If you have severe pain in the right hypochondrium, nausea and vomiting that does not give relief, a bitter taste is felt in the mouth, it is possible that you have an attack of acute cholecystitis.
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, or it can manifest itself as a complication after other ailments, such as pancreatitis, certain types of gastritis, hepatitis, and others. The disease develops gradually, at first hardly noticeable, so it is necessary to treat acute cholecystitis as soon as possible, the symptoms of which have already appeared.
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 unfortunate consequences. Bile stagnates in the body, loses itsantimicrobial properties, as a result, the walls of the gallbladder become infected (including bacteria from the gastrointestinal tract). Up to 95 percent of cholecystitis occurs due to cholelithiasis.
Rarely, the disease is caused by other causes: acalculous cholecystitis can be triggered by vasculitis, prolonged starvation, sepsis, abdominal surgery, trauma, 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 abdominal diseases are prone to attacks of acute cholecystitis. They are marked by severe pain in the abdomen. If you think you are having an attack of acute cholecystitis, see your doctor immediately (call an ambulance).
Chronic cholecystitis is the result of repeated bouts of acute cholecystitis. Most often it is calculous (that is, with gallstones). The walls of the gallbladder thicken over time, pathological changes in the bile ducts or the bladder itself occur, the ability to store and release bile decreases, and stones form. To prevent the disease from developing into a chronic form, it is necessary to pay attention to the pathological conditions of the body in a timely manner and treat acute cholecystitis.
Disease symptoms
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 inback or under the right shoulder blade and even comes to cramps.
With the development of the disease, the patient may experience bouts of nausea, he vomits, sometimes with an admixture of bile, but it does not become easier after vomiting. Patients may also complain of dry mouth, furred tongue. There are frequent complaints of bloating, belching with air. All these signs require immediate treatment of acute cholecystitis.
Symptoms of acute cholecystitis also include:
- fever, fever;
- jaundice;
- grey chair;
- palpitations and other signs of intoxication.
Besides this, you should pay attention to the following symptoms:
- Murphy and Obraztsova: with deep palpation of the right hypochondrium, it is difficult for the patient to breathe, it hurts to take a breath;
- Grekova - Ortner: the patient experiences pain when tapping the right costal arch with the palm of his hand;
- Shchetkina-Blumberg: pain in cholecystitis intensifies if you quickly press your hand on the anterior abdominal wall and release it.
Causes of acute cholecystitis
The main causes of cholecystitis are gallstones:
- cholesterol stones (most common);
- bilirubin stones, or pigment stones (occur when red blood cells are destroyed).
Other causes of disease:
- stagnation of bile in the body;
- cirrhosis of the liver and biliary tract;
- fastweight loss (whether due to diet or obesity surgery);
- pregnancy (the position of the fetus affects the gallbladder, as well as hormonal changes in the body).
Gender and age play an important role in the occurrence of acute cholecystitis. Women are affected on average 2-3 times more often than men. It is also noted that the disease develops more often if a woman has given birth to at least one child, is protected by contraceptives with a high content of estrogen, and is overweight. However, excess body weight can cause disease regardless of gender: a sedentary lifestyle and an unhe althy diet with a lot of fatty heavy foods make it 4 times more likely to seek medical help for acute cholecystitis. However, intense physical work also contributes to the development of cholecystitis, as increased stress negatively affects the gallbladder and bile ducts.
The risk of getting sick rises sharply after 40-50 years, but the exact reasons why this happens have not yet been clarified. Older men are more likely to have acute acalculous cholecystitis.
Cholecystitis is more common in adults than in children, but in many cases the disease begins in childhood and continues into adulthood.
Also, factors that provoke acute cholecystitis include diseases such as diabetes, Crohn's disease, immunodeficiency.
Pathology can occur as a result of taking cholesterol-lowering drugs, prolonged fasting, abdominal injuries.
Diagnosis of disease
At the slightest suspicion of acute cholecystitis, the patient must, in most cases, be hospitalized and conduct studies within 24 hours to confirm the diagnosis, since the disease is life-threatening.
In a typical course of acute cholecystitis, it is not difficult for an experienced doctor to confirm the diagnosis.
In addition to the physical examination of the abdomen, examinations such as ultrasound and computed tomography of the abdomen should be performed. When diagnosing, the doctor must make sure that we are talking 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, if its walls are thickened, if there are other changes, pus, stones, and so on. The success of this study reaches 90 percent.
In some cases, radiography, endoscopic, laparoscopic and other types of studies may be required. Urine and blood tests are mandatory - general, for bilirubin, amylase and lipase, pancreatic enzymes, as well as those aimed at assessing liver function.
Conservative therapy for acute cholecystitis
If there is no threat of diffuse peritonitis in acute cholecystitis, examinations and conservative treatment are indicated. The patient is primarily prescribed painkillers and antibiotics. With cholecystitis, antispasmodics are introduced to relieve pain (for example, "Papaverine", "No-shpa" and others). Combined drugs for cholecystitis(antispasmodics and painkillers, for example) are most effective.
Antibiotics for cholecystitis are used to suppress gallbladder infection and prevent it from developing.
The patient during therapy must maintain a strict diet, complete starvation is possible on the first day. Cold is applied to the right hypochondrium.
