Inflammation of the gallbladder, accompanied by the formation of stones in the organ and its ducts, is gallstone disease (cholelithiasis) or calculous cholecystitis. Phlegmonous variant of the pathology is its complication. It is diagnosed mainly in people over 40 years old, and women are more affected.
Medical certificate
Cholecystitis can have an acute or chronic course. Acute, in turn, is calculous when the pathological process is accompanied by the formation of calculi in the organ, and stoneless.
According to the severity of destructive processes, the disease is divided into the following forms:
- Catarrhal. In this case, there is swelling and redness of the mucous membranes of the bladder, its increase. The lumen of the organ is gradually filled with inflammatory fluid.
- Phlegmonous. Damage to all the membranes of the gallbladder is observed. In this case, purulent infiltrates and ulcers are formed.
- Gangrenous. This is the final stage of the pathological process. It is characterized by necrosis of sections of the walls of the bubble. Often this leads to rupture of the organ and death of the patient.
Determining the form of the disease allows you to choose the most effective treatment tactics.
Features of pathogenesis
Under the influence of some factors, stagnant phenomena first develop in the gallbladder. As a result of violations of the outflow of fluid, its composition changes. Infectious agents actively multiply in it. Gradually, the internal pressure on the walls of the organ increases, which leads to inflammation and the formation of pus. At this stage, cholecystitis becomes phlegmonous. The stage itself is called destructive, because it leads to irreversible changes in the structure of the gallbladder.
Inflammatory effusion and pus impregnate the walls of the organ, which leads to their thickening. The appearance of minor hemorrhages is possible. The inflammatory process provokes pathological changes in the mucosa. Scars begin to form on it.
The walls of the gallbladder expand rapidly under pressure. Bile with impurities of mucus, pus and calculi burst, increase it. As a result, the patient experiences a severe pain syndrome, which forces him to consult a doctor.
Main reasons
The following factors contribute to the development of phlegmonous cholecystitis:
- change in the composition of bile;
- progressive congestive processes in the organ;
- relapse of inflammation.
The onset of the disease occurs due to the lack of treatment for primary inflammation in the gallbladder or the wrong treatment tactics. The development of the phlegmonous form is always preceded by a long-term calculous cholecystitis. It, in turn, may appear under the influence of the following factors:
- errors in nutrition;
- inactive lifestyle;
- decreased immunity;
- long-term medication;
- hormonal changes during pregnancy;
- gastrointestinal pathology;
- hereditary predisposition.
According to the International Classification of Diseases of the 10th revision, phlegmonous cholecystitis refers to diseases of the gallbladder, biliary tract and pancreas. Its acute form is code K81.0, and its chronic form is K81.1.
Clinical picture
When the calculous form of the disease becomes phlegmonous, the patient clearly feels the clinical manifestations of the pathology. The course of the purulent process is always accompanied by an increase in temperature. The patient gradually develops signs of intoxication. If the inflammation goes beyond the affected organ, it begins to negatively affect the work of the whole organism.
With the phlegmonous stage of the disease, pain is intensified. Discomfort increases when the patient breaks the diet, takes alcoholic beverages or is subjected to intense physical exertion. In addition, the cause of the increase in pain can serve as a psycho-emotional overstrain or stress state.
Acute phlegmonous calculous cholecystitis occurs with the following symptoms:
- arterial hypotension;
- general weakness;
- vomiting, bitter belching;
- taste of bile in the mouth;
- performance of cold perspiration.
Pain sensations usually appear in the right side and only intensify with a change in body position, deep breaths. Bloating is sometimes observed against the background of impaired functioning of the smooth muscles of the intestine.
Chronic and acute phlegmonous cholecystitis
The medical history of most patients is associated with its acute course. The first symptoms in this case are pain in the right hypochondrium, which can give back to the lower back or neck, severe vomiting. In addition, tachycardia is observed.
In a chronic course, the clinical picture is somewhat modified. Pain syndrome is periodic. However, the patient is concerned about constant belching and a feeling of bitterness in the mouth, general weakness and dizziness.
