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Acute cholecystitis


Inflammation of the gallbladder wall when microbes enter it. It is possible both against the background of gallstone disease, and in the absence of stones. Women suffer more often.
Symptoms and course:
Typically an acute onset after an error in the diet: plentiful, fatty, fried or spicy foods, drinking alcohol, confectionery with cream, mushrooms, etc. Pain in the right hypochondrium is usually severe (as with biliary colic), is given to the back, right shoulder blade, right supraclavicular region. If pancreatitis joins, then they spread to the left hypochondrium. In older people suffering from coronary heart disease, pain can occur at the left of the sternum or behind the sternum - reflex angina pectoris. Many patients have nausea and vomiting, first eaten by food, and subsequently with an admixture of bile or bile. The temperature rises from low subfebrile numbers to high. On palpation of the abdomen, pain in the right hypochondrium and under the spoon is determined, the abdominal muscles are tense, after 2-4 days a painfully strained gall bladder begins to be felt in the form of a rounded formation, as well as an enlarged painful liver. The pulse is quickened, blood pressure tends to decrease in most patients by 2-3 days yellowness of the skin, sclera and mucous membranes appears.
The following forms of acute cholecystitis are distinguished.
The catarrhal form occurs with a low temperature, moderate pain lasting from 2 to 7 days, minor changes in blood tests - leukocytosis up to 12000. Timely and proper drug therapy leads to recovery, otherwise it can go into a phlegmonous form.
Phlegmonous cholecystitis is more severe: severe pain, often vomiting, unbearable relief, high fever (38-39 ± C), chills, severe general weakness, loss of appetite, expressed leukocytosis in blood tests.
Gangrenous cholecystitis is more severe than phlegmonous, temperature is above 39 ± C, peritonitis is often attached - inflammation of the peritoneum. Without timely surgery, it can be fatal.
In the elderly, even phlegmonous and gangrenous cholecystitis is not always clearly defined: the temperature increase can be slight, the pain and symptoms of peritoneal irritation are mild or completely absent.
The complications of acute cholecystitis include: perforation (violation of the integrity of the wall) of the gallbladder with the subsequent development of purulent or biliary peritonitis, the formation of fistulas or abscesses, acute cholangitis. Blockage of the neck of the bladder or its duct when a large stone is wedged in leads to a gall bladder stretching, if it is mucus, then it is called “mucocele”, transparent transudate is “dropsy”, pus is “empyema”. Concomitant pancreatic inflammation - reactive pancreatitis is a fairly common complication.
Recognition of acute cholecystitis is difficult, since its manifestations resemble other diseases of the abdominal organs: acute appendicitis, pancreatitis, perforated gastric and duodenal ulcers, right-sided renal colic and acute pyelonephritis. The diagnosis is made on the basis of the clinic, from the laboratory data the number of leukocytes matters. Ultrasound allows you to identify stones in the biliary tract, swelling of the wall of the gallbladder, its size, condition of the main bile ducts. Of the x-ray methods, a survey picture of the abdominal cavity is important.
Treatment:
Patients with acute cholecystitis, regardless of condition, should be hospitalized in the surgical department of the hospital. Assigned to bed rest, hunger, warmer with ice on the right hypochondrium. Injections are prescribed antispasmodics, baralgin, analgin. Detoxification therapy is carried out by intravenous administration of solutions of 5% glucose, saline, hemodesis, with a total amount of 2-3 liters per day. Broad-spectrum antibiotics are prescribed. If the inflammatory process does not subside within 24 hours of intensive treatment, patients are indicated for surgery - removal of the gallbladder (cholecystectomy).