Exacerbation of acute cholecystitis. Symptoms, diagnosis and treatment of acute cholecystitis. The main causes of acute cholecystitis

The cause of pain in the right side is most often cholecystitis. At the same time, if a chronic inflammatory process in the gallbladder is manifested by aching pains, then acute inflammation gives severe symptoms and requires urgent medical care.

However, acute cholecystitis does not always require surgery - medical tactics depends on the form of inflammation and the presence of stones in the gallbladder.

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Acute cholecystitis - what is it?

Acute cholecystitis is a sudden inflammation of the gallbladder walls. Swelling of the mucosa, preventing the outflow of bile, promotes reproduction pathogenic microorganisms(streptococcus, klebsiella, staphylococcus, clostridia, coli etc.).

Acute cholecystitis is severe pain attack, which can often be stopped with medications in injections or intravenous infusions. Sometimes inflammation continues to develop even against the background drug therapy. In such cases, the risk of necrosis of the bladder wall and peritonitis is high.

The main causes of acute cholecystitis:

• Gallstones - gallstones are the most common cause the development of acute inflammation (acute calculous cholecystitis);
• Infection in the biliary tract - most often occurs with poisoning and intestinal infections;
• Diseases of the stomach, pancreas - hypoacid gastritis, in which secretion is reduced gastric juice, or hypofunction of the pancreas with enzyme deficiency often accompanied by stagnation of bile;
• Poor nutrition - overeating, eating foods that irritate the gastrointestinal tract (smoked meats, fatty, fried foods, marinades and canned food), as well as alcohol often provoke an attack of acute cholecystitis;
• Vascular pathology - atherosclerotic changes in the vessels supplying the gallbladder lead to ischemic changes in its walls and provoke a severe inflammatory reaction (gangrenous, phlegmonous cholecystitis).

The clinical picture at the first appeared cholecystitis repeats biliary colic. An attack of cholecystitis is acute pathology requiring urgent care.

The main signs of acute cholecystitis:

Pain
Pain occurs in the right hypochondrium, can spread to upper part abdomen and radiates to the right side (back, shoulder blade, neck, chest, arm).

Acute pain in cholecystitis is quite intense and constant, in contrast to cramping pain in biliary colic, which occurs without inflammation. The patient tries to lie on his right side, legs crossed.

Nausea, vomiting
An attack of biliary colic may be preceded by a feeling of bitterness in the mouth, this sensation does not go away even with the appearance of pain. Developing attack accompanied by nausea, often - bilious vomiting.

After the release of the contents of the stomach, the vomit is colored in yellowish color. At the same time, vomiting brings the patient some relief, albeit temporary.

General symptoms
Acute inflammation always provokes a rise in body temperature. At the same time, according to temperature indicators can be judged on the severity inflammatory response. Catarrhal cholecystitis (common inflammation) is accompanied by subfebrile condition - 37.5 - 38ºС.

Gangrenous (purulent fusion of the bladder walls) and phlegmonous (necrotic) form of inflammation of the gallbladder is always accompanied by a rise in temperature to 39ºС and above.

Moreover, the more pronounced the inflammation, the more it suffers. general state patient. There is weakness and other symptoms of intoxication.

Gangrenous and acute phlegmonous cholecystitis run with symptoms acute abdomen: "board-shaped" belly - tension abdominal wall due to severe pain and fast developing inflammation. Often there is jaundice eyeballs and tachycardia up to 120 beats / min.

• At the same time, failure to provide timely medical care is fraught with the development of peritonitis.

Diagnostics

At acute symptoms in the abdominal cavity, it is important to quickly make a diagnosis. Pre-acute cholecystitis is diagnosed on the basis of the patient's complaints and the characteristic symptoms of the disease. The doctor receives confirmation of the diagnosis on the following studies:

• complete blood count - leukocytosis and ESR, as signs of inflammation in the body;
• blood biochemistry - an increase in liver function tests;
• Ultrasound of the abdomen - the gallbladder is enlarged, the walls with a double contour in thickness reach more than 4 mm, Murphy's symptom (tension of the gallbladder with slight pressure with an ultrasonic sensor), stones can be detected, dilated bile ducts;
• cholangiography (x-ray examination of the biliary tract) and CT are prescribed in cases of suspected destructive inflammation(cystic phlegmon or gangrene).

