Calculous cholecystitis is a form of a chronic process in which various stones (stones) are present in the gallbladder. Their number and size may vary. Sometimes this is one large enough stone, the diameter of which can reach 5-6 cm or more, or maybe a lot of very small stones with a diameter of a fraction of a millimeter, in other words, sand. What is calculous cholecystitis? This will be discussed in this article.
According to statistics, 10% of the adult population suffers from cholelithiasis. Chronic calculous cholecystitis in women worries five times more often than men. The age category of patients is from 40 years and older. Children and young people under 30 years of age are very rarely affected by this disease.
Gallstones. What is the danger?
It is the size of gallstones that determines the symptoms, the severity of the course, the clinic of the disease, and possible complications of gallstone disease ( cholelithiasis ). Chronic calculous cholecystitis is dangerous for its complications.
In most cases (75%), stones are located in the body of the gallbladder, but sometimes small stones can enter the bile duct, thereby obstructing or completely blocking it and causing bile stone colic attacks.
If calculi up to 3 mm in size are able to exit independently through the ducts, then stones from 3 to 7 mm in size when leaving the gallbladder can obstruct (block) the bile duct, and such a complication will require urgent surgical help.
The composition of gallstones also varies. They may be:
- cholesterol - stones of this kind are not visible during radiography;
- calcareous;
- pigmented;
- mixed.
Most often, mixed types of gallstones are found, their shape is very diverse (round, multifaceted or even branched).
Causes of the problem
Calculous cholecystitis (cholelithiasis) is not formed immediately. Consider the factors that contribute to the formation of calculi in the gallbladder:
- cholestasis, or stagnation of bile, for example, can be with excesses of the body of the gallbladder;
- dyscholia, or altered composition of bile, its thickening due to high cholesterol or secretion;
- cholecystitis, or inflammation in the gallbladder.
In addition, a calculous cholecystitis diet can provoke a diet, more precisely, systematic eating disorders (too high-calorie, fatty and cholesterol-rich foods, lack of vitamins in the diet). Systematic starvation and low-calorie diets, and even prolonged use of contraceptive hormonal drugs can also lead to cholelithiasis.
Among the diseases that often become the impetus for the formation of gallstones are known:
- obesity and metabolic disorders;
- endocrine diseases, for example, diabetes mellitus;
- liver diseases, for example, hepatitis and cirrhosis;
- biliary dyskinesia;
- pancreatitis
- duodenitis;
- Crohn's disease;
- chronic gastritis;
- helminthiases.
Pathogenesis of gallstones formation
Bile contains acids, lipids, pigments and minerals. Normally, all of these components are in a colloidal (dispersed) state. With the adverse factors listed above, the level of the cholesterol coefficient of bile is violated, that is, the ratio of the concentration of its acids to the content of cholesterol. This contributes to the precipitation of cholesterol in the sediment with its subsequent crystallization. So stones are formed in the gallbladder.
Classification
What is calculous cholecystitis? The clinical course of cholelithiasis may be acute or chronic. Depending on the symptoms, there is a typical, esophagalgic, cardiological, intestinal and atypical calculous cholecystitis. Symptoms and treatment may vary depending on the course of the disease.
There are four stages of cholelithiasis in accordance with an ultrasound examination:
- Precious, or initial - its characteristic signs are the presence of thick bile, gall stasis and the formation of microlites (sand) in the gall bladder. This stage of the disease with the right choice of treatment and normalization of nutrition in most cases is reversible.
- The formation of calculi - during ultrasound examination, one or more medium-sized stones are found.
- Chronic calculous cholecystitis - this stage of the disease involves the presence of calculi of various sizes in the gallbladder. It can be either one large stone, or the formation of a small diameter or several small ones.
- Complicated calculous cholecystitis - this stage of the disease is characterized by the development of various complications, for example, obstruction of the bile ducts.
Diagnostics
Ultrasound is the main diagnostic test for the diagnosis of calculous cholecystitis. What is it, the idea has already developed. Using ultrasound, a specialist will determine the number and size of stones located in the gallbladder, and their location, as well as the condition of the walls of the bladder.
Instrumental examination methods for calculous cholecystitis also include endoscopic retrograde cholangiopancreatography (ERCP). This method allows you to examine the condition of the biliary tract and determine the degree of obstruction, which will help the specialist choose the right tactics for the operation. The method boils down to filling the bile ducts with radiopaque material during FGDS, after which an X-ray examination is performed.
