Cholecystitis acute and chronic
Gastroenterology / / May 11, 2016
Cholecystitis - an inflammation of the gallbladder, which occurs most often due to obstruction of the cystic duct due to gallstones.The gallbladder is a sac located under the liver.It stores bile, which is produced in the liver.Bile helps the gut digest fats.
90% of cases of cholecystitis associated with stones in the bile duct (eg, calculous cholecystitis), the remaining 10% of cases are calculous cholecystitis.
Distinguish acute and chronic cholecystitis.
cholecystitis The incidence increases with age.The physiological explanation of gallstone disease incidence rate in the elderly is unclear.Increased incidence in older men was associated with a change in androgen-estrogen ratios.
Gallstones occur in women 2-3 times more often than men, which leads to a higher frequency of calculous cholecystitis in women.Elevated levels of progesterone during pregnancy can lead to stagnation of bile, resulting in higher rates of gallbladder disease develops in pregnant women.Cholecys
Chronic cholecystitis swelling, irritation and inflammation of the gallbladder that persists for a long time.
Chronic cholecystitis is usually caused by repeated attacks of acute cholecystitis.Most of these attacks are caused by gallstones in the gallbladder.These attacks cause a thickening of the walls of the gallbladder dysmotility, inflammatory changes in the gallbladder or bile ducts.Over time, the gallbladder is less able to store and release bile, a so-called bile stasis, followed by its condensation and the formation of calculi (stones).
Chronic cholecystitis can be catarrhal and purulent.In the form of catarrhal cholecystitis, gallbladder wall thickening, compacted, sclerosing, mucosa atrophy.When purulent cholecystitis involved in all sectors of the gallbladder wall: formed abscesses - sources of new exacerbations of chronic cholecystitis.At relapse of the disease observed vascular congestion, feeding the gallbladder wall, its swelling.The mucous membrane is thickened, with polypoid changes in some areas and covered with sores.The latter, filled with connective tissue, forming scar deformity.Sometimes formed adhesions with neighboring organs, a condition called pericholecystitis.
Causes of chronic cholecystitis and risk factors
Risk factors for calculous cholecystitis (cholecystitis with the presence of gallstones in the bladder) are similar to the causes of gallstones and include the following:
floor - Some ethnic groups
- Obesityor rapid weight loss
- Medicines (especially hormonal therapy in women)
- Increasing age
- Hereditary factor
acalculous cholecystitis associated with the stagnation of bile in the gallbladder, consists of the following risk factors:
- Diseases such as diabetesdiabetes, heart disease, including myocardial infarction, cardiovascular complications
- Consequences of surgery or severe trauma or
burns - Sepsis
- Long-term parenteral nutrition
- Prolonged fasting
- Sickle cell anemia
- AIDS patients who havecytomegalovirus, cryptosporidiosis, or microsporidiosis
- Weakened immune system and exhaustion
- Improper diet, the prevalence in the diet of fatty, high-calorie foods and foods rich in cholesterol
- Sedentary lifestyle
Symptoms of chronic cholecystitis
- Pain in the right upper quadrantabdomen.It may be acute, episodic, lasting less than 60 seconds and cramping, lasting from 1 to 72 hours.The pain can be constant and dull in the upper right quadrant of the abdomen without irradiation.The intensity of pain depends on the severity of inflammation in the presence of the gall bladder and dyskinesia.Dyskinesia on hypotonic type provides constant pain and gently, with dyskinesia of hypertensive type appears sharp pain paroxysmal character, reminiscent of biliary colic.The pain shifted to the right lumbar region, and the right shoulder blade.
- The bitterness in the mouth;
- Often intolerance of fatty and fried foods;
- Increased gas separation;
- Abdominal distension (flatulence);
- Gallstones and thickened gallbladder wall, always determined by ultrasound;
- Nausea and vomiting;
- Yellowing of the skin and whites of the eyes;
- Feces clay-colored;
- Increased number of white blood cell count, increased ESR.
diagnosis of chronic cholecystitis
Typically, diagnosis of chronic cholecystitis is quite simple.Diagnosis is based on patient complaints, survey data and laboratory studies.
