Calculous cholecystitis
The content of the article:
- Causes of calculous cholecystitis and risk factors for its development
- Forms of the disease
- Symptoms of calculous cholecystitis
- Diagnostics
- Treatment of calculous cholecystitis
- Possible complications and consequences
- Forecast
- Prevention
Calculous cholecystitis is multifactorial, that is, a disease developing as a result of the influence of many causal factors, acute or chronic inflammation of the gallbladder, a prerequisite for which is the presence of stones (calculi) in its lumen.
Calculous cholecystitis - inflammation of the gallbladder with the formation of stones in its lumen
Despite the fact that chronic calculous cholecystitis is the main manifestation of gallstone disease, its symptomatic form, in most cases these concepts are usually identified, since the presence of stones in the gallbladder cavity irreversibly leads to the development of inflammatory changes in it, asymptomatic calculus carriage is quite rare phenomenon.
Currently, in economically developed countries, there is a steady tendency towards an increase in the incidence by about 2 times every 10 years. Recent studies indicate that 1/10 of the world's population suffers from calculous cholecystitis; according to preliminary estimates, by 2050 the number of such patients will at least double. In the Russian Federation, the prevalence of the disease is approximately 12%, in most cases people aged 40 to 60 suffer, women get sick 6 times more often than men.
Calculous cholecystitis is sometimes called a "disease of well-being", since the main prerequisites for its development are an excessive amount of animal fats, refined carbohydrates in the diet, a small amount of plant foods, and a high calorie content of the meals consumed.
In the structure of the surgical pathology of the gastrointestinal tract, calculous cholecystitis also occupies one of the leading positions: for example, in Russia, more than 100,000 operations on the abdominal cavity are performed annually to remove an altered, functionally incompetent gallbladder.
Causes of calculous cholecystitis and risk factors for its development
The gallbladder is a hollow saccular organ with a thin wall, with a volume of 30 to 70 ml, lying in a corresponding fossa on the hepatic surface. The production of bile does not occur in it: here it accumulates, being delivered from the liver lobules along the common hepatic and cystic ducts, and matures.
After each meal (in portions), as well as in small volumes during the day, bile is secreted from the bladder into the duodenum through the bile duct to ensure normal physiology of digestion. In total, 500-600 ml of bile is formed in the liver per day.
As a result of a change in the physicochemical properties of bile, its infection, impaired motility (dyskinesia) of the ducts, the presence of some concomitant diseases and the effects of other causes, sedimentation occurs, the formation of microcrystallization embryos, transforming into gallstones (calculi).
Stagnation of bile is accompanied by damage to the inner lining of the gallbladder, the release of pro-inflammatory enzymes and inflammatory mediators, which provoke the development of a local inflammatory reaction, to which, often, a bacterial infection joins again (normally bile is sterile).
Concrements in most cases have a rounded shape, sometimes - faceted, ground to each other surfaces (faceted stones), can be single and multiple, in severe cases, occupying the entire lumen of the bladder.
By chemical composition, gallstones can be of the following types:
- cholesterol (formed around crystallized cholesterol molecules);
- pigmented (consisting mainly of calcium bilirubinate, formed due to the precipitation of insoluble indirect bilirubin);
- mixed.
Causes of calculous cholecystitis:
- chronic hemolytic anemia;
- cirrhosis of the liver (including with alcoholic illness);
- infectious processes in the bile ducts;
- congenital metabolic diseases;
- dysfunction of the intestinal-hepatic circulation (long-term parenteral nutrition, pathology or resection of the ileum);
- enzymatic pathologies;
- pathology of the structure of the hepatobiliary zone, which determines the violation of the passage of bile;
- systematic violation of the principles of balanced nutrition;
- stagnation in the gallbladder, provoked by mechanical compression by volumetric neoplasms of neighboring organs.
Liver cirrhosis can lead to calculous cholecystitis
Risk factors:
- female sex, high fertility (fertility);
- pregnancy;
- rapid weight loss (low-calorie diet);
- long intervals between meals;
- excessive body weight;
- massive surgical interventions;
- extensive burns;
- neuroendocrine disorders;
- chronic psycho-emotional overstrain or acute stress;
- inadequate physical activity;
- taking oral contraceptives;
- genetic predisposition (burdened family history of calculous cholecystitis);
- frequent consumption of spicy, spicy, fatty, fried, salty foods;
- low content in the diet of dietary fiber, fiber;
- old age (age-related involution);
- hypodynamia;
- high blood cholesterol levels; and etc.
Forms of the disease
Depending on the duration of the course, calculous cholecystitis can be of two forms:
- acute - characterized by a sharp, intense pain syndrome due to blockage of the bile duct calculus at any level or the neck of the gallbladder, infection of the contents;
- chronic - a long sluggish process with episodes of exacerbations and remissions.
Nevertheless, even with the manifestation of the disease with an acute attack, it is advisable to regard it as an exacerbation of a latent chronic process, since the formation of stones implies a long existence of pathology.
Forms of chronic calculous cholecystitis depending on the course of the inflammatory process:
- rarely recurrent;
- often relapsing;
- monotone;
- atypical chronic cholecystitis.
