Chronic cholecystitis: causes, symptoms and treatment

Chronic cholecystitis is the most common chronic disease affecting the bile duct and gall bladder.Inflammation affects the walls of the gallbladder, in which stones are sometimes formed, and motor-tonic disorders of the biliary (bile-excreting) system occur.

Currently, cholecystitis affects 10-20% of the adult population, and this disease tends to grow further.

This is due to the inactive way of life, the nature of nutrition (excessive consumption of rich animals fatty foods - fatty meat, eggs, butter), the growth of endocrine disorders (obesity, diabetes mellitus). Women are sick 4 times more often than men, this is due to the intake of oral contraceptives, pregnancy.

In this material, we will tell you everything about chronic cholecystitis, symptoms and aspects of treating this disease. In addition, consider the diet, and some folk remedies.

Chronic calculous cholecystitis

Chronic calculous cholecystitis is characterized by the formation of gallstones in the gallbladder, more often affects women, especially those who are overweight. The cause of this disease is the phenomenon of stagnation of bile and high salt content, which leads to disruption of metabolic processes.

instagram viewer

The formation of stones leads to disruption of the functioning of the gallbladder and bile ducts and the development of the inflammatory process, which subsequently spreads to the stomach and 12-colon. In the phase of exacerbation of the disease, hepatic colic is observed in the patient, manifested as an acute pain syndrome at the top of the abdomen and in the region of the right hypochondrium.

The attack can last from a few moments to several days and is accompanied by nausea or vomiting, bloating, a general condition of weakness, a sensation in the mouth of a bitter taste.

Chronic non-calculous cholecystitis

Noncalic (chronic) chronic cholecystitis, as a rule, is a consequence of conditionally pathogenic microflora. It can be caused by an E. coli, staphylococcus, streptococcus, somewhat less often by a proteome, enterococcus, Pseudomonas aeruginosa.

In some cases, there are noncalculous cholecystitis, which are caused by pathogenic microflora (typhoid fever, shigella), protozoal and viral infection. Microbes can enter the gallbladder through the blood (hematogenous way), through the lymph (lymphogenous way), from the intestine (by contact).

Causes

Why does chronic cholecystitis occur, and what is it? The disease can appear after acute cholecystitis, but more often it develops independently and gradually. In the emergence of chronic form the most important are various infections, in particular E. coli, typhoid and paratyphoid sticks, streptococci, staphylococci and enterococci.

Primary sourcesinfections can be:

acute or chronic inflammatory processes of the gastrointestinal tract (infectious enterocolitis - inflammatory bowel disease, pancreatitis, appendicitis, intestinal dysbacteriosis),
respiratory tract (sinusitis, tonsillitis), the oral cavity (periodontal disease),
inflammatory diseases of the urinary system (pyelonephritis, cystitis),
sexual system (adnexitis - in women, prostatitis - in men),
viral liver damage,
parasitic invasion of the biliary tract (giardiasis, ascariasis).

Cholecystitis always begins with disorders in the outflow of bile. It stagnates, in connection with this can develop cholelithiasis, DZHVP, which are immediate precursors of chronic cholecystitis. But there is a reverse movement of this process. Because of chronic cholecystitis, pancreatic motility slows down, stagnation of bile develops, and stone formation increases.

In the development of this pathology, not the last role is assigned to malnutrition. If a person eats large portions with significant intervals between meals, if eaten at night, consumes fatty, spicy, has a lot of meat, then he is at risk for developing cholecystitis. He can develop spasm of the sphincter of Oddi, stagnation of bile occurs.

Symptoms of chronic cholecystitis

When chronic cholecystitis occurs, the main symptom is pain symptoms. Adults feel dull aching pains in the right hypochondrium, which usually occur 1-3 hours after eating abundant, especially fatty foods and fried foods.

The pain radiates to the top, to the area of the right shoulder, neck, shoulder blade, sometimes to the left hypochondrium. It increases with physical activity, shaking, after taking sharp snacks, wine and beer. With the combination of cholecystitis with cholelithiasis, sharp pains such as biliary colic can occur.

Along with pain, there are dyspeptic phenomena: a sense of bitterness and metallic taste in the mouth, belching of air, nausea, bloating, alternating constipation and diarrhea.

Chronic cholecystitis does not occur suddenly, it is formed for a long time, and after exacerbations, against the background of treatment and compliance diets, there come periods of remission, the more carefully you follow the diet and maintenance therapy, the longer the period of absence of symptoms.

Why there is an exacerbation?

The main causes of exacerbation are:

Incorrect or untimely treatment of chronic cholecystitis;
An acute disease not associated with the gallbladder.
Overcooling, infectious process.
The general decrease in immunity associated with inadequate intake of nutrients.
Pregnancy.
Violation of diet, alcohol.

Diagnostics

For the diagnosis of the most informative methods are the following:

Ultrasound of the abdominal cavity;
Holegraphy;
Duodenal sounding;
Cholecystography;
Scintigraphy;
Diagnostic laparoscopy and bacteriological examination are the most modern and accessible diagnostic methods;
Biochemical blood test shows high liver enzymes - GGTP, alkaline phosphatase, AsT, AlT.

Of course, any disease is easier to prevent than treatment and early research, can identify early violations, deviations in the chemical composition of bile.

Treatment of chronic cholecystitis

If you have signs of chronic cholecystitis treatment includes a diet (table number 5 according to Pevzner) and drug therapy. During an exacerbation from food exclude sharp food, fried and fatty, smoked, alcohol. Eat small meals 4 times a day.

The approximate scheme of treatment:

To anesthetize and relieve inflammation apply drugs of the NSAID group, removal of the spasm of the smooth muscles of the bladder and ducts is carried out by antispasmodics.
Antibiotic therapy for the appearance of symptoms of inflammation (ampicillin, erythromycin, cyprox).
To eliminate stagnation of bile used drugs that enhance the peristalsis of the biliary tract (olive oil, sea buckthorn, magnesium) Choleretics (drugs that increase the secretion of bile) are used with caution, so as not to cause increased morbidity and aggravation of stagnant phenomena.
During the abatement of an exacerbation, physiotherapy procedures are prescribed-UHF therapy, acupuncture and other procedures.
Spa treatment.

At home, treatment of chronic cholecystitis is possible in the case of mild disease, but in the period of severe exacerbations the patient should be in hospital. First of all, the goal is to stop the pain syndrome and remove the inflammatory process. After achieving the desired effect, the doctor prescribes cholagogue and antispasmodics for the normalization of the functions of education, the secretion of bile and its progress along the biliary tract.

Operation

In chronic calculous cholecystitis, surgical removal of the gallbladder, the source of calculus formation, is indicated.

In contrast to the treatment of acute calculous cholecystitis, an operation to remove the gallbladder (cholecystotomy laparoscopic or open) in chronic cholecystitis is not an emergency measure, is scheduled.

The same surgical techniques are used as in acute cholecystitis - laparoscopic gallbladder removal, cholecystectomy from the mini-access. For attenuated and elderly patients - percutaneous cholecystostomy for the formation of an alternative pathway of bile outflow.