Acute cholecystitis. Catarrhal, phlegmonous, gangrenous cholecystitis Gangrenous cholecystitis what are the complications after surgery

The most severe and dangerous complication of calculous cholecystitis is acute gangrenous cholecystitis or gangrene of the gallbladder. This disease is characterized by the death of areas in the wall of the bladder, associated with serious circulatory disorders.

In most cases, necrotic changes in the bile wall occur against the background of phlegmonous inflammation, but sometimes there are cases when wall necrosis is not accompanied by obvious signs of purulent inflammation and in this case is a consequence of ischemic damage to the cystic artery. Gangrenous form mainly occurs in the elderly when the regenerative abilities of the tissue are significantly reduced, and the blood supply to the gallbladder wall is weakened. Also, the cause of the disease can be infectious agents, such as staphylococcus aureus, E. coli, streptococcus, anaerobic microflora, typhoid bacillus. In the gallbladder, the infection can enter through the intestines, as well as with blood or lymph.

Symptoms of acute gangrenous cholecystitis

• a sharp appearance of high temperature in the absence of complaints about health and well-being, more often at night;
• the occurrence of spasmodic pain in the right side of the abdomen, but sometimes in the entire abdominal cavity;
• duration and intensity of pain attacks;
• spread of pain in the shoulders, collarbone, lower back;
• the intensity of pain increases if the patient lies on the right side;
• vomiting and nausea;
• constipation or diarrhea;
• moisture, pallor of the skin;
• tachycardia;
• headache;
• weakness;
• lethargy;
• drowsiness;
• fainting or semi-conscious state;
• frequent breathing;
• bloating;
• the stomach is not involved in breathing.

Sometimes gangrenous cholecystitis is accompanied by jaundice.

Diagnosis of gangrenous cholecystitis

The diagnosis is based on the characteristic complaints of patients, a thorough examination, tests, ultrasound. Treatment of this disease should be immediate in order to avoid the development of peritonitis as a complication. An emergency hospitalization of the patient in the surgical department and an early determination of further treatment tactics are required.

Rupture of the gallbladder in gangrenous cholecystitis

Acute gangrenous cholecystitis can lead to rupture of the wall (perforation) of the gallbladder. A hole is especially easily formed where the stone presses on the wall, as a result of which a bedsore forms under it, which contributes to perforation.

Usually gangrene of the gallbladder develops no earlier than 3-4 days of inflammation. Therefore, the patient should have enough time to seek medical help and prevent this complication. As a rule, rupture of the gallbladder occurs in those patients who do not go to the doctor until the last, hoping that "it will pass by itself."

With a belated visit to the doctor, serious changes occur that threaten not only the health of the patient, but also his life. When a hole is formed in the wall of the bladder, the purulent contents of which spill into the abdominal cavity, infection occurs and gangrenous cholecystitis complicated by peritonitis can be ascertained. If the protective reactions of the body work correctly, then the liquid does not spread throughout the abdominal cavity, but affects only a small area of ​​it. In this case, an abscess or abscess is formed in the abdominal cavity, which is more favorable for the patient.

Treatment of gangrenous cholecystitis

With gangrene of the gallbladder, urgent cholecystectomy is indicated - an operation to remove the gallbladder. Today it is the main method of treatment. It is prescribed in case of failure of conservative treatment methods.

Laparoscopic removal of the gallbladder

Laparoscopic cholecystectomy is performed under general anesthesia. A special needle is inserted into the patient's abdomen, through which gas enters the abdominal cavity, which significantly improves the visualization of internal organs. After that, 4 incisions up to 2-3 cm in size are made, through which a video camera and manipulation instruments are inserted. Through one of the incisions, the gallbladder is removed, after which a thin drainage is brought to its bed, and sutures are applied to the wounds.

It is important to remember that acute gangrenous cholecystitis is a complication of milder forms of calculous cholecystitis, so do not start the disease at its initial stage and, at the slightest suspicion, consult a doctor.

Gangrenous cholecystitis is often a secondary process, since it is considered one of the most dangerous complications of another form of inflammation of the gallbladder - calculous. In gastroenterology, this pathology is also known as gallbladder gangrene. A characteristic sign of the disease is that with such a disease, the tissues of this organ die off, which, in turn, is caused by a violation of blood circulation in it.

