Low-grade fever. The first signs of acute cholecystitis - emergency care, diagnosis, conservative and surgical treatment Chronic cholecystitis exacerbation temperature 37.1

It is known that almost all inflammatory diseases are accompanied by fever. Therefore, many patients are interested in the question of whether temperature with cholecystitis is a characteristic symptom or an exception to the rule. According to doctors, the disease is almost always accompanied by fever.

Often, inflammation of the gallbladder occurs due to the penetration of infection through the blood or lymph into the organ. This is possible with appendicitis, enterocolitis, pancreatitis and other inflammatory diseases.

Depending on the characteristics of the course of the disease, catarrhal, phlegmonous, and gangrenous forms of the disease are distinguished. With inflammation of the gallbladder (various forms), temperature and other symptoms may be different. It all depends on the cause of the pathology.

How does acute inflammation of the gallbladder manifest itself?

In most cases, acute cholecystitis occurs against the background of cholelithiasis, so the manifestations of these pathologies are similar.

The disease manifests itself as a sharp pain on the right under the ribs, which lasts about 6 hours or more. A slight increase in body temperature is observed in many patients.

Acute inflammation of the gallbladder is accompanied by fever, pain, nausea

In elderly patients with acute cholecystitis, appetite decreases or is absent, fever, weakness, and vomiting occur.

During catarrhal cholecystitis

During this form of the disease, the patient has a low-grade fever (from 37 to 37.5°). This condition indicates inflammation of the gallbladder. In addition, pain occurs in the right side of the abdomen, the heart rate increases (up to 100 beats per minute), etc.

During the phlegmonous form of the disease

Phlegmonous cholecystitis (PC) has a more severe course than the previous form of the disease. Patients are interested in whether there can be a temperature during the development of FC. During the illness, the fever becomes more pronounced (up to 38 - 39°), as inflammation intensifies. In addition, the patient experiences pain on the right side under the ribs, weakness, and decreased appetite.

During phlegmonous inflammation, the temperature rises to 39°

During gangrenous inflammation of the gallbladder?

This form of the disease manifests itself against the background of phlegmonous cholecystitis. Then the exhausted body is no longer able to restrain pathogenic microbes that penetrate the organ.

During gangrene of the gallbladder there is also a fever, an increase in temperature to 38 - 39° is observed. The patient exhibits excessive sweating, weakness, tachycardia, etc.

Does fever occur against the background of calculous cholecystitis?

This form of the disease is characterized by the presence of stones in the gallbladder.

In acute calculous inflammation, the temperature rises slightly. In addition, there is pain, nausea, and vomiting.
Abscess, perforation of the gallbladder is manifested by fever and jaundice.

During chronic cholecystitis

Chronic cholecystitis can act as an independent disease or develop against the background of an acute form of the disease.

With chronic inflammation of the gallbladder, pain in the right side, itching, jaundice, and sometimes vomiting appear. As the disease worsens, the patient develops a fever.

Thus, an inflammatory disease can be identified by pain, a sharp deterioration in health and fever. If you notice these signs, then you need to hospitalize the patient, since in some cases surgery cannot be avoided.

Symptoms of cholecystitis depend on the cause that caused the inflammatory reaction, the age and gender of the patient. Women seek help several times more often than men.

Acute inflammation

The main causative agents of acute inflammation of the gallbladder are Escherichia coli, streptococci, staphylococci, and Pseudomonas aeruginosa. In women, the infection can penetrate from the genitourinary organs with adnexitis, colpitis, etc. There are acalculous and calculous cholecystitis.

Complications of inflammation include:

• peritonitis;
• abscess;
• cholangitis;
• pancreatitis;
• lymphadenitis;
• dropsy;
• empyema;
• jaundice;
• sepsis.

Against the background of housing and communal services

In obese women, acute inflammation of the gallbladder occurs more often. Acalculous cholecystitis develops mainly in men. Inflammation against the background of cholelithiasis (GSD) is manifested by the following symptoms:

1. Biliary colic. Localized on the right in the hypochondrium. It occurs more often at night or in the morning, grows and bothers the patient for an hour. On examination, you may notice increased sweating.
2. Temperature increase. The temperature usually stays between 37-38 degrees. With a purulent process and melting of the bladder wall, the temperature reaches 39-40 degrees. It is worth noting that in weakened patients and elderly people, even with purulent processes, the temperature does not exceed 38 degrees.
3. Belching with bitterness, distension in the upper abdomen, bloating.
4. Obstructive jaundice caused by blockage of the duct with a stone.

Upon examination, the doctor detects the following symptoms:

• at the height of inspiration, when pressing on the right hypochondrium, the patient feels a sharp pain (Murphy's symptom);
• when lightly pressing on the site of the bladder projection, the patient notes pain (Keur's symptom);
• the patient feels pain when the doctor taps the edge of the costal arch on the right (Ortner's symptom).

Acalculous cholecystitis

The pathology is characterized by high mortality, as patients are in critical condition. Difficult diagnosis in severe cases is explained by a blurred picture and, in some cases, the absence of pain.

A feature of inflammation is its sudden onset, which is accompanied by severe pain (biliary colic). The symptom is caused by stretching of the bladder, an increase in pressure in it, and a violation of the outflow of bile. As a result of inflammation, the bladder swells and presses on the adjacent peritoneum.

The patient's pain first occurs on the right side, then radiates to the right shoulder, scapula, and chest. Sometimes the pain imitates myocardial infarction, radiating to the left side of the chest. In some cases, patients complain of pain that extends to the lower back. If the patient does not receive help, the symptoms intensify after a few hours.

Colic forces a person to take a certain position - lying on the right side or back. Colic is accompanied by fever and chills - signs that are characteristic of purulent inflammation. The patient is constantly thirsty and is bothered by nausea and flatulence. Vomiting and constipation may occur.

