If you have severe pain in the right hypochondrium, nausea and vomiting, which does not give relief, a bitter taste is felt in your mouth, it is quite possible that you have an attack of acute cholecystitis.
Cholecystitis is one of the most common diseases. According to the international classification of diseases (ICD-10), it belongs to the class of pathologies of the digestive tract. This disease can be independent, and can manifest itself as a complication after other ailments, such as pancreatitis, some types of gastritis, hepatitis and others. The disease develops gradually, at first hardly noticeable, therefore it is necessary to treat acute cholecystitis as soon as possible , the symptoms of which have already manifested.
What is cholecystitis
ICD-10 cholecystitis is an inflammation of the gallbladder. The primary cause of the disease is the bile ducts, through which the gall bladder is cleansed of bile, clogged with stones. This phenomenon has unpleasant consequences. Bile stagnates in the body, loses its antimicrobial properties, as a result, the walls of the gallbladder become infected (including bacteria that have got from the gastrointestinal tract). Due to cholelithiasis, up to 95 percent of cholecystitis occurs.
Less commonly, the disease is caused by other reasons: stoneless cholecystitis can be triggered by vasculitis, prolonged fasting, sepsis, abdominal surgery, trauma, salmonellosis, and other factors not associated with the formation of gallstones.
The disease proceeds in acute and chronic form. The acute form is diagnosed with a rapidly developing inflammatory process. On average, 15 percent of patients with abdominal diseases are prone to bouts of acute cholecystitis. They are marked by severe abdominal pain. If you suspect you have an attack of acute cholecystitis, consult a doctor immediately (call an ambulance).
Chronic cholecystitis is the result of repeated attacks of acute. Most often it is calculous (that is, with gallstones). The walls of the gallbladder thicken over time, pathological changes in the bile ducts or the bladder itself occur, the ability to store and release bile decreases, and stones form. So that the disease does not develop into a chronic form, it is necessary to pay attention to the pathological conditions of the body in a timely manner and treat acute cholecystitis.
Symptoms of the disease
The most noticeable symptom of the disease is a sharp pain in the right hypochondrium. The pain with cholecystitis is very strong, lasts a long time - about six hours, often gives in the back or under the right shoulder blade and even comes to seizures.
With the development of the disease, the patient may experience bouts of nausea, vomiting, sometimes with an admixture of bile, but it does not become easier after vomiting. Also, patients may complain of dry mouth, tightness of the tongue. Complaints of bloating, belching with air are frequent. All these signs require the immediate treatment of acute cholecystitis.
Symptoms of acute cholecystitis also include:
- fever, fever;
- jaundice;
- gray stool;
- palpitations and other signs of intoxication.
In addition, it is necessary to pay attention to the following symptoms:
- Murphy and Obraztsova: with deep palpation of the right hypochondrium, it is difficult for the patient to breathe, it is painful to take a breath;
- Grekov - Ortner: the patient experiences pain when the palm strikes the edge of the arch on the right;
- Shchetkina - Blumberg: pain with cholecystitis intensifies if you quickly press on the front abdominal wall with your hand and release it.
Causes of acute cholecystitis
The main causes of cholecystitis are gallstones:
- cholesterol stones (the most common case);
- bilirubin stones, or pigment stones (occur during the destruction of red blood cells).
Other causes of the disease:
- stagnation of bile in the organ;
- cirrhosis of the liver and biliary tract;
- rapid weight loss (regardless of whether it occurred as a result of a diet or surgical treatment of obesity);
- pregnancy (the position of the fetus, as well as hormonal changes in the body, affect the gallbladder).
An important role in the occurrence of acute cholecystitis is played by gender and age. Women are exposed to the disease on average 2-3 times more often than men. It was also noted that the disease develops more often if a woman has given birth to at least one child, is protected by contraceptives with a high estrogen content, and is overweight. However, overweight can cause the disease, regardless of gender: a sedentary lifestyle and unhealthy diet with a lot of heavy fatty foods make you seek medical help about acute cholecystitis 4 times more often. However, intense physical work also contributes to the development of cholecystitis, since increased loads negatively affect the gallbladder and bile ducts.
