Acute cholecystitis is the most common complication of gallstone disease. The disease is characterized by clear clinical symptoms, but in rare cases, the disease is atypical. Pain localized in the abdomen is one of the key signs of the disease.
The basis of acute cholecystitis is blockage of the gallbladder duct with stones. Primarily, non-bacterial inflammation develops, then the infection joins. Such an effect is caused by prostaglandins, lysolecithin and other similar substances. The gall bladder is affected by toxic acids that affect the affected mucous membrane.
General intoxication is a symptom that is characterized by acute cholecystitis. Symptoms of the disease quickly increase: there is moderate pain in the epigastric, right hypochondrium, which often radiates to the shoulder blade, right shoulder. Sometimes nausea, vomiting is added. In almost all cases, a temperature increase of up to 39 ° C is observed. , higher numbers suggest abscess or bacteremia. Palpation reveals pain in the right hypochondrium during inspiration (Murphy's syndrome).
Acute cholecystitis is difficult to differentiate with an attack of pain in the biliary region. For an accurate diagnosis, an observation is carried out, which is carried out for two hours. With prolonged pain, surgery to remove the affected organ is required.
In some cases, the symptom may be mild. This is observed in patients who take tranquilizers and the elderly. In some cases, the disease begins with a toxic form, which is characterized by a marked increase in temperature, intense abdominal pain, bacteremia, a significant increase in the level of white blood cells in the blood.
The diagnosis of acute cholecystitis can only be made when clinical signs are taken into account, since they are specific to it. However, various methods of instrumental diagnostics are used: ultrasound, hepatobiliary scanning. If an abscess is suspected, computed tomography is used.
Acute cholecystitis affects the blood picture, which also helps in its diagnosis. In studies, an increase in the level of leukocytes is observed. In some patients, an increase in the concentration of amylase is noted. This suggests the addition of pancreatitis.
Ultrasound examination allows you to get a significant amount of information about the condition of the bile ducts, liver, pancreas. If stones, thickening of the wall or swelling of the organ are found, the diagnosis of acute cholecystitis is made.
When a patient enters the hospital, the following activities are carried out: determination of the level of leukocytes, ultrasound. Primary treatment is based on the appointment of antibiotics that act on enterococci, gram-negative bacteria. Infusion therapy is also carried out , which is designed to prevent dehydration, restore alkaline-acid balance. If vomiting occurs, a nasogastric tube is inserted .
The next stage of therapy is surgery, which is necessary if the condition worsens due to the low effectiveness of previously used drugs.
The choice of surgery for this disease is between an open or closed type of cholecystectomy. In some cases, the application of cholecystostomy. Open cholecystectomy is used in the presence of severe complications in the form of an abscess, perforation, gangrene. The operation of choice is considered laparoscopic organ removal.