Upon examination, the doctor identifies the following symptoms:

• coating on dry tongue;
• bloating;
• muscle tension in the anterior abdominal wall;
• enlarged gallbladder (sometimes not palpable);
• the bubble hurts when pressed;
• The liver is enlarged and hurts.

In old age, there is a discrepancy between the clinical manifestations of inflammation and the severity of pathological changes in the wall of the gallbladder. In some cases, gangrenous processes occur against the background of apparent improvement. The patient's symptoms subside due to the death of sensitive receptors.

The course of the disease and prognosis depend on changes in the bladder. Catarrhal inflammation with treatment ends in recovery. With the development of the phlegmonous form, the disease is severe. The patient develops fever with chills, and intoxication develops.

The patient complains of nausea and dry mouth. Vomiting, sharp abdominal pain, and bloating occur. The temperature may last for several days. With timely treatment, recovery occurs. In some cases, the pathology becomes chronic.

The severe form is gangrenous cholecystitis. The patient's bladder accumulates gas, which is released by bacteria. Complications of the pathology are:

• breakthrough of the gallbladder wall;
• wall melting;
• peritonitis.

When the wall breaks through, the patient experiences severe pain, hiccups, flatulence, pressure decreases, and the passage of gas and feces stops. During the examination, the doctor listens for noises in the area of ​​the bladder. Pancreatitis is often associated with the disease, which complicates diagnosis.

To clarify the diagnosis, laboratory and instrumental examinations are performed. Clinical blood test shows leukocytosis, high ESR. Biochemical analysis indicates a moderate increase in bilirubin and transaminase activity (ALT, AST). An ultrasound reveals an enlargement of the bladder wall and an accumulation of exudate around it. When the wall melts, an accumulation of pus is found in the cavity of the bladder.

Chronic form of inflammation

Chronic cholecystitis is less common in women than in men. There are acalculous and calculous inflammation. The inflammation may be purulent or catarrhal. Inflammation in acalculous cholecystitis is localized in the neck of the bladder.

The causes of inflammation are associated with exposure to bacteria or fungi:

• Escherichia;
• staphylococcus;
• streptococcus;
• Pseudomonas aeruginosa;
• Proteus;
• shigella;
• mushrooms.

Chronic processes in the wall of the gallbladder occur with viral hepatitis A, B, C, D. Patients with stagnation of bile, changes in its composition and infections more often suffer from pathology. The following factors play a role in the mechanism of disease development:

• physical inactivity;
• eating disorders;
• allergy.

In women, congestion occurs during pregnancy. The occurrence of pathology in women can also be triggered by dieting and fasting.

During the course of the disease, there are 2 stages - remission and exacerbation. According to the form they are distinguished:

• sluggish;
• recurrent;
• purulent chronic cholecystitis.

Signs of cholecystitis depend on the severity of the disease. A mild course is manifested by two exacerbations per year. Colic bothers patients no more than four times a year. If relapses of the disease occur 4 times a year, they speak of moderate severity. The severe form is manifested by more than 5 relapses per year with frequent colic.

In chronic cases, several syndromes are distinguished:

1. Painful. Manifested by pain in the right hypochondrium. The nature of the symptom is long-term paroxysmal. The pain radiates to the right side of the body (sternum, shoulder, lower back). Occurs mainly due to errors in diet, after stress, overwork. Sometimes the symptoms are accompanied by fever, weakness, and pain in the heart area.
2. Dyspeptic. The syndrome is manifested by belching, nausea, and heaviness. The patient develops bitterness in the mouth, constipation, intolerance to fatty and fried foods; no gases escape. There may be a feeling of “a stake in the chest” after eating.
3. Cholestatic. The syndrome is manifested by an increase in bilirubin in the blood. The patient's skin and sclera turn yellow, urine darkens, and feces become discolored.
4. Asthenovegetative. The syndrome is manifested by excessive thinness of the patient. Fatigue, irritability, and sleep disturbances appear.
5. Intoxicating. During purulent processes, the temperature rises to 39-40 degrees; with ordinary catarrh, the patient’s temperature is 37-38 degrees.
6. Intestinal. The syndrome manifests itself as pain in the navel area. May be accompanied by diarrhea or constipation.

Chronic inflammation can occur in different clinical variants:

• cardiac;
• arthritic;
• neurasthenic;
• low-grade fever;
• hypothalamic.

With the cardiac variant, patients develop arrhythmia and changes are detected on the ECG. After eating, aching pain in the heart may appear (especially when lying down). The arthritic variant is manifested by pain in the joints. The low-grade variant can occur with a temperature of 37-38 degrees for 2 weeks. Patients may experience chills.

The neurasthenic variant occurs with the appearance of fatigue, irritability, malaise, and sleep disturbances. Intoxication may occur. With the hypothalamic variant, trembling of the limbs, increased blood pressure, increased heart rate, angina attacks, swelling, and muscle weakness appear.

Xanthogranulomatous cholecystitis

A rare form of inflammation of the gallbladder, in which the walls of the organ thicken with the formation of cholesterol stones. The mechanism of development of the pathology and the causes of its occurrence have been little studied. The disease manifests itself as attacks of acute cholecystitis. Sometimes doctors observe a picture that is characteristic of chronic inflammation of the gallbladder.

Patients experience colic with pain radiating to the right shoulder and shoulder blade. Symptoms include belching, nausea, vomiting, and bitterness in the mouth. Sometimes fever and chills appear. Upon examination, the doctor reveals pain in the projection of the gallbladder.

It is worth noting that the disease often occurs against the background of gallstone disease. It is recommended to remove the stones. The patient is offered surgery (laparoscopy or cholecystectomy).

