesium sulfate for hypomotor dysfunction. Diathermy, inductothermia, paraffin, ozokerite, and UHF therapy are prescribed for the gallbladder area. During the period of the onset of remission, physical therapy is used to promote emptying of the gallbladder.

Acalculous cholecystitis

Acute acalculous cholecystitis occurs due to the penetration of infection into the gallbladder with reduced evacuation capacity (stagnation of bile contributes to the development of infection).

The reflux of pancreatic juice into the bile ducts and gallbladder, which damages the mucous membrane of the gallbladder, also plays an important role in the development of inflammation. Very often, acute acalculous cholecystitis is combined with inflammatory changes in the pancreas (cholecystopan-creatitis).

The symptoms of acalculous chronic cholecystitis are similar to those of chronic cholecystitis, only pain in the right hypochondrium is not so intense, although longer lasting.

In case of long-term persistent course of the disease, in case of ineffectiveness conservative treatment cholecystectomy (removal of the gallbladder) is prescribed.

Can acalculous cholecystitis lead to cholelithiasis?

Chronic cholecystitis often develops against the background of existing cholelithiasis as a result of constant injury to the mucous membrane of the gallbladder by hard stones.

However, the widespread belief that chronic cholecystitis must necessarily be combined with cholelithiasis is incorrect. There is no such direct dependence. It can appear for many other reasons.

If, in the presence of inflammation, stones are also found in the gallbladder, they speak of calculous cholecystitis. If there is inflammation, but there are no stones - about stoneless.

However, acalculous cholecystitis often precedes stone formation. Therefore, even in the absence of symptoms, it is still necessary to treat acalculous cholecystitis in order to avoid further unpleasant consequences and exacerbations of the disease.

Pain and discomfort during exacerbations of chronic cholecystitis are caused by spasms of the gallbladder and biliary dyskinesia, so doctors, in addition to anti-inflammatory treatment, use antispasmodics to relieve discomfort.

Antispasmodics such as atropine, metacin, belladonna preparations, and antispasmodics are widely used. But you need to know that this group medicines contraindicated in patients with glaucoma, prostate adenoma, pregnancy, which limits their use in a significant proportion of patients.

Another group of antispasmodics, such as drotaverine, papaverine, bencyclane, acts on smooth muscles, providing an antispastic, and therefore analgesic, effect. However, these drugs affect all of the body's smooth muscles, including those that make up the walls of blood vessels and the urinary tract, which can cause heart palpitations, urinary incontinence, and some other undesirable effects.

In this regard, most doctors prescribe antispasmodic drugs strictly individually, giving preference to those that do not have systemic action and strictly selectively affect the cells of the gastrointestinal tract.

To improve the outflow of bile, as a rule, choleretic agents are prescribed - allohol, cholenzyme, a decoction of corn silk and flowers of the main choleretic herb - immortelle.

Diagnosis of acute acalculous cholecystitis

Diagnosis of acute cholecystitis is complex. Purpose diagnostic measures is not only establishing the fact of cholecystolithiasis and

signs of inflammation of the gallbladder wall, but also the ability to choose an adequate treatment method.

The patient's severe general condition, high body temperature, severe chills, tachycardia, severe pain in the right hypochondrium, and increased ESR make it possible to suspect acute cholecystitis.

In patients over 60 years of age, the diagnosis of acute cholecystitis is often difficult due to its atypical course. General and local reactions can be mild, purulent and destructive forms are often observed, and diffuse peritonitis.

For an accurate diagnosis, ultrasound, biochemical blood tests and several specific examinations are performed.

Ultrasound examination may show signs of acute cholecystitis - thickening of the walls of the bladder (more than 4 mm), a “double contour” of the wall, an increase in size, a stone at the mouth of the cystic duct.

The role of ultrasound in predicting the nature of the proposed operation is extremely important. Reliable signs of the technical complexity of the planned cholecystectomy are: the absence of a free lumen in the gallbladder;

thickened or thinned bladder wall; large stationary stones; accumulation of fluid.

Diagnostics also uses dynamic ultrasound, which is a regularly performed ultrasound examination. It helps to assess whether the clinical picture of the disease is changing or remaining stable. Dynamic ultrasound allows you to timely analyze the course of the inflammatory process and carry out the necessary surgical intervention in advance.

Laparoscopy is indicated for patients with an unclear clinical diagnosis. In acute cholecystitis, laparoscopy has a high resolution and also provides significant assistance in the differential diagnosis of other inflammatory diseases of the abdominal organs and tumor lesions.

The purpose of the study is to isolate acute cholecystitis in a number of other pathological conditions: to distinguish it from acute appendicitis, acute pancreatitis, painful manifestations of urolithiasis, pyelonephritis, liver abscess, perforated gastric and duodenal ulcers.

Treatment of acute acalculous cholecystitis

Patients with acute cholecystitis are subject to hospitalization in a surgical hospital.

Absolute indication surgical treatment is suspected of perforation, gangrene, phlegmon of the bladder.

In the absence of complications, doctors often practice wait-and-see tactics under the guise of massive daily doses of broad-spectrum antibiotics, which are effective against intestinal microflora typical of biliary tract infections.

For antibacterial therapy, drugs that can penetrate well into bile are used.

Active treatment tactics are used for all destructive forms of acute cholecystitis, which occurs with signs of purulent intoxication or peritonitis. Waiting treatment tactics are preferable for this form of acute cholecystitis, when, as a result of conservative therapy, it is possible to stop the inflammatory process.

The question of choosing treatment tactics for a patient with acute cholecystitis in the clinic is decided in the first hours of hospital stay, from the moment the clinical diagnosis is made and confirmed by ultrasound or laparoscopic methods.

If the choice falls on surgical intervention, then the operation is performed in different terms from the moment of hospitalization.

The preoperative period of hospital stay is used for intensive therapy, the duration of which depends on the category of severity and physical condition of the patient. In mild cases, surgical treatment is carried out in the first 6-12 hours from the moment of admission to the hospital (after preoperative preparation). If the patient’s physical condition requires more intensive and lengthy preoperative preparation - within a period of 12 to 48 hours.

In any case, it is advisable to follow a gentle diet (table No. 5).

How and how is chronic acalculous cholecystitis treated?

Treatment of chronic acalculous cholecystitis is usually carried out on an outpatient basis, in case of exacerbation and protracted course - in the therapeutic department of the hospital, in the remission phase - at a resort or in a dispensary.

Therapeutic measures are aimed at suppressing infection, reducing the inflammatory process, increasing the body's defenses, and eliminating metabolic and dyskinetic disorders.

In the acute stage, a special diet is prescribed - table No. 5.

To eliminate pain, no-spa, halidor, papaverine, and metoclopramide are used. For severe pain, use baralgin. As a rule, pain is relieved in the first 1-2 weeks from the start of treatment; usually, therapy with these drugs does not exceed 3-4 weeks.

Pain in chronic acalculous cholecystitis depends not only on pronounced dyskinetic disorders, but also on the intensity of the inflammatory process in the biliary tract.

It turns out to be very effective early application antibacterial therapy. It is advisable to prescribe broad-spectrum antibiotics that do not undergo significant biotransformation in the liver. Prescribe erythromycin (0.25 g 6 times a day), doxycycline hydrochloride (0.05-0.1 g 2 times a day); metacycline hydrochloride (0.3 g 2-3 times a day). It is possible to use furazolidone (0.05 g 4 times a day).

Treatment with antibiotics is carried out for 8-10 days. After a 2-4 day break, it is advisable to repeat treatment with these drugs for another 7-8 days.

