Inflammation of the gallbladder, accompanied by the formation of stones in the organ and its ducts, is cholelithiasis (GSD) or calculous cholecystitis. The phlegmonous variant of the pathology is its complication. It is diagnosed mainly in people over 40 years old, and women are more affected.
Medical certificate
Cholecystitis can be acute or chronic. Acute, in turn, is calculous, when the pathological process is accompanied by the formation of stones in the organ, and stoneless.
According to the severity of destructive processes, the disease is divided into the following forms:
- Catarrhal. In this case, there is swelling and redness of the mucous membranes of the bladder, its increase. The lumen of the organ is gradually filled with inflammatory fluid.
- Phlegmonous. There is a lesion of all membranes of the gallbladder. In this case, purulent infiltrates and ulcers are formed.
- Gangrenous. This is the final stagepathological process. It is characterized by necrosis of sections of the bladder walls. Often this leads to rupture of the organ and death of the patient.
Determination of the form of the disease allows you to choose the most effective treatment tactics.
Features of pathogenesis
Under the influence of some factors, congestion first develops in the gallbladder. As a result of violation of the outflow of fluid, its composition changes. Infectious agents actively multiply in it. Gradually, the internal pressure on the walls of the organ increases, which leads to inflammation and the formation of pus. At this stage, cholecystitis becomes phlegmonous. The stage itself is called destructive, because it leads to irreversible changes in the structure of the gallbladder.
Inflammatory effusion and pus impregnate the walls of the organ, which leads to their thickening. There may be small hemorrhages. The inflammatory process provokes pathological changes in the mucosa. Scars begin to form on it.
The walls of the gallbladder expand rapidly under pressure. Bile with impurities of mucus, pus and calculi burst, increase it. As a result, the patient experiences severe pain, which forces him to seek medical attention.
Main reasons
The following factors contribute to the development of phlegmonous cholecystitis:
- change in the composition of bile;
- progressive stagnant processes in the body;
- relapse of inflammation.
The occurrence of the disease occurs according todue to the lack of treatment of primary inflammation in the gallbladder or incorrectly chosen tactics of therapy. The development of the phlegmonous form is always preceded by a long-term calculous cholecystitis. It, in turn, may appear under the influence of the following factors:
- malnutrition;
- inactive lifestyle;
- decreased immunity;
- long-term medication;
- hormonal changes during pregnancy;
- pathology of the gastrointestinal tract;
- hereditary predisposition.
According to the International Classification of Diseases of the 10th revision, phlegmonous cholecystitis refers to diseases of the gallbladder, biliary tract and pancreas. Its acute form has the code K81.0, and the chronic form has the code K81.1.
Clinical picture
When the calculous form of the disease becomes phlegmonous, the patient clearly feels the clinical manifestations of the pathology. The course of the purulent process is always accompanied by an increase in temperature. The patient gradually develops signs of intoxication. If inflammation goes beyond the affected organ, it begins to negatively affect the work of the whole organism.
In the phlegmonous stage of the disease, pain intensifies. Discomfort increases when the patient violates the diet, takes alcoholic beverages or is subjected to intense physical exertion. In addition, psycho-emotional overstrain or a stressful state can serve as the cause of the increase in pain.
Acute phlegmonouscalculous cholecystitis occurs with the following symptoms:
- arterial hypotension;
- general weakness;
- vomiting, bitter belching;
- taste of bile in mouth;
- performance of cold perspiration.
Pain sensations usually appear in the right side and only intensify with a change in body position, deep breaths. Sometimes there is bloating due to impaired functioning of the smooth muscles of the intestine.
Chronic and acute phlegmonous cholecystitis
The medical history of most patients is associated with its acute course. The first symptoms in this case are pain in the right hypochondrium, which can radiate to the lower back or neck, severe vomiting. In addition, there is tachycardia.
In a chronic course, the clinical picture is somewhat modified. The pain syndrome is periodic. However, the patient is worried about constant belching and a feeling of bitterness in the mouth, general weakness and dizziness.