If problems arise with the gallbladder, you should not postpone a visit to a gastroenterologist, as complications of the pathology can lead to death. If there is a suspicion of acute cholecystitis, you should not apply a heating pad, take analgesics and laxatives, or rinse the stomach until the doctor arrives.

The site is a medical portal for online consultations of pediatric and adult doctors of all specialties. You can ask a question on the topic "temperature with cholecystitis" and get a free online doctor’s consultation.

Questions and answers on: temperature with cholecystitis

2014-03-17 13:03:53

Irina asks:

Can there be a body temperature with cholecystitis of 38.5 and body aches, headaches,

2015-09-21 20:30:29

Dima asks:

Doctor, help me understand what’s wrong with me. What tests should I take? 3 months ago, pain began in the lower back on the right and left, pain in the right hypochondrium, nausea, weakness... I went for an ultrasound - the liver was enlarged by 4 cm, there was sand in the kidneys. I don't drink, I don't smoke at all. Hepatitis A, B - no, HIV - no. For 2 years I did not treat bacteria of the genitourinary system - mycoplasma and gardnerella. I thought maybe this was affecting something and the urologist prescribed a powerful course of antibiotics - Lavomax, Orgil, Clubax, Fluconazole. and for the liver betargin. I drank this for 3 weeks. I did another ultrasound - the liver is normal. But there was constant dry mouth and insomnia. It hasn't been more than a month. I had a headache after a bad night's sleep. After 3 days in a row I didn’t sleep at all, the pain in the right lower back began again and the temperature was 37-38.5 for 3 days, but after a good sleep it went away. I went to gastroenterology for several days because they found another hernia. resp. diaphragm. And today there was itching of the skin and pimples when scratching on the torso and legs. Here is what we have from the gastroent analysis. An. blood. wedge. - 4.69 * 10 g/m; Hb - 147 g/l; CPU - 0.9 Lake. - 5.1. *10 g/l; ESR - 5 mm/h, polychromasia - 1 conventional unit. units Urinalysis class. - Ud. weight 1020 protein 0.096 g/l, sugar - no, Leukocyte 3-5 e/p/z, Er - occasionally, bacteria - a lot. Coprogram - normal, feces per i/gl - negative; Biochemical research blood - Total protein - 73.1 g/l, C-reactive. protein - negative, blood sugar 5.2 mmol, l; Blood electrolytes Potassium - 4.35, Sodium - 144.6, Chlorine - 103.3, Hbs Ag - negative, PB - negative, ALT - 14.9 units/l, AST - 17.8 units/l, bilirubin total - 10.4 mmol/l, direct - 2.1; indirect - 8.3; Thymol test 2 units, alkaline phosphatase - 58.9 units/l, GGTP 18.8; Blood amylase - 60.1 gh/l; Ultrasound - signs of chronic disease. cholecystitis, MKD. TSH - 3.52. Fasting glucose - 4.36, glucose with load after 30 minutes - 4.48, glucose with load after 60 minutes - 4.37, glucose with load after 90 minutes - 4.33, glucose with load after 120 minutes - 3.86 . Tank. sowing for non-specialized microf. - staphylococus haemolyticus - 10*4, Esherichia coli 10*4. As you can see, I had a fever and a rash appeared, and insomnia and dry mouth for more than a month... maybe some kind of infection. what tests should I take??????????

Answers Vasquez Estuardo Eduardovich:

Good afternoon, Dima! Your condition does not resemble an infectious process; I find more signs of congestion against the background of chronic hepatocholecystopancreatitis (it is possible that signs of gastroduodenitis remained after antibiotics). Further, I evaluate the signs of a nervous system disorder as consequences. Your doctor will take all these points into account. Have a little patience.

2015-07-31 17:07:13

Olga asks:

Good afternoon I am 23 years old. In our family, 3 people had severe vomiting and fever every other day; they didn’t eat the same food, and there was no diarrhea. I vomited 3-4 times during the night and the urge did not stop until I received an injection of metoclopromide. On the second day, my lower back hurt and I also had a fever. And for 3-4 days after each meal (light, diet) I felt nauseated. My family felt better faster, I felt worse, perhaps due to the fact that I already have chronic cholecystitis, I’m almost constantly on a diet. During an endoscopy, they discovered inflammation of the gastric mucosa; on an ultrasound, they found stagnation of bile with flakes; they did probing 4 times and treated it. Mom only gave blood for analysis - everything was normal. After 2 months, the situation repeated itself - 2 people were allegedly poisoned by something while in the village, 2 people felt great, came home and the next day I started vomiting. I was not in the village, I could not eat the same thing that caused others to vomit. All the symptoms were exactly the same as in the first case. What could be the reason and how to avoid recurrence of such situations in the future?

2015-06-07 16:49:44

Valentina asks:

Hello!

My husband in 2009 (23 years old) had poisoning (severe diarrhea for several days and fever; there were no signs of jaundice). They admitted him to the hospital, gave him a blood test and discharged him. Blood biochemistry after treatment showed the following results: ALT 43, AST 36, Cholestyrin 3.06, Triglycerides 0.35, total bilirubin 45, direct 16, indirect 29.
Can there be poisoning in Gilbert's syndrome without jaundice?

A year after diets and physical restrictions. loads, etc., I took a blood test again and all the indicators were normal except bilirubin and cholesterol (total bilirubin 37, direct 10, indirect 27, cholesterol 2.17).

Then, six months later, I was again hospitalized with poisoning, and again everything was normal except bilirubin (Total 45, Direct 15, Indirect 30).

Another year later, everything is normal again except for bilirubin (General 34, Direct 9, Direct 25).