Laboratory studies include:
- Physical examination
- abdominal ultrasound
abdominal cavity - Review radiography
- Scintigraphy of the gallbladder (HIDA-scan)
- Blood tests (general analysis, amylase indicatorsand lipase)
- study of bile by the chromatic fractional duodenal intubation
Treatment of chronic cholecystitis
chronic calculous cholecystitis and its complicated forms are treated surgically.Surgery to remove the gallbladder is called a cholecystectomy.Most often done laparoscopic cholecystectomy.This operation is without surgical incisions, which contributes to more rapid recovery.Patients usually go home from the hospital the day of surgery, or the next morning.
open cholecystectomy requires a larger incision in the upper right abdomen.
conservatively treat uncomplicated nekalkulezny cholecystitis.The purpose of conservative treatment is the elimination of the inflammatory process, the fight against the stagnation of bile and biliary dyskinesia.
main part of conservative treatment is rest and light diet.As a rule, appointed by antibiotics and sulfa drugs for 2-3 weeks.If there is dyskinesia on hypotonic type, then prescribe holetsistokinetikami (magnesium sulfate, Carlsbad salt, olive oil, gipofizin, sorbitol, xylitol, and others.).appoint choleretic (Holagol, holosas, allohol) When dyskinesia of hypertensive type, antispasmodics (atropine, belladonna preparations, no-spa, platifillin et al.).When mixed forms of dyskinesia recommend cholagogue vegetable - broth of corn stigmas, syrup or broth hips, as well as a sedative - valerian, motherwort, bromine.
Small gallstones may be dissolved drugs chenodeoxycholic acid or ursodeoxycholic acid (Ursofalk, Ursosan).This treatment can take two years or more, and stones may reappear after treatment.It is important to note that this therapy is effective only in the presence of cholesterol gallstones.
Effective duodenal intubation, tubeless tyubazh, alkaline mineral waters (Essentuki, etc.).
can be assigned to physical therapy, such as diathermy, UHF, ultrasound, mud, ozocerite, paraffin baths in the area of the gall bladder, radon and hydrogen sulfide baths.
Patients shown and spa treatment at resorts Essentuki, Borjomi, Zheleznovodsk and others.
Prediction (expectations) chronic cholecystitis
Cholecystectomy is a common procedure with low risk.
Uncomplicated cholecystitis has an excellent prognosis, with very low mortality.Most patients with acute cholecystitis have complete recovery within 1-4 days.However, 25-30% of patients, or require surgery or have some complications.When complications such as perforation, the prognosis is less favorable.Perforation occurs in 10-15% of cases.
Complications of chronic cholecystitis
- Cancer of the gallbladder (rarely)
- Deterioration of the general state of
Prevention of chronic cholecystitis
- sparing diet and a change of diet
- Fighting obesity
- Early treatment of diseases of the abdominal cavity
- Timely complete and effective treatment of acute cholecystitis
- Prevention of constipation
- Moderate physical activity.
Acute cholecystitis - is a sudden inflammation of the gallbladder accompanied by severe abdominal pain.
In 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder.Other causes include severe illness and rarely tumors of the gallbladder.Acute cholecystitis can occur at stagnation of bile in the gallbladder.Accumulation of bile causes irritation and pressure increase in the gall bladder.This may lead to infection and perforations (gap) in the body.
Acute cholecystitis may be catarrhal and destructive.The destructive cholecystitis, in turn, divided into purulent, abscess, ulcer-phlegmonous, diphtheritic and gangrenous.
Causes of acute cholecystitis and risk factors
Causes of acute cholecystitis are similar to the causes of and risk factors for chronic cholecystitis.
- stones in the gall bladder.There are two main types of gallstones.The first type of stones from cholesterol stones, which are by far the most common type.Cholesterol gallstones do not have anything to do with cholesterol levels in the blood.The second type of stones, stones of bilirubin is produced when red blood cells are destroyed (hemolysis).This leads to high levels of bilirubin in the bile.These stones are called as pigment stones.
- Gender and age.The stones are more common in women and people over 40 years.
- Hereditary factor.