A wide range of predisposing factors can cause such a disorder, depending on which the disease is divided into several groups. The main risk group is the elderly. This is due to the fact that the recovery processes of the tissues of the gallbladder are much slower, and the blood supply is weakened due to the age category.

The establishment of the final diagnosis is carried out on the basis of a doctor's examination, as well as with the help of a number of laboratory and instrumental examinations. Treatment of the disease is performed only by surgery.

Etiology

There are several reasons for the formation of such a disease. Often this form of the inflammatory process develops against the background of calculous cholecystitis and subsequent phlegmonous. Thus, all three forms, as it were, flow into one another. It follows from this that such a disorder is secondary and rarely acts as an independent pathology. The primary form develops against the background of impaired blood flow in the cystic artery.

Very often, acute gangrenous cholecystitis is formed due to the influence of certain pathological microorganisms, which include:

• streptococcus;
• typhoid or Escherichia coli;
• gas-forming microflora;
• other anaerobic microflora.

Pathogenic microorganisms can enter the walls of the gallbladder in several ways:

• with blood flow;
• with lymph;
• through the intestines.

In addition, a high probability of the occurrence of such a disease is observed in persons with pronounced atherosclerosis of the vessels of the circulatory system.

Classification

In medicine, gangrenous cholecystitis is divided into several groups. The first of them is caused by the causes of the appearance of gangrene of the gallbladder. Thus, the disease is divided into:

• primary- is diagnosed most rarely and is associated with impaired blood flow in the cystic artery;
• secondary- is the most common form of such a disease, since it is a complication of phlegmonous and calculous cholecystitis.

Like other types of inflammation of the gallbladder, the gangrenous form exists in several forms:

• acute- characterized by a vivid expression of symptoms and a gradual increase in its intensity. With untimely therapy, it can lead to serious consequences;
• erased- observed in old age and differs from the previous course by a slight pain syndrome and a slight increase in temperature. However, at the same time, there are more vivid signs of a violation of the functioning of other internal organs.

Symptoms

The disease in all cases is accompanied by a pronounced clinical picture, which leads to a serious condition of the patient.

Symptoms of gangrenous cholecystitis include:

• a sharp increase in body temperature, often at night. At the same time, the person does not complain about the deterioration and poor health;
• gradually increasing pain syndrome, which can not only be localized in the projection of this organ, that is, on the right side of the abdomen, but often spreads over the entire surface of the anterior abdominal wall. Also, patients note the spread of soreness in the area of ​​​​the shoulders, lower back and collarbone. The intensity of pain greatly increases in a horizontal position lying on the right side;
• violation of the stool, which is expressed in the alternation of constipation and diarrhea;
• bouts of nausea, accompanied by profuse vomiting;
• increased heart rate;
• pallor of the skin;
• severe headaches;
• general weakness and lethargy;
• constant sleepiness;
• an increase in the size of the abdomen;
• alternating lethargy and agitation.

In some cases, there is a condition called "toxic scissors". It implies a manifestation of signs of severe intoxication of the body and pronounced tachycardia, which are combined with a completely normal temperature. This atypical course of the disease quite often indicates deep changes in the tissues of the gallbladder, up to necrosis of the walls of this organ.

Rare symptoms of the disease include:

• moisture and yellowness of the skin;
• dryness of the oral mucosa;
• the appearance of a white coating on the tongue;
• decrease in blood pressure values;
• decrease in the daily volume of urine;
• semi-conscious state.

Diagnostics

Only a doctor can establish the final diagnosis, based on laboratory and instrumental examinations. But before their appointment, a specialist needs to conduct an objective examination:

• to study the medical history and anamnesis of the patient's life - to search for the causes of the onset of the disease, in particular, phlegmonous or calculous cholecystitis;
• perform a thorough survey and physical examination with mandatory palpation of the abdomen, measurement of blood pressure, pulse and temperature, as well as the study of the skin - this will provide the doctor with a complete picture of the first time of onset, the presence and intensity of symptoms.

Only after this, a laboratory examination is carried out, which includes:

• general analysis and biochemistry of blood;
• general urine analysis;
• coprogram.

But, instrumental diagnostics, which involves the implementation of:

• Ultrasound of the affected organ;
• radiography;
• EGDS - an endoscopic procedure for examining the internal surface of the digestive tract;
• CT and MRI - in cases where other methods of instrumental diagnosis cannot detect pathology;
• multifractional duodenal sounding.