Obstructive phlegmonous cholecystitis
Acute obstructive cholecystitis is a pathological condition that usually occurs against the background of a calculous form of the disease. It is characterized by blockage by the stones of the ducts of the gallbladder, which causes their obstruction. The disease is accompanied by severe pain. In addition, there is an increase in the gallbladder in size, so that the patient can independently feel it. The clinical picture is expressed by nausea and vomiting, loss of strength. A similar condition lasts from several hours to whole days. When the stone moves back to the organ, all the symptoms disappear.
The lack of treatment for acute obstructive phlegmonous calculous cholecystitis is dangerous for the development of sepsis and cirrhosis. In some patients, liver failure, bilirubin encephalopathy occurs.
Diagnostic Methods
Diagnosis begins by examining the patient’s medical history. Phlegmonous cholecystitis always develops from a catarrhal form of pathology. At the same time, cholecystitis itself in 95% of cases is a complication of the presence of calculi in the ducts of the bladder.
Then a physical examination is carried out, the patient's complaints are examined. The doctor may feel bloating on palpation. When you click on the region of the right hypochondrium, the patient experiences severe pain discomfort. Also, the doctor can feel the inflamed gall bladder.
An obligatory diagnostic step is blood and urine tests. In the case of the inflammatory process, an acceleration of ESR, an increase in the number of leukocytes, is observed. For a visual assessment of the affected organ, an ultrasound, x-ray, CT and MRI are performed. In severe cases, a biopsy may be required.
Conservative therapy
Treatment of phlegmonous cholecystitis is carried out exclusively in a hospital. With a stoneless form, medication is acceptable. In the case of an acute course of calculous phlegmonous disease, surgery is indicated.
Conservative treatment includes the following activities:
- Reception of antispasmodic and painkillers, including narcotic nature. Medicines help relieve pain.
- Conducting antibiotic therapy to suppress the infectious process. Antibiotics show good efficacy in the calculous form of the disease. In the case of phlegmonous due to destructive processes, blood flow is disturbed. This complicates the transportation of the active substances of the drug to the lesion.
- Diet therapy. In the first two days, the patient is offered fasting. Then the diet expands somewhat. Products irritating the gastrointestinal tract are strictly prohibited. The diet is as gentle as possible, and the dishes are steamed and grinded. Food is mainly fractional.
In addition, it is important for the patient to provide physical and emotional peace. With a deterioration in well-being, the question of conducting an operation is resolved.
Surgical intervention
Surgical treatment for cholecystitis is carried out in three different ways. The choice of a specific option depends on the condition of the patient and the results of his examination:
- Most preferred is laparoscopic surgery. During the procedure, the doctor makes several punctures on the abdominal wall, through which he introduces tools for medical manipulations.
- Traditional abdominal surgery is rarely used today, for example, in the case of infections in the gallbladder or adhesions. Recovery is usually long and very difficult.
- Percutaneous cholecystostomy is used in the treatment of critically ill patients. The operation involves performing a small incision in the abdomen, through which a drainage tube is subsequently inserted into the gallbladder.
If the operation is not possible according to indications, the patient is recommended a procedure for crushing stones using extracorporeal shock wave lithotripsy. It is always accompanied by the use of specific medicines. However, with this treatment option, cases of relapse are possible.
After the operation, it is important for all patients, without exception, to follow a strict diet and adhere to a healthy lifestyle. In the first few days, eating food and any liquid is strictly prohibited. On the third day, mashed fruits and vegetables, watery cereals, and fruit drinks are allowed.
Possible complications
In the absence of treatment or the wrong tactics, phlegmonous cholecystitis can lead to complications. Among them, the most common are the following:
- The transition of the disease into a gangrenous form, which can provoke a rupture of the gallbladder, the outflow of its contents into the peritoneal cavity. As a result, peritonitis develops.
- The formation of fistulas and abscesses.
- Involvement of neighboring organs in the pathological process. We are talking about damage to the intestines, liver and pancreas.
Also, the disease can be complicated by sclerosis of the gallbladder. In this case, healthy cells are replaced by dense connective tissue.
Prevention Methods
To prevent the development of a complicated form of calculous cholecystitis - phlegmonous, it is necessary to follow the doctor's recommendations. Preventive measures are usually aimed at reducing the risk of relapse. To this end, it should:
- adhere to a low-calorie diet;
- avoid psycho-emotional overload;
- take prescribed medications.
Seeking medical help at the stage of calculous cholecystitis development almost always avoids its phlegmonous form.