In the phase of subsiding exacerbation, it is recommended to place a heating pad on the area of ​​the right hypochondrium, make hot poultices from oats or flaxseed, applications of paraffin and ozokerite will be useful.

The use of choleretic drugs during an exacerbation of severe inflammatory processes in the gallbladder and bile ducts is contraindicated.

In case of a pronounced allergic component, antihistamines are used - diphenhydramine, diazolin, suprastin, tavegil, telfast, etc.

Choleretic drugs - choleretics (drugs that stimulate the formation of bile) are recommended for use in the remission phase in combination with enzyme preparations. If there is hypotension of the gallbladder, tocholeretics are prescribed with cholekinetics - drugs that enhance muscle contraction of the gallbladder and thereby promote the release of bile into the intestine.

The following choleretics are mainly prescribed: allochol, cholenzyme, decholin; a number of synthetic substances - oxafenamide, nicodine; herbal preparations - fiamine, holagon, corn silk.

Cholekinetic agents are magnesium sulfate (magnesium sulfate), Carlsbad salt, xylitol, sorbitol, mannitol, holosas.

Allochol is prescribed 1-2 tablets 3 times a day after meals, nicodin - 0.5-1 g 3-4 times a day before meals. The course of treatment with choleretic drugs is 10-30 days, depending on the effect.

Treatment tactics outside of exacerbation are determined by the nature of dyskinetic disorders. For the hypotonic type of dyskinesia, allochol is used in combination with festal, cholekinetics, and for the hypertensive type, antispasmodics (no-spa, halidor, papaverine) are used.

For dyskinesias of the gallbladder, olimetin (Rovahol) is effective - 3-5 drops per piece of sugar 30 minutes before meals 3-4 times a day. You can take Cerucal - 10 mg 3-4 times a day.

Therapeutic duodenal intubation is indicated only in the absence of gallstones.

When the inflammatory process is sluggish, agents are used that increase the body’s immunological resistance (vitamins, aloe injections, prodigiosan, etc.).

Surgery shown:

- with a persistent course of the disease with preserved gallbladder function, but existing adhesions, deformation, pericholecystitis; - with a disabled or severely deformed gallbladder, even in the absence of sharp pain; - in the case of difficult-to-treat pancreatitis and cholangitis.

In the remission phase, treatment also involves following a diet, taking choleretic medications, and exercising.

Physical therapy plays an important role in chronic cholecystitis with insufficient emptying of the gallbladder. Morning exercises and measured walking are of greatest importance. The complex of therapeutic exercises includes exercises for the trunk muscles in a standing, sitting and lying position on the back and right side with a gradual increase in the range of movements and load on the abdominal press.

Balneological resorts with mineral waters for drinking treatment are shown: “Arzni”, “Berezovsky Mineral Waters”, “Borjomi”, “Java”, “Jermuk”, “Druskininkai”, “Essentuki”, “Izhevsk Mineral Waters”, “Pyatigorsk”, "Truskavets". Contraindications to spa treatment are acute cholecystitis or a non-functioning gallbladder, chronic cholecystitis with frequent exacerbations.

Enzymatic cholecystitis

Changes in the chemical composition of bile (discrimination) in the form of an increase in the concentration of bile salts can cause aseptic inflammation of the gallbladder.

The occurrence of cholecystitis has been proven to be the damaging effect of pancreatic juice and the negative impact of pancreatic reflux into the bile ducts of the gallbladder and the excretory ducts of the liver.

With free outflow of pancreatic juice into the duodenum, no changes in the gallbladder are detected. But when the outflow is disrupted and hypertension increases in the biliary system, when the gallbladder is stretched, a change in the normal capillary blood flow in the wall of the bladder occurs. This causes disruption of tissue metabolism, which leads to the development of enzymatic cholecystitis.

During the inflammatory process in the gallbladder, a shift in normal acidity to the acidic side occurs (bile acidosis), which contributes to the loss of cholesterol in the form of crystals and a change in the ratio of bile acids towards cholesterol (cholate-cholesterol ratio). Therefore, in the diet of patients with cholecystitis of enzymatic origin, foods that contribute to tissue acidification should be sharply limited or excluded. These are primarily flour and spicy dishes, meat, fish, brains, etc.

Features of nutrition of patients with cholecystitis

Fats stimulate bile secretion, and the majority of patients with cholecystitis do not need to limit them. However, animal fats are high in cholesterol and should be consumed in moderation.

If there is insufficient flow of bile into the intestines, fats are poorly broken down, which leads to irritation of the intestinal mucosa and the appearance of diarrhea.

It has been proven that diets with an increased amount of fat due to vegetable oil have a positive effect on the lipid complex of bile, bile formation and bile excretion.

It should also be remembered that vegetable oils (corn, sunflower, olive) due to the content of unsaturated fatty acids- arachidonic, linoleic, linolenic - improve cholesterol metabolism, participate in the synthesis of certain substances (arachidonic acid), and affect the motility of the gallbladder.

Fats increase the metabolism of fat-soluble vitamins, especially vitamin A.

Carbohydrates, especially easily digestible ones (sugar, honey, jam), which were previously not limited in order to replenish glucose reserves in the liver, are now recommended to be reduced in the diet, especially if you are overweight.

Special studies It has been shown that glycogen stores are reduced only with massive liver necrosis, and the inclusion of large amounts of easily digestible carbohydrates can enhance lipogenesis and thereby increase the likelihood of gallstone formation. Therefore, the consumption of flour and sweet foods should be limited.

The diet should be rich in plant fiber, which eliminates constipation, and this reflexively improves the emptying of the gallbladder. The diet should include carrots, pumpkin, watermelons, melons, grapes, wheat and rye bran.

For oxalaturia and phosphaturia, you should limit tomatoes, sorrel, spinach, and radishes.

In case of exacerbation of chronic cholecystitis in the first week, the calorie content of food is 2000 calories per day, later, when the inflammatory process subsides, the calorie content can be increased to 2500 calories.

It should be borne in mind that food poor in proteins leads to the development of fatty liver, disruption of the synthesis of many enzymes and hormones. Long-term restriction of protein intake in the menu of patients with chronic cholecystitis is not justified.

A complete vitamin composition of food is a necessary condition for diet therapy of chronic cholecystitis.

You should include in your diet foods that contain lipotropic factors: oatmeal and buckwheat, cottage cheese, cheese, cod, soy products.

Reflux into the biliary tract can lead to cholecystitis

Long-term use of anticholinergics and antispasmodics leads to dysfunction of the biliary tract, the development of hypotension (relaxation) and atony (loss of efficiency) of the sphincter of Oddi, which contributes to the reflux of duodenal contents into the biliary tract, with the formation of “pharmacological” cholestasis.

The sphincter of Oddi is a muscle knot that compresses the junction of the gallbladder and the duodenum. When this pressure weakens, the “gate” constantly remains open and the infected intestinal contents enter the bile ducts and gallbladder. This is how inflammation occurs.

In case of peptic ulcer with localization of the process in the duodenal bulb, changes in the biliary tract are also often observed.

Prolonged pain indicates cholecystitis

Biliary colic occurs suddenly and quickly reaches a peak - within a few minutes. This is a constant pain, it does not go away, but it can vary in intensity. It lasts from 15 minutes to 4-5 hours.

If the pain lasts more than 4-5 hours, then this usually indicates a complication - inflammation of the gallbladder (cholecystitis). The pain is usually quite severe, but movement does not worsen the pain.