According to the phase of the disease:
- aggravation;
- fading exacerbation;
- remission (persistent, unstable).
Depending on the severity, calculous cholecystitis is classified into mild, moderate and severe forms.
Symptoms of calculous cholecystitis
The manifestations of calculous cholecystitis depend on many factors:
- the number and size of calculi;
- localization of calculi;
- the degree of exposure to provocateurs;
- the initial state of the patient's body;
- the presence of a secondary infection.
In the interictal period (in remission), the course of chronic calculous cholecystitis does not differ in a pronounced clinical picture, the following manifestations of the disease are characteristic:
- discomfort, discomfort in the liver area, aggravated after exertion, with errors in the diet, dull, non-intense bursting pains after eating are possible, spreading to the right shoulder, right half of the neck, back;
- the appearance or intensification of painful sensations after sudden movements, prolonged stay in an inclined position;
- recurrent heaviness in the right hypochondrium;
- bitterness, dry mouth;
- liver odor from the mouth;
- belching bitter;
- nausea;
- tendency to constipation.
In more than 70% of cases, the main manifestations of chronic calculous cholecystitis (especially in elderly patients) are asthenic symptoms: general weakness, drowsiness, recurring headaches, episodes of dizziness, intolerance to intense exertion, decreased ability to work, irritability, tearfulness, etc.
Bitterness in the mouth may indicate calculous cholecystitis.
Symptoms of calculous cholecystitis with an exacerbation of a chronic process and in an acute form of the disease are similar:
- paroxysmal (cramping) acute, high intensity pain in the right hypochondrium lasting from several hours to several days (pain syndrome is longer than biliary colic, not accompanied by inflammation of the bladder);
- irradiation of pain to the right side, right half of the back, neck, lower back;
- nausea, repeated vomiting (first with an admixture of previously eaten food, then - a bitter yellowish liquid);
- belching bitter;
- bitterness in the mouth;
- bloating;
- reflex urinary retention, stool;
- an increase in body temperature up to 38-39 ºС, chills, torrential sweat (in some cases);
- the development of obstructive jaundice during fixation of calculi in the common bile duct (urine the color of beer, discoloration of feces, yellowing of the sclera and skin).
A characteristic feature of calculous cholecystitis in the elderly and senile age is a latent course: blurred clinical picture and the absence of obvious signs of the disease in most cases (more than 75% of patients).
Diagnostics
Diagnostic measures for suspected calculous cholecystitis:
- clinical blood test (increase in ESR, increase in the number of leukocytes with a neutrophilic shift to the left);
- biochemical blood test (increased cholesterol, conjugated bilirubin, acute phase markers in an acute process or exacerbation of a chronic one);
- Ultrasound of the abdominal organs (the presence of calculi in the gallbladder cavity or in the lumen of the bile ducts, inflammatory changes in the cystic wall);
- cholecystography, cholangiography;
- hepatocholescintigraphy;
- endoscopic retrograde cholangiopancreatography (ERPCG).
Treatment of calculous cholecystitis
The main goals of treating calculous cholecystitis are:
- relief of an acute condition;
- neutralization of pain syndrome;
- preventing the development of complications (including life-threatening ones).
Exacerbation of chronic or an attack of acute calculous cholecystitis are indications for hospitalization of the patient in a hospital and deciding on the expediency of surgery during the first hours.
In the absence of contraindications, preference is given to early, within the first 3 days after hospitalization, endoscopic cholecystectomy (mortality and the likelihood of developing postoperative complications in this case are minimal) after preliminary infusion and drug therapy:
- detoxifying agents;
- antibacterial drugs;
- antispasmodics;
- antiemetics;
- enzyme preparations;
- drugs for the relief of concomitant dyspeptic disorders.
Endoscopic cholecystectomy is indicated for acute calculous cholecystitis
Patients with acute complicated cholecystitis are subject to emergency abdominal surgery.
Treatment of chronic calculous cholecystitis during the period of remission is carried out in several directions:
- destruction of stones (oral, with medication (ursodeoxycholic or chenodeoxycholic acid) or with extracorporeal shock wave lithotripsy);
- pharmacotherapy aimed at normalizing the functioning of the gastrointestinal tract (antispasmodics, prokinetics, enzyme preparations, enterosorbents);
- diet therapy (fractional, frequent meals, refusal of fatty, fried, high-calorie foods, foods containing coarse vegetable fiber, adherence to the water regime - 1.5-2 liters per day).
Possible complications and consequences
Complications of calculous cholecystitis can be:
- postcholecystectomy syndrome after removal of the gallbladder (up to 50% of patients);
- cholangitis;
- pancreatitis;
- pericholecystitis;
- peritonitis;
- empyema, gangrene of the gallbladder;
- biliary fistula, intestinal obstruction;
- hepatitis, cirrhosis;
- peri-vesicular abscess, etc.
Forecast
With an uncomplicated course, the prognosis is favorable. Mortality in complicated calculous cholecystitis (peritonitis, empyema, gallbladder gangrene, formation of fistulas, abscesses, etc.) or in the presence of a severe concomitant pathology in the patient reaches 50-60%.
Prevention
- Compliance with a rational diet.
- Refusal from overeating, starvation, forced weight loss.
- Adequate physical activity.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