The risk of getting sick rises sharply after 40-50 years, but the exact reasons why this happens are still not clear. In older men, acute stoneless cholecystitis is more likely to occur.
Cholecystitis in adults is more common than in children, but in many cases the disease occurs in childhood and continues into adulthood.
Also, factors that provoke acute cholecystitis include diseases such as diabetes, Crohn's disease, immunodeficiency.
Pathology can occur as a result of taking drugs to lower cholesterol, prolonged fasting, and injuries to the abdomen.
Diagnosis of the disease
At the slightest suspicion of acute cholecystitis, the patient needs to be hospitalized in most cases and research within 24 hours to confirm the diagnosis, since the disease poses a threat to life.
In a typical course of acute cholecystitis, it is not difficult for an experienced doctor to confirm the diagnosis.
In addition to a physical examination of the abdomen, it is necessary to conduct such examinations as ultrasound and computed tomography of the abdominal cavity. When diagnosing, the doctor must make sure that it is about acute cholecystitis, and not about pancreatitis, whose symptoms are similar, or appendicitis or another disease. At the ultrasound, the doctor will see if the size of the gallbladder is enlarged, its walls are thickened, are there any other changes, pus, stones, etc. The effectiveness of this study reaches 90 percent.
In some cases, radiography, endoscopic, laparoscopic and other types of studies may be required. Urinalysis and blood tests are mandatory - general, for bilirubin, amylase and lipase, pancreatic enzymes, as well as aimed at assessing liver functions.
Conservative treatment of acute cholecystitis
If there is no threat of diffuse peritonitis in acute cholecystitis, examinations and conservative treatment are indicated. The patient is prescribed primarily painkillers and antibiotics. With cholecystitis, pain relievers are prescribed antispasmodics (for example, "Papaverine", "No-shpa" and others). Combined drugs for cholecystitis (antispasmodics and painkillers, for example) have the most effective effect.
Antibiotics for cholecystitis are used to suppress the gallbladder infection and prevent it from developing.
The patient must maintain a strict diet during therapy, complete starvation is possible on the first day. Cold is applied to the right hypochondrium.
To dissolve stones, use preparations of chenodeoxycholic or ursodeoxycholic acid. To maintain the functions of the organs, choleretic and hepatoprotectors are prescribed. Such treatment can last more than two years, but the possibility of relapse remains.
Surgery
If signs of diffuse peritonitis are detected, the patient undergoes an emergency surgery - cholecystectomy (removal of the gallbladder). With peritonitis, mortality is very high even during emergency operations, so procrastination with hospitalization with signs of acute cholecystitis is extremely dangerous.
If the examination revealed calculous cholecystitis (i.e. with stones), no later than three days from the onset of the disease in the absence of contraindications, early surgery is recommended to prevent complications after acute cholecystitis. Its meaning is the removal of the gallbladder damaged by the disease.
Currently, there are two types of operations: laparotomy and laparoscopic cholecystectomy. In the first case, this is a normal open operation with an abdominal incision, which is now being performed less and less. Laparoscopy is performed without surgical incisions using special equipment. During laparoscopic surgery, small incisions are made through which the video camera and instruments are inserted. This type of cholecystectomy is less traumatic, has a short rehabilitation period, after it there are no seams left, practically no adhesions. It can also be used as a diagnostic method.
After the operation, the patient quickly recovers, after two months he can return to his usual life, however, there remains a need to follow a strict diet for six months and further control his diet.
A relatively new type of non-invasive surgery is remote shock wave lithotripsy. Gallbladder lithotripsy is used if there are contraindications for intracavitary surgery. It is carried out using an apparatus that sends a shock wave to a stone and crushes it until it turns into dust.
The prognosis for acute cholecystitis is generally favorable. After surgery due to calculous cholecystitis, almost all patients no longer experience symptoms of the disease.
Disease complications
Acute cholecystitis more often than other diseases leads to diffuse peritonitis. Peritonitis is manifested in a significant increase in pain on the 3-4th day of the disease, muscle tension of the abdominal wall, soreness of the peritoneum.