Are surgeries performed to remove the gallbladder for acalculous cholecystitis?

Hardly ever. Conservative anti-inflammatory treatment is usually prescribed. The exception is patients with persistent pain and a sharply enlarged gallbladder, as well as severe manifestations of pericholecystitis.

Nutrition

Diet and nutritional therapy should be aimed at releasing bile from the gallbladder and eliminating inflammation. You should only consume easily digestible fats: butter and vegetable oils (olive, sunflower, corn), which stimulate the secretion of bile. The diet includes foods that contain a lot of magnesium salts. They promote the secretion of bile, reduce pain, and relieve spasm of the gallbladder. There are a lot of magnesium salts in buckwheat, vegetables and fruits.

The best diet for gallbladder diseases is frequent and small meals. This is due to the fact that when we eat, a reflex contraction of the gallbladder occurs, and the bile dilutes. There is an outflow of bile. A snack is a sandwich and an apple.

Basic dietary principle in acute cholecystitis (as well as in exacerbation of chronic cholecystitis) - maximum sparing of the digestive tract. In the first two days, the patient should drink exclusively liquid, and in small portions. During this period, you can take it diluted in half with regular boiled water still mineral water, sweet fruit and berry juices - also half and half with water, weak tea, rosehip decoction.

As pain and inflammation decrease, which usually happens after 1-2 days, you can switch to pureed food. Prescribed mucous and pureed soups made from oats, rice, semolina; porridge made from rice, oats, semolina; sweet fruit and berry jelly, mousses, jellies. The amount of food is limited so as not to put stress on the digestive organs.

Further expansion of the diet occurs due to the inclusion in the diet of pureed low-fat cottage cheese, lean pureed meat, steamed, and low-fat boiled fish. During this period, you can also include white bread crackers in your diet. You should eat in small portions 5 times a day, preferably at certain hours. You need to drink plenty of fluids (2-2.5 liters of liquid).

After 5-10 days from the onset of acute cholecystitis (or exacerbation of chronic cholecystitis), the patient switches to diet No. 5a.

This is a physiologically complete diet, with a moderate limitation of fats and table salt, mechanical and chemical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract, with the exception of foods and dishes that enhance the processes of fermentation and putrefaction in the intestines, as well as strong stimulants of bile secretion, gastric secretion, pancreas glands, substances that irritate the liver (extractives, organic acids, foods rich in essential oils, organic acids, cholesterol, purines, fried foods containing products of incomplete breakdown of fat). All dishes are prepared boiled or steamed. Individual baked dishes without a rough crust are allowed. Food is given mostly pureed, pureed soups or with finely chopped vegetables and well-cooked cereals. Diet: 5-6 times a day in small portions.

Food temperature 15-60 °C. Diet 5 times a day.

It is not recommended to take: very fresh bread; puff pastry and pastry, fried pies, cakes, cream pies; meat, fish, mushroom broths; okroshka, green cabbage soup; fatty meats (lamb, pork); poultry (duck, goose); liver, kidneys, brains; smoked meats, canned food, most sausages, fried meat; fatty fish (chum salmon, sturgeon, stellate sturgeon); salted, smoked fish, caviar, canned fish. Limit cream, 6% fat milk, fermented baked milk, sour cream, full-fat cottage cheese, fatty and salty cheese. Exclude beef, lamb lard and fats, cooking oil, margarine; fried and hard-boiled eggs; sorrel, radish, radish, green onion, garlic, mushrooms, pickled vegetables, black pepper, horseradish, mustard; ice cream, chocolate, cream products; black coffee, cocoa, cold drinks. Alcohol is completely excluded.

Bread and flour products: wheat bread from first and second grade flour, rye bread from sifted and peeled flour (yesterday's baking); baked savory products with boiled meat and fish, cottage cheese, apples; dry biscuits, dry biscuits, crackers; puddings and cereal casseroles (buckwheat, oatmeal) - steamed and baked; boiled vermicelli, dumplings, finely chopped pasta, cheesecakes; boiled pasta.

Soups: vegetables, cereals with vegetable broth, dairy with pasta, fruit; Vegetarian borscht and cabbage soup, beetroot soup. Flour and vegetables for dressing are not fried, but dried.

Meat and meat products: lean or low-fat meats - without tendons (beef, young lean lamb, pork, rabbit, veal), lean poultry - without skin (chicken, turkey) boiled, baked after boiling, in pieces or chopped, cabbage rolls, pilaf with boiled meat; milk sausages; low-fat sausage, ham.

It is impossible to completely exclude meat from the diet - it contains animal protein that is beneficial for the body, which includes essential amino acids necessary for the liver to synthesize enzymes, hormones, blood elements and to maintain immunity.

Fish: low-fat varieties (pike perch, cod, bream, perch, navaga, silver hake) in chopped form; boiled or steamed (quenelles, meatballs, soufflé).

Milk and dairy products: milk - in its natural form or in dishes (porridge, casseroles, etc.), fermented milk drinks (kefir, acidophilus, yogurt), fresh non-acidic cottage cheese - in its natural form or in casseroles, krupeniki, cheesecakes, lazy dumplings, soufflé, pudding, noodles with cottage cheese. Sour cream is used as a seasoning for dishes.

Cheeses: mild, low-fat cheeses.

Eggs: no more than one egg per day, steamed and baked egg white omelettes; if well tolerated, up to two eggs per day are allowed (soft-boiled; steamed or baked omelettes (prohibited in case of cholelithiasis).

Cereals: any dishes from various cereals, especially buckwheat and oatmeal; pilaf with dried fruits, carrots, puddings with carrots and cottage cheese; Krupeniki. Buckwheat and oatmeal are very useful, since the carbohydrates they contain are converted into fats to a lesser extent; They are rich in fiber and vitamins.

Fats: butter - in its natural form and in dishes, vegetable oils (olive, corn, sunflower).

Vegetables: various vegetables in raw, boiled and baked forms; salads from raw and cooked vegetables and fruits; side dishes, non-sour sauerkraut; onions after boiling, green pea puree.

Snacks: fresh vegetable salad with vegetable oil, fruit salads, vinaigrettes, squash caviar; jellied fish after boiling; soaked lean herring, stuffed fish, seafood salads (squid, seaweed, scallops, mussels), boiled fish and boiled meat, sausages - doctor's, dairy, diet; lean ham.

Spices: parsley and dill; a small amount of red ground sweet pepper, bay leaf, cinnamon, cloves, vanillin; white sauce with a little sour cream added without toasting the flour; dairy, vegetable, sweet fruit sauces. The flour is not sautéed.

Fruits: various fruits and berries (except sour ones) raw and in dishes; lemon, black currant - if well tolerated; jams, preserves from ripe and sweet berries and fruits; dried fruits, compotes, jelly, jellies, mousses.

Sweet dishes and sweets: marmalade, non-chocolate candies, marshmallows, jam, jam from sweet ripe fruits, honey. However, you should not get carried away with sweet dishes. It is recommended no more than 50-70 g of sugar per day (including sugar contained in sweets, fruits, and confectionery). For older people, this norm is 30-50 g. You can replace some of the sugar with xylitol and sorbitol. People who are prone to obesity should avoid sugar completely.

Beverages: tea, coffee with milk, fruit, berries and vegetable juices. It is recommended to constantly use vitamin decoctions and infusions of rose hips and wheat bran. Infusions and decoctions from special collections of medicinal herbs are recommended to be taken 1/2 cup 2-3 times a day 20-30 minutes before meals, the course is 2-3 months (the break between them is 2-3 weeks).