This year I took the tests again and the picture is the same (General 40, Direct 10.3, Indirect 29.7). He was diagnosed with Gilbert's syndrome. I also took a fasting test - I fasted for a day (General 59, direct 11.2, Indirect 47.8). This seemed to confirm the diagnosis.

But I am confused by the fact that everywhere they write that with direct bilirubin syndrome, less than 20% of the total is obtained, and my husband has 25. Could this be due to the syndrome?

And this moment is also confusing: when my husband was 9 years old, he was sick with Botkin, 10 days after recovery he had a blood biochemistry test and the total bilirubin was 22, and six months later he repeated the test and the total bilirubin was 19. How normal! Could this happen with Gilbert's syndrome? Or was the diagnosis made incorrectly?

Can a failure in bilirubin-related processes be acquired?

I also forgot to write for the ultrasound scan. In the ultrasound results for 2010, he was told only about deformation of the gall bladder. In 2011, they wrote about severe deformation of the gall bladder, chronic cholecystitis. And in 2014 they write: diffuse changes in the liver parenchyma, chronic cholecystitis, inflection of the bile duct in the area of ​​the bottom of the body and neck.

Answers Vasquez Estuardo Eduardovich:

Hello, Valentina! Digestive dysfunction in 2009 could have occurred independently of Gilbert's syndrome, which mainly manifests itself clinically or laboratory after age 20. Be guided more by what the attending physician says, and not by what you read (reading what is written in different sources is not a sufficient basis for challenging a doctor’s diagnosis). The diagnosis of “chronic hepatocholecystitis with gallbladder dyskinesia” has probably not yet been excluded by the attending physician and can be raised during the monitoring of the patient.

2013-08-28 13:13:08

Denis asks:

Hello, dear doctors! A controversial and uncertain situation with the diagnosis arose. Nobody can deliver it. The problem concerns my wife of 23 years. Help with professional advice. Everything was like that.
On the evening of 08/22/2013, she began to experience pain in her right side from the side of her stomach and radiating to her back, the nature of which was sharp. Then the temperature gradually rose, but not high to 37.7. An ambulance was called. The emergency doctor said it might be kidney stones. They took her away, but brought her back 2 hours later. There, a gynecologist checked her (everything turned out to be in order), then the surgeon felt her and also suggested that it was the kidneys, dismissing appendicitis. They injected me with a painkiller and referred me to a urologist. The next day we went to the urologist at the general clinic and had a fluorography done (everything was normal). Without conducting any tests or a banal examination, he prescribed etolfort and diclotol. Realizing that the Hippocratic Oath is now out of fashion, I took the initiative into my own hands and decided to conduct examinations privately (of course, with government-qualified doctors in a public clinic, only in a more prestigious one for sailors). Since there were holidays and weekends, we waited for Monday 08/26. During this time, the pain went away and the temperature only in the evening, the general condition improved. An ultrasound was done in the morning. Nothing was shown, there were no stones anywhere, all organs and their sizes with ducts were normal, except for the gallbladder, which was slightly curved. The ultrasound conclusion, based only on complaints, and consultations previously received from the above-mentioned doctors, stated the following signs: hr. cholecystitis, kidney microliths. Next we take blood and urine tests. On 27/08 we came for tests, and there was a whole bunch of abnormalities (Hemoglobin - 132.8, leukocytes - 8.7, ESR - 55 mm/h, band neutrophils - 20%, segmented neutrophils - 40%, eosinophils - 1, lymphocytes - 31 , monocytes - 8, total bilirubin - 13.9, bound bilirubin - 1.3, free bilirubin - 12.6, bilirubin and bacteria in the urine, other blood and urine parameters were normal). The doctor who took and tested the blood said that this was the first time she had seen such indicators and that she did not think that we would come at all. The wife almost faints, it’s horrifying. We decide to retake the tests. Until the next day, there was no fever and no pain; we did not take any prescribed medications or herbal infusions that day. The condition has almost completely returned to full health, no complaints and good tone, as soon as PMS started in my wife (my period should start in the next few days). On 28/08 in the morning on an empty stomach we donate blood and urine again. We arrive at lunch - again awkward tests (Hemoglobin - 130.9, leukocytes - 7.0, ESR - already 60, band - 10, segmented - 60, eosinophils - 1, lymphocytes - 26. monocytes - 3; leukocytes in urine - 30 -35, flat epithelium appeared -3-4, bacteria were as they were). They refer us to nephrology (one doctor in the whole city!). The doctor, having felt and looked at the tests, suggests, but does not make a diagnosis, that it is pyelonephritis and urgent hospitalization is necessary. But her condition is improving every day and the pain goes away almost completely. We don’t know what to do, because he’ll go to the hospital and be pumped full of antibiotics. But the most interesting thing is that no one takes responsibility for officially making a diagnosis, and the treatment has already been thought out. Based on tests and ultrasounds, I called up doctors I knew (some retired, some in another city) and all the time they reported different assumptions: urolithiasis, cholelithiasis, pregnancy, menstruation, cystitis, oncology, in short, a set of all practically diseases. And every day she gets better and better. Based on the information provided, please give advice. Respond to the request, I don’t know what to do, which doctor to go to, what other tests to do, because it’s easiest to go to the ward under a needle, but will there be a result and will the diagnosis be made correctly, and it’s easy to ruin the stomach and liver with antibiotics, while giving it a long way more than one salary.
Best regards Denis!