In addition to these instrumental methods of examination, laboratory ones are used, such as a general analysis and a biochemical blood test. Using the first for this disease, you can see an increased ESR in the presence of an inflammatory process in the gallbladder, as well as an increase in neutrophils in the leukocyte analysis.
A biochemical blood test for this disease is reduced to determining the level of the following:
- ALT and AST;
- bilirubin;
- alkaline phosphatase;
- total protein;
- CRP.
These indicators will be increased in case of stagnation of bile (cholestasis). Such a development of the disease is possible with obstruction by the calculus of any of the bile ducts.
There are other additional methods for diagnosing a disease such as calculous cholecystitis. Symptoms and treatment will depend on the condition of the biliary tract and the general condition of the liver as a whole. These diagnostic methods include:
- intravenous cholegraphy;
- oral cholecystography;
- hepatobioscintigraphy.
Calculous cholecystitis. Symptoms and treatment. general information
In some cases, the patient does not suspect that he has calculous cholecystitis. What is it, he learns only after the onset of an attack of biliary colic. It is characterized by sharp pain in the hypochondrium on the right, which can give off to the epigastrium, lower back, scapula or neck.
Such attacks often occur after holidays and feasts, when a person who is unsuspecting of his ailment allows himself to take alcohol and have a good bite with fatty, spicy, smoked or salty foods. Physical attacks or strong emotions can also provoke such attacks. After the patient is taken to a medical institution and examined, he learns about the diagnosis of calculous cholecystitis. Exacerbation may be accompanied by nausea and vomiting.
To operate or not?
With a diagnosis of calculous cholecystitis, symptoms and treatment may vary depending on the stage of development of the disease and the state of the biliary tract. If reversible processes are still possible in the pre-stone or in the initial stage, then in all the others, when the formation of stones has already begun, the most appropriate solution will be the operation with a diagnosis of calculous cholecystitis. And the faster the surgery will be performed, the less likely the occurrence of complications.
Preparation for surgery is to take antibiotics and rehydrate the body if necessary. The fight against dehydration is necessarily carried out if the patient had repeated vomiting at the time of the attack. These activities can significantly reduce the risk of developing sepsis.
With a diagnosis of chronic calculous cholecystitis, surgery is most often performed using a laparoscope. This modern method can reduce pain in the rehabilitation period and reduce recovery time, as well as reduce the risk of postoperative complications.
Pain relief
Attacks of cholelithiasis may differ in the nature of the pain and its intensity. In severe cases, nausea and vomiting are possible, and if the stone completely blocks the common bile duct, the color of the stool may become light, because it will lack bile pigment. With such severe attacks, you must urgently contact a medical institution or call an ambulance.
If the disease manifests itself exclusively in painful attacks, you can try to relieve the pain yourself. To do this, take a couple of tablets of the drug "No-shpa" or "Papaverine" and put the cold on the right hypochondrium. In this case, stop eating at least 12 hours. If this does not help, seek medical attention.
Calculous cholecystitis. Treatment without surgery
Without surgery, this disease can be treated, but each of these methods has its contraindications and complications, and also does not guarantee that the disease will not recur. We list these methods:
- acid treatment;
- contact destruction of gallbladder calculi;
- extracorporeal shock wave lithotripsy.
Now let's talk specifically about each of them.
Acidic preparations
Currently, with a diagnosis of chronic calculous cholecystitis, treatment is possible without surgery, but this method is too expensive and there is no guarantee that there will be no relapse. The course of therapy is long - at least 24 months. There are also necessary conditions associated with the size of the stones, their composition, the state of the gallbladder and its ducts:
- The size of the stones should not be more than 1.5 cm in diameter.
- The composition of the stones is exclusively cholesterol.
- The gallbladder and its ducts should function normally and be in good condition.
With a diagnosis of calculous cholecystitis, treatment without surgery is carried out with Henofalk and Ursofalk, which are chenodeoxycholic and urodesoxycholic acid, respectively.
The essence of treatment is that these acid-containing preparations accumulate in the composition of bile and gradually dissolve cholesterol calculi. But there is no guarantee that the disease will never return. Relapses are possible.
