Non-calculous( non-calculous) cholecystitis

Chronic inflammation of the gallbladder can be accompanied by the formation of concrements of salts from different components of bile. If this process is absent or is delayed according to some opinions, then the disease is called "acalculous cholecystitis"( non-calculous).

In the International Classification differ: simply cholecystitis without the phenomena of cholelithiasis( stone formation) and cholecystitis in cholelithiasis, respectively, the forms are coded as K 81 and K 80. The term "tubeless" can be attributed to folk interpretation.

The disease often occurs in the form of chronic with periodic exacerbations. But there are also acute forms. Among all gastroenterological diseases, non-calculous cholecystitis accounts for 5-10%.It was found that women suffer 4 times more often.

The causes of chronic disease include malnutrition, obesity, endocrine disruptions in menopause. Therefore, the treatment of stone-free cholecystitis is always associated with a change in habits, lifestyle.

What disorders develop in the gallbladder?

Among physicians, the opinion is held that the stone-free cholecystitis is a form of transformation of chronic inflammation into cholelithiasis. However, long-term follow-up of patients does not support this theory.

The inner mucosa has a mesh pattern due to the alternation of thick folds, areas of atrophy and polyposis sprouting. The replacement of inflammatory tissue with scarring leads to fibrosis and an irreversible change in shape.

The loss of muscle fibers is accompanied by a reduction in contractile capacity, and the involvement of nerve endings in the process contributes to the atrophy of the walls and stops the release of bile into the duodenum. All clinical signs of cholecystitis are associated with a subsequent disruption of the digestive process.

What causes the disease?

It is necessary to distinguish between causes and provoking factors. The development of inflammation is always caused by pathogenic microorganisms. They can get into the gallbladder:

• with a blood flow( hematogenous pathway) - from distant chronic foci in the human body, this mechanism is observed in patients with carious teeth, sinusitis and tonsillitis, chronic pneumonia, in women with adnexitis;
• for lymphatic vessels - from inflamed kidneys( pyelitis, pyelonephritis), pancreas, liver;
• ascending way from the intestine - with acute infectious gastroenteritis, colitis, helminthic invasion;
• by contact - from neighboring organs with hepatitis, pancreatitis.

The following are the most pathogenic species of microorganisms:

• enterococcus;
• Proteus;
• E. coli;
• staphylococcus aureus.

The most common is a mixed flora. The provoking factors themselves do not cause inflammation in the absence of gallstone cholecystitis, but create favorable conditions for the ingression and multiplication of bacteria. These include any violations of the biliary tract, causing stagnation in the bladder( cholestasis).

This mechanism is facilitated by the disturbed neuro-endocrine regulation of the digestive process in patients with obesity, during menopause, in the absence of sufficient physical activity, under the influence of the mechanical factor and toxins of worms and parasites in the intestine( amoeba, ascarids, lamblia), parasitic infection in the liver.

To disrupt adequate production and the supply of bile leads:

• disturbed diet;
• overeating of fatty, fried and spicy food;
• alcoholism;
• smoking( toxic effect of nicotine);
• frequent stressful conditions.

Classification of

Acute non-calculous cholecystitis has no subspecies and is characterized by the most striking clinical signs of the disease. Chronic galloping gall bladder lesions proceed for a long time and is divided into stages: for the period of exacerbation, alternation of stagnation and exacerbation, persistent or unstable remission.

Depending on the frequency of exacerbations, the current is distinguished:

• monotonous( constant);
• is intermittent.

According to the degree of inflammation from the gallbladder, two forms are assumed: uncomplicated, complicated - the transition of inflammation to adjacent tissues and organs. The manifestation of clinical symptoms allows us to distinguish a typical form, atypical flow.

Symptoms of acanthine cholecystitis

Symptoms of noncalculous cholecystitis consist of two main syndromes: pain and dyspepsia. Pain syndrome is most pronounced in the period of exacerbation and acute disease.