In acute cholecystitis, it is important not to harm. Many people just don't know how to deal with acute inflammation gallbladder, and provoke deterioration. In doing so, you should know:

• Neither No-shpa, nor Baralgin and other painkillers in tablets will eliminate inflammation that has already begun.
• A hot heating pad applied to the right side is effective for biliary colic that has arisen against the background of cholelithiasis, and is prohibited in acute cholecystitis. Heat will only increase inflammation and aggravate the patient's condition.
• It is strictly forbidden to carry out a gastric lavage and take a laxative.

First aid in acute cholecystitis includes:

• Bed rest, except for any physical activity and emotional experiences.
• Cold on the right side - moistened cold water a towel, a heating pad with ice, or a regular bottle of lemonade from the refrigerator.
• Immediate call for an ambulance.

Treatment of acute cholecystitis - drugs, diet, surgery

Acute inflammation of the gallbladder in any case requires hospitalization. The method of treatment is chosen depending on the symptoms of acute cholecystitis.

Conservative treatment

Drug therapy, as the main treatment tactic, aims to:

• Withdrawal pain syndrome- Atropine or Platifillin (less effective) subcutaneously, antispasmodics (Baralgin, No-shpa, Papaverine) intramuscularly or intravenously.
• Elimination of inflammation antibacterial drugs a wide range actions (Ampicillin, Amoxiclav, Cefotaxime and others) in injections.
• Prevention of bile stasis - choleretic agents, sometimes duodenal sounding is performed to evacuate stagnant bile.
• Detoxification therapy (removal of intoxication) - Ringer's solution, Hemodez, saline solution (with antispasmodics).

Diet

In the first 1-2 days of the disease, the patient is forbidden to eat, you can drink water, mineral water (warm and without gas!) or sweet tea. When leveling an acute attack of cholecystitis (its catarrhal form, in the absence of stones in the gallbladder) with medication, the patient is discharged home.

Throughout the treatment of cholecystitis, the patient complies.

The diet for acute cholecystitis excludes three "F": fatty, fried, egg yolk. Also, do not add spicy spices to your food. Smoked meats, marinades, yeast buns, any alcohol and carbonated drinks are prohibited.

Dishes are steamed or boiled, taken in small portions up to 6 times a day. The menu is dominated by vegetables and fruits (with the exception of citrus fruits). Compliance with the diet will prevent re-inflammation of the gallbladder and the transition to chronic form.

Operation

Planned or emergency surgery - cholecystectomy - is indicated in the following cases:

• acute cholecystitis and large/multiple stones in the gallbladder;
• lack of improvement during conservative treatment;
• identification of a severe form of cholecystitis;
• gallbladder rupture and peritonitis.

Most often, the gallbladder is removed by laparoscopic access, through 2-3 punctures of the abdominal wall, while sometimes it is enough local anesthesia. Laparoscopic surgery for acute cholecystitis is easily tolerated by the patient.

AT severe cases(phlegmon, peritonitis) an open surgical intervention is performed, followed by massive antibiotic therapy.

Elderly people who, due to their age, cannot endure even a minimally invasive operation, undergo a cholecystostomy. Drainage is brought into the gallbladder (to improve the outflow of bile) and sutured to the skin.

Treatment prognosis

Recovery of catarrhal cholecystitis usually occurs in 5-10 days, the disease is eliminated without complications. It is not always advisable to remove the gallbladder when diagnosing cholecystitis, even with its frequent relapses. There are no "unnecessary" organs in the body, and cholecystectomy will significantly affect the patient's quality of life.

Often after surgery, people complain about liquid stool. However, when severe course disease, an operation is necessary to remove the threat to the life of the patient.

Complications of acute cholecystitis - perforation (rupture) of the gallbladder, peritonitis and formed vesico-intestinal fistulas - carry a mortal danger. In addition, prolonged or recurrent cholecystitis is fraught with the development of pancreatitis.

Acute cholecystitis is a disease that is rarely independent, in the vast majority of cases it is a complication of its ducts.

