Stoneless chronic cholecystitis is an inflammation of the gallbladder without the formation of bile stones. This form causes pain in the right hypochondrium and dyspeptic disorders.
In the field of gastroenterology, the share of chronic damage accounts for 5 to 10% of cases. In women, chronic stoneless cholecystitis occurs about 4 times more often. These are the statistics. Some researchers classify chronic stoneless cholecystitis as a transitional form to a disease such as cholesterol calculosis. But, as medical practice has shown, patients in the future do not suffer from gallstone disease.
Causes of the disease
The etiology of this disease is made up of various infections:
- E. coli;
- enterococcus;
- staphylococcus;
- Proteus;
- mixed flora .
The penetration of bacteria into the gallbladder through the intestines occurs in conditions such as:
- dysbiosis;
- colitis;
- enteritis;
- hepatitis;
- pancreatitis
Less commonly, an infectious lesion spreads through lymph or blood from infectious foci located remotely.
For example, an infection spreads with diseases such as:
- periodontal disease;
- tonsillitis in chronic form;
- appendicitis;
- pneumonia;
- pyelitis;
- adnexitis.
The provoking factors that activate infectious processes include:
- cholestasis;
- biliary dyskinesia;
- invasion by parasites such as giardia, roundworm, amoeba;
- sphincter dysfunction;
- obesity;
- dysmenorrhea;
- physical inactivity;
- malnutrition;
- nervous exhaustion, etc.
Stoneless chronic cholecystitis involves thickening and deformation of the gallbladder. The mucous membrane acquires a mesh structure due to the fact that atrophic regions alternate with polyps that form thick folds.
A thickening of the muscle membrane occurs. Cicatricial fibrous tissue appears in it. With the prevalence of the inflammatory process, pericholecystitis can develop, adhesions with organs located in the vicinity, abscesses, pseudo-diverticuli can appear.
Disease classification
The lesion is mild, moderate and severe. The disease involves the presence of three stages:
- exacerbation;
- subsidence and exacerbation;
- persistent and unstable remission.
Stoneless chronic cholecystitis can occur with relapse. Also, the disease is monotonous and intermittent.
Depending on the degree of damage, it is customary to distinguish between a complicated and uncomplicated form of chronic non-calculous cholecystitis. It is also customary to distinguish between typical and atypical species. The latter form is divided into intestinal, cardialgic and esophagalgic type.
Symptoms of chronic stoneless cholecystitis appear differently depending on the degree of gallbladder damage.
How does the disease manifest to a mild degree?
Mild cholecystitis is characterized by short exacerbations lasting 2-3 days. Basically, they are provoked by malnutrition and are easily eliminated with a proper diet.
The general condition of the body is normal, body temperature is normal. The examination did not reveal a functional violation of the liver, gall bladder and pancreas. Microscopic examination of bile does not show any abnormalities.
How does the middle form flow?
With the average form of a disease such as chronic stoneless cholecystitis, remission and exacerbation succeed each other. The duration of exacerbations is 2-3 weeks. Typically, the patient is concerned about pain and severe dyspeptic disorder. As a rule, this condition is caused by eating fatty foods or overeating. In some cases, a respiratory infection is the provocateur of exacerbation.
How does chronic stoneless cholecystitis proceed in this case? Symptoms are varied. With exacerbation, patients lack appetite, weight loss, intoxication appears, expressed in asthenia and migraine. Joint pain may also bother you.
Some patients, in addition to pain in the right hypochondrium, may complain of dull pain in the left hypochondrium and upper abdomen. Pain often spreads to the heart. Patients are concerned about nausea, constipation, or diarrhea.
In a laboratory study of bile, an increase in the amount of mucus, leukocytes, cholesterol, Ca bilirubinate, bile salts, and in some cases microliths is noted. Microflora detection is also possible.
In an acute condition, a change in liver function tests is detected in patients. Often there is moderate hypoalbuminemia, a slight increase in transaminase activity, mainly AJIT, a moderate increase in thymol test and alkaline phosphatase activity .
Indicators of a laboratory study of the liver become normal during the period of remission. The patient may be disturbed by a feeling of heaviness in the upper abdomen and bloating after eating. Often a person is bothered by constipation or diarrhea.
Dyspeptic manifestations intensify when eating fatty foods or coarse fiber. Such food can trigger an exacerbation of the disease.
How does severe form occur?
Severe stoneless chronic cholecystitis is characterized by a course with constant relapses without remission. The disease spreads beyond the gallbladder. Chronic hepatitis and pancreatitis join the underlying disease.
Patients complain of a lack of appetite, persistent nausea, heaviness in the upper abdomen. Sometimes the pain is girdling. A strict diet is recommended for patients, which leads to weight loss and asthenia. In some cases, sepsis appears in a chronic form.
The functionality of the gallbladder is severely impaired. The wall of the organ thickens. If, with an average degree, the functionality of the liver is partially disrupted, then with a severe form of the disease, hepatitis in a chronic form or cholangitis is often manifested.
In this case, the following processes occur:
- the liver increases in size;
- a decrease in serum albumin is noted;
- globulin fractions and the concentration of total bilirubin increase.
When conducting an ultrasound of the abdominal organs, an expansion of the gallbladder ducts is noted, a βstagnantβ gallbladