Acute cholecystitis
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms of acute cholecystitis
- Diagnosis of acute cholecystitis
- Treatment of acute cholecystitis
- Potential consequences and complications
- Forecast
- Prevention
Acute cholecystitis is an inflammation of the gallbladder characterized by sudden onset, rapid onset and severity of symptoms. This is a disease that occurs in a patient for the first time 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 wavy course.
In women, acute cholecystitis is diagnosed more often than in men. The incidence increases with age. In this regard, experts suggest that hormonal changes may affect the development of acute cholecystitis. Obese people, taking hormones and pregnant women are at high risk.
Acute cholecystitis - 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 its infection with pathogenic microbial flora (Escherichia coli, salmonella, streptococci, staphylococci). With a preserved drainage function, i.e., with an undisturbed outflow, infection of bile does not lead to the development of the disease.
In 90-95% of patients, calculus (stone) leads to obstruction of the bile duct. In other cases, a violation of the outflow of bile occurs due to edema of the walls of the bile duct, caused by an inflammatory process or its blockage by parasites, a tumor. Most often acalculous acute cholecystitis develops secondarily, against the background of sepsis, salmonellosis, traumatic injuries.
Factors that increase the risk of acute cholecystitis include:
- age over 40;
- sedentary lifestyle;
- improper diet with a high content of fatty foods in the diet;
- female;
- European race;
- pregnancy;
- hormonal contraception;
- obesity;
- prolonged fasting;
- salmonellosis;
- sickle cell anemia;
- diabetes;
- sepsis;
- gastritis with low acidity;
- violation of the rheological properties of blood.
In most cases, the cause of acute cholecystitis is a stone in the bile duct.
Forms of the disease
Depending on what caused the blockage of the bile duct, calculous (stone) and non-calculous (acalculous) acute cholecystitis are distinguished.
According to the degree of morphological changes in the gallbladder, cholecystitis is:
- catarrhal - the inflammatory process is limited to the mucosa and submucosa 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 enters the peri-vesicular space;
- gangrenous - necrosis of the gallbladder wall occurs (partial or total);
- gangrenous-perforated - perforation of the gallbladder wall in the necrosis zone with the release of bile into the abdominal cavity, which leads to the development of peritonitis;
- empyema - purulent inflammation of the contents of the gallbladder.
Symptoms of acute cholecystitis
The disease begins with a sudden painful attack (biliary, or hepatic colic). The pain is localized in the region of the right hypochondrium or epigastrium, it can radiate to the right half of the neck, the right supraclavicular region, to the region of the lower corner of the right scapula. A pain attack usually develops after severe emotional stress, eating fatty, spicy foods and / or alcohol. The pain is accompanied by nausea and vomiting, an increase in body temperature. About 20% of patients develop obstructive jaundice, caused by blockage of the bile duct by edema or calculus.
Specific symptoms of acute cholecystitis:
- Murphy's symptom - the patient involuntarily holds his breath at the moment of pressure in the right hypochondrium;
- Ortner's symptom - tapping along the edge of the right lower costal arch is accompanied by increased painful sensations;
- Kera's symptom - increased pain on inspiration during palpation in the right hypochondrium;
- phrenicus symptom (de Mussey-Georgievsky symptom) - pressing with a finger between the legs of the sternocleidomastoid muscle on the right is accompanied by painful sensations;
- with percussion of the anterior abdominal wall, tympanitis is detected, which is explained by the development of reflex paresis of the intestine.
Acute cholecystitis begins with sudden biliary or hepatic colic
A sign of the development of peritonitis, that is, involvement in the inflammatory process of the peritoneum, is a positive symptom of Shchetkin-Blumberg - a sharp pain when the hand is pulled back, pressing on the stomach.
Diagnosis of acute cholecystitis
The diagnosis of acute cholecystitis is made on the basis of a characteristic clinical picture, confirmed by the data of laboratory and instrumental examination:
- 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 analysis (the appearance of bilirubin with obstructive jaundice);
- ultrasound scanning of the gallbladder (presence of stones, thickening of the walls, infiltration of the peri-vesicular space);
- radioisotope scanning of the gallbladder;
- chest x-ray and electrocardiography for differential diagnosis.
Radiography of the abdominal cavity with this disease is not very informative, since in 90% of cases, gallbladder stones are X-ray negative.
Ultrasound of the gallbladder in acute cholecystitis can detect calculi
Differential diagnosis of acute cholecystitis with the following diseases is required:
- penetrating or perforated ulcer of the stomach and / or duodenum;
- gastralgic form of myocardial infarction;
- acute pancreatitis;
- hernia of the esophageal opening of the diaphragm;
- acute appendicitis;
- right-sided lower lobe pneumonia;
- acute hepatitis;
- some parasitic infections.
Treatment of acute cholecystitis
Treatment of acute cholecystitis is carried out in the surgical department of the hospital, strict bed rest is shown. During the first 24-48 hours, gastric contents are evacuated through a nasogastric tube. The liquid is administered intravenously during this period.
Treatment of acute cholecystitis is carried out in a surgical department
After the signs of acute inflammation have subsided, 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 symptoms of the disease have subsided, the diet expands, and the patient is transferred to diet No. 5. Diet for acute cholecystitis is one of the main methods of treatment. Eating small meals often helps bile flow well. To reduce the load on the liver and biliary system in the diet, the content of animal fats, spices, and essential oils is reasonably reduced.
Western experts have a different approach to the organization of the diet for acute cholecystitis. They also limit the amount of fat in the diet, but they 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 perirenal novocaine blockade according to Vishnevsky in order to relieve acute pain syndrome, as well as the appointment of antispasmodic and antibacterial drugs.
The optimal choice may be Odeston - a drug with a rare combination of simultaneously choleretic and selective (targeted) antispasmodic action, affecting exclusively the sphincter of Oddi and the bile ducts, which helps to regulate the circulation of bile and is used to treat diseases of the gallbladder and biliary tract, including gallstone diseases (cholelithiasis).
After stopping the symptoms of acute cholecystitis in the presence of stones in the gallbladder, lithotripsy is recommended, that is, dissolution of stones (with ursodeoxycholic and chenodeoxycholic acids).
Diet therapy is an important part of the treatment of acute cholecystitis
Surgical treatment of acute cholecystitis is carried out according to the following indications:
- emergency - the development of complications (peritonitis, etc.);
- urgent - the 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 the traditional open and laparoscopic methods.
Potential consequences and complications
Acute cholecystitis is a dangerous disease that, in the absence of qualified assistance, 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-vesicular abscess or peritonitis;
- gallstone obstruction of the intestine (overlap of the lumen of the small intestine by a calculus of significant size migrating from the gallbladder);
- emphysematous cholecystitis (develops as a result of infection of bile with gas-forming bacteria - clostridia).
After removal of the gallbladder, a small proportion of patients develop postcholecystectomy syndrome, manifested by frequent loose stools. Compliance with the diet helps to quickly achieve normalization in this case. Only in 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 with complete recovery and only in a small percentage of cases becomes chronic, the likelihood of chronic acute calculous cholecystitis is much higher.
The prognosis deteriorates sharply with the development of complications (peritonitis, peri-vesicular 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:
- adherence to the rules of a healthy diet (limiting fats and spices, eating in small portions, having dinner no later than 2-3 hours before bedtime);
- refusal to abuse alcoholic beverages;
- getting enough physical activity during the day;
- compliance with the water regime (during the day, you should drink at least 1.5 liters of liquid);
- avoidance of psycho-emotional stress and physical overload;
- normalization of body weight;
- timely diagnosis and treatment of helminthic invasions (giardiasis, ascariasis).
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
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!