For normal functioning digestive organs need natural dietary fiber, which is found in large quantities in wheat bran, and to a lesser extent in rolled oats, nuts, vegetables, and fruits.

The use of wheat bran is a means of preventing and treating constipation, gallbladder diseases, obesity, and diabetes. In addition, wheat bran is rich in B vitamins and has the ability to neutralize and adsorb toxic substances formed during the digestion process.

Wheat bran can be consumed in its natural form (2-3 tablespoons) or cooked from it.

Preparation of wheat bran: steam 2-3 tablespoons of bran with boiling water and leave for 30 minutes. Divide into four servings and eat throughout the day, adding to soups, borscht, porridge or simply drinking milk. A decoction of bran is very useful, which can be prepared as follows: grind the bran in a coffee grinder, pour boiling water, boil for 10 minutes and leave for several hours (up to a day). Strain the broth, add sugar or xylitol, sorbitol, lemon juice. You can use honey instead of sugar.

Also recommended for this disease are a vitamin drink made from rose hips, an infusion of rose hips, tea from rose hips and black currant berries, tea from rose hips with raisins, tea from rose hips and rowan berries, and a yeast drink.

Sample diet menu No. 5A

1st breakfast: steamed curd soufflé, pureed rice porridge with milk, tea.

2nd breakfast: baked apple with sugar.

Lunch: pearl barley soup with pureed vegetarian vegetables, steamed meat cutlets with carrot puree, jelly.

Afternoon snack: rosehip decoction.

Dinner: steamed fish dumplings with mashed potatoes, semolina casserole with sweet gravy, tea.

At night: kefir.

Sample menu(second option)

On an empty stomach: rosehip decoction - 1 glass.

1st breakfast: vegetable salad- 150 g, buckwheat porridge with butter, milk sausages - 60 g, tea.

2nd breakfast: fresh cheese - 100 g, with milk - 50 g and sugar - 10 g.

Lunch: milk soup with semolina dumplings, steamed meat cutlets, boiled noodles.

Dinner: cheese pudding from low-fat fresh cheese, tea.

Before bed: 1 glass of kefir.

For the whole day: bread - 400 g, butter - 15 g, sugar - 50 g.

Diet dishes for cholecystitis are prepared mainly by steaming or boiling. Baked dishes are acceptable, but fried ones are definitely excluded, since this method of cooking produces substances that irritate the liver, the mucous membrane of the stomach and intestines.

During the period of remission, meat, for example, can only be lightly fried after boiling it.

The daily intake of table salt should not exceed 10 g. For the normal functioning of the gallbladder, it is important that animal and plant proteins in food are in optimal proportion.

Puréed food should not be eaten for a long time, but only during an exacerbation.

For chronic cholecystitis, the diet has general recommendations with acute cholecystitis:

1. Meals should be frequent (4-6 times a day), in small portions, optimally eating at the same time. The second breakfast, afternoon snack and second dinner should not be too plentiful.

2. The amount of main food components is the same as in a normal diet: protein 90-100 g, fat 80-100 g, carbohydrates 400 g, daily calorie content 2500-2900 kcal. A distinctive feature is the increase in the content of vegetable oil (olive, sunflower, corn, soybean) to 50% of all fats.

3. Including additional sources of plant fiber in the diet (apples, melon, tomatoes, etc.). It is important to note that in case of chronic cholecystitis, it is extremely undesirable to consume red currants, lingonberries, and legumes. It is useful to carry out courses of taking wheat bran for 4-6 weeks: pour over the bran with boiling water, steam, drain the liquid, add the resulting mass 1-1.5 tablespoons to dishes 3 times a day.

4. Not recommended: spicy, salty, fried foods, dishes with a high content of extractive substances (strong meat and fish broths, egg yolks, vinegar, pepper, mustard, horseradish, fried and stewed dishes); alcoholic drinks and beer; cold and carbonated drinks. Refractory and difficult to digest fats (lard, lard, fatty meats and fish) should be excluded. The combination of alcoholic beverages and fatty foods is especially dangerous.

5. Recommended: dairy, fruit, vegetable soups; lean meats (beef, rabbit, chicken, turkey) and fish (hake, cod, bream, perch, pike perch) boiled or steamed; doctor's sausage, ham, soaked herring; porridge; puddings, casseroles, cheesecakes; boiled vermicelli, noodles, various vegetables, raw, boiled, baked; salads from boiled and raw vegetables and fruits; protein omelettes. Fermented milk products, fresh cottage cheese, lazy dumplings, cottage cheese soufflé, mild cheese (Russian, Yaroslavl). From animal fats, butter is recommended.

6. As seasonings you can use parsley, dill in small quantities, fruit and berry sauces. Vegetables such as radishes, radishes, turnips, onions, garlic, as well as sorrel and spinach are generally not well tolerated and should be avoided.

7. For drinks, you can drink weak tea, fruit, vegetable, and berry juices (but not decoctions of lingonberries or red currants), and rosehip decoction. All drinks must be warm; drinking cold drinks stimulates contractions and may cause pain. Do not drink highly carbonated drinks (Cola, Fanta, Sprite, highly carbonated mineral waters).

If cholecystitis is combined with reduced secretory function of the stomach, then mineral waters should be taken 30 minutes before meals, with increased secretion - 1.5 hours before meals.

If all acute phenomena disappear after 3-4 weeks, the patient can be switched to diet No. 5: 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). The amount of fat in the diet is adjusted to the physiological norm, 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.

Therapeutic nutrition is combined with the prescription of antibacterial therapy, antispasmodics and bed rest.

The importance of therapeutic nutrition in the treatment of patients with liver and gallbladder damage especially increases in cases of chronic cholecystitis. Proper nutrition can provide a long-term state of remission. Violation of the diet, its qualitative and quantitative deviations can cause an exacerbation of the disease. Among the reasons that contribute to the exacerbation of chronic cholecystitis, one of the first places is occupied by the consumption of fatty and spicy foods, alcohol, cold and carbonated drinks, etc. Poor nutrition is also one of the reasons for the transition of acute cholecystitis to chronic.

The diet for patients with chronic cholecystitis outside the period of exacerbation is structured in such a way that its main components have an active effect on the biliary function and prevent bile stagnation. The prescribed diet should also have a stimulating effect on the secretory and motor functions of the intestine. If you are prone to diarrhea, your diet should be adjusted accordingly.

For patients with chronic cholecystitis, frequent split meals are recommended at the same hours, which promotes better outflow of bile. Large amounts of food disrupt the rhythm of bile secretion and cause spasm of the bile ducts. A spasm of the pylorus may occur reflexively, and the normal secretory-motor activity of the intestine is disrupted.

Hence the frequent occurrence of pain and various types of dyspepsia after a heavy meal.

The main dietary requirement for patients with chronic cholecystitis is diet No. 5. It is preferable to administer fats in the form of vegetable oils, primarily because of their good choleretic effect. For chronic cholecystitis occurring with bile stagnation syndrome, it is recommended to increase the fat content in the diet to 100-120 g at the expense of vegetable oils (1/2 of the total amount of fat). This diet option promotes the activation of bile secretion, improves the hepatic-intestinal circulation of the compounds that make up bile, increases its bactericidal properties and intestinal motor function, and promotes the removal of cholesterol from the intestines with feces.

The choleretic effect of vegetable oils may serve as a contraindication to their introduction into the diet of patients with cholelithiasis. In these cases, activation of the functional activity of the biliary system may be accompanied by an attack of biliary colic. For patients of this profile, a diet with the usual ratio of animal to vegetable fat.