The acute condition is differentiated from acute appendicitis, peptic ulcer, cholelithiasis, pleurisy and myocardial infarction.

Treatment

After confirming the diagnosis, emergency hospitalization of the patient and immediate operation are necessary. Any delay can cause such a complication as rupture of the gallbladder, which leads to the development of peritonitis, which, in turn, can cause the death of the patient.

The basis of surgical treatment is the removal of the gallbladder - cholecystectomy. Such an operation is performed in several ways:

• laparoscopically - excision of the affected organ is performed using special tools through several small incisions on the abdomen;
• laparotomy - removal of the gallbladder occurs through a large incision in the anterior abdominal wall.

In addition to surgery, patients are shown taking medications to relieve symptoms, as well as following the rules of dietary table No. 5.

Gangrenous cholecystitis is a dangerous pathology characterized by focal or complete necrosis of the gallbladder tissue. The risk group includes people over 40 years of age suffering from cholelithiasis and other chronic pathologies of the digestive tract. Self-medication or lack of timely therapy leads to rupture of the organ, infection of the peritoneum and death.

In most patients, gangrene is a secondary pathology that occurs against the background of advanced calculous cholecystitis. According to statistics, women get sick 5 times more often and usually after 40 years.

The main cause of gangrenous cholecystitis is the previous cholelithiasis, which occurs against the background of:

1. An unbalanced diet, the use of poor-quality and heavy products for the digestive organs.
2. Metabolic disorders.
3. Hormonal failure.
4. Anatomical features of the gastrointestinal tract (gastrointestinal tract).

Under the influence of adverse factors, the composition of bile and its consistency change. Over time, this leads to a violation of the outflow of the secret, the formation of a stagnant mass of sand, flakes, and then stones.

Adhesions and strictures (narrowings) of the bile ducts, benign and malignant tumors of the bladder and neighboring organs lead to the same consequences. They have a mechanical effect on the channels and interfere with the release of bile.

Infections are often the cause of necrosis. Pathogenic microorganisms penetrate from the intestines or with the flow of blood and lymph. A healthy body is able to overcome the infection and prevent serious complications. Chronic diseases deplete local immunity.

Necrosis of the gallbladder is often provoked by the following pathogens:

• intestinal, typhoid bacillus;
• anaerobic representatives of pathogenic flora;
• streptococcus.

Less commonly, gangrene occurs as a separate disease (primary form) that is not associated with pathologies of the digestive system. This is due to impaired blood flow in the cystic artery.

Rare pathology leads to:

• atherosclerosis;
• thrombosis;
• compression of blood vessels by tumors.

Regardless of the form, acute gangrenous, calculous cholecystitis is always manifested by severe symptoms. Often the disease is disguised as a disease of the heart, stomach or intestines.

Necrosis occurs in an acute or erased form. The first is observed in 90% of people and is accompanied by severe pain, with which patients enter the surgical department.

The task of the doctor is to establish the true cause of the ailment and quickly provide assistance. It happens that patients are admitted in an extremely serious condition and time does not allow for a full diagnosis. In this case, a detailed medical history is collected and the patient is examined.

With gangrene, an abnormally enlarged bladder and surrounding infiltrate are palpated. Tense abdominal muscles often indicate the development of peritonitis - a dangerous complication of many diseases, expressed in the outpouring of bile into the abdominal cavity.

For the diagnosis of peritonitis, the Shchetkin-Blumberg test is performed. The doctor presses on the abdomen, and then abruptly withdraws his hand. With a positive result, the patient experiences an increase in pain. If the discomfort is localized on the upper right, one can assume acute inflammation or rupture of the bladder wall.

Additionally, positive symptoms are determined:

1. Kera - increased discomfort when tapping on the costal arch while inhaling.
2. Courvoisier. On palpation of the area of ​​the right hypochondrium, an enlarged gallbladder is found, which protrudes from under the lower edge of the liver.
3. Pekarsky. When you press on the xiphoid process, located in the area of ​​​​the solar plexus, discomfort appears on the right under the ribs.
4. Boas - the pain increases with pressure from the back (between the 9th and 11th vertebrae).
5. Mussi-Georgievsky. Pressure in the right supraclavicular region increases discomfort under the ribs.

With diffuse peritonitis, the survival rate is about 60%, the success of the operation depends on the timely treatment and diagnosis of the complication.