If during the period of remission the patient feels unstable aching pain in the hypochondrium on the right or in the epigastric region, then during the exacerbation phase the pains become more intense, permanent. There is a characteristic irradiation in the right collarbone, lower back.

The patient notes the association of the pain syndrome with the consumption of fried, sharp and fatty foods. A person with chronic cholecystitis becomes irritable, suffers from insomnia, often complains of headaches. The condition improves in the prone position on the right side, warming the right hypochondrium with the clasped hands.

dyspeptic syndrome characterized by symptoms total digestion disorders, patients reported that:

• constant bitterness in the mouth;
• disorders of stools are expressed in alternating diarrhea and constipation;
• nausea sometimes becomes vomiting;
• stomach is constantly swollen( flatulence);
• eructation of eaten food occurs after eating and at night.

The course of the disease

The tubeless cholecystitis as a chronic disease flows in an easy, moderate and severe form. They differ in clinical and laboratory characteristics.

With mild degree of

The periods of exacerbation last no longer than 2-3 days. Often do not require special treatment, and all symptoms of disorders are well eliminated by diet. The general condition of the patient does not suffer, the temperature is normal.

Additional examination does not reveal any functional disorders of the gallbladder, liver, pancreas. Examination of bile does not indicate signs of pathology.

For the moderate form

Each exacerbation lasts for 2-3 weeks. The remissions are short-lived. All the signs of the disease are expressed in patients. Exacerbations can be provoked by the transferred respiratory infections.

Patients complain:

• for decreased appetite, bitterness in the mouth, nausea;
• typical pain in the hypochondrium right, in the upper half of the abdomen, in the region of the heart by the type of angina pectoris;
• sometimes adds soreness to the joints;
• bloating with diarrhea or constipation;
• weakness and frequent headaches;
• possible weight loss.

Laboratory means in bile are found the increased content of mucus, salts, leukocytes, cholesterol, representatives of pathogenic microflora. In blood tests, there is a violation of liver tests, which indicates functional changes in the liver.

These include increased activity of transaminases( especially alanine), alkaline phosphatase;moderately reduced albumin fraction of proteins;increase of thymol test. All the indicators come back to normal during the remission period, but the patient has an unpleasant feeling of heaviness in the abdomen to the right above, flatulence, unstable stools.

In the case of severe

The inflammatory process proceeds continuously without periods of remission. The disease extends to nearby organs and tissues, characterized by complications.

With prolonged absence of treatment, it is possible to form a blocked out abscess( empyema) from the gallbladder with the release of bile pigments into the blood and the manifestation of jaundice of the skin, sclera and mucous membranes, general sepsis.

First of all, the bile ducts( cholangitis), liver and pancreas are affected. To the symptoms, pains are very intense, not only the right hypochondrium, but also the entire upper abdomen, waist( girdle), lack of appetite, vomiting, weight loss.

In blood tests: hepatic assays are violated, persistent hypoalbuminemia is detected, alkaline phosphatase and bilirubin are increased. In the urine, bilirubin derivatives are detected, high diastase.

In the analysis of feces - an increase in the mass of feces, oily shine( steatorrhea), the secretion of protein. Often there are changes in coronary blood supply, signs of myocardial ischemia on the ECG, the phenomena of vegetative dystonia.

Significance of atypical forms of

Atypical course of noncalculous cholecystitis can mimic the symptoms of intestinal, cardiac, esophagus, kidney, stomach disease. Accordingly, the following manifestations are the first in the clinical manifestation.

With esophagic type - difficulty in swallowing, constant heartburn, heaviness in the sternum, in case of intestinal manifestation - pain along the bowel, diarrhea or constipation, constant bloating.

pathology. Cardialgic forms are characterized by stenocardic pains behind the sternum, attacks of rhythm disturbance from extrasystoles to paroxysmal arrhythmia attacks, ECG disturbances are detected, in young people chronic cholecystitis is able to simulate rheumatic process, causes pain in the joints.