Contact destruction of gallbladder calculi
This treatment method involves not one, but several procedures. They are carried out as follows. During the ultrasound, the doctor punctures the anterior abdominal wall with a long needle in the area of the projection of the gallbladder, and introduces a catheter into the bladder itself, through which special drugs can dissolve gallstones. These procedures are carried out several times. Keep in mind that they are not suitable for everyone. There are certain limitations, the same as with the method described above. In addition, there may be complications, for example, inflammation of the intestinal mucosa.
Extracorporeal Shock Wave Lithotripsy
In this procedure, a sensor is located on the patient’s skin in the area of the projection of the gallbladder on the anterior abdominal wall, shock waves will come from it and affect gallstones. To perform such a procedure, the following conditions are necessary:
- there should not be any inflammatory processes in the gallbladder;
- the size of the stones is not more than 3.5 cm;
- the gallbladder and ducts should work well.
This method is not completely safe. The following complications are possible:
- stone closure of the ducts of the gallbladder;
- obstructive jaundice;
- the development of acute pancreatitis or diabetes.
By far, the most safe treatment for calculous cholecystitis in relation to complications remains cholecystectomy, i.e. gallbladder removal.
Possible complications
Calculous cholecystitis must be treated, because it is dangerous for its complications. We list the most common of them:
- Acute pancreatitis.
- Empyema of the gallbladder (inflammation with subsequent filling of the bladder with purulent contents).
- Destructive cholecystitis.
- Cholangitis (an inflammatory process in the bile ducts).
- Secondary biliary cirrhosis.
- The formation of fistulas between the bile ducts and the bladder.
- Intestinal obstruction.
- Oncology of the gallbladder.
- Choledocholithiasis (calculi in the bile ducts).
Diet
Ideally, you need to eat right before the patient is diagnosed with chronic calculous cholecystitis. A correctly selected diet can serve as a prophylaxis of the disease in question. We outline its main goals:
- Decreased blood lipids. This mainly relates to cholesterol and its fractions.
- Ensure the normal functioning of the gallbladder and prevent stagnation in it.
- Gradually strive for weight loss, if necessary. Weight loss should be smooth, in a month you can lose no more than 2-3 kg.
- Drink plenty of fluids, up to 2 liters per day.
- Eat enough vitamins and minerals with food; vegetables, fruits and lots of greens should be present in the diet.
- To ensure good intestinal motility, eat foods rich in fiber, as well as whole grain bread and wheat bran.
- Refuse animal fats.
- Vegetable fats should be present in the diet, but not more than 80 g per day.
- Meat eaten should be lean (not fatty).
- Refuse salty and spicy foods, as well as fried foods. Dishes should be boiled or steamed, the use of salads from raw vegetables is also encouraged.
- You need to eat in small portions 5-6 times a day.
The same rules apply to nutrition after cholecystectomy (removal of the gallbladder).
Alcohol should be mentioned separately. Any alcohol is strictly prohibited in this disease. As more than one medical history shows, acute calculous cholecystitis very often occurs precisely after taking alcohol. Very often, patients are hospitalized directly because of the festive table.
Alternative Medicine Prescriptions
With a diagnosis of calculous cholecystitis, folk remedies can also be used for treatment. Medicinal preparations, infusions and decoctions with a choleretic effect are used to reduce the concentration of bile and reduce congestion in the gallbladder.
An effective tool in the people is considered a decoction of immortelle flowers. To prepare it, 15 g of dry raw materials are poured into 80 ml of hot water and boiled in a water bath for 30 minutes. The drink is allowed to cool and filtered, then added to 100 ml of cold boiling water and taken in 50 ml twice a day before meals.
For the treatment of cholelithiasis, people commonly use lingonberry infusion . To prepare the medicine, 3 tablespoons of the raw material are poured into a thermos and filled with steep boiling water in a volume of 1 liter. If these manipulations are done in the evening, then in the morning medicinal tea will be ready.
Conclusion
It is believed that the best treatment is disease prevention. This fully applies to such a disease as calculous cholecystitis. Proper nutrition and a healthy lifestyle will help to avoid this unpleasant ailment. And if it so happened that the ZhKB still formed, then urgent measures should be taken to eliminate it. Recall that at the initial stage, when sand is present in the gallbladder, and not large stones, the process can still be reversed.