Also, acute cholecystitis can lead to perforation of the gallbladder. In this case, the pain will decrease for a while, but then all the symptoms, including pain, become stronger.
Complications of the disease include cholangitis, pancreatitis, gangrene of the gallbladder, suppuration in the bladder. A particular complication is damage to the bile ducts during an operation to remove the gallbladder.
Repeated attacks of acute cholecystitis can lead to a chronic course of the disease.
Preventive measures
With a predisposition to the formation of gallstones, it is difficult to completely prevent the possibility of acute cholecystitis. However, the likelihood of developing cholelithiasis can be reduced by preventive measures, as a result of which the risk of acute bouts of acute cholecystitis and the development of chronic will be reduced.
Stagnation of bile is prevented by an active lifestyle. Mobility does not allow stones to form, and also maintains a normal body weight.
If there is excess weight, you can not sharply reduce it.
It is also necessary to maintain water balance (you need to drink at least 2 liters of water per day).
Carefully monitor your health, give up alcohol and smoking, as they reduce immunity and adversely affect the digestion process.
Acute cholecystitis is often a concomitant disease in the pathology of the gastrointestinal tract, so all diseases of the gastrointestinal tract must be treated in a timely manner.
The basic rule is proper nutrition. It is necessary to eat food regularly, at the same time, at least three to five times a day, in small portions. This helps prevent bile congestion in the gallbladder.
Nutrition for acute cholecystitis
Diet plays a major role in the treatment of the disease. Therefore, the patient must first remember what they eat with cholecystitis, and strictly observe all restrictions in order to prevent a recurrence of the attack.
Diet varies at each stage of the disease:
- From the moment of hospitalization, the patient is shown starvation until the pain disappears (but not more than 4 days). At this stage, only liquids are allowed (mineral water without gas, weak tea, fruit drinks, decoctions of chamomile, peppermint, wild rose) are also allowed. You need to drink often, in small sips.
- After removing the pain syndrome, rubbed liquid food can be introduced into the diet - a weak broth, rice, semolina, oatmeal soups, milk soups, jelly, low-calorie kefir. You need to eat in small portions. At this stage, you need to drink more than 2 liters of water per day.
- Closer to recovery, lean fish and meat are added to the diet. As before, only mashed food, boiled or steamed, is allowed, but the portions can be increased. At this stage, the diet allows vegetables and fruits, dry bread, biscuits, marshmallows, coffee with milk.
In acute and chronic cholecystitis, in no case should you eat fried, smoked, spicy, pickled, spicy. The banned foods for cholecystitis are chocolate, sweet soda, pastry, mushrooms. This heavy food has an extremely negative effect on the digestive system and can lead to a new attack.
After recovery, nutritional restrictions remain, the patient is assigned a diet No. 5a (the intake of fats and foods rich in coarse fiber, oxalic acid, cholesterol, and nitrogenous extractives is limited).
Treatment with folk remedies
Folk remedies are recommended to be used as additional. It is dangerous to completely replace traditional therapy with them, especially in the acute form. If a disease is suspected, it is first necessary to consult a doctor. First, acute cholecystitis should be treated, the symptoms of which develop and require immediate medical attention, and only after that you can resort to medicinal herbs and fees.
Treatment of chronic cholecystitis with folk remedies is also used as an addition to the main method of therapy. Mostly used plants with choleretic, anti-inflammatory, antimicrobial properties, as well as honey and olive oil. It is recommended to replace morning tea with a decoction of corn stigmas or dogrose. One of the effective means for both cholecystitis and other diseases of the gastrointestinal tract is a decoction of untreated oat grains.
Any folk remedy must be approved by the attending physician.
With a diet, a healthy lifestyle, the risk of stones in the gallbladder and the development of cholecystitis is very small. However, with the appearance of symptoms characteristic of acute cholecystitis, it is necessary not to self-medicate, but to consult a doctor immediately to make an accurate diagnosis and to cure the disease as soon as possible without provoking the appearance of complications and developing into a chronic form.