The lumbar and pyelonephritis types flow under the mask of inflammation of the kidneys or osteochondrosis in the lumbar region, pain is most disturbed in the kidney area, a positive Pasternatsky symptom is revealed on the right, but during the examination there is no evidence of inflammation in the urine, changes in the roentgenogram of the spine.

The gastroduodenal type is very similar to the course of peptic ulcer of the stomach or duodenum, gastroduodenitis with increased gastric secretion, pains occur more often at night. With fibrogastroscopy, changes are not detected.

Diagnosis

The insidiousness of noncalculous cholecystitis forces physicians to perform differential diagnostics with gallbladder damage of all cases of admission to the hospital or treatment in the clinic with diseases of the stomach, kidneys, heart.

Specific for cholecystitis is Ortner's symptom - increased pain when palpation of the abdomen at the point of projection of the gallbladder at the height of inspiration while tapping along the costal arch on the right. Elevated level in blood analysis of aminotransferases, alkaline phosphatase, bilirubin, γ-glutamyltranspeptidase.

For the full visual confirmation of the inflammatory process in the gallbladder, the results of the apparatus research methods are important:

• ultrasound - allows to see the unevenness of the inner layer of the epithelium, atrophic processes in the wall, the heterogeneous consistence of bile;
• X-ray cholecystography;
• scintigraphy with isotopes.

Treatment of

Treatment of noncalculous cholecystitis is treated more often by non-surgical methods. Indications for surgical treatment in acute form are suspicions of gangrene or phlegmon of the bladder, perforation( rupture) of the organ. In chronic course in surgical intervention, no more than 1.5% of patients need.

First of all, the patient will be recommended to change negative habits( smoking, drinking alcohol, unwillingness to walk).In a diet all life it is necessary to adhere to rules:

• is more often, small portions;
• avoid fatty meat foods, dishes cooked by roasting, smoking, pickled and salted vegetables, hot sauces, beer, soda;
• in food should include lean meat and fish in boiled form, in soups, stewed vegetables, salads, fruits, sour-milk products, porridges.

The choice of mineral water depends on the acidity of the gastric juice, so it is worth consulting with a doctor. Medicamentous treatment consists in carrying out antibacterial therapy with the purpose of destruction of the infectious agent, which caused inflammation.

Treat non-calculous cholecystitis without knowing the flora of the contents of the bladder starting with broad-spectrum antibiotics( Cefazolin, Amoxicillin, Ampicillin).When the analysis is available, correction of the drugs is possible. To eliminate pain, prescribe drugs spasmolytics( Drotaverin, No-Shpu, Platifillin).They are administered intramuscularly or can be taken in tablets if there is no vomiting.

for normalization of bile secretion and its intake into the intestine. It is recommended that the preparations of choleretic action( Allochol, Flamin, Ursosan) and restoring the motility of the gallbladder( Motilium, Trimedat, Motilak) be recommended. Substitutes for enzymes( Creon, Pangrol, Pancreatin) help to establish the process of digestion, reduce dyspeptic disorders.

Folk remedies in the medical process

Non-calculous cholecystitis therapy with folk remedies includes the use of herbal decoctions and infusions with anti-inflammatory and antispasmodic effect. They are connected to the main treatment and have a good effect in the remission period. All herbal decoctions are advised to drink warmly before meals for 30 minutes.

Patients are recommended to alternate the intake of chamomile, calendula flowers, licorice root, hips, tea with mint and oregano. You can make a combination of them. Take herbs followed by courses for 1.5-2 months, then take a break and repeat.

How to prevent the recurrence?

Patients should learn how to assess their condition on their own. For example, with acute pain, do not exercise. In other cases, walking, morning exercises, swimming are shown.

Compliance with the rules of dietary nutrition will help to replace drugs. Patients know which disorders cause pain, so do not bring your condition to a serious form of the disease. A constant regime without overeating on holidays helps to maintain health and a good mood.