Obstructive phlegmonous cholecystitis
Acute obstructive cholecystitis is a pathological condition that usually occurs against the background of the calculous form of the disease. It is characterized by blockage of the gallbladder ducts by stones, which causes their obstruction. The disease is accompanied by severe pain syndrome. In addition, there is an increase in the gallbladder in size, so that the patient can feel it on his own. The clinical picture is expressed by nausea and vomiting, loss of strength. Similar statelasts from several hours to whole days. When the stone passes back into the organ, all symptoms disappear.
The lack of treatment of acute obstructive phlegmonous calculous cholecystitis is dangerous for the development of sepsis and cirrhosis of the liver. Some patients develop liver failure, bilirubin encephalopathy.
Diagnostic Methods
Diagnosis begins with a patient's medical history. Phlegmonous cholecystitis always develops from a catarrhal form of pathology. At the same time, cholecystitis itself in 95% of cases is a complication of the presence of stones in the bladder ducts.
Then a physical examination is carried out, the study of the patient's complaints. The doctor may feel bloating on palpation. When pressing on the area of the right hypochondrium, the patient experiences severe pain discomfort. The doctor may also feel for an inflamed gallbladder.
Blood and urine tests are an obligatory stage of diagnostics. In the case of an inflammatory process, there is an acceleration of ESR, an increase in the number of leukocytes. For a visual assessment of the affected organ, ultrasound, radiographic examination, CT and MRI are performed. In severe cases, a biopsy may be required.
Conservative Therapy
Treatment of phlegmonous cholecystitis is carried out exclusively in a hospital setting. With a stoneless form, drug therapy is acceptable. In the case of an acute course of calculous phlegmonous disease, an operation is indicated.
Conservative treatment includes the followingEvents:
- Taking antispasmodic and pain medications, including narcotic ones. Medications help relieve pain.
- Antibiotic therapy to suppress the infectious process. Antibiotics show good efficacy in the calculous form of the disease. In the case of phlegmonous, due to destructive processes, the blood flow is disturbed. This complicates the transportation of the active ingredients of the drug to the lesion.
- Diet therapy. In the first two days, the patient is offered fasting. Then the diet expands somewhat. Products that irritate the gastrointestinal tract are strictly prohibited. The diet is as sparing as possible, and the dishes are steamed and ground. Meals are mostly fractional.
In addition, it is important for the patient to provide physical and emotional rest. If you feel worse, the issue of an operation is decided.
Surgery
Surgical treatment for cholecystitis is carried out in three different ways. The choice of a specific option depends on the patient's condition and the results of his examination:
- Laparoscopic surgery is considered the most preferred. During the procedure, the doctor makes several punctures on the abdominal wall, through which he inserts instruments for medical manipulations.
- Traditional abdominal surgery is rarely used today, for example in cases of gallbladder infections or adhesions. Recovery is usually long and very difficult.
- Percutaneouscholecystostomy is used in the treatment of seriously ill patients. The operation involves making a small incision in the abdomen, through which a drainage tube is subsequently inserted into the gallbladder.
If the operation is not possible according to the indications, the patient is recommended a procedure for crushing stones by means of extracorporeal shock wave lithotripsy. It is always accompanied by the use of specific medications. However, with this treatment option, relapses are possible.
After the operation, it is important for all patients, without exception, to follow a strict diet and maintain a he althy lifestyle. In the first few days, eating and any liquid is strictly prohibited. On the third day, mashed fruits and vegetables, watery cereals, compotes are allowed.
Possible Complications
If left untreated or the wrong tactics chosen, phlegmonous cholecystitis can lead to complications. Among them, the most common are the following:
- The transition of the disease into a gangrenous form, which can provoke a rupture of the gallbladder, the outflow of its contents into the peritoneal cavity. As a result, peritonitis develops.
- Formation of fistulas and abscesses.
- Involvement of neighboring organs in the pathological process. We are talking about damage to the intestines, liver and pancreas.
Also, the disease can be complicated by sclerosis of the gallbladder. At the same time, he althy cells are replaced by dense connective tissue.
Prevention Methods
To prevent the development of a complicated form of calculous cholecystitis - phlegmonous, you must follow the doctor's recommendations. Preventive measures are usually aimed at reducing the risk of recurrence of the disease. To this end, you should:
- stick to a low-calorie diet;
- avoid psycho-emotional overload;
- take prescribed medications.
Seeking medical help at the stage of development of calculous cholecystitis almost always avoids its phlegmonous form.