The main cause of acute cholecystitis is. Blockage of the biliary tract by a stone leads to a violation of the outflow and stagnation of bile, stretching and damage to the walls of the gallbladder. The condition may be exacerbated by concomitant biliary dyskinesia. In stagnant bile, bacteria begin to multiply, and in the future, the combination of these factors leads to the onset of an acute inflammatory process.

AT rare cases the infection is introduced into the gallbladder by the hematogenous route from another source of infection in the body or during sepsis.

Do not confuse acute cholecystitis with biliary (hepatic) colic, although the symptoms in these conditions are very similar, and the cause is almost always the same - stones. Hepatic colic occurs suddenly against the background of general well-being, and acute cholecystitis still develops gradually, the symptoms increase for at least several hours, and more often several days. Of course, hepatic colic can lead to acute cholecystitis, but this does not always happen. In any case, both of these conditions are urgent, can lead to severe complications and require immediate medical attention.

Symptoms of acute cholecystitis

Based on these signs, cholecystitis can be suspected:

• constant, aggravated by movement and coughing pain in the right hypochondrium, the patient may say that the entire right side hurts, without indicating a clear localization, irradiation to right shoulder blade or hand;
• nausea and repeated vomiting, not bringing relief, with a bitter taste of bile;
• fever up to 38-40 degrees, chills, increased heart rate;
• bloating and lagging of its right half from the left during breathing;
• skin and sclera may acquire a yellow tint ().

In older people, the clinical picture may be blurred, pain may be mild or absent altogether, and the disease begins with the onset of nausea, vomiting, and fever. This makes it difficult to set correct diagnosis and precious time for conservative treatment may be lost.

Pain syndrome without other signs of the disease indicates that the patient's inflammatory process has begun recently and possibly conservative treatment. The addition of nausea, vomiting, and especially jaundice, indicates a phlegmonous or, even worse, gangrenous stage of the disease, requiring surgical treatment.

Diagnosis of acute cholecystitis

Patients with suspected acute cholecystitis undergo a standard set of tests:

• (usually unchanged, possibly dark urine);
• (an increase in the level of leukocytes and ESR is possible - signs of inflammation);
• biochemical analysis of blood (an increase in the level of bilirubin is possible, alkaline phosphatase, liver enzymes).

Ultrasound of the gallbladder and its ducts - the "gold standard" in diagnosis any diseases of this organ. The doctor can see a change in its shape and size, thickening of the walls, thickening of bile, calculi. Stones may have a different structure, and not all of them may be visible when ultrasound examination. In such cases, computed tomography may be required to accurately diagnose the disease.

Treatment

If acute cholecystitis is suspected, you should consult a doctor; in most cases, patients are hospitalized in a hospital. Treatment should be carried out under the supervision of a doctor, as it is important to correctly assess the dynamics and condition of the patient, and prevent complications.

1. A strict diet is prescribed: hunger for 1-3 days, followed by the introduction of mashed, thermally processed vegetables, low-fat into the diet meat dishes and low-fat dairy products.
2. Antibacterial therapy to suppress the microbial flora that caused inflammation - intravenous or intramuscular administration of broad-spectrum antibiotics.
3. Antispasmodics are especially effective in the presence of biliary dyskinesia, with their help, a stone stuck in the duct can pass into duodenum or return to the gallbladder, opening the way for the outflow of bile.
4. Cholagogue drugs are prescribed by a doctor, based on the results of ultrasound. If the stone that clogged the duct has entered the duodenum, then the use of antispasmodics and choleretic agents will help to quickly cope with inflammation. If the stone returned back to the gallbladder, then choleretic drugs can provoke re-occlusion of the bile duct with all the ensuing consequences.
5. Painkillers are prescribed to reduce pain, usually non-steroidal anti-inflammatory drugs (Ketorol, Baralgin, Diclofenac, etc.).
6. Water-salt solutions and glucose are administered to patients to relieve intoxication with jaundice, as well as to compensate for the loss of fluid and electrolytes (if there was repeated vomiting).

If medical therapy fails, patients are shown surgical treatment- removal of the gallbladder (cholecystectomy).