Symptoms of acute complicated cholecystitis increase gradually. First, the body temperature rises, pain joins. It is localized in the zone of the right hypochondrium or spills over the entire abdomen, giving to the left side, shoulder blades, lower back.

If a person did not know about the presence of chronic pathologies, it is problematic to determine the localization of the process at home.

Additional symptoms include:

• weakness;
• drowsiness;
• nausea and profuse vomiting;
• constipation, diarrhea;
• headache and dizziness;
• increase in the volume of the abdomen;
• lethargy, followed by excitement;
• pallor and semi-consciousness.

Less commonly observed:

• decrease in the amount of urine excreted;
• dryness of the tongue, the appearance of a white coating;
• sweating;
• yellowing of the eye sclera, skin, mucous membranes;
• severe itching.

Sometimes all the typical signs of intoxication are present, but the temperature remains within the normal range.

The erased form is rare, it is detected in people older than 50-60 years. The clinical picture is characterized by the absence of pain or its slight manifestation. From the side of other organs, all of the above symptoms are manifested.

The worsening of the situation is indicated by a decrease in pain or their complete disappearance.

The necrotic process leads to damage to the nerve endings, and they cease to function together with the affected organ.

To confirm the diagnosis, an ultrasound examination of the abdominal cavity is performed, and an x-ray, which determines the condition of the internal organs.

The examination is supplemented with general and biochemical blood and urine tests. If possible, assess the characteristics of the feces.

When in doubt, carry out:

1. MRI (magnetic resonance imaging) and CT (computed tomography).
2. Endoscopic examination of the upper gastrointestinal tract.
3. Colonoscopy.

To differentiate cholecystitis, myocardial infarction and other cardiovascular diseases, an electrocardiogram is performed. To exclude peptic ulcer, a duodenal examination is prescribed, and pulmonary pleurisy is diagnosed using X-ray or fluorography.

When the diagnosis of acute gangrenous cholecystitis is confirmed, the patient is prepared for an emergency operation.

It is impossible to save an organ affected by gangrene, therefore the only effective method of eliminating the disease is cholecystectomy - removal of the gallbladder.

Depending on the severity of the condition and the development of complications, the intervention is carried out by laparoscopic or classical methods. In the first case, several punctures are made in the abdominal wall through which the necessary instruments are inserted.

This intervention has a number of advantages:

• less likely to lead to complications during surgery;
• does not leave large scars;
• allows you to shorten the recovery period.

However, laparoscopy is not always possible. With an extensive affected area, diffuse peritonitis, abscesses, laparotomy is preferred. The operation is performed through a large incision, through which dead tissue, infiltrates are removed, and the abdominal cavity is sanitized if it becomes infected.

The classic method is different:

• high trauma;
• the risk of developing severe bleeding;
• long-term rehabilitation;
• the likelihood of divergence of the seams, their suppuration.

Late seeking medical attention or prolonged diagnosis leads to perforations of the gallbladder. Usually through holes are formed in the place of localization of large stones.

Bile and pus enter the abdominal cavity and provoke the development of:

• Gnoynikov. This is the name of the infected areas limited by the capsule.
• Fistulas, that is, hollow communications between two organs, more often between the gallbladder and stomach or duodenum.

• Diffuse peritonitis. This is inflammation of the peritoneum against the background of its infection or irritation with bile.
• sepsis. The term refers to blood poisoning.

With timely assistance and highly qualified surgeons, the prognosis is favorable. After the bubble bursts, the patient's life is in danger.

Gangrene of the gallbladder tissue is not treated with drugs. They are prescribed as aids before and after surgery.

With severe pain in the abdomen, it is forbidden to drink painkillers and antispasmodics on your own. This will lead to the elimination or blurring of specific symptoms that aid early diagnosis. Considering that gangrenous inflammation is life-threatening, rash actions can play a cruel joke.

In the postoperative period appoint:

• painkillers;
• antispasmodics;
• antimicrobial injections;
• drugs to restore intestinal motility (especially relevant after laparotomy);
• sorbents;

• detoxification droppers;
• laxatives or antidiarrheal medicines;
• enzymes.

Other medicines are selected depending on the patient's condition, the results of the study and the outcome of the operation.

