chronic cholecystitis

Chronic cholecystitis - chronic inflammation of the gallbladder. The disease is common, more common in women.

Etiology, pathogenesis. The bacterial flora (E. coli, streptococci, staphylococci, and others.), In rare cases - anaerobes, worm infestation (roundworm) and fungal infection (actinomycosis), hepatitis viruses; cholecystitis occur toxic and allergic nature. Penetration of the microbial flora in the gallbladder happens enterogenous, hematogenous or lymphogenous way. Predisposing factors of occurrence of cholecystitis is the stagnation of bile in the gall bladder, which can cause gallstones, passing-ment and excesses biliary dyskinesia gallbladder and biliary tract, disturbances of tone and motor function of the biliary tract under the influence of various emotional stress, endocrine and autonomic disorders , reflexes of pathologically altered organs of the digestive system. Stagnation of bile in the gall bladder and contribute to the omission of the viscera, pregnancy, lack of exercise, sparse meals, etc.; also it has the value of a throw of pancreatic juice into the bile path when their psoriasis with its proteolytic action on the mucous membrane of the bile ducts and gall bladder.

The immediate trigger for the outbreak of inflammation in the gallbladder often overeating, especially the reception is very oily and spicy food, alcohol intake, acute inflammation in other organs (tonsillitis, pneumonia, adnexitis, and so on. D.).

Chronic cholecystitis can occur after acute, but more likely to develop on their own, and gradually, against gallstones, gastritis with secretory insufficiency, chronic pancreatitis and other diseases of the digestive organs, obesity.

Symptoms within. Characterized by a dull, aching pain in the right hypochondrium, either permanently or occurs after 1-3 hours after ingestion and is particularly abundant fatty and fried foods. The pain may radiate up to the right shoulder and neck, right shoulder blade. From time to time may occur a sharp pain resembling biliary colic frequent dyspeptic symptoms: a sense of bitterness and metallic taste in the mouth, belching air, nausea, bloating, disturbance of bowel movements (often alternating constipation and diarrhea), as well as irritability, insomnia. Jaundice is not typical. On palpation of the abdomen, usually determined by the sensitivity and sometimes soreness in the projection of the gall bladder to the anterior abdominal wall and light resistance of the abdominal wall muscle (resistance). Often the positive symptoms Musso - St. George's, Ortner, Obraztsova - Murphy. The liver is enlarged with several plotnovata and painful on palpation of the edge of the complications of chronic cholecystitis (chronic hepatitis, cholangitis). Gallbladder in most cases, is not palpable, as he usually wrinkled due to chronic scar-sclerosing process. In exacerbations observed leukocytosis, increased erythrocyte sedimentation rate, and temperature reaction. When duodenal sounding often fail to get the gallbladder bile in portion (due to violation of concentration ability of the gallbladder and cystic disorders reflex), or that portion of the bile has only a few darker than A and C, is often cloudy. Microscopic examination of the duodenal contents revealed a large number of mucus cells desquamated epithelium, "leukocyte", especially in the portions in the bile (detection of "white blood cells" in the bile do not attach such significance as before, as a rule, they are the nuclei decaying duodenal epithelial cells) . Bacteriological study of bile (especially repeated) to determine the causative agent of cholecystitis.

When holetsistografii marked change in the shape of the gall bladder, it is often the image is blurred due to violation of concentration ability of the mucosa, sometimes it detected the stones. After receiving the stimulus - holetsistokinetika (usually two egg yolks) - The lack of adequate contraction of the gallbladder. Symptoms of chronic cholecystitis determined and ultrasound (as bladder wall thickening, and so its deformation. D.).

The flow in most cases, long-term, is characterized by alternating periods of remission and exacerbation; the latter often result from eating disorders, drinking alcohol, heavy physical work, joining of acute intestinal infections, hypothermia. Forecast favorable in most cases. The deterioration of the general condition of patients and the temporary loss of their ability to work - only for periods of exacerbation of the disease. Depending on the peculiarities of isolated latent (sluggish), the most common - relapsing, purulent ulcer forms of chronic cholecystitis. Complications: the accession of chronic cholangitis, hepatitis, pancreatitis. Often the inflammatory process is a "push" to the formation of gallstones.

Chronic cholecystitis differentiate from cholelithiasis (these two diseases are often combined), chronic cholangitis. The main importance holetsisto- data and cholegraphy, especially repeated to eliminate gallstones and sonography.

Treatment. In exacerbations of chronic cholecystitis patients hospitalized in the surgical or therapeutic treatment, and hospitals were carried out as in acute cholecystitis. In mild cases may outpatient treatment. Assign bed rest, diet (diet number 5a), with eating 4-6 times a day, antibiotics (oletetrin, erythromycin, chloramphenicol, ampicillin inside or Gly-kotsiklin, monomitsin et al. Parenterally). Assign as sulfa drugs (sulfadimezin, sudfa-pyridazine, etc..). To eliminate biliary dyskinesia, spastic pain, improve zhelcheottoka prescribe antispasmodics and holinoliticheskie means (papaverine hydrochloride, no-spa, atropine sulfate, platifillina tartrate, etc..), While blurred exacerbations and during inflammation subsided -duodenalnye sensing (through 1 -2 days, a course of 8-12 treatments) or the so-called blind or tubeless, tyubazh with magnesium sulfate or warm mineral water (Essentuki number 17 and others.). In severe inflammatory pain is used Amidopyrine or analgin / m, but perirenal blockade vokainovye-administered novocaine - 30-50 ml of 0.25 0.5% solution intradermally over the area of ​​maximum tenderness or appoint electrophoresis with novocaine this area. During remitting inflammatory process and may have a thermal physiotherapy on the right hypochondrium (diathermy, UHF, inductothermy et al.).

To improve the outflow of bile from the gall bladder in the period of exacerbation and in remission widely prescribe cholagogue: allohol (2 tablets 3 times a day), holenzim (1 tablet 3 times a day), broth (10:250) flowers Helichrysum sand (1/2 cup 2-3 times a day before meals); decoction or infusion of corn stigmas (10: 200 1-3 tablespoons 3 times a day) or a liquid extract (30-40 drops 3 times a day); cholagogue tea (one tablespoon to brew 2 cups boiling water, strained infusion take 1/2 cup 3 times a day for 30 minutes before a meal); tsikvalon, Nicodin et al., as well as olimetin, rovahol, enatin (0.5-1 g 3-5 capsules per day) and Holagol (5 drops of sugar for 30 minutes before a meal three times a day). These funds have antispasmodic, choleretic, non-specific anti-inflammatory and diuretic. In mild attack of biliary colic Holagol appoint 20 drops to the reception.

Carry out the treatment of chronic cholecystitis mineral water (Essentuki number 4 and №17, Slavyanovskaya, Smirnoff, Mirgorod, NAFTA, the newly-Izhevsk, etc.) And magnesium sulfate (1 tablespoon 25% solution of 2 times a day) or a salt Carlsbad (1 teaspoon in a glass of warm water 3 times a day). After remitting acute cholecystitis and to prevent further aggravation of (preferably annually) shown spa treatment (Essentuki, Zheleznovodsk, Truskavets, Morshyn and other resorts, including local, for the treatment of cholecystitis).

With the failure of conservative treatment and frequent exacerbations carried out surgical treatment of chronic cholecystitis (cholecystectomy usually).

Prevention of chronic cholecystitis is in compliance with diet, exercise, physical activity, obesity prevention, treatment of focal infection.