Prevention of acute cholecystitis

This complication is rarely the first manifestation of gallstone disease. Most patients are aware of their disease and have received preventive advice from their doctor before. Most often, acute cholecystitis is provoked by an error in the diet (overeating, the presence of fatty, fried, salty, spicy or pickled foods) or drinking alcohol. That is why the main measure for the prevention of acute cholecystitis was, is and remains a diet.

Which doctor to contact

If pain occurs in the right hypochondrium, you should go to a therapist or gastroenterologist, conduct an ultrasound of the liver and gallbladder. If surgery is necessary, the patient is transferred to surgery department. After the exacerbation subsides, it is recommended to consult a nutritionist to select the right nutrition.

Scientific report on the topic “Acute cholecystitis. Actual problems and unresolved issues":

The first channel, the program "Live is great!" with Elena Malysheva, in the section “About medicine”, a conversation about the symptoms of acute cholecystitis (see from 32:50 min):

Cholecystitis is an inflammatory process in the gallbladder that can be chronic and acute course. Among the pathologies of the internal organs, cholecystitis is particularly dangerous, because it not only leads to the development of a severe pain syndrome, but also to inflammation and the formation of stones. With the advancement of stones, the patient needs urgent surgical care, the untimely provision of which can lead to death.

Acute and chronic cholecystitis is closely associated with cholelithiasis, and in 95% of cases, the diagnosis of these pathologies occurs simultaneously, while it is very difficult to determine which of them is primary. Annually, the number of registered cases of these pathologies increases by 15%, and the formation of calculi in the adult population is growing by 20% per year. It is also noted that in males the susceptibility to cholecystitis is significantly lower than in women after 50 years.

Clinical picture and causes of cholecystitis

Cholecystitis is divided into gangrenous, perforative, phlegmonous, purulent, catarrhal.

Acute cholecystitis and its causes

most great danger represents acute form cholecystitis, in which the formation of calculi occurs not only in the gallbladder itself, but also in its ducts. It is the formation of stones that represents greatest danger with a disease that is also called calculous cholecystitis. Initially, the accumulation of calcium, cholesterol and bilirubin salts on the walls of the bladder turns into calcifications, however, with the accumulation of these deposits, they increase, which can lead to the formation of inflammatory processes in the gallbladder. Quite often, stones penetrate the bile ducts and create a serious obstacle to the outflow of bile from the gallbladder. This development of events can cause peritonitis if the pathology is not treated in time.

Causes of chronic cholecystitis

Chronic cholecystitis is characterized by a longer course of pathology. It is characterized by periods of exacerbation and remission. The pathology is based on damage to the walls of the gallbladder against the background of a violation of the process of bile evacuation (pathology of the sphincter of Oddi, hyper- or hypomotor dyskinesia). These factors are joined by a secondary bacterial infection, which not only supports the process of inflammation, but also translates it into a purulent one.

Chronic cholecystitis is divided into non-calculous and calculous. With calculous, it is stones and sand that cause trauma to the mucous membrane of the gallbladder, clog the neck of the bladder or its ducts and prevent the excretion of bile.

Acalculous forms develop against the background of anomalies in the development of the ducts and bladder, their ischemia (with diabetes) and kinks, strictures and tumors of the bladder and general cystic duct, slugging of bile in those receiving parenteral nutrition, rapidly losing weight, pregnant women, obstruction of the ducts with worms, irritation by pancreatic enzymes.

The most common microorganisms that cause inflammation are staphylococci and streptococci, as well as proteus, Pseudomonas aeruginosa, enterococci, escheria. Emphysematous forms of the disease are associated with exposure to clostridia. In more rare cases, chronic cholecystitis may occur against the background of viral lesions biliary system, protosis infection, salmonellosis. All types of infections can enter the bladder by hematogenous, lymphogenous or contact (intestinal) routes.

At various options helminthic invasions - fascioliasis, strongyloidiasis, opisthorchiasis, giardiasis, roundworms, partial obstruction of the bile ducts (in the presence of ascariasis), the development of symptoms of cholangitis (with fascioliasis), with giardiasis, persistent dysfunction of the biliary tract is observed.