The issue of introducing eggs into the diet should be decided individually. Eggs are valuable food product, have an active choleretic effect, enhance motor function gallbladder, and therefore their introduction into the diet of patients with chronic cholecystitis is indicated. At the same time, the presence of these properties provokes pain in some people when consuming eggs, which forces them to limit their introduction into the diet in such cases.

Vegetables, fruits and berries have a stimulating effect on the secretion of bile and other digestive juices and help eliminate constipation. We can recommend carrots, zucchini, tomatoes, cauliflower, grapes, watermelon, strawberries, apples, prunes, etc. Biliary activity is especially enhanced with the simultaneous introduction of vegetables with vegetable oils. Therefore, it is recommended to eat salads with vegetable oil, etc. The diet should contain wheat bran in pure form or as part of special types of bread.

For cholecystitis that occurs with diarrhea, vegetables and berries are introduced into the diet in the form of juices, preferably diluted in half with water, or in pureed form. In these cases, preference is given to juices containing tannins(blueberries, quince, pomegranates, etc.). Vegetables rich in essential oils (radish, radish, turnip, onion, garlic), as well as oxalic acid (sorrel, spinach), are poorly tolerated by patients due to their irritating effect on the mucous membrane of the digestive tract.

Cholecystitis is quite common among women, especially during pregnancy. Although excess weight often leads to gallstones, a sharp decline weight still in to a greater extent may complicate the course of cholecystitis.

It is also known that cholecystitis is more common among amateurs low calorie diet those with a predominance of proteins or those who prefer diets that allow them to lose weight in a short period of time. Prevention of cholecystitis and chronic cholecystitis consists of following a diet, playing sports, exercising, preventing obesity, and treating focal infections.

The best way to prevent the development of cholecystitis is to maintain normal weight and following a moderate-calorie, low-fat diet.

• In acute cases of the disease, it is necessary to adhere to the most gentle diet possible (warm drinks, soups, liquid cereals). Take pureed food (vegetable puree, fruit puddings, mousses, steamed meat cutlets etc.). After a few days, you can eat boiled meat or fish.
• Include foods rich in fiber (vegetables and fruits, especially sweet ones), whole grains (whole grain bread, brown rice), lean meat (chicken, turkey) or lean fish.
• Choose low-fat dairy products (low-fat cottage cheese, low-fat milk, low-fat yogurt, kefir) and avoid or reduce the consumption of dairy products such as butter, cheeses, cream, ice cream.
• Avoid fried foods and sweets such as donuts, cookies, desserts, cakes, and sodas.
• Avoid spicy and smoked foods, as well as vegetables with a lot of essential oils, such as garlic, onions, radishes, as they are irritating to the digestive system.
• Reduce consumption of coffee and alcoholic beverages. For cholecystitis, fluid intake is indicated, such as weak tea, juices, rosehip decoction, and mineral water without gases.
• Try to stick to 4-5 meals a day in small portions instead of 3 meals a day with large amounts of food. With frequent meals in small portions, fats are better absorbed, which is very important for cholecystitis.
• It is useful to carry out courses of taking wheat bran for 4-6 weeks: pour over the bran with boiling water, steam, drain the liquid, add the resulting mass 1-1.5 tablespoons to dishes 3 times a day.

Often chronic cholecystitis develops against the background of obesity. In this case, it is useful to carry out 1-2 fasting days per week, for which you can use the following diets:

1. Curd and kefir day (900 g of kefir for six doses, 300 g of cottage cheese for three doses and 50-100 g of sugar)

2. Rice-compote day (1.5 liters of compote prepared from 1.5 kg of fresh or 250 g of dry fruit is divided into six doses; rice porridge cooked in water from 50 g of rice is divided into two doses)

3. Watermelon or grape day (2 kg of ripe watermelon or grapes are divided into six doses)

4. Fruit day (1.5-2 kg of ripe apples for six doses). This diet is especially good if you are prone to constipation and putrefactive processes in the intestines.

Disease prevention

Prevention of cholecystitis is a balanced diet, prevention of obesity, and an active lifestyle.

Prevention of chronic cholecystitis consists of following a diet, playing sports, physical education, preventing obesity, and treating focal infections.

Who is at particular risk?

Those people whose bile stagnates in the gallbladder are especially predisposed to the development of cholecystitis. This happens when:

- compression and kinks of the bile ducts; — dyskinesia of the gallbladder and biliary tract; — violations of the tone and motor function of the biliary tract; — endocrine and autonomic disorders; - pathological changes in the digestive system.

Increases bile stagnation:

- fasting; - irregular eating, combined with overeating; - sedentary lifestyle; - habitual constipation; — infections (Escherichia coli, cocci and other pathogens that penetrate from the intestines or are carried through the bloodstream).

In case of chronic cholecystitis, you must follow the rules healthy eating, including frequent fractional writing techniques.

As for medications, it is advisable to take antispasmodics and drugs containing pancreatin - mezim-forte, pensital, creon, pancitrate. It is useful to take several courses of probiotics - enterol, bifiform, hilak-forte. A daily intake of multivitamin complexes with microelements is required.

Choleretic drugs, including those of herbal origin, are prescribed only after examination of the gallbladder and pancreas.

A bandage is not worn for cholecystitis; it is used only if there is a hernia of the anterior abdominal wall.

What changes occur in the gallbladder as a result of inflammation?

With chronic catarrhal (edematous) inflammation (cholecystitis), the walls of the gallbladder become denser. At the same time, in some areas the epithelium is absent, in others it grows with the formation of small polyps.

The muscular layer of the wall is usually hypertrophied (thickened), and the mucous membrane, on the contrary, is atrophied. The walls of the gallbladder are covered with inflammatory infiltrates, which can lead to the development of ulcers on the mucous membrane, which is then scarred by epithelial cells.

Deposits of calcium salts may occur in certain areas of the gallbladder wall.

The bladder often becomes deformed due to the appearance of adhesions with neighboring organs.

– forms of inflammatory damage to the gallbladder that differ in etiology, course and clinical manifestations. Accompanied by pain in the right hypochondrium, radiating to the right arm and collarbone, nausea, vomiting, diarrhea, flatulence. Symptoms occur against the background of emotional stress, dietary errors, and alcohol abuse. Diagnosis is based on physical examination, ultrasound examination of the gallbladder, cholecystocholangiography, duodenal intubation, biochemical and general analysis blood. Treatment includes diet therapy, physiotherapy, analgesics, antispasmodics, and choleretic drugs. According to indications, cholecystectomy is performed.

ICD-10

K81

General information

Cholecystitis is an inflammatory disease of the gallbladder, which is combined with motor-tonic dysfunction of the biliary system. In 60-95% of patients, the disease is associated with the presence of gallstones. Cholecystitis is the most common pathology of the abdominal organs, accounting for 10-12% of the total number of diseases in this group. Inflammation of the organ is detected in people of all ages; middle-aged patients (40-60 years old) suffer most often. The disease affects females 3-5 times more often. Children and adolescents are characterized by the acalculous form of the pathology, while calculous cholecystitis predominates among the adult population. The disease is diagnosed especially often in civilized countries, which is due to the characteristics of eating behavior and lifestyle.