Having eliminated gangrenous cholecystitis, in the postoperative period you need to eat right. In the first 2 days, food is not consumed. Drinks are allowed pure water. Then they switch to dried fruit compotes and a rosehip broth.

Gradually, vegetable purees, pureed soups, durum wheat pasta are introduced into the menu. All meals consumed in the hospital are coordinated with the doctor.

When the results of the control examination show the absence of acute gastrointestinal diseases, you can switch to the classic diet No. 5 according to Pevzner.

The basics of the diet are the fragmentation of nutrition and the exclusion of heavy foods. Dishes are not fried, do not marinate. You need to eat in small portions 5-6 times a day. Hot and cold are prohibited.

From the products you can eat:

1. Kashi. Especially recommend oatmeal, buckwheat, rice, semolina.
2. Dairy products. Low-fat kefir, curdled milk, whey are preferred.
3. Vegetables. The basis of the diet are carrots, beets, broccoli.
4. Fruits and berries. They must not be sour. You can apples, bananas, blueberries.
5. Yesterday's bread.

Washed down with compotes, freshly squeezed juices, jelly. Some weak green tea is allowed. The use of alcohol, coffee and cocoa is excluded.

The list of prohibited products includes:

1. All kinds of sausages.
2. Smoked products.
3. Pickles and pickled vegetables.
4. Meat and fish broths.
5. Sour fruits and berries. This refers to sour varieties of apples, citrus fruits, cranberries.
6. Patés and canned food produced on an industrial scale.
7. Fresh cabbage, beans. They cause unwanted flatulence.
8. Shop semi-finished products.
9. Fatty meat, fish.

It is recommended to adhere to the dietary diet constantly, but after 1-2 years many people switch to the usual diet.

Bile is a fluid produced by the liver. It contains various substances, including bile pigments, salts, cholesterol and lecithin. The bile enters tiny bile ducts, which join like the branches of a tree to form the main bile duct. The gallbladder is a reservoir that stores bile. When a person eats, the bladder contracts and bile flows into the duodenum.

What causes cholecystitis?

95% of cases are caused by gallstones, which are formed from cholesterol and bilirubin in bile. Other less common reasons:

• damage - abdominal trauma, surgical intervention;
• infection - if the infectious process is located in the bile, inflammation of the gallbladder may develop;
• tumor - it can disrupt the exit of bile from the bladder, which can lead to its stagnation and the development of cholecystitis.

Risk factors for the formation of gallstones:

• female (in men, gallstones develop 2 to 3 times less often, so the symptoms of cholecystitis in women are much more common);
• belonging to the Scandinavian and Latin American ethnic group;
• obesity or rapid weight loss;
• some medicines;
• pregnancy (during pregnancy, an increased level of progesterone can lead to stagnation of bile);
• age (cholecystitis in children is much less common than in adults and, especially, the elderly).

Acalculous cholecystitis occurs in conditions in which bile stasis develops:

• critical condition;
• major surgery or severe injury;
• blood poisoning;
• starvation;
• heart diseases;
• diabetes;

Classification of cholecystitis

If the disease develops suddenly, it is called acute cholecystitis. If the development of the disease occurs slowly, it is chronic cholecystitis. Depending on the type of damage to the gallbladder wall and the severity of the disease, catarrhal, phlegmonous or gangrenous acute cholecystitis is isolated. Both of the latter species are purulent in nature.

Signs of cholecystitis

The most common complaint in acute cholecystitis is severe pain in the upper third of the abdomen. Some patients present with signs of peritoneal irritation and pain may radiate to the right shoulder or shoulder blade. Often the pain begins in the epigastric region, and then moves to the right hypochondrium. At first, the pain syndrome in acute cholecystitis is paroxysmal in nature, but then it becomes permanent in almost all cases. Many patients may have the following symptoms of an attack of cholecystitis:

• elevated temperature;
• chills;
• bloating;
• nausea and vomiting;
• increased sweating.

In acute cholecystitis, the doctor may identify the following positive symptoms:

• Murphy's symptom - the doctor inserts fingers into the right hypochondrium, after which he asks the patient to take a deep breath, which causes sharp pain.
• Ortner's symptom - the doctor gently taps his palm on the costal arch on the right, which causes severe pain.

