Acalculous chronic cholecystitis is an inflammation of the gallbladder without the formation of gallstones. This form causes pain in the right hypochondrium and dyspeptic disorders.
In the field of gastroenterology, chronic lesions account for 5 to 10% of cases. In women, chronic acalculous cholecystitis occurs about 4 times more often. Those are the statistics. Some researchers classify chronic acalculous cholecystitis as a transitional form of a disease such as cholesterol calculosis. But, as medical practice has shown, patients do not suffer from gallstone disease in the future.
Causes of disease
The etiology of this disease is various infections:
- E. coli;
- enterococcus;
- staph;
- proteus;
- mixed flora.
The penetration of bacteria into the gallbladder through the intestines occurs under conditions such as:
- dysbacteriosis;
- colitis;
- enteritis;
- hepatitis;
- pancreatitis.
Rarely, infection spreads through lymph or blood from distant infection foci.
For example, the infection is spread by diseases such as:
- periodontal disease;
- chronic tonsillitis;
- appendicitis;
- pneumonia;
- pyelitis;
- adnexitis.
Provoking factors that activate infectious processes include:
- cholestasis;
- biliary dyskinesia;
- invasion by such parasites as giardia, roundworm, amoeba;
- sphincter dysfunction;
- obesity;
- dysmenorrhea;
- physical inactivity;
- malnutrition;
- nervous exhaustion, etc.
Acalculous chronic cholecystitis involves thickening and deformity of the gallbladder. The mucous membrane acquires a mesh structure due to the fact that atrophic areas alternate with polyps that form thick folds.
There is a thickening of the muscle membrane. It appears scar fibrous tissue. With the prevalence of the inflammatory process, pericholecystitis may develop, adhesions with neighboring organs, abscesses, pseudodiverticula may appear.
Disease classification
Defeat is easy, medium and hard. The disease involves three stages:
- aggravation;
- subsidence and aggravation;
- persistent and unstable remission.
Acalculous chronic cholecystitis can occur with relapses. Alsothe disease is monotonous and intermittent.
Depending on the degree of damage, it is customary to distinguish between complicated and uncomplicated forms of chronic non-calculous cholecystitis. It is also customary to distinguish between typical and atypical species. The latter form is subdivided into intestinal, cardialgic and esophagalgic types.
Signs of chronic acalculous cholecystitis manifest themselves differently depending on the degree of damage to the gallbladder.
How does the disease manifest itself in a mild degree?
For mild cholecystitis, short exacerbations are characteristic, lasting 2-3 days. They are mainly caused by poor nutrition and are easily eliminated with proper diet.
The general condition of the body is normal, the body temperature is normal. The examination does not reveal a functional disorder of the liver, gallbladder and pancreas. Microscopic studies of bile do not show any abnormalities.
How is the middle form going?
With the average form of a disease such as chronic acalculous cholecystitis, remission and exacerbation follow each other. The duration of exacerbations is 2-3 weeks. Usually the patient is concerned about pain and severe dyspeptic disorder. As a rule, this condition is caused by eating fatty foods or overeating. In some cases, an infection of the respiratory system acts as a provocateur of an exacerbation.
How does chronic acalculous cholecystitis proceed in this case?The symptoms are varied. During exacerbation, patients have no appetite, body weight decreases, intoxication appears, which is expressed in asthenia and migraine. Joint pain may also bother.
Some patients, in addition to pain in the right hypochondrium, may complain of dull pain in the left hypochondrium and upper abdomen. Pain often radiates to the heart. Patients suffer from nausea, constipation or diarrhea.
In a laboratory study of bile, an increase in the amount of mucus, leukocytes, cholesterol, Ca bilirubinate, bile s alts, and in some cases microliths is noted. It is also possible to detect microflora.
In an acute condition, patients show a change in liver function tests. Often there is mild hypoalbuminemia, a slight increase in transaminase activity, mainly AJIT, a moderate increase in thymol test and alkaline phosphatase activity.
Liver lab results become normal during remission. The patient may be disturbed by a feeling of heaviness in the upper abdomen and bloating after eating. Often a person suffers from constipation or diarrhea.
Dyspeptic manifestations are aggravated by the intake of fatty foods or coarse fiber. Such food can provoke an exacerbation of the disease.
How does the severe form progress?
Severe acalculous chronic cholecystitis is characterized by a course with constant relapses without remission. The disease spreads beyond the gallbladder. Chronic hepatitis and pancreatitis join the main disease.
Patients complain of lack of appetite, incessant nausea, heaviness in the upper abdomen. Sometimes the pain is excruciating in nature. Patients are recommended a strict diet, which leads to weight loss and asthenia. In some cases, sepsis appears in a chronic form.
The functionality of the gallbladder is severely impaired. The body wall thickens. If, with a moderate degree, the functionality of the liver is partially impaired, then with a severe form of the disease, hepatitis in a chronic form or cholangitis often manifests itself.
The following processes take place:
- liver increases in size;
- reduced serum albumin;
- globulin fractions and the concentration of total bilirubin increase.
During the ultrasound examination of the abdominal organs, there is an expansion of the gallbladder ducts, a "stagnant" gallbladder, chronic pancreatitis with a decrease in the functionality of the pancreas.
Patients often complain of dyspeptic disorders, nausea, weight loss. They have increased fecal volume, steatorrhea, creatorrhea, and amylorrhea.
In a severe form of the disease, the work of blood vessels and the heart is disturbed, vegetovascular dystonia appears, coronary insufficiency with corresponding changes in the ECG.
How does the atypical form proceed?