Chenodeoxycholic or ursodeoxycholic acid preparations are used to dissolve stones. To maintain the functions of organs, choleretic and hepatoprotectors are prescribed. Such treatment can last more than two years, but the possibility of relapse remains.
Surgical treatment
When signs of diffuse peritonitis are detected, the patient undergoes emergency surgery - cholecystectomy (removal of the gallbladder). With peritonitis, mortality is very high even with emergency operations, so delaying hospitalization with signs of acute cholecystitis is extremely dangerous.
If the examination reveals calculous cholecystitis (that is, with stones), no later than three days from 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 damaged by the disease.
Currently, there are two types of operations: laparotomy and laparoscopic cholecystectomy. In the first case, this is a common open operation with an incision in the abdominal cavity, which is now performed less and less frequently. Laparoscopy is performed without surgicalincisions using special equipment. During laparoscopic surgery, small incisions are made through which a video camera and instruments are inserted. This type of cholecystectomy is less traumatic, has a short rehabilitation period, there are no stitches left after it, and there are practically no adhesions. It can also be used as a diagnostic method.
After the operation, the patient recovers quickly, after two months he can return to his usual life, however, there is still a need to follow a strict diet for six months and then control his diet.
Relatively new type of non-invasive operation - remote shock wave lithotripsy. Lithotripsy of the gallbladder is used if there are contraindications for intracavitary surgery. It is performed using a machine that sends a shock wave to the stone and crushes it until it turns into dust.
Prognosis for acute cholecystitis is generally favorable. After surgery for calculous cholecystitis, almost all patients no longer experience symptoms of the disease.
Complications of the disease
Acute cholecystitis more often than other diseases leads to diffuse peritonitis. Peritonitis is manifested in a significant increase in pain on the 3rd-4th day of the disease, tension in the muscles of the abdominal wall, pain in 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, includingpain, getting stronger.
Complications of the disease include cholangitis, pancreatitis, gangrene of the gallbladder, suppuration in the bladder. A particular complication is damage to the bile ducts during an operation to remove the gallbladder.
Repeated attacks of acute cholecystitis can lead to a chronic course of the disease.
Prevention measures
With a predisposition to the formation of gallstones, it is difficult to completely prevent the possibility of acute cholecystitis. However, the likelihood of developing cholelithiasis can be reduced by preventive measures, as a result of which the risk of attacks of acute cholecystitis and the development of chronic cholecystitis will decrease.
Stagnation of bile is prevented by an active lifestyle. Mobility prevents the formation of stones, and also maintains normal body weight.
If you're overweight, don't drop it drastically.
It is also necessary to maintain water balance (you need to drink at least 2 liters of water per day).
Carefully monitor your he alth, give up alcohol and smoking, as they reduce immunity and negatively affect the digestion process.
Acute cholecystitis is often a concomitant disease in gastrointestinal pathologies, so all diseases of the gastrointestinal tract must be treated in a timely manner.
The basic rule is proper nutrition. It is necessary to eat regularly, at the same time, at least three to five times a day, in small portions. This helps prevent bile stasis in the gallbladder.
Nutrition for acute cholecystitis
Diet plays a major role in the treatment of the disease. Therefore, the patient must first of all remember what they eat with cholecystitis, and strictly observe all restrictions in order to prevent a recurrence of an attack.
Diet is different at each stage of the disease:
- From the moment of hospitalization, the patient is shown fasting until the pain disappears (but not more than 4 days). At this stage, only liquids are allowed (mineral water without gas, weak tea, fruit drinks, decoctions of chamomile, mint, rose hips are also acceptable). You need to drink often, in small sips.
- After the pain syndrome is relieved, pureed liquid food can be introduced into the diet - weak broth, rice, semolina, oatmeal soups, milk soups, jelly, low-calorie kefir. You need to eat in small portions. At this stage, you need to drink more than 2 liters of water per day.
- Closer to recovery, lean fish and meat are added to the diet. Only pureed food, boiled or steamed, is still allowed, 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 for cholecystitis are chocolate, sweet soda, sweet pastries, mushrooms. This heavy food has a very negative effect on the digestive system and can lead to a new attack.
After recovery, dietary restrictions remain, the patient is prescribed diet No. 5a (the intake of fats andfoods rich in coarse vegetable fiber, oxalic acid, cholesterol, nitrogenous extractives).
Treatment with folk remedies
Folk remedies are recommended to be used as additional ones. It is dangerous to completely replace traditional therapy with them, especially in the acute form. If you suspect a disease, you should first consult a doctor. First, treatment of acute cholecystitis, the symptoms of which develop and require immediate medical supervision, should be carried out, and only after that one can resort to medicinal herbs and preparations.
Treatment of chronic cholecystitis with folk remedies is also used as an addition to the main method of therapy. Plants with choleretic, anti-inflammatory, antimicrobial properties, as well as honey and olive oil are mainly used. It is recommended to replace morning tea with a decoction of corn stigmas or wild rose. One of the effective remedies for both cholecystitis and other diseases of the gastrointestinal tract is a decoction of unpeeled oat grains.
Any folk remedy must be approved by your doctor.
With a he althy diet, he althy lifestyle, the risk of gallstones and cholecystitis is very small. However, if symptoms characteristic of acute cholecystitis appear, it is necessary not to self-medicate, but to immediately consult a doctor in order to make an accurate diagnosis and cure the disease as quickly as possible, without provoking complications and developing intochronic form.
