Rapidly and rapidly developing inflammation of the gallbladder is called acute cholecystitis. The disease, which has arisen for the first time, ends with complete recovery with adequate treatment. When the seizures are repeated, the chronic course of the disease is diagnosed. With age, the possibility of getting cholecystitis increases, more pathogens are affected by women than men. In the risk zone - pregnant women, taking hormonal drugs and obese people.
Acute cholecystitis - causes
Acute inflammation of the gallbladder is characterized by impaired movement in the body of bile because of the blockade of its outflow. In most cases, the development of pathology is combined with the presence of stones (up to 95% of diseases), and in 60% of patients there is a bacterial infection: E. coli, cocci, salmonella in bile. Different provoking factors can cause cholecystitis, the causes of the ailment are called the following:
- infection, bacterial flora in bile;
- sclerosis of the walls of the bladder or atrophy;
- the kink of the organ and the subsequent outflow of bile;
- changing the walls of the bladder due to age;
- pancreatic juice in the bladder, casting of pancreatic enzymes;
- malnutrition - fatty, spicy food and excessive food;
- blockage of the bile duct or damage to the walls by solid formations.
Acidless cholecystitis
Depending on the presence of stones - biliary calculi - inflammation of the gallbladder is divided into calculous (with stones) and non-calculous. The latter pathology is more rare. As a rule, beskamenny cholecystitis has a chronic form, and if acute, it is associated with the entry of the pathogen directly into the gallbladder during inflammatory processes in the intestine. The pathology is caused by such factors as:
- parasitic infection of the organ;
- the presence of bacteria;
- viral disease;
- E. coli ;
- staphylococcus, enterococcus;
- Proteus.
Calculous cholecystitis
Because of the chemical imbalance in the body in the bladder and its ducts, solid formations are formed-stones. They injure the bile ducts, causing pain, discomfort, inflammation and provoking acute calculous cholecystitis. The causes of cholelithiasis, leading to the pathology of the bladder:
- overweight;
- complications from rapid weight loss;
- reception of oral contraceptives;
- diabetes mellitus ;
- elderly age;
- consumption of drugs that lower the level of cholesterol in the blood, etc.
Acute cholecystitis - symptoms
As a rule, acute cholecystitis manifests itself after taking harmful food, experiencing stress or taking alcohol. The organism reacts sharply to negative factors. Reduced pressure, colic, vomiting, bloating and other signs, he reports that inflammation of the gallbladder has begun, the symptoms of which are difficult to overlook. The severity of the symptoms depends on the stage of the disease. Specific signs of acute cholecystitis, distinguishing it from other diseases and helping to diagnose pathology:
- If you press on the area between the legs of the sternocleidomastoid muscle, pain appears.
- With deep palpation, the patient is not able to inhale.
- During the palpation of the right subcostal area, inhalation pains.
- There is a protective tension of the abdominal muscles.
- Soreness at the moment of tapping the edge of the palm arch of the costal arch from the right side (the location of the bladder).
Complaints for acute cholecystitis
When a pathological condition occurs, the patient feels unwell. Among the uncomfortable symptoms complained of: bitterness in the mouth, nausea, vomiting with an admixture of bile, after which there is no relief. Possible liquid stools with acute cholecystitis, the appearance of jaundice and the subsequent increase in the gallbladder, an increase in body temperature (up to 40 degrees). But the most important complaint and the main signs of acute cholecystitis are not passing pain.
Character and localization of pain in acute cholecystitis
The disease begins with a sharp attack. Pains with acute cholecystitis occur, as a rule, in the right hypochondrium region, can appear in the epigastrium. Unpleasant sensations for a long time do not pass, irradiate upward in the scapula and the right shoulder, neck, supraclavicular area, back. Pain pumped with bouts:
- arise at night or in the morning;
- become stronger, but cease after a while (from 30 to 60 minutes);
- the attack is hard for a person, he is forced to take an uncomfortable position, pull his legs to his stomach and try to warm the inflamed place.
What is the danger of cholecystitis?
The attack of acute cholecystitis usually lasts for several days, but infections and sepsis can cause complications. Sometimes during the development of the disease the perforation of the wall of the bladder occurs. As a result, there is inflammation or a vesicourous fistula is formed. A diagnosis of pathology, performed at the wrong time, lack of proper therapy increases the likelihood that complications of acute cholecystitis will develop. The most common of them are:
- pancreatitis - inflammation of the pancreas;
- Cholangitis - pathology of the bile duct;
- a caulinian abscess;
- empyema (suppuration), gangrene or perforation of the gallbladder;
- biliary fistula;
- purulent diffuse peritonitis;
- jaundice.
Acute cholecystitis - diagnosis
Patients treated with acute pain to the doctor after the bright signs of cholecystitis, as a rule, are hospitalized, placed in a hospital. This is due to the clinical similarity of symptoms with appendicitis. The hospital performs differential diagnosis of acute cholecystitis. The result is obtained after a series of surveys, which includes laboratory and instrumental methods. Diagnosis is not difficult and includes:
- the analysis of blood (general), revealing the presence of inflammation;
- blood chemistry;
- Ultrasound of the abdominal cavity, allowing to examine the gallbladder, its volume;
- Analysis of urine;
- Radiography overview - with suspicion of peritonitis.