Common causes of chronic cholecystitis:

violation of the diet, an abundance of spicy and fatty foods in the diet, obesity, alcoholism;

the presence of helminthic invasion - opistrochiasis, strongyloidiasis, giardiasis, ascariasis;

cholelithiasis;

biliary dyskinesia;

prolapse of the abdominal organs, pregnancy, congenital anomalies in the development of the gallbladder.

In the presence of any type of cholecystitis, the inflammatory process in the walls of the gallbladder leads to obstruction of the lumen of the ducts, its narrowing, stagnation of bile, which gradually begins to thicken. A vicious cycle is formed that eventually leads to allergic or autoimmune inflammation.

The formulation of the diagnosis of acute chronic cholecystitis contains such data as:

stage (remission, subsiding exacerbation, exacerbation);

severity (severe, moderate, mild);

the nature of the course (often recurrent, monotonous);

the state of the functions of the gallbladder (non-functioning bladder, functionality is preserved);

the nature of biliary dyskinesia;

complications.

Symptoms of acute cholecystitis

The provoking factor leading to the development of an acute attack of cholecystitis is alcohol abuse, overeating of fatty, spicy food, powerful stress. In this case, the patient experiences the following symptoms:

the appearance of yellowness of the skin;

belching with air;

vomiting that does not bring relief, constant nausea, in some cases vomiting of bile;

the presence of an intense taste of bitterness in the mouth;

a slight increase in body temperature to subfebrile indicators;

severe weakness, increased fatigue;

acute attacks of pain in the right hypochondrium, upper abdomen, which can radiate to the right shoulder blade, much less often the pain radiates to the left hypochondrium.

The duration of acute cholecystitis depends on the severity of the pathology and can vary from 10 days to 1 month. In moderate and mild cases, when the purulent process does not develop and there are no stones, the patient recovers very quickly. However, with reduced immunity, the presence secondary pathologies, in case of perforation of the bladder wall, not only severe complications, but the risk of death is high.

Symptoms of chronic cholecystitis

Chronic cholecystitis is not characterized by a sudden onset, on the contrary, it develops systematically, over a long period of time, after exacerbations. Against the background of therapy in combination with diet, there are periods of remission of the pathology, the duration of which depends on compliance with the diet and the intake of maintenance drugs.

The main symptom of chronic cholecystitis is Blunt pain in the area of ​​the right hypochondrium, which is present for several weeks and may radiate to lumbar region, right shoulder, acquire a aching character. Pain intensifies after taking alcohol, carbonated drinks, spicy or fatty foods, stress and hypothermia, in women, the period of exacerbation may depend on premenstrual syndrome(PMS).

The main symptoms of chronic cholecystitis:

yellowing of the skin;

subfebrile temperature;

heaviness in the right hypochondrium;

belching bitterness, bitterness in the mouth;

dull pain in the right hypochondrium, which radiate to the shoulder blade, back;

lack of appetite, nausea, vomiting, indigestion;

quite rare, but may be present atypical symptoms, which manifest themselves in the form of constipation, bloating, swallowing disorders, pain in the heart.

To diagnose the presence of both chronic and acute cholecystitis, the most informative methods are:

cholegraphy;

cholecystography;

scintigraphy;

Ultrasound of the abdominal organs;

duodenal sounding;

biochemical blood test, which, in case of illness, shows high performance liver enzymes - Alt, AST, alkaline phosphatase, GGTP;

most accessible and modern methods diagnostics are bacteriological examination and laparoscopy.

Of course, any pathology is much easier to prevent than to cure, therefore timely diagnosis can detect violations in early stages and deviations in chemical composition bile. With an appropriate diet, the period of remission of chronic cholecystitis can be extended to the maximum and prevent the development of serious complications.

Treatment of chronic cholecystitis

Treatment of a chronic process that passes without the formation of calculi is always done conservative methods, the main of which is dieting (dietary table No. 5 - fractional, frequent meals with consumption enough liquid, mineral water). In the presence of stones in the gallbladder - restriction of shaky driving, physical overload, hard work.

The following drugs are used:

antibiotics - in most cases, a wide spectrum of action, cephalosporins;

enzyme preparations - "Creon", "Mezim", "Pancreatin";

detoxification - intravenous infusions of glucose solution, sodium chloride;

non-steroidal anti-inflammatory drugs - to relieve pain and inflammation.