In chronic cholecystitis, a progressive deterioration of the patient's condition occurs. The pain can be constant and aching or sharp and paroxysmal (biliary colic). Symptoms worsen after eating fatty foods. Other signs of chronic cholecystitis:

• A bitter taste in the mouth is due to the reflux of bile from the duodenum into the stomach and esophagus.
• Bitter burp.
• Diarrhea or constipation.
• Skin itching is a sign that bile cannot normally exit the biliary tract and enters the bloodstream. This symptom is usually associated with jaundice.
• Subfebrile temperature.
• Fatigue, irritability and decreased appetite.

If the disease develops in a young child who still cannot explain what and where it hurts, parents need to carefully consider the presence of vomiting, bloating, indigestion, belching after eating, and poor appetite.

Complications

Cholecystitis can lead to serious complications, including:

• purulent destruction of the gallbladder (empyema or gangrene);
• liver abscess;
• bile peritonitis;
• mechanical jaundice;
• sepsis;
• fistula between the bladder and the digestive tract.

How is the disease diagnosed?

Diagnosis of cholecystitis is based on a thorough study of the patient's complaints and symptoms, as well as the use of the following laboratory and instrumental examinations:

• blood tests (general and biochemical);
• ultrasound examination;
• computed tomography.

Diet for cholecystitis

Proper nutrition and maintaining a normal body weight play a very important role in the treatment and prevention of the disease. List of foods that you can eat with cholecystitis:

• Fiber-rich foods (fresh fruits and vegetables). Fiber speeds up digestion and maintains a healthy gastrointestinal tract.
• Whole grains (eg, whole wheat or oat bread, brown rice, bran).
• Beans and lentils.
• Lean meats (such as chicken, turkey, or fish).
• Low fat dairy products.

Regular exercise will help maintain a normal body weight and prevent gallstones in both men and women.

Those foods that people with cholecystitis should not eat:

• fatty dairy products;
• cooked foods high in fat (doughnuts, cookies, buns);
• eggs;
• mayonnaise;
• cream;
• bacon, red meat;
• nuts;
• olives;
• ice cream;
• black tea, coffee;
• alcohol;
• spicy food;
• products with refined carbohydrates;
• carbonated drinks.

Nutrition for cholecystitis after cholecystectomy should be of a special nature for several weeks or months of the postoperative period. In medical institutions, these patients are recommended a Pevsner 5 diet, the menu of which does not contain fatty, fried and refined foods.

After cholecystectomy, it is difficult for the body to absorb fats and fat-soluble vitamins, since for this it needs bile, which accumulates in the gallbladder, being released from it when necessary. After the bladder is removed, bile is still produced in the liver, but it is released into the intestines in a continuous stream. Therefore, when eating fatty foods, there is not enough bile in the intestines for the normal absorption of fats. This can cause bloating and diarrhea. Recipes for how you can reduce symptoms:

• Eat lean meats (chicken and fish without skin, removing all visible fat before cooking).
• Be wary of foods containing hidden fats (fast food, high-fat dairy products, baked goods, nuts, and nut butters).
• You can eat low-fat or low-fat dairy products.
• You need to be careful when eating food not at home. Best choices include vegetable soup and salad, grilled fish or skinless chicken, rice, or baked potatoes. You need to eat in small portions.
• It is necessary to limit the consumption of fats and oils (no more than 2 - 3 teaspoons of butter or margarine).

Treatment of cholecystitis

Conservative treatment

A patient with cholelithiasis and cholecystitis may need to be hospitalized. In severe cases, the patient may be forbidden to consume any solid or liquid foods. This may require intravenous fluids. Antibacterial agents are prescribed to fight the infection. First aid for an attack of cholecystitis includes antispasmodics, antiemetics and painkillers. In the conservative treatment of this disease, as well as in its prevention, an important role is played by diet, mineral water (Naftusya, Morshynska), choleretic herbs (tansy, corn stigmas, helichrysum, and others) and their fees.

Surgery

Because cholecystitis often recurs, most people with this disease eventually need to have their gallbladder removed (cholecystectomy). The timing of surgery depends on the severity of symptoms and the risk of problems during or after the procedure. With the development of complications, the operation should be done immediately, since only this can save the patient's life.

Most often, cholecystectomy is performed laparoscopically through several small incisions in the abdomen under the control of a tiny camera using special tools. Rarely, an open cholecystectomy is needed, which requires a large incision in the anterior abdominal wall.

Prevention

You can reduce your risk of developing cholecystitis by following simple tips to prevent gallstones from forming.