Answers Vasquez Estuardo Eduardovich:

Hello Denis!
It is very bad when patients and their relatives begin to be introduced into such a delicate profession as medicine (Read: http://medic-info.org/publ/diagnlech/1-1-0-9).
The picture you described is not something terrible. From a medical point of view, it is quite natural that she is feeling better, and tests also show signs of inflammation (this is a further protective reaction of the body), especially since the start of treatment is delayed due to the fact that you continue to conduct various types of consultations.
Apparently, sand of a renal nature came out at first, it is possible that against the background of existing cholecystitis or dyskinesia of the gallbladder, and then the condition can turn into pyelonephritis, if not cured, then of a chronic nature.
Decide and stop with one general practitioner or urologist (any of them is able to correct this problem) and do not further delay the treatment that is offered. You don't have to understand all the intricacies of the prescription or possible side effects!
Unfortunately, not without them, and we doctors do not have the right to think only about the disadvantages; we think about priorities in terms of protecting the patient.

2013-05-22 18:02:00

Angy asks:

Hello, after bronchitis and taking antibiotics, a week after withdrawal, severe pain began in the stomach and intestines, and thrush began. A day later, my lower abdomen and then my left kidney started to hurt. I did a general blood test - leukocytes were at the upper limit (9), everything else was within normal limits (there seemed to be no infection). I did an ultrasound - it didn’t show anything wrong, they diagnosed salt diathesis and cholecystitis (although it was indicated that everything was fine with the gall bladder). They prescribed pills, but in the evening the kidney ached, the pain was simply unbearable, the temperature rose to 38.3, was weak, they called an ambulance and did a urine test (blood clots, leukocytes 3+ (500), red blood cells 4+ (250). They diagnosed left-sided pyelonephritis . Considering the normal blood test and ultrasound, could the inflammation develop in half a day? Or is it something else? They prescribed antibiotic treatment, but earlier, during the examination at the hospital, they said that this could all be caused by drug treatment (too frequent use antibiotics).So is the diagnosis correct, and what is the best treatment?

Answers Chemodanov Sergey Gennadievich:

Hello. It is necessary to do an ultrasound of the kidneys, and, if possible, urography. It is impossible to exclude urolithiasis, and, as a rule, acute pyelonephritis.

2012-09-03 06:40:13

Oksana asks:

Hello. Tell me, can I be poisoned by the vapors of the fire retardant? We had such a treatment in the room after it - headache, burning in the esophagus and stomach, loss of appetite, then temperature (on the 7th day) 39, then the pain in the left hypochondrium remained, then subsided all symptoms after taking Karsil and Omez, and then again acute pain, now in the left hypochondrium of a girdle nature, and moving to the right hypochondrium. Ultrasound cholecystitis, diffuse changes in the pancreas. Treatment with Omez, pancreatin was prescribed, now after 5 days of treatment there is constant pain on both sides , intensifying after eating and with deep breathing. Tell me whether the treatment has been prescribed correctly. What examination should I undergo? I am 26 years old and I would really not like to be diagnosed with cholecystitopancreatitis.

Answers Tsarenko Yuri Vsevolodovich:

Dear Oksana. Fire-retardant intumescent paints "UNIPOL" are high-tech compositions on a modified acrylic base and, if the application technology is violated, are hepatotoxin; treatment is adequate.

2012-07-26 21:43:29

Alexandra asks:

Hello! My 70-year-old grandmother had surgery for rectal cancer in June of this year, the stoma was not removed, over the past month every day the temperature has risen to 37-38 before defecation, after bowel movements the temperature subsides on its own, pain is noted during bowel movements in the anus area. mucus and pus are periodically released with feces. Today the temperature has jumped to 39.6 and nothing can bring it down. From the soot, if you get sick - cholecystitis, pancreatitis. What could be the cause of the grandmother’s condition. How can I help her? Thank you!

Answers Lukashevich Ilona Viktorovna:

Dear Alexandra, you did not indicate which anastomosis was performed on your patient. Without an examination, it is extremely difficult to figure out what happened to your grandmother, but linking the temperature to the act of defecation makes one think about such a complication as anastomosis failure with feces entering the surrounding tissues and the formation of an abscess near the stitched sections of the colon and rectum. This situation requires immediate hospitalization of the patient for further examination and, if this assumption is confirmed, surgical treatment and removal of the ostomy. Call an ambulance and go to the emergency surgical department.

2012-07-20 09:23:20

Dmitry asks:

Good afternoon I am 27 years old.

Please help me determine the cause of the disease or recommend some examination methods.
I have been suffering from hepatitis for 2 months now and there is no exact diagnosis. High bilirubin in the blood is 320. When injecting intravenous solutions, 2 liters per day, it is possible to reduce it to 270. As soon as the amount is reduced, bilirubin rises again to 320 (218-102). Before this I had never suffered from hepatitis and had no complaints about my liver. I don’t abuse alcohol and don’t work with toxic substances.
He suffered from serious illnesses such as pneumonia and an enlarged thyroid gland.

The illness began after I drank a liter of beer with salted sea gobies (homemade). The next day, the chill did not attach any importance to this. On the 3rd day, 05/15/12, the temperature rose to 38-39, aches all over the body, severe weakness, severe sweating with an unpleasant smell of sweat. After eating, pain in the solar plexus, heartburn and nausea. Lost appetite, increased sensitivity to odors (like the flu) 18.05 urine darkened and stool became lighter, temperature dropped, aches and sweating disappeared. My eyes turned yellow and I went to the clinic (I was kept at home for 2 days). On May 21 I was sent to the injection department of the 7th hospital in Dneprodzerzhinsk. After the droppers (Reamberin, saline solution, resorbilact, Ringer's solution, glucose, glutargin, dexamethasone), nausea and severe weakness disappeared.