How is the atypical form characterizedchronic acalculous cholecystitis? The patient is worried about constant heartburn, heaviness, chest pain, transient dysphagia. With the intestinal type, pain in the intestinal region, bloating, and constipation come to the fore.
At a young age, chronic acalculous cholecystitis is similar to latent rheumatism. Patients complain of asthenia, pain in the joints. Auscultation reveals low heart sounds.
The atypical course of the disease includes lumbar and pyloric-densal type of chronic cholecystitis. In the lumbar form, patients experience pain in the spine. In such cases, an x-ray of the spinal column is indicated.
Symptomatics of the cardialgic form
This form of the disease is characterized by arrhythmia (extrasystole) or chest pain. The ECG also changes.
In middle and old age, the cardiac form is similar to angina pectoris or coronary insufficiency, which occurs in a chronic form. Patients complain of pain in the heart, tachycardia.
Gastroduodenal form
The clinic of chronic cholecystitis in this case resembles a peptic ulcer or gastroduodenitis with an increased level of formation of gastric acid. Patients complain of stomach pain at night.
Diagnostic Methods
On palpation of the abdomen in the area of the gallbladder, pain is noted, which increases with inhalation or tapping of the right costal arch.
In a laboratory study, an increased indicator is determined:
- transaminase;
- alkaline phosphatase;
- γ-glutamyl transpeptidases.
Very important diagnostic methods include:
- ultrasound;
- cholecystography;
- celiacography;
- cholescintigraphy;
- duodenal sounding.
Based on the latest study, we can talk about the intensity of the inflammatory process.
Typical changes at the macroscopic level are manifested in the turbidity of bile, as well as the presence of flakes and mucus.
Microscopic examination reveals an increased number of leukocytes, bilirubin, protein, cholesterol, etc.
Bacteriological culture of bile examines its microbial flora.
With the help of cholecystography in patients suffering from a chronic form of acalculous cholecystitis, the motor and concentration functionality of the gallbladder, its contours and position are evaluated.
Echography reveals deformation of the gallbladder, atrophic processes in its walls, unevenness of the inner epithelium, the presence of inhomogeneous contents with inclusions of bile of a heterogeneous consistency.
Differential diagnosis is carried out with biliary dyskinesia, chronic cholangitis, ulcerative colitis of non-specific nature, and Crohn's disease.
Therapy Methods
How is chronic acalculous cholecystitis treated? Treatment is usually conservative. Doctors recommend sticking to a diet. It is advised to exclude fatty and fried foods, spicy dishes, carbonated and alcoholic drinks from the diet.
For abdominal painit is recommended to take such antispasmodics as "Platifillin", "Drotaverin", "Papaverin" and others.
In case of exacerbation of the disease or in combination with cholangitis, antibacterial treatment with Cefazolin, Amoxicillin, Erythromycin, Ampicillin, Furazolidone, etc. is used.
To normalize the work of the gastrointestinal tract, it is advised to take "Festal", "Mezim-forte", "Pancreatin".
To increase the secretion of bile, they usually resort to taking choleretics ("Allochol", "Holenzim", "Oxaphenamide").
Magnesium sulfate and sorbitol are used to stimulate gallbladder contraction.
During the period of exacerbation or remission, it is advisable to conduct a course of herbal therapy. Decoctions of chamomile, calendula, rosehip, licorice, mint are accepted.
During the period of remission, tubage is carried out, mineral water is drunk, exercise therapy is carried out.
Surgery
In case of surgical intervention, the medical history is taken into account. Chronic acalculous cholecystitis, which is expressed in the deformation of the walls of the gallbladder and uncorrected cholangitis and pancreatitis, requires surgery.
In this case, cholecystectomy is performed through open intervention, laparoscopy or mini-access.
Using folk methods
How elsechronic acalculous cholecystitis is eliminated? Treatment with folk remedies also has a positive effect.
The roots of calamus, valerian, dried inflorescences of St. John's wort, calendula, nettle, corn, flax seeds are used. It is also advisable to use linden, peppermint, motherwort, chamomile, dill, horsetail, wild rose.
When using folk methods in the chronic course of the disease, phytotherapy is added to the flowers of immortelle and elderberry.
Phytotherapy
Phytotherapy involves the use of a cocktail of the following herbs:
- peony - 20 ml;
- valerian - 20 ml;
- hawthorn - 20 ml;
- mint - 20 ml;
- Bella Beauty - 10 ml;
- motherwort - 20 ml;
- calendula - 30 ml;
- wormwood - 20 ml.
In the presence of glaucoma, belladonna is not added.
Drink the remedy should be 1-8 drops three times a day five minutes before taking an infusion of herbs for 1 tbsp. l of water for 4-6 weeks. A mixture of calamus and elecampane tinctures is taken in equal amounts. Also drink 1-8 drops three times a day two minutes before taking the infusion of herbs for 1 tbsp. l. water for 4-6 weeks.
It should be remembered that the phytotherapeutic collection is connected at a dose of 0.00325, i.e. the 14th dilution, and increases daily by 1-2 dilutions until the optimal dose is reached.
A suitable dose is one that does not cause dyspeptic disorders, but rather reduces the degree of present manifestations. Such a dosetaken during the course, but if discomfort appears, then it is reduced by 1-2 units.
Forecast
What is the prognosis of such a disease as chronic acalculous cholecystitis? An exacerbation in a mild form is rare. The disease has a favorable course. A worse prognosis occurs if exacerbations occur frequently with moderate severity of the disease.
Prevention
Preventive measures are concluded in the timely treatment of the disease, the rehabilitation of foci of infection, the elimination of disorders in the nervous system, as well as the restoration of normal metabolism. You should also follow the correct diet, fight intestinal infections and helminthic lesions.