• You need to reduce weight slowly (up to 1 kg per week).
• You need to maintain a healthy weight through diet and exercise.
• It is necessary to follow a rational, balanced and healthy diet.

- an insidious disease with its "silence". It develops without characteristic symptoms and may not declare itself directly for years. Meanwhile, sluggish inflammation and the peaceful growth of the so-called pebbles in the gallbladder can lead to severe, intractable complications and to the most tragic outcome.

People who fall into the risk group for cholecystitis cannot be called healthy. They tend to have high cholesterol levels, nervous diseases, and of course hormonal problems that cause obesity and diabetes. After all, it is a metabolic disorder in the body that leads to a deterioration in the quality of bile produced by the liver, and hence to cholecystitis.

Paradoxically, an acute manifestation of cholecystitis for a careless patient can play a good role: it will make you see a doctor and undergo an examination.

Let's find out what signals of our body indicate acute cholecystitis, and what symptoms distinguish the chronic form of this disease.

Acute inflammation

In an acute form, both calculous cholecystitis (from the Latin “calculus” - a pebble) and stoneless cholecystitis proceed.

If you do not start treatment, you can “wait” for such a complication as peritonitis: infected bile, along with pus, will break out of the bladder into the peritoneum.

In addition to the abdominal cavity, with complications of the disease, the bile ducts, pancreas, and lymph nodes can become inflamed. In the gallbladder accumulates pus, fluid, the bladder is stretched. All this threatens with sepsis - a severe putrefactive infection of the whole organism.

cholelithiasis - cholecystitis

What is the nature of acute inflammation in cholelithiasis? What happens in a situation where stones or calculi have already formed in the gallbladder - this is the name of the lumps formed from the cholesterol sediment of bile and mucus.

Firstly, colic is very disturbing in the right side under the ribs, sometimes “in the pit of the stomach”. Pain, often increasing, occurs at night or in the morning. The upper abdomen is bursting, the intestines are swollen. There is a bitter burp.

Body temperature rises to 37-38 degrees. More severe purulent inflammation of the gallbladder causes fever up to 39-40 degrees. An exception to this rule is the weakened and elderly people with low immune system resistance, whose temperature rarely rises above 38.

Sometimes, if the bile duct is clogged with a stone, obstructive jaundice is observed - the whites of the eyes, tongue, and skin turn yellow.

Doctors use several methods of palpation to recognize the symptoms of acute cholecystitis. A sharp pain is felt if you press on the right hypochondrium at the time of a strong breath. Painful for the patient will be a slight pressure on the place where the gallbladder is located. The third symptom is pain when tapping with fingers on the right edge of the costal arch.

Acalculous cholecystitis

Acalculous cholecystitis, the symptoms of which are more common in men, is difficult to diagnose, and neglected patients often die.

Inflammation begins with a sudden attack. The inflamed bladder swells, presses on the peritoneum, bile does not depart. Usually the stomach hurts on the right, with a return to the back, shoulder and shoulder blade. Sometimes the pain is felt in the chest on the left, and it is easy to confuse it with the heart. No wonder doctors examine such patients to exclude myocardial infarction.

But there are some differences between biliary or hepatic colic: without medical help, attacks intensify, can last up to several hours. Accompanied by nausea, chills, thirst, constipation and vomiting are possible, plaque on the tongue is also characteristic.

With severe inflammation, the temperature rises. A person is looking for postures that will alleviate the condition, as a rule, lies on his right side.

What does the examination of such patients by doctors show? Tense abdomen, enlarged liver, which hurts when pressed.

A different clinic is observed in patients after 70 years: nerve receptors die off by old age, there is practically no pain, but irreversible inflammatory processes continue, up to gangrene of the gallbladder tissues.

The severity and severity of the symptoms, as well as the prognosis for recovery, depend on how deeply the inflammation has managed to hit the body. If only the mucous membranes are affected (catarrhal inflammation), then timely treatment can completely get rid of the disease.

When purulent processes have spread through cells and tissues, the disease proceeds and is treated much harder. With sharp pains, fever, intoxication, nausea and vomiting. The fever does not subside for several days.

Acalculous cholecystitis, the treatment of which gives results, but it is likely that the disease will become chronic.

Gangrenous cholecystitis

The most severe form of pathology is gangrenous cholecystitis.