Causes of cholecystitis

• Cholelithiasis. Cholecystitis due to cholelithiasis occurs in 85-90% of cases. Stones in the gallbladder cause bile stasis. They clog the lumen of the outlet, injure the mucous membrane, cause ulceration and adhesions, supporting the process of inflammation.
• Biliary dyskinesia . The development of pathology is promoted functional impairment motility and tone of the biliary system. Motor-tonic dysfunction leads to insufficient emptying of the organ, stone formation, inflammation in the gallbladder and ducts, and provokes cholestasis.
• Congenital anomalies. The risk of cholecystitis increases with congenital curvatures, scars and constrictions of the organ, doubling or narrowing of the bladder and ducts. The above conditions provoke a violation of the drainage function of the gallbladder, stagnation of bile.
• Other diseases of the biliary system. The occurrence of cholecystitis is influenced by tumors, cysts of the gallbladder and bile ducts, dysfunction of the valve system of the biliary tract (sphincters of Oddi, Lutkens), Mirizzi syndrome. These conditions can cause deformation of the bladder, compression of the ducts and the formation of bile stasis.

In addition to the main etiological factors, there are a number of conditions, the presence of which increases the likelihood of the appearance of symptoms of cholecystitis, affecting both the utilization of bile and changes in its qualitative composition. Such conditions include dyscholia (violation normal composition and consistency of gallbladder bile), hormonal changes during pregnancy and menopause. The development of enzymatic cholecystitis is facilitated by the regular reflux of pancreatic enzymes into the cavity of the bladder (pancreatobiliary reflux). Cholecystitis often occurs against the background poor nutrition, alcohol abuse, tobacco smoking, adynamia, sedentary work, hereditary dyslipidemia.

Pathogenesis

The main pathogenetic link of cholecystitis is considered to be stasis of gallbladder bile. Due to dyskinesia of the biliary tract, obstruction of the bile duct, the barrier function of the epithelium of the bladder mucosa and the resistance of its wall to the effects of pathogenic flora are reduced. Stagnant bile becomes a favorable environment for the proliferation of microbes, which form toxins and promote the migration of histamine-like substances to the site of inflammation. With catarrhal cholecystitis, swelling and thickening of the organ wall occurs in the mucous layer due to its infiltration by macrophages and leukocytes.

The progression of the pathological process leads to the spread of inflammation to the submucosal and muscular layers. The contractility of the organ decreases down to the point of paresis, and its drainage function. An admixture of pus, fibrin, and mucus appears in infected bile. The transition of the inflammatory process to adjacent tissues contributes to the formation of a perivesical abscess, and the formation of purulent exudate leads to the development of phlegmonous cholecystitis. Due to circulatory disorders, foci of hemorrhage occur in the wall of the organ, areas of ischemia and then necrosis appear. These changes are characteristic of gangrenous cholecystitis.

Classification

Diagnostics

The main difficulty in verifying a diagnosis is considered to be determining the type and nature of the disease. The first stage of diagnosis is a consultation with a gastroenterologist. Based on complaints, studying the medical history, and conducting a physical examination, a specialist can establish a preliminary diagnosis. Upon examination, positive symptoms of Murphy, Kera, Mussi, and Ortner-Grekov are revealed. To determine the type and severity of the disease, the following examinations are carried out:

• Ultrasound of the gallbladder. It is the main diagnostic method, it allows you to determine the size and shape of the organ, the thickness of its wall, contractile function, and the presence of stones. In patients with chronic cholecystitis, thickened sclerotic walls of the deformed gallbladder are visualized.
• Fractional duodenal intubation. During the procedure, three portions of bile are collected (A, B, C) for microscopic examination. Using this method, you can evaluate the motility, color and consistency of bile. In order to detect the pathogen that caused bacterial inflammation, the sensitivity of the flora to antibiotics is determined.
• Cholecystocholangiography. Allows you to obtain information about the functioning of the gallbladder and biliary tract in dynamics. Using the X-ray contrast method, impaired motor function of the biliary system, stones and deformation of the organ are detected.
• Laboratory blood test. In the acute period, neutrophilic leukocytosis and accelerated ESR are detected in the CBC. A biochemical blood test shows increased levels of ALT, AST, cholesterolemia, bilirubinemia, etc.

In doubtful cases, hepatobiliscintigraphy is additionally performed to study the functioning of the biliary tract.

1. Diet therapy. The diet is indicated at all stages of the disease. It is recommended to eat small meals 5-6 times a day in boiled, stewed and baked form. Long breaks between meals (more than 4-6 hours) should be avoided. Patients are advised to avoid alcohol, legumes, mushrooms, fatty meats, mayonnaise, and cakes.
2. Drug therapy. In acute cholecystitis, painkillers and antispasmodics are prescribed. When identifying pathogenic bacteria antibacterial agents are used in bile, depending on the type of pathogen. During remission, choleretic drugs are used to stimulate bile formation (choleretics) and improve the outflow of bile from the organ (cholekinetics).
3. Physiotherapy. Recommended at all stages of the disease for the purpose of pain relief, reducing signs of inflammation, and restoring the tone of the gallbladder. For cholecystitis, inductothermy, UHF, and electrophoresis are prescribed.

Removal of the gallbladder is carried out in case of advanced cholecystitis, ineffectiveness of conservative treatment methods, or calculous form of the disease. Two techniques for organ removal have found widespread use: open and laparoscopic cholecystectomy. Open surgery is performed for complicated forms, the presence of obstructive jaundice and obesity. Videolaparoscopic cholecystectomy is a modern, low-traumatic technique, the use of which reduces the risk postoperative complications, shorten the rehabilitation period. If stones are present, non-surgical stone crushing is possible using extracorporeal shock wave lithotripsy.

Prognosis and prevention

The prognosis of the disease depends on the severity of cholecystitis, timely diagnosis and proper treatment. With regular use of medications, adherence to diet and control of exacerbations, the prognosis is favorable. The development of complications (phlegmon, cholangitis) significantly worsens the prognosis of the disease and can cause serious consequences (peritonitis, sepsis). To prevent exacerbations, you should adhere to the basics of a balanced diet, exclude alcoholic beverages, and active image life, to rehabilitate foci of inflammation (sinusitis, tonsillitis). Patients with chronic cholecystitis are recommended to undergo an annual ultrasound of the hepatobiliary system.

The topic of the article is the terrible disease cholecystitis. Let's find out why the disease develops. Consider the symptoms of cholecystitis. What methods are used to detect the disease? Medicinal and traditional methods of treatment.

What medicinal herbs treat cholecystitis. Is it possible to relieve an attack of cholecystitis on your own?

Cholecystitis means inflammation in the gallbladder, combined with a malfunction of the motor-tonic biliary system. No one is immune from manifestation, but representatives of the fairer sex are more susceptible to its occurrence.

The development of the disease begins with stagnation of bile - this leads to disruption of its outflow and penetration of infection into the gallbladder. After an organ becomes infected, inflammation spreads further throughout the body, and characteristic signs appear.

Often the disease develops when the efferent ducts are partially or completely blocked by calculi (stones).

Complications of the disease cholecystitis

Ignoring the problem and refusing medical care for cholecystitis is fraught with critical consequences. With a prolonged illness, inflammation may spread to adjacent areas (diseases such as pancreatitis, pleurisy, cholangitis may occur).

Late diagnosis and lack of treatment for phlegmonous cholecystitis is fraught with empyema (accumulation of pus). An advanced stage of tissue decay risks becoming the start for the development of an abscess.

Violation of the integrity of the walls of the gallbladder by a stone leads to the penetration of fluid into the abdominal cavity, peritonitis. Ignoring the manifestations of exacerbation is fraught with transition to a chronic condition.

If urgent measures are not taken, the complication ends in death.