Choleretic drugs are divided into:

Choleretics are drugs that stimulate the formation of bile. These funds contain bile acids and bile: "Decholin" ( sodium salt dehydrocholic acid), "Hologon" (dihydrocholic acid), "Holenzim", "Vigeratin", "Liobil", "Allochol". Herbal preparations that enhance the secretion of bile: "Konvaflavin", "Berberine", corn silk, Flacumin. Synthetic drugs: Hymecromon (Cholestil, Holonerton, Odeston), Tsikvalon, Hydroxymethylnicotinamide (nicotine), Osalmid (oxafenamide).

Cholekinetics are divided into: cholespasmolytics that reduce the tone of the sphincter of Oddi and the biliary tract: "Mebeverin" ("Duspatalin"), "Eufillin", "Platifillin", "Atropine", "Olimetin", "No-shpa", "Drotaverine hydrochloride" ; increasing the tone of the gallbladder and promoting the release of bile (cholikinetics) - "Xylitol", "Mannitol", "Sorbitol", "Cholecystokinin", "Choleretin", "Pituitrin", magnesium sulfate.

During periods of exacerbation, herbal medicine is especially widely used, in the absence of allergies - decoctions of calendula, valerian, peppermint, dandelion, chamomile. During periods of remission can be assigned homeopathic remedies or herbal medicine using other herbs - buckthorn, tansy, marshmallow, yarrow.

It is extremely important to follow a strict diet during treatment, both during periods of exacerbation and during periods of remission of the pathology. In addition to the diet, with cholecystitis and gallstones, it is necessary to periodically carry out tubages with magnesia or mineral water, with xylitol, positive effect physiotherapy is also different - SMT therapy, reflexology, electrophoresis.

In calculous chronic cholecystitis, when the symptoms of the pathology are pronounced, it is recommended to resect the gallbladder, as a source of proliferation of stones, which, when advanced, can pose a threat to the patient's life. The advantage of chronic cholecystitis with the presence of stones, compared with acute calculous cholecystitis, is planned operation for which you need to carefully prepare. While doing surgical intervention use the method of cholecystectomy from mini-access, and laparoscopic surgery.

If there are contraindications regarding surgical intervention, in chronic cholecystitis, in some cases, treatment can be carried out by shock wave lithotripsy (crushing of stones), during this extracorporeal procedure, stones are not removed, but simply destroyed, so relapses of pathology often occur. There is also a technique for the destruction of stones by exposure to salts of chenodeoxycholic and ursodeoxycholic acid, however, such treatment not only does not give complete cure, but it is also very long. The process of destruction of stones by this method can last up to 2 years.

Treatment of acute cholecystitis

In the case when acute cholecystitis is detected for the first time, there are no stones in the bladder, and a severe clinical picture with purulent complications is not recorded - it is enough to carry out conservative drug therapy, which includes: cholagogues, enzyme and detoxification therapy, NSAIDs, antispasmodics, antibiotics.

In the presence of severe forms of destructive cholecystitis, removal of the gallbladder (cholecystectomy) should be performed in without fail. Most often, resection of the gallbladder is performed from a mini-access. If the patient refuses to perform the operation, an attack of acute cholecystitis can be removed with the help of medications, however, you need to be aware that large stones will cause relapses and lead to the transition of the pathology into a chronic form, the treatment of which quite often ends surgical intervention about complications.

Today at medical practice use three main methods of surgical intervention for the treatment of cholecystitis - laparoscopic cholecystectomy, open cholecystectomy, for debilitated patients - percutaneous cholecystectomy.

All patients with acute cholecystitis, without exception, must follow a strict diet that allows only tea for the first two days, after which there is a transition to diet table No. 5A. It is characterized by the fact that all products are cooked by boiling or steaming, using a minimum of fat, excluding alcohol-containing and carbonated drinks, seasonings, smoked, fried foods.

Acute cholecystitis is inflammatory disease gallbladder, arising rapidly against the background of a disturbed outflow of digestive secretions. Pathology is characterized sudden appearance symptoms. At adequate treatment acute cholecystitis can be quickly stopped unpleasant symptoms. This helps to prevent the occurrence of severe complications. Therefore, it is worth considering in more detail what acute cholecystitis is, what pathology has symptoms and treatment.