- stagnation of bile in the gallbladder.
- Cirrhosis of the liver and biliary tract (pigmented stones).
-High level of bilirubin caused by chronic hemolytic anemia, including sickle-cell anemia.
- Rapid weight loss from a very low calorie diet, or after surgery for obesity.
Symptoms of acute cholecystitis
Most people with gallstones never had any symptoms.Gallstones are often found during a routine X-ray or ultrasound, abdominal surgery or other medical procedures.
However, if large stones are in the cystic duct or common bile duct (choledocholithiasis), you may have cramping pain in the middle of the right upper abdomen.This is known as biliary colic.Pain passes if the stone passes into the first part of the small intestine.
main symptoms that can occur in acute cholecystitis:
- Pain in the right upper or middle upper abdomen.It can be a constant, sharp, cramping, give in the back or under the right shoulder blade.
- Fever and fever.
- Yellowing of the skin and whites of the eyes (jaundice)
- of clay (gray) color of the chair.
- Nausea and vomiting.
It is very important to consult a doctor if you have symptoms of stones in the gallbladder.
diagnosis of acute cholecystitis
Studies conducted to detect gallstones or inflammation of the gall, bladder usually include:
- Physical examination of the abdomen
- abdominal ultrasound
abdominal cavity - Endoscopic Retrogradecholangiopancreatography
City radiography using contrast media (cholecystography, cholegraphy, cholangiography, and tseliako- gepatografiya)
- Magnetic resonance cholangiopancreatography
- Percutaneous retrograde cholangiography
- Radioisotope study (radioholetsistografiya, scintigraphy)
- Laparoscopy allows you to visually assess the state of the walls of the gallbladder
- blood tests for bilirubin, amylase and lipase
- Complete blood count
- liver function tests
- pancreatic enzymes.
Treatment of acute cholecystitis
Surgery. In general, patients who have symptoms of acute cholecystitis need surgery either immediately or after a period of time.Currently, the most commonly used laparoscopic cholecystectomy.This procedure is carried out without surgical incisions, which promotes rapid recovery of the patient.In the past, even in the simplest cases, to conduct an open cholecystectomy - removal of the gallbladder through an incision in the abdomen.This is done now, but this is done less frequently.
Conservative treatment. In case of small stones of cholesterol can be effectively treated preparations chenodeoxycholic acid or ursodeoxycholic acid, which is capable of dissolving cholesterol gallstones.However, such a treatment can last for about 2 years and more, and you are not insured by the reappearance of stones after the end of treatment.In some cases, antibiotics are needed to fight infection.
In rare cases, chemicals are transferred into the gallbladder through a catheter.They quickly dissolve cholesterol stones.This medication is not used very often, because the procedure is burdensome, and the chemicals are highly toxic.
Lithotripsy. Remote shock-wave lithotripsy (ESWL) of the gallbladder is also used in some cases, if there are conditions that prevent implementation intracavitary surgery.
- Removal of the gallbladder (cholecystectomy)
- gallbladder cancer: causes, symptoms, stages, treatment
- obstruction of the bile ducts
- Cancer of the bile duct (Cholangiocarcinoma)
- Diet fordiseases of the liver and biliary tract
Prediction (expectations) acute cholecystitis
Gallstones develop in many people without causing symptoms.The probability of the symptoms or complications from gallstones is low.Almost all patients who have undergone surgery for gallstones, no longer experiencing symptoms, unless symptoms have been caused only by gallstones.
Complications of acute cholecystitis
Obstruction of the cystic duct or common bile duct by gallstones can cause the following problems:
- Acute cholecystitis
- Chronic cholecystitis
- Choledocholithiasis - common bile duct stones
- peritonitis - inflammation of the mucous membrane of the abdomen
- Empyema (pus in the gallbladder)
- Gangrene of the gallbladder
- bile duct injury during cholecystectomy.
prevention of acute cholecystitis
Unfortunately, the formation of stones in the gall bladder can not be completely prevented.However, preventive measures can reduce the probability of their occurrence and development of acute and chronic cholecystitis.Prevention of acute and chronic cholecystitis is identical.