Cholecystitis: symptoms and treatment in adults

To begin with, specialists study the symptoms characteristic of suspected cholecystitis. Treatment in adults is prescribed only after a complete diagnosis based on the clinical picture. Character traits attacks should be studied by everyone.

These are sudden and intense tingling in the area of ​​the right hypochondrium, vomiting with bile, fever, flatulence, uncontrolled belching, a bitter taste, white marks on the tongue and tachycardia. Sometimes the attack is complicated by yellowing of the skin and sclera, darkening of the urine.

Also, a deficiency of bile affects the digestion process: it does not occur completely, so the stool becomes lighter. Symptoms of cholecystitis in adults depend on the nature of the inflammatory process, and also on the presence of stones.

With acalculous cholecystitis, the main manifestations are erased, but the attack remains prolonged (characterized by increasing pain after eating, belching and a typical bitter taste). The chronic form, unlike the acute one, is more common and is characterized by a wave-like course.

The main manifestation is painful right-sided attacks, localized in the hypochondrium, radiating higher (to the neck, shoulder blade, shoulder). Colic worsens during movement.

Exacerbation is caused by poor diet, recently experienced stressful situations, and physical fatigue. Pain often occurs along with malaise, excessive sweating, sleep disturbance, neuroses, diarrhea, flatulence, and vomiting.

Accompanied by pain in the right side of the body, vomiting, fever, bitter taste, hepatomegaly (increase in liver size).

Symptoms chronic manifestation cholecystitis are not clearly expressed. In addition to the characteristic bitter taste in the mouth, accompanied by a nauseating state, there is bloating, shallow, rapid breathing, chills, and tachycardia.

Specific symptoms of the acute period

The following specific manifestations indicate an exacerbation of cholecystitis. Sharp pain originates to the right of the hypochondrium when the costal arch is tapped. Intensified pain is felt during inhalation when palpating the bladder. There is an expansion of the gallbladder in the elongated zone of its lower part, located under the edge of the liver.

It is characterized by tingling when checking the area in the area of ​​the thoracic vertebrae (9-11) and 3 cm to the right of the spinal column. It gives off a wave of pain with light pressure above the collarbone on the right. Intense pain when pressing on the xiphoid process of the sternum.

Is it possible to relieve an attack of cholecystitis on your own?

During an attack, you should not take painkillers, apply heat to the problem area, or use infusions, decoctions, or drugs that have a biliary effect. All you can do is take a comfortable position (ensure peace) and drink liquid in small portions.

It is not recommended to relieve an attack of cholecystitis on your own. Serious consequences are possible. Therefore, the right decision would be to immediately visit a doctor and have a personal consultation.

Timely drug therapy helps eliminate the acute inflammatory process within three days, and complete recovery within a month.

Watch a video about the treatment of acalculous cholecystitis:

1. which category of people is more susceptible to cholecystitis;
2. what is dyskinesia;
3. Under what conditions of the gallbladder should allohol not be used?
4. what mineral waters are used in the treatment of cholecystitis;
5. diet for cholecystitis.

Cholecystitis: causes of pathology

The main prerequisites are stagnation of bile and an infectious process. Pathogenic microflora is able to penetrate through the blood flow and lymph from other foci of the infectious process in a chronic form. Often the progression of the disease is determined by the presence of the following conditions in the body.

Cholelithiasis. Stagnation of bile leads to the appearance of stones (they block the lumen of the exit ducts, damage the mucous membrane, developing inflammation, adhesions and ulcerations).

Biliary tract disorder. Accompanied by dysfunction of the motility of the gallbladder and biliary system (the biliary system includes the bile ducts and gallbladder). Due to a malfunction, the organ does not have time to empty itself, the formation of stones and the development of inflammation are noted.

Congenital anomalies. Curvatures, scars, organ deformation, doubling or narrowing of the ducts.

In addition, the manifestation of symptoms of cholecystitis is provoked by the presence of the following pathologies:

• diabetes;
• pancreatitis;
• gastritis, gastric and duodenal ulcers, stomach cancer;
• increased pressure in the duodenum;
• decreased secretory function of the stomach;
• trauma to the abdominal cavity, abdomen;
• appendicitis;
• pregnancy;
• chronic constipation;
• infections;
• intestinal infections (dysentery, coli infection, salmonellosis, cholera);
• obesity.

As well as an inactive lifestyle, frequent age-related changes and addiction to alcohol, smoking, and drugs. Often the pathology worsens against the background of hypothermia, sudden shocks of the body (while cycling, running).

From the video you will learn about exercises for cholecystitis (contraindications - gallstones):

Classification of the disease

In gastroenterological practice, there are several classifications of the disease. Each of them is different, which gives the doctor the opportunity to correctly diagnose pathologies and determine therapy.

Based on the severity, type of inflammatory, destructive changes, the manifestation of cholecystitis can be acute or chronic. The main symptoms of the acute period are inflammation and pain.

The advanced form is characterized by a slow, dimly manifested course, and painful attacks have a nagging format and do not always occur.

Severity

Easy stage. A mild pain syndrome lasting about a quarter of an hour is typical. The pain stops on its own. Digestive disorders are rare. It appears no more than twice a year. The functioning of other organs is not impaired.

Medium severity. Accompanied by persistent pain. Dyspeptic disorders (“lazy” stomach) are pronounced. The pathology appears more often than three times a year. There is a disturbance in the functioning of the liver.

Heavy. This stage of cholecystitis is characterized by long-term pain and digestive problems, recurring more than once a month. The medications you take do not improve your well-being. The functioning of other gastrointestinal organs is impaired, and the presence of hepatitis and pancreatitis is often detected.

Calculous. Stones are detected inside the organ (diagnosed in 90% of patients). It can be characterized by either intense occurrence of colic or not appearing at all for a long time.

Non-calculous. Diagnosed in 10% of situations (characterized by the absence of stones, stable recovery and a minimum of relapses).

Acute form

Catarrhal. Accompanied by right-sided tingling in the hypochondrium area, spreading to the shoulder, lumbar area or shoulder blade. There is a urge to vomit, a high temperature of up to 37.5°C, tachycardia, increased blood pressure, and the presence of white marks on the tongue.

Phlegmonous. Characterized especially acute form manifestations. Pain manifests itself with elementary loads, changes in body position (even coughing and breathing can provoke it). Complemented by nausea, vomiting, temperature fluctuations up to 39°C, malaise, chills, tachycardia.

Gangrenous. In fact, this is the third stage of development after an exacerbation. There is an intensification of all processes of organ damage and a strong weakening of the body’s protective properties.

Exacerbation

The disease is characterized by a wave-like format - temporary periods of remission alternate with attacks. Exacerbation without the presence of stones is caused by the abuse of fatty, fried, smoked, salty, spicy foods, semi-finished products, overeating, drinking alcohol, frequent stressful situations, allergies (in particular food), as well as lack of fiber in the diet.

Relapse calculous form provoked by changes in body position and intense physical activity. More often, exacerbations of the disease affect patients with anomalies in the development of the biliary system or obesity.

Relapses are more likely to occur in pregnant women. Frequent hypothermia and colds also run the risk of causing pathology.

Diagnosis of cholecystitis

The main difficulty in identifying pathology is diagnosing the format and type. The initial stage is an examination by a gastroenterologist. The doctor makes a preliminary diagnosis taking into account the patient’s complaints, physical examination, and general clinical picture.

To determine the form, type, and severity of the pathology, laboratory tests are required:

• blood sampling for general (biochemical analysis);
• collecting bile for culture (the pathogen is identified).

In addition, the patient is referred for the following studies.