Bile is a digestive secret that is produced by liver cells and accumulates in the cavity of the gallbladder. Normally, they penetrate pathogenic microbes from the duodenum 12. However, only with a disturbed outflow of the digestive secretion are conditions favorable for inflammatory processes created.

In 90% of patients, the cause of acute cholecystitis is considered to be bile stasis against the background of the appearance of stones in the organ. The disease develops with mechanical blockage of the ducts by stones. If this process provokes inflammation, then acute calculous cholecystitis occurs. This form pathology is diagnosed more often in patients older than 40 years.

Allocate the following reasons acute cholecystitis of the acalculous type:

• Changes in the rheological characteristics of bile;
• Anomalies in the development of the digestive organ;
• Violation of the patency of the ducts due to the pressure of the tumor;
• Injuries of the hepatobiliary system;
• Inflammation in neighboring organs;
• Wearing tight clothing (corset).

Cholecystitis attack is more common in women. Experts attribute this to the following features of the body:

• Negative effects of progesterone;
• Squeezing of the organs of the biliary tract during pregnancy;
• Passion for strict diets.

Important! There is also . In the first case, the pathology has a sudden onset, leading to the appearance of an intense pain syndrome. The chronic form causes pathological changes the walls of the organ, characterized by a long course.

Types of disease

The modern classification of acute cholecystitis suggests the existence of the following forms of the disease:

• Catarrhal. This form of pathology is characterized by a favorable prognosis. The disease leads to an increase in the size of the body, thickening of the walls. Cholecystitis provokes the occurrence of pain, bouts of vomiting;
• Phlegmous. The disease causes the appearance of pus in the tissues of the organ, accompanied by severe pain. Patients note the following symptoms acute cholecystitis: indomitable vomiting that does not bring relief, fever, signs of intoxication;
• Gangrenous. Most dangerous form leading to necrotic changes in the tissues of the organ. It can provoke perforation of the walls, the occurrence of peritonitis.

According to the classification of acute cholecystitis according to the severity of the disease, mild, moderate and severe form diseases.

Clinical manifestations

The first symptom of acute cholecystitis is sharp pain in the right hypochondrium. The sudden development of pain syndrome is characteristic, which can be stopped only by strong painkillers. However, over time, the pain reappears.

The nature and localization of pain in acute cholecystitis are as follows:

• Intense pain, which is constantly growing, radiates to the right shoulder blade, lower back;
• progressive weakness;
• pressure reduction;
• Flatulence and tension of the abdominal muscles.

The patient also has other characteristic symptoms attack of cholecystitis:

• A sharp increase in temperature;
• Dyspeptic phenomena (flatulence, bitter taste in oral cavity, diarrhea, belching);
• Nausea and bouts of vomiting, which do not bring relief, only exhaust the patient;
• Jaundice of the sclera and skin;
• development of tachycardia. If the heart rate exceeds 120 beats, then the development of serious violations in the body;
• Hue change stool and urine.

Possible Complications

If signs of acute cholecystitis appear against the background of migration of stones, then perforation of the ducts or the wall of the organ may occur. This condition poses a direct threat to the patient's life, as it provokes inflammation of the abdominal cavity.

The listed complications in acute cholecystitis are characterized by the following symptoms:

• Acute pain that increases during palpation;
• Strong thirst;
• Increase in body temperature;
• A sharp decrease in pressure against the background of tachycardia;
• severe weakness;
• Enlargement of the abdomen in size;
• Vomiting green contents;
• Paleness of skin and tongue.

Important! With the development of peritonitis, the patient needs emergency medical care, urgent hospitalization.

With the advanced form of the disease, such complications of acute cholecystitis develop:

• The appearance of emphysema of the gallbladder;
• fistulas;
• The development of purulent inflammation;
• Sepsis (occurrence of a generalized infection);
• Necrosis of the digestive organ.