I spent a month in the infectious diseases hospital and were tested for hepatitis B, C (using the PCR method) and immunoglobulins for B, C, E, A. Ultrasound (echo signs of diffuse changes in the liver parenchyma (acute hepatitis), cholecystitis, exacerbation period). Computed tomography of the abdominal cavity without contrast - conclusion: hepatomegaly, fatty hepatosis. Liver: position has not changed, the size has increased due to the right lobe, the contour is clear and even. The structure of the liver is homogeneous, the density of the liver parenchyma is from 38 to 43 HU (the norm is 50-60 HU). The intra- and extrahepatic bile ducts are not dilated, not changed, the course is centrifugal, the contents are homogeneous. The lymph nodes of the porta hepatis are not enlarged. The rest of the organs are normal.
I had an ERCP. Conclusion: There is no pathology in the ductal system of the rapeseed.
When palpating the abdomen, there is no pain; the abdomen is soft. I have already been checked by 4 surgeons and attending physicians.
Also tested for:
-Screening for autoimmune thyroid diseases No. 3 - normal
-Alpha-fetaprotein (AFP) is normal;
-Perinuclear (p-ANCA) and Cytoplasmic (c-ANCA) antibodies are normal;
- Antimitochondrial antibodies are normal.

At the moment I am worried about itching and sometimes there is pain in the right hypochondrium and the right side of the back. Bilirubin 320. Smoked smells are irritating.

Currently, treatment consists of:
Dexamethasone (the dose was reduced from 6t to 5t; there was no decrease in bilirubin).
Heptral, phosphoglyph.
Ursalizin 900 mg at night after meals (about 25 days now)
Droppers: Cytoflafin in physical. solution 400 ml, Ringer's solution 400 ml, Xylate 400 ml in the morning and glutargin in saline. solution 400 ml, ornitox in glucose 5% 400 ml. In the evening. According to this scheme, it was possible to reduce bilirubin to 270, as soon as the amount was reduced it rose again to 320.
I have been taking Stillat (antibacterial) for 4 days.

Diagnosis so far: cholangitis is in question

Thanks in advance for your help!

Acute cholecystitis is an inflammation of the gallbladder, characterized by a sudden onset, rapid progression and severity of symptoms. This is a disease that occurs for the first time in a patient and, with adequate treatment, ends in recovery. In the same case, if the manifestations of acute cholecystitis are repeated repeatedly, this is regarded as an exacerbation of chronic cholecystitis, which is characterized by a wave-like course.

In women, acute cholecystitis is diagnosed more often than in men. The incidence rate increases with age. In this regard, experts suggest the possible influence of hormonal changes on the development of acute cholecystitis. At increased risk are people who are obese, taking hormonal medications and pregnant women.

Acute cholecystitis is an acute, rapidly developing inflammation of the gallbladder

Causes and risk factors

The main cause of acute cholecystitis is a violation of the outflow of bile from the gallbladder and infection with pathogenic microbial flora (E. coli, salmonella, streptococci, staphylococci). With preserved drainage function, i.e., with undisturbed outflow, infection of bile does not lead to the development of the disease.

Factors that increase the risk of acute cholecystitis include:

• age over 40 years;
• sedentary lifestyle;
• unhealthy diet with a high content of fatty foods in the diet;
• female;
• European race;
• pregnancy;
• hormonal contraception;
• obesity;
• prolonged fasting;
• salmonellosis;
• sickle cell anemia;
• sepsis;
• violation of the rheological properties of blood.

Forms of the disease

Depending on what caused the blockage of the bile duct, calculous (stone-like) and non-calculous (stoneless) acute cholecystitis are distinguished.

According to the degree of morphological changes in the gallbladder, cholecystitis occurs:

• catarrhal - the inflammatory process is limited to the mucous and submucous membrane of the gallbladder;
• phlegmonous - purulent inflammation, in which infiltration of all layers of the walls of the gallbladder occurs. In the absence of treatment, the mucous membrane ulcerates, and the inflammatory exudate penetrates into the paravesical space;
• gangrenous – necrosis of the gallbladder wall occurs (partial or total);
• gangrenous-perforative - perforation of the gallbladder wall in the area of ​​necrosis with the release of bile into the abdominal cavity, which leads to the development of peritonitis;
• Empyema is purulent inflammation of the contents of the gallbladder.

In women, acute cholecystitis is diagnosed more often than in men. The incidence rate increases with age.

Symptoms of acute cholecystitis

The disease begins with a sudden painful attack (biliary or hepatic colic). The pain is localized in the area of ​​the right hypochondrium or epigastrium, and can radiate to the right half of the neck, the right supraclavicular region, and the area of ​​the lower angle of the right scapula. A painful attack usually develops after severe emotional stress, consumption of fatty, spicy foods and/or alcohol. The pain is accompanied by nausea and vomiting, increased body temperature. Approximately 20% of patients develop obstructive jaundice, caused by blockage of the bile duct by edema or stone.

Specific symptoms of acute cholecystitis:

• Murphy's symptom - the patient involuntarily holds his breath when pressure is applied to the right hypochondrium;
• Ortner's symptom - tapping along the edge of the right lower costal arch is accompanied by increased pain;
• Kehr's symptom - increased pain on inspiration during palpation in the right hypochondrium;
• phrenicus symptom (de Mussy-Georgievsky symptom) – finger pressure between the legs of the sternocleidomastoid muscle on the right is accompanied by painful sensations;
• percussion of the anterior abdominal wall reveals tympanitis, which is explained by the development of reflex intestinal paresis.

A sign of the development of peritonitis, i.e., involvement of the peritoneum in the inflammatory process, is a positive Shchetkin-Blumberg symptom - sharp pain when withdrawing the hand pressing on the abdomen.

