Treatment of acute cholecystitis. Symptoms, causes of the disease. Diet in cholecystitis

If you have severe pain in the right hypochondrium, nausea and vomiting, which does not give relief, a bitter taste is felt in your mouth, it is possible that you have an acute cholecystitis attack.

Cholecystitis is one of the most common diseases. According to the International Classification of Diseases (ICD-10), it belongs to the class of pathologies of the digestive tract. This disease can be independent, and can manifest as a complication after other ailments, for example, pancreatitis, certain types of gastritis, hepatitis and others. The disease develops gradually, at first it is not noticeable, therefore it is necessary to conduct as soon as possible treatment of acute cholecystitis, the symptoms of which have already manifested itself.

What is cholecystitis?

Cholecystitis according to ICD-10 is an inflammation of the gallbladder. The primary cause of the disease is the bile ducts, through which the gallbladder is cleared of bile, clogged with stones. This phenomenon has unpleasant consequences. Bile stagnates in the body, loses its antimicrobial properties, as a result, the walls of the gall bladder are infected (including bacteria that have got out of the gastrointestinal tract). Because of cholelithiasis, up to 95 percent of cholecystitis occurs.

More rarely the disease is caused by other causes: acuminate cholecystitis can be triggered by vasculitis, prolonged starvation, sepsis, cavitary operations, traumas, salmonellosis and other factors not associated with the formation of gallstones.

The disease occurs in acute and chronic form. The acute form is diagnosed with a rapidly developing inflammatory process. On average, 15 percent of patients with diseases of the abdominal cavity are prone to acute cholecystitis. They are marked by severe pain in the abdomen. If you suspect that you have an attack of acute cholecystitis, immediately consult a doctor (call an ambulance).

Chronic cholecystitis is the result of repeated seizures of the acute. Most often it is calculous (that is, with gallstones). The walls of the gallbladder thicken with time, pathological changes occur in the bile ducts or the bladder itself, the ability to store and release bile is reduced, and stones are formed. To prevent the disease from developing into a chronic form, it is necessary to pay attention in a timely manner to the pathological conditions of the body and to treat acute cholecystitis.

Symptoms of the disease

The most noticeable symptom of the disease is a sharp pain in the right hypochondrium. Pain with cholecystitis is very strong, lasts a long time - about six hours, often gives in the back or under the right shoulder blade and even comes to seizures.

With the development of the disease, the patient may experience attacks of nausea, it vomits, sometimes with an admixture of bile, but it becomes easier after vomiting. Also, patients can complain of dry mouth, lagging of the tongue. There are frequent complaints of bloating, belching of the air. All these signs require immediate treatment for acute cholecystitis.

Symptoms of acute cholecystitis also include:

• Fever, fever;
• Jaundice;
• A chair of gray color;
• Heart palpitations and other signs of intoxication.

In addition, it is necessary to pay attention to the following symptoms:

• Murphy and Obraztsova: with deep palpation of the right hypochondrium, it is difficult for a patient to breathe, it is painful to inhale;
• Grekova - Ortnera: the patient is experiencing pain when poking with the palm of the edge arch on the right;
• Щщетна - Блюмберга: pains at a cholecystitis amplify, if quickly to press a hand on anterior abdominal wall and to release.

The causes of acute cholecystitis

The main causes of cholecystitis are stones in the gallbladder:

• Stones from cholesterol (the most common case);
• Stones from bilirubin, or pigmented (arise when the red blood cells are destroyed).

Other causes of the disease:

• Congestion of bile in the organ;
• Cirrhosis of the liver and biliary tract;
• Rapid weight loss (regardless of whether as a result of a diet or surgical treatment of obesity it occurred);
• Pregnancy (on the gallbladder affects the position of the fetus, as well as hormonal changes in the body).

An important role in the occurrence of acute cholecystitis is played by sex and age. Women are susceptible to the disease on average 2-3 times more often than men. It is also noted that the disease often develops, if a woman gave birth to at least one child, is protected by contraceptives with an increased estrogen content, has excess weight. However, overweight can cause disease regardless of sex: a sedentary lifestyle and improper diet with a lot of fatty heavy foods make it 4 times more likely to seek help from doctors about acute cholecystitis. However, intensive physical work also contributes to the development of cholecystitis, since increased loads negatively affect the gallbladder and bile ducts.