Diagnostic measures

Diagnosis of acute cholecystitis involves the following activities:

• Examination and questioning of the patient to identify violations in diet food, Availability stressful situations, the appearance of symptoms of an attack of cholecystitis;
• Ultrasound of the organs of the hepatobiliary system. The method allows to differentiate the type of inflammation by increasing the size of the organ, thickening of the walls, the presence of stones;
• Holding computed tomography. The examination is used for a detailed study of the structure of the organs of the hepatobiliary tract;
• Performing endoscopic retrograde cholangiopancreatography. This type of diagnosis of acute cholecystitis allows you to examine the condition of the bile ducts;
• Blood study. The test results will show pronounced leukocytosis, elevated ESR, high level bilirubin, amylase, ALT, AST.

For acute cholecystitis differential diagnosis prevents the development of other diseases digestive organs who have similar symptoms. At the time of diagnosis, acute cholecystitis is differentiated from appendicitis, pyelonephritis, pancreatitis, urolithiasis, perforated ulcer, liver abscess, right-sided pleurisy.

How to relieve an attack of cholecystitis at home?

What to do if a person has an acute attack of cholecystitis? It is important to call an ambulance immediately. First aid for acute cholecystitis involves the following algorithm:

1. Lay the patient on the bed, exclude any kind physical activity.
2. Place an ice pack on the abdomen.
3. To relieve pain, you can use antispasmodic drugs(Drotaverin, Baralgin, Papaverin).
4. To eliminate vomiting, you should drink mint tea, still water, medicines (Trimedat, Cerucal). During an attack, you need to ensure that the patient's tongue does not sink.

First aid for cholecystitis should exclude the use of analgesics and drugs. Such drugs can only lubricate the manifestations of cholecystitis in adults. Therefore, the treatment and diagnosis of acute cholecystitis can be complicated.

Important! With inflammation of the gallbladder, you need to stop taking alcoholic beverages, cleansing the intestines with enemas, applying a warm heating pad to the abdomen.

What is the treatment for acalculous cholecystitis?

If the disease is diagnosed for the first time, the patient has no stones, purulent complications, then conservative treatment of acute cholecystitis is indicated. AT similar situations prescribe antibiotic therapy to eliminate the pathogenic microflora.

To eliminate pain, dilation of the bile ducts, antispasmodics are indicated. With symptoms of intoxication, detoxification therapy is performed. With the appearance of cholecystitis, treatment involves adherence to a therapeutic diet.

Diet therapy is based on the following rules:

• Fractional meals up to 6 times a day in small portions;
• Rejection alcoholic beverages, fried, fatty and spicy foods;
• Food must be freshly prepared heat treatment involves boiling, baking and steaming;
• To prevent the development of constipation, it is necessary to introduce foods enriched with dietary fiber into the menu.

Important! If acute cholecystitis causes destructive changes in the organ, then surgical methods of treatment are used.

How to treat calculous cholecystitis?

There are such methods of treating acute cholecystitis, which occurs against the background of the appearance of calculi:

• Carrying out laparoscopic cholecystectomy;
• Removal of an organ through abdominal surgery;
• Performing percutaneous cholecystectomy. This tactic is used to treat cholecystitis in older women.

Important! With large stones, the refusal of surgical intervention can provoke the occurrence of repeated attacks, complications, and the transition of the pathology to a chronic form.

Forecast and prevention

With medication treatment of mild forms of cholecystitis can completely eliminate unpleasant symptoms, prevent complications. If the drugs were chosen inadequately, then the disease can become chronic. When a patient develops complications, the risk of a fatal outcome increases significantly.

After an emergency or planned cholecystectomy, the quality of life of the patient worsens slightly. The synthesis of digestive secretions continues in the liver. Therefore, often there is a postcholecystectomy syndrome, characterized by pain, diarrhea, flatulence. These symptoms can be removed with medication or diet.

For the prevention of acute cholecystitis, experts recommend adhering to, abandoning the use of alcoholic beverages, spicy and fatty foods. To normalize the digestive processes, you need to eat every 3.5 hours. In this case, the last meal should take place 2 hours before going to bed. To prevent stagnation of the digestive secretion, one should increase the level of physical activity, avoid stressful situations, normalize body weight, and treat intestinal parasitic diseases in a timely manner.