Diagnosis of acute cholecystitis

The diagnosis of acute cholecystitis is made on the basis of a characteristic clinical picture, confirmed by laboratory and instrumental examination data:

• general blood test (leukocytosis, shift of the leukocyte formula to the left, acceleration of ESR);
• biochemical blood test (increased activity of liver enzymes, increased alkaline phosphatase, bilirubin);
• general urine test (appearance of bilirubin in obstructive jaundice);
• Ultrasound scanning of the gallbladder (presence of stones, thickening of the walls, infiltration of the paravesical space);
• radioisotope scanning of the gallbladder;
• chest radiography and electrocardiography for the purpose of differential diagnosis.

Those at increased risk of acute cholecystitis are people who are obese, taking hormonal medications, and pregnant women.

X-ray of the abdominal cavity in this disease is not very informative, because in 90% of cases, gallstones are X-ray negative.

Differential diagnosis of acute cholecystitis with the following diseases is necessary:

Treatment of acute cholecystitis is carried out in the surgical department of a hospital; strict bed rest is indicated. During the first 24-48 hours, gastric contents are evacuated through a nasogastric tube. During this period, fluid is administered intravenously.

After the signs of acute inflammation subside, the probe is removed and the patient is prescribed a water-tea break for several days, and then diet No. 5a according to Pevzner. 3-4 weeks after all the symptoms of the disease have subsided, the diet is expanded, and the patient is transferred to diet No. 5. Diet for acute cholecystitis is one of the main methods of treatment. Frequent meals in small portions promote good bile flow. To reduce the load on the liver and biliary system, it is reasonable to reduce the content of animal fats, seasonings, and essential oils in the diet.

Western experts have a different approach to organizing a diet for acute cholecystitis. They also limit the fat content in the diet, but recommend eating no more than 2-3 times a day with a mandatory 12-16-hour break at night.

Conservative treatment of acute cholecystitis includes performing a perinephric novocaine blockade according to Vishnevsky to relieve acute pain, as well as prescribing antispasmodic and antibacterial drugs.

After relief of the symptoms of acute cholecystitis in the presence of stones in the gallbladder, lithotripsy is recommended, i.e. dissolution of stones (with ursodeoxycholic and chenodeoxycholic acids).

Surgical treatment of acute cholecystitis is carried out for the following indications:

• emergency – development of complications (peritonitis, etc.);
• urgent – ​​ineffectiveness of conservative therapy carried out within 1-2 days.

The essence of the operation is to remove the gallbladder (cholecystectomy). It is performed using both traditional open and laparoscopic methods.

Possible consequences and complications

Acute cholecystitis is a dangerous disease that, in the absence of qualified help, can lead to the development of the following complications:

• empyema (acute purulent inflammation) of the gallbladder;
• perforation of the gallbladder wall with the formation of a peri-vesical abscess or peritonitis;
• cholelithiasis (obstruction of the lumen of the small intestine by a large calculus migrating from the gallbladder);
• emphysematous cholecystitis (develops as a result of infection of bile by gas-forming bacteria - clostridia).

After removal of the gallbladder, a small proportion of patients develop postcholecystectomy syndrome, manifested by frequent loose stools. In this case, following a diet helps to quickly achieve normalization. In only 1% of operated patients, diarrhea is persistent and requires drug treatment.

Forecast

The prognosis for uncomplicated forms of acute cholecystitis, provided timely medical care is provided, is generally favorable. Acute non-calculous cholecystitis usually ends in complete recovery and only in a small percentage of cases becomes chronic; the likelihood of chronicity of acute calculous cholecystitis is much higher.

The prognosis sharply worsens with the development of complications (peritonitis, peri-vesical abscess, empyema). The probability of death in this case is, according to various sources, 25–50%.

Prevention

Prevention of acute cholecystitis includes the following measures:

• compliance with the rules of a healthy diet (limiting fats and spices, eating small portions, dinner no later than 2-3 hours before bedtime);
• refusal to abuse alcoholic beverages;
• sufficient physical activity during the day;
• compliance with the water regime (during the day you should drink at least 1.5 liters of liquid);
• avoiding psycho-emotional stress and physical overload;
• normalization of body weight;
• timely diagnosis and treatment of helminthic infestations (giardiasis, ascariasis).

Video from YouTube on the topic of the article:

Fatty foods are the main “provocateur” of exacerbation of cholecystitis

That is why it is important to know the symptoms of exacerbation of chronic cholecystitis - in order to quickly take action and seek medical help.

What provokes an exacerbation

Chronic cholecystitis can be (with stones) or without stones. Exacerbation of the latter can be provoked by:

• consuming large amounts of fatty, fatty, smoked or pickled foods, as well as combinations of these unhealthy foods;
• binge eating;
• drinking alcohol;
• severe stress;
• allergies - especially food allergies;
• a diet that lacked fiber and plant fiber for a long time.

In the case of calculous cholecystitis, exacerbation can be additionally caused by:

• bumpy ride;
• physical activity (especially after a long period of physical inactivity);
• a sudden change in body position, especially if the person has eaten a heavy meal beforehand.

Exacerbation of chronic cholecystitis is more likely to occur in a person with the following conditions:

1. abnormalities in the development of the biliary tract;
2. obesity;
3. dyskinesia (impaired coordination of muscle movements) of the biliary tract;
4. during pregnancy;
5. during hypothermia, colds or exacerbation of chronic pathologies of internal organs.

Warning! Chronic cholecystitis can be in the acute stage from 1 time per month to 3-4 relapses per year. Depending on this, doctors talk about mild, moderate or severe course of the disease, which determines the general tactics of its treatment.

Signs of exacerbation

The main ones are abdominal pain, disorders called “dyspepsia,” weakness, and fever. Let's look at each of them in more detail.

Pain syndrome

The first thing that indicates an exacerbation of chronic cholecystitis is abdominal pain. Its location, intensity and duration depend on the following individual characteristics:

• what type of cholecystitis is accompanied by;
• are there any complications of gallbladder inflammation;
• whether there are (and what exactly) concomitant diseases of the digestive tract.