The risk of getting sick sharply grows after 40-50 years, but the exact reasons why this occurs are not yet clarified. Older men often have sharp, acerbic cholecystitis.

Cholecystitis in adults is more common than in children, but in many cases the disease occurs in childhood and continues in the adult.

Also, factors that provoke acute cholecystitis include diseases such as diabetes, Crohn's disease, and immunodeficiency.

Pathology can arise as a result of taking medications to lower cholesterol, prolonged fasting, and stomach injuries.

Diagnosis of the disease

At the slightest suspicion of acute cholecystitis patient must in most cases be hospitalized and within 24 hours to conduct a study to confirm the diagnosis, as the disease carries a life threat.

With a typical course of acute cholecystitis, it is not difficult to confirm the diagnosis to an experienced physician.

In addition to physical examination of the abdomen, it is necessary to conduct such examinations as ultrasound and computed tomography of the abdominal cavity. When diagnosed, the doctor must make sure that it is about acute cholecystitis, and not about pancreatitis, the symptoms of which are similar, or appendicitis or another disease. On ultrasound, the doctor will see if the size of the gallbladder is enlarged, whether its walls are thickened, whether there are other changes, pus, stones, and so on. The effectiveness of this research reaches 90 percent.

In a number of cases, radiography, endoscopic, laparoscopic and other types of research may be required. Mandatory urine and blood tests - common, for bilirubin, amylase and lipase, pancreatic enzymes, and also aimed at assessing liver function.

Conservative therapy of acute cholecystitis

If there is no threat of spilled peritonitis in acute cholecystitis, examinations and conservative treatment are indicated. The patient is prescribed primarily painkillers and antibiotics. When cholecystitis for pain relief, antispasmodics are introduced (for example, "Papaverin", "No-shpa" and others). Combined drugs with cholecystitis (antispasmodics and analgesics, for example) have the most effective effect.

Antibiotics for cholecystitis are used to suppress the infection of the gallbladder and prevent it from developing.

The patient should be able to withstand a strict diet during therapy, in the first day, complete starvation is possible. On the right hypochondrium superposed cold.

To dissolve stones, use drugs of chenodeoxycholic or ursodeoxycholic acid. Cholagogue and hepatoprotectors are prescribed to maintain the functions of the organs. Such treatment can last more than two years, but the possibility of relapse remains.

Surgery

If there are signs of spilled peritonitis, the patient is urgently operated on - cholecystectomy (removal of the gallbladder). With peritonitis, lethality is very high even during emergency operations, so delay with hospitalization at the signs of acute cholecystitis is extremely dangerous.

If calculous cholecystitis (i.e., with stones) is found at the examination, no later than three days after the onset of the disease, in the absence of contraindications, an early operation is recommended to prevent complications after acute cholecystitis. Its meaning is the removal of the gallbladder, which is damaged by the disease.

Currently, two types of operations are performed: laparotomic and laparoscopic cholecystectomy. In the first case, this is a common open surgery with a cut of the abdominal cavity, which is now less and less frequent. Laparoscopy is performed without surgical incisions with the help of special equipment. During a laparoscopic operation, small incisions are made through which a video camera and instruments are inserted. This kind of cholecystectomy is less traumatic, has a short rehabilitation period, there are no stitches after it, there are almost no adhesions. It can also be used as a diagnostic method.

After the operation, the patient quickly restores, after two months he can return to his usual life, but there is a need to observe a strict diet for half a year and then control his nutrition in the future.

A relatively new type of non-invasive surgery is remote shock wave lithotripsy. Lithotripsy of the gallbladder is used if there are contraindications to carrying out an intracavitary operation. It is carried out by means of an apparatus sending a shock wave to a stone and crushing it until it turns into dust.

The prognosis for acute cholecystitis is generally favorable. After surgery due to calculous cholecystitis, almost all patients no longer experience symptoms of the disease.