Acute cholecystitis - treatment
If acute calculous cholecystitis is diagnosed, the treatment involves emergency hospitalization and immediate (in the first 24-48 hours) evacuation of gastric contents. For this, a nasogastric tube is used. The patient is shown a strict bed rest. For several days he is refused food, fluids are injected into the body intravenously. Along with this, medication is prescribed. Subsequently, the patient is transferred to a diet as one of the main methods of treatment. The correct diet regimen promotes a good outflow of bile.
Acute cholecystitis is an emergency
Acute cholecystitis, the symptoms and treatment of which are determined with the help of a doctor, should be observed in the hospital. But not everyone applies for medical care at the first sign of pathology, preferring to stay at home for the first few days. This is fraught with complications. Pre-medical care for acute cholecystitis is important to provide with caution. The patient should not heat the inflamed place, take a hot bath, drink painkillers alone. Emergency assistance should be aimed at providing a person peace of mind before the arrival of physicians. It is necessary:
- to provide him with a horizontal position;
- protect from stress (emotional and physical);
- to reduce the incidence of nausea, give a decoction of mint;
- put the cold in the right hypochondrium, but not longer than 15 minutes.
Acute cholecystitis - clinical recommendations
Acute cholecystitis is a serious pathology, but if it is detected in time, conservative therapy is possible. When the inflammation of the gallbladder is diagnosed in children, non-drug treatment is usually used. It includes diet, special physical exercises, stay in a sanatorium for the restoration of the body. Especially useful stay at the resorts of mineral waters. In difficult cases, therapy involves taking medication, possibly surgical intervention. Treatment is carried out at an outpatient level.
Acute cholecystitis - drugs
The use of drugs in the treatment of pathology is shown in different cases - when the disease is at an early stage, for example, stones are present in the bladder, but do not cause much discomfort, and when complications occur. The further treatment depends on the severity of the inflammation and the general condition of the patient. With the help of medications, doctors try to remove the inflammation, normalize the bile composition and ensure its normal outflow. Drug therapy implies:
- Spasmolytic drugs in the first day of the attack to relieve pain (Papaverin, No-Shpa, Dimedrol).
- Antibiotics for acute cholecystitis (Ampicillin, Tetracycline, Cephzoline). They can be replaced by sulfanilamide if the first is not tolerated by the patient (Sulfazin, Ftalazol, Sulgin). They have an antimicrobial effect.
- Detoxification of the body with drugs. During the first stay in the hospital, infusion means are introduced (plasma, Dextran, Ringer's solution, Reopoliglyukin).
- Cholagogue, plant and synthetic (Ursoliv, Ursosan, Febihol, nettle leaves, burdock roots, artichoke extract).
- Kupirovanie symptoms of pathology. Lithotripsy when detecting stones in the bladder (dissolving them).
Acute cholecystitis is an operation
According to some indications, the inflammation of the gallbladder is surgically treated. The development of complications implies an emergency intervention, and the operation is performed when the proposed therapy is ineffective. Block acute complicated cholecystitis and completely forget about it can only remove the gallbladder. The operation is performed by the traditional open and laparoscopic method. As a rule, if acute phlegmonous cholecystitis is diagnosed, one of the varieties of pathology leading to gangrene, the patient immediately put on the table to the surgeon.
In acute cholecystitis
During treatment and in the future, a patient with cholecystitis should follow a special diet. The diet in this case is not only the prevention of the development of the disease, but also a successful method of therapy. In severe disease, a diet with acute inflammation of the gall bladder implies complete starvation (in the first days after the attack). It is allowed to drink only juices, broth of a dogrose, tea without sugar. After this, the patient passes to diet number 5 - anti-inflammatory food. The recommendations are as follows:
- Carbohydrates are limited to 200 g per day. It means taking simple carbohydrates: jams, sugar, honey, jam.
- The amount of protein is reduced to 80 g. Fat is the same.
- Caloric content of the daily ration is about 1600 kcal. Liquids are consumed up to 2.5 liters.
- The principle of fractional nutrition is observed.
- Food should be prepared without salt.
- All products are served in grated form: in the form of purees, soups, soufflé.
In the list of prohibited ingredients:
- beans;
- cabbage;
- salted products;
- mushrooms, including broths;
- sour fruits and berries;
- sausages;
- canned stewed meat;
- cottage cheese;
- cocoa.
The basis of nutrition is:
- lean beef and chicken;
- Steamed fish;
- vegetarian soups;
- crackers;
- dairy products;
- oatmeal, rice, wheat porridge;
- vegetables;
- kissels;
- dried fruits.
From sweet it is possible to use:
- honey;
- sugar;
- marshmallow;
- marmalade;
- add sweeteners to drinks.
To further not disturb acute cholecystitis, you must adhere to a rational diet and after therapy. In most cases, with the observance of diet and conservative medical treatment, it is possible to achieve remission. Taking any medications (painkillers, choleretic) with inflammation of the gallbladder should be controlled by a doctor.