It is dangerous because the gas that bacteria release accumulates in the gallbladder and inflates it like a balloon, threatening to tear or “melt” the tissues of the gallbladder. In addition to severe pain, hiccups, noise in the abdomen, a person's blood pressure decreases, the discharge of gases and feces stops.

If cholecystitis is combined with pancreatitis, it is difficult to diagnose it immediately. Gangrenous cholecystitis is confirmed by ultrasound - accumulations of fluid or pus are visible around the organ or in its cavity. In the blood test data, an excess of leukocytes, ESR, ALT, AST activity is characteristic, bilirubin is slightly elevated.

What can and cannot be done during an attack until medical help arrives?

If you suspect, you should not take analgesics and other strong drugs for pain relief - this will make diagnosis difficult. You can reduce spasm and pain by taking drotaverine (no-shpa). You can not wash the stomach, take a laxative in any form. Colic can be dulled by warming up under a blanket or wrapping up in a blanket, and a heating pad, especially on the right side, cannot be applied - this will only spur inflammation.

chronic form of inflammation

Chronic cholecystitis, like acute cholecystitis, is divided into purulent and catarrhal, acalculous and calculous. If there are no stones, the focus of inflammation is in the neck of the bladder.

Chronic inflammation is caused by a fungal and bacterial infection, as well as viral hepatitis A, B, C, D. Pathology develops if allergic and autoimmune diseases are added to infectious causes. An important role is also played by lifestyle, leading to stagnation and changes in the chemical composition of bile: lack of physical activity and unhealthy diet.

Hard starvation or "fat-burning" diets are especially dangerous. In women, pregnancy is a risk factor. Regardless of gender and age, severe stress, severe resentment and other emotional outbursts can provoke gall disease.

Chronic cholecystitis can take three forms: sluggish, recurrent and purulent. In any form, the stage of remission is replaced by the stage of exacerbation.

If one or two exacerbations occur in a year, and colic bothers no more than four times, doctors talk about a mild form. When relapses occur twice as often, this is already of moderate severity. And the most difficult option is five or more relapses per year and frequent colic.

Medical practice identifies a number of syndromes characteristic of chronic cholecystitis.

1. Pain syndrome. Pain, as a rule, aching, burning and prolonged, in the same places as in acute cholecystitis: the right hypochondrium and the entire right side of the body.
2. Dyspeptic syndrome combines symptoms associated with the body's response to digestion. Almost immediately after eating there is bitterness in the mouth, heaviness in the right side, belching. Between meals, nausea, spasm behind the sternum (as if a stake was stuck) may occur.
3. Cholestatic syndrome shows us the consequences of a violation of the "chemistry" of bile, in which there is too little acid to dissolve cholesterol and bilirubin - the concentration of these substances in the blood increases. The intestines lack bile pigment. The result - the skin and sclera turn yellow, the urine darkens to brown, and the feces, on the contrary, brighten.
4. Asthenovegetative syndrome. A person gets tired quickly, sleeps poorly, is constantly irritated, often has an asthenic build, thinness.
5. Intoxication syndrome manifests itself in the same way as in acute inflammation. The usual catarrh of the gallbladder causes subfebrile temperature up to 38 degrees, with purulent inflammation, the fever rises to 40.
6. Intestinal syndrome - diarrhea or constipation occurs, abdominal pain is usually concentrated around the navel.

The most mysterious property of chronic cholecystitis is the wide range of clinical variants. Inflammation of the gallbladder seems to change into different camouflage suits - cardiac, arthritic, neurasthenic, subfebrile, hypothalamic.

In the cardiac variant, arrhythmia is observed, which is recorded by the ECG. After eating, a person's heart aches, especially if he lies down. In the arthritic variant, the patient suffers from joint pain.

With a subfebrile course of the disease, a person may not be bothered by anything, except for chills and a slight increase in temperature for one to two weeks. (He does not pay attention to discomfort in the abdomen - he is already used to it).

If the disease develops in a neurasthenic variant, the symptoms are varied: headaches, dizziness, motor passivity, insomnia, apathy, anger, excessive touchiness and suspiciousness.

The hypothalamic variant is characterized by such signs as high blood pressure, trembling of the extremities, swelling, muscle weakness, high pulse.

Such a variety of symptoms once again shows how everything is interconnected in our body and what an important role the liver plays in this system.