Complications of the disease

Acute cholecystitis often leads to diffuse peritonitis. Peritonitis is manifested in a significant increase in pain on the 3-4th day of the disease, the tension of the muscles of the abdominal wall, the soreness of the peritoneum.

Also, acute cholecystitis can lead to perforation of the gallbladder. In this case, the pain will decrease for a while, but then all the symptoms, including pain, become stronger.

Complications of the disease include cholangitis, pancreatitis, gall bladder gangrene, suppuration in the bladder. A special complication is the damage to the bile ducts during the operation to remove the gallbladder.

Multiple attacks of acute cholecystitis can lead to a chronic course of the disease.

Preventive measures

With a predisposition to the formation of gallstones completely prevent the possibility of acute cholecystitis is difficult. However, the likelihood of developing cholelithiasis can be reduced by preventive measures, which will reduce the risk of attacks of acute cholecystitis and chronic development.

Stagnant bile is impeded by an active lifestyle. Mobility does not give rise to stones, but also maintains a normal body weight.

If there is excess weight, you can not sharply reduce it.

Also it is necessary to observe the water balance (at least 2 liters of water a day).

Carefully monitor your health, give up alcohol and smoking, as they reduce immunity and negatively affect the digestive process.

Acute cholecystitis is often a concomitant disease in the pathology of the digestive tract, so all diseases of the gastrointestinal tract must be treated promptly.

The basic rule is proper nutrition. It is necessary to take food regularly, at the same time, at least three to five times a day, in small portions. This helps prevent gall bladder congestion .

Nutrition for acute cholecystitis

Diet plays a major role in the treatment of the disease. Therefore, the patient must first of all remember what is eaten with cholecystitis, and strictly observe all restrictions to prevent a recurrence of the attack.

Diet varies at each stage of the disease:

• From the moment of hospitalization, the patient is shown fasting until pain disappears (but not more than 4 days). At this stage only liquids are allowed (mineral water without gas, soft tea, fruit drinks, broths of chamomile, mint, dogrose) are also permissible. Drink often, in small sips.
• After removing the pain syndrome, you can enter into the diet a mashed liquid food - a thin broth, soups from rice, semolina, oatmeal, milk soups, jelly, low-calorie kefir. There is a need in small portions. At this stage it is necessary to drink more than 2 liters of water per day.
• Closer to recovery in the diet is added to lean fish and meat. It is still allowed only protrudaya food, boiled or cooked for a couple, but portions can be increased. At this stage, the diet allows vegetables and fruits, dry bread, biscuits, marshmallows, coffee with milk.

In acute and chronic cholecystitis, in no case should you eat fried, smoked, spicy, pickled, spicy. Prohibited foods with cholecystitis - chocolate, sweet soda, baked pastry, mushrooms. This heavy food has a very negative effect on the digestive system and can lead to a new attack.

After recovery, the dietary constraints persist, the patient is assigned diet No. 5a (the consumption of fats and foods rich in coarse plant fiber, oxalic acid, cholesterol, nitrogen extractives is limited).

Treatment with folk remedies

Folk remedies are recommended as additional. Completely to replace them with traditional therapy, especially in acute form, is dangerous. If you suspect a disease, you should first contact your doctor. First, acute cholecystitis should be treated, the symptoms of which develop and require immediate medical supervision, and only after that can resort to medicinal herbs and dues.

Treatment of chronic cholecystitis with folk remedies is also used as an adjunct to the main method of therapy. Mostly used plants with choleretic, anti-inflammatory, antimicrobial properties, as well as honey and olive oil. Morning tea is recommended to replace the broth of corn stigmas or dogrose. One of the effective tools for cholecystitis, as well as for other diseases of the gastrointestinal tract is the decoction of raw oats.

Any folk remedy should be approved by the attending physician.

With a diet, a healthy lifestyle, the risk of gallstones and the development of cholecystitis is very small. However, when symptoms are characteristic of acute cholecystitis, it is necessary not to engage in self-medication, but immediately to see a doctor to make an accurate diagnosis and cure the disease as soon as possible without provoking complications and developing into a chronic form.