Ultrasound. A diagnostic method that allows you to identify the shape, parameters of the bubble, wall thickness and the presence of stones.

Fractional duodenal studies. The method studies the shade and consistency of bile.

Cholecystocholangiography. The functioning of the organ is assessed, violations of the motor function of the biliary system, the presence of stones or deformities are identified.

If there are doubts when making a diagnosis, they additionally resort to fibrogastroduodenoscopy, diagnostic laparoscopy and multislice computed tomography.

Drug therapy for cholecystitis

Treatment of cholecystitis should be comprehensive. In addition to taking medications, doctors prescribe the use of tubage and diet. If necessary, surgery may be performed.

Only a doctor can select medications, their regimen, frequency and dosage, only after establishing an accurate diagnosis, taking into account the clinical picture and individual characteristics sick.

Patients with an acute form require the use of painkillers and antispasmodics. When the inflammation process is complicated by infection, antibiotics are added.

Prescription of such drugs is practiced.

Anti-inflammatory: diclofenac, meperidine.

Antispasmodics: baralgin, papaverine, dicetel, duspatalin, no-shpa, odeston.

Choleretic - during remission of inflammation: choleretics (to stimulate bile formation): allochol, hepabene, decholine, silymar.

Cholekinetics (to stimulate the excretion of bile): platiphylline, sorbitol, xylitol, olimethine.

Antibiotics: fluoroquinolones (levofloxacin, norfloxacin, ofloxacin, ciprofloxacin).

Macrolides (azithromycin, clarithromycin, midecamycin, erythromycin).

Semi-synthetic tetracyclines: metacycline, doxycycline).

If the pathogenic microflora does not respond to antibacterial agents, the use of nitrofuran agents - furazolidone, furadonin - is additionally included in the prescription. If the gallbladder malfunctions, it is recommended to take motilium, cerucal, motilac.

Probing and use of tubage for cholecystitis

The tube is used to flush the gallbladder from congestion. This manipulation promotes the excretion of bile, as well as stimulation of the functioning of the gallbladder (carried out using both a probe and a probe-free method). The number of procedures is determined by the doctor. The course duration is on average three months.

Use of a probe tube. It involves inserting a duodenal tube through the mouth. This way, bile is removed and the excretory tract is cleansed.

The use of probeless (blind) tubage or duodenal intubation. In the morning, on an empty stomach, the patient is given 2 glasses of a remedy that has a choleretic effect (herbal infusion, warm mineral water, medication).

Then the patient lies on his right side, bending his knees. A warm heating pad is placed in the hypochondrium area on the right. The patient lies in this position for an hour and a half. After the specified time, bile begins to be released.

Cholecystitis: surgical techniques

When the diagnosis is complicated or caused by cholelithiasis, surgery may be performed. The operation is also performed to eliminate excess pus or if there is pathological changes in the bile duct and its ducts.

Removal of the gallbladder is carried out only in cases of advanced disease, low effectiveness of conservative treatment, and also in cases of calculous cholecystitis.

IN modern surgery Either open or laparoscopic cholecystectomy is used. The latter is characterized as a low-traumatic method, the use of which helps reduce the risk of postoperative complications and also shorten the rehabilitation period.

In the presence of stones, non-surgical crushing of stones using extracorporeal shock wave lithotripsy is used.

Open intervention is performed in patients with complicated forms, obstructive jaundice, and obesity.

How to treat cholecystitis using traditional methods

The use of medications made from natural ingredients helps alleviate the condition and normalize well-being. Such compositions - herbal infusions, decoctions - are effective and safe. However, in order to prevent unpleasant consequences, before using this or that remedy, it is advisable to consult your doctor.

The following recipes will help get rid of cholecystitis.

Method I Combine freshly squeezed carrot juice with aloe, beet, black radish, and vodka juice (0.5 l each). Add 500 g of honey. The container with the composition is set aside in a dark and cool place for half a month. Take 20 ml of the composition three times a day before meals.

II method. Mix dried, crushed plantain with dill seed, yarrow, mint, chamomile, oregano, valerian (all components equally).

Brew 30 g of the mixture with 300 ml of boiling water. After two hours, filter the product. Take 30 ml of the drug three times a day before meals.

III method. Combine butter with peeled pumpkin seeds, honey, sunflower oil in equal proportions (100 g each). Transfer the mixture to a separate container and bring to a boil. Next, boil the mixture over low heat for 5 minutes.

Store the product in the refrigerator, consume 20 g of the composition per day.

Use of medicinal herbs

To strengthen the positive results of drug treatment, increase immunity, improve general condition and well-being, doctors advise using infusions and decoctions of medicinal plants.

Compositions based on choleretic herbs will bring great benefits: mint, corn silk, immortelle, black radish juice, tansy, or dandelion.

It is also useful to take remedies from cholekinetic plants: calendula, lavender, cornflower, dandelion, chicory. Infusions or decoctions are prepared from herbs and used for three to four months.

Cholecystitis: nutrition, diet and prevention

A properly selected diet for cholecystitis reduces irritation of the gallbladder. Six meals a day are provided in small portions. In case of exacerbation of cholecystitis, nutrition must meet the following requirements.

The first two days of fasting - drinking weak, unsweetened tea is allowed, rice water(liquid is taken in small portions). On the third day, it is allowed to introduce vegetable soups, liquid non-dairy porridges, and jelly from non-acidic berries into the diet (provided that the pain subsides).

On the fifth day, you can enrich your diet with boiled meat, lean fish, dairy products. On the seventh day, you are allowed to season your food with vegetable oil or butter.

The menu is enriched with: sweet fruits, potatoes, stewed cauliflower, baked apples, boiled eggs.

Patients are prohibited from consuming: fatty, fried, spicy, smoked, salty foods, semi-finished products, fast food, soda, alcoholic drinks, baked goods, nuts, cocoa, chocolate, raw vegetables, fruits, marinades.

How to avoid getting cholecystitis

It is easier to prevent a disease than to cure it. Therefore, attention should be paid to preventive measures to avoid the manifestations of cholecystitis. Pay attention to your diet - eat fresh healthy foods, exclude excessively fatty, spicy, smoked and salty foods.

Eat at least five times a day in small portions at fixed times (such a simple technique will allow all organs of the gastrointestinal tract to function correctly, and therefore prevent the possibility of failure).

Every day, devote at least half an hour to physical activity (perform exercises consisting of 7-10 exercises). Watch your body weight (extra pounds are not beneficial).

The use of aggressive diets and excessive physical activity will provoke an existing disease or lead to its primary manifestation. It is better to lose weight gradually, losing 500-700 grams weekly.

The disease is serious, and if you do not recognize it and do not start treating cholecystitis on time, this can aggravate the situation - lead to complications, chronic forms, disability.

Conclusion

From the article you learned about the symptoms and treatment of cholecystitis in adults. We covered the following points in detail:

1. what is cholecystitis and why does it occur;
2. what diseases and conditions of the body provoke diseases of the digestive system;
3. what exist medical methods and methods for determining cholecystitis;
4. what medicinal and traditional methods are used to treat the disease;
5. What complications does cholecystitis lead to?

P.S. There are no incurable diseases, there are incurable people - those who hate living beings, ungrateful, depressed in spirit, who have exhausted their life span. What do you think about this statement of the Tibetan monks?

Is there a cause-and-effect relationship between a person’s thoughts and his illnesses? Can resentment provoke the appearance of sand in the gallbladder, which then turns into cobblestones? Or is this a myth? You can debunk him.

Write your opinion in the comments.

Best regards, Tina Tomchuk