The last factor will influence the prescribed treatment, but especially the diet during exacerbation of chronic cholecystitis.

The main symptom of exacerbation is pain in the right hypochondrium

Pain during exacerbation of pathology is usually located in the right hypochondrium, but can also be felt in the area “under the stomach”. It may be constant, not very strong, aching in nature, and may even be felt not as pain, but as a heaviness under the right rib.

The above characteristics of pain are more typical for decreased tone of the gallbladder. If the tone of the organ is increased, or the exacerbation was provoked by the movement of a stone, signs of exacerbation of chronic cholecystitis will be called biliary colic. It is a pain:

• strong;
• on the right under the rib;
• paroxysmal in nature;
• radiating to the right shoulder blade, shoulder or under the collarbone;
• relieved by applying a warm heating pad to the area;
• after vomiting the pain intensifies.

If cholecystitis is complicated by the spread of inflammation to the peritoneum, which “envelops” the gallbladder, then other characteristics of pain appear:

1. constant;
2. worsens when moving the right hand or bending the body, turning.

If an exacerbation of cholecystitis has led to the development of inflammation in the pancreas, the pain may become girdling in nature, radiating to the pit of the stomach, the left hypochondrium, and the area around the navel.

When inflammation of the gallbladder has led to irritation of the solar plexus, the pain is described as:

• having a burning character;
• intense;
• radiating to the back;
• aggravated by pressing on the lower area of ​​the sternum.

Dyspepsia

This term refers to the following symptoms indicating that chronic cholecystitis has worsened:

1. bitterness in the mouth;
2. vomiting - mixed with bile;
3. nausea;
4. belching bitter;
5. bloating;
6. diarrhea.

Itchy skin

A person is bothered by itching when bile stagnates in its ducts, its pressure in them increases, and some of the bile acids enter the blood. The whole body may itch, but the itch can be felt anywhere.

Warning! The symptom is more typical for cholelithiasis, but can also appear in the acalculous version of chronic cholecystitis. This sign indicates that treatment of the disease should be carried out in a hospital and not at home.

Other symptoms

In a quarter of people, an exacerbation of the inflammatory process of the gallbladder will be accompanied by pain in the heart, which is associated with the commonality of the nerve fibers of these two organs.

Skin itching and increased bilirubin levels in the blood lead to psycho-emotional disorders:

• weaknesses;
• irritability;
• increased fatigue;
• rapid mood changes.

In 30-40% of people, exacerbation of cholecystitis will be accompanied by an increase in temperature up to 38 degrees.

Additionally, joint pain, headaches, weakness in the limbs, increased sweating, arrhythmia and increased heart rate may also occur.

Help with exacerbations

The main thing to do in case of exacerbation of cholecystitis is to seek medical help. A person can either call an ambulance if the pain is very severe or is accompanied by a deterioration in the general condition, or go to an appointment with a gastroenterologist on the same day as the first signs of exacerbation of the disease appear.

First aid for cholecystitis should be provided by an ambulance team or doctors at a surgical hospital. Medical professionals will make a diagnosis and measure the person’s overall condition, such as blood pressure and pulse. Depending on this, they will decide what to use for pain relief: drugs that reduce muscle tone (they also reduce pressure in blood vessels), or direct painkillers. You don’t need to take any pills until the specialists arrive - you could harm yourself.

Rosehip decoction is an excellent choleretic agent, but it should not be used during an exacerbation.

All you can do before paramedics arrive is:

• do not eat food (especially if there is nausea or vomiting);
• drink liquid in small amounts;
• lie down in bed, taking a comfortable position (usually on your right side);
• put a slightly warm heating pad under your side, while strictly monitoring your sensations. If this causes increased pain, the heating pad should be removed.

Warning! You should not take any herbs (especially choleretic), drink medications, or warm your stomach in a warm bath. Even if before an exacerbation a “blind tubage” was prescribed, then during an exacerbation it is contraindicated - by strengthening the work of the diseased gallbladder, you can provoke the development of surgical complications in yourself.

Treatment of exacerbation of chronic cholecystitis is carried out first in surgical and then therapeutic complications. A person is prescribed injectable forms of antibiotics, drugs that relieve spasms of the gallbladder muscles, painkillers, medications necessary for the treatment of concomitant diseases of the pancreas, stomach, and intestines. If necessary, surgery is performed to remove the gallbladder.

If a decision is made on conservative treatment of the pathology, it is imperative that in case of exacerbation of cholecystitis, it is necessary to provide the body with everything necessary, while “switching off” the contractions (but ensuring the outflow of bile) of the diseased gallbladder, giving it the opportunity to recover.

Meets the following requirements:

1. In the first two days, you need to fast, drink only weak and unsweetened tea, rice water in a total volume of at least 2 liters per day. At the same time, you need to drink liquid in small portions so that it is absorbed.
2. On the third day, if the pain subsides, the diet is expanded. Introduced: vegetable soups, liquid non-dairy porridges (semolina, oatmeal, rice), jelly from non-acidic berries.
3. By day 5, boiled meat and low-fat fish and dairy products are added.
4. After another 2 days, food can be seasoned with a small amount of vegetable oil or butter. You can already add dairy products, sweet fruits, potatoes, stewed cauliflower, baked apples without peel, white bread crackers, and a boiled egg to your diet.
5. Under no circumstances should you eat: pickles, marinades, onions, sorrel, spinach, white cabbage, or drink alcohol.
6. Simple carbohydrates are limited.

Physiotherapy and herbal intake are very useful outside of exacerbation of the disease. The attending physician-therapist, to whose “department” the person is transferred to relieve the symptoms of exacerbation of cholecystitis, should tell you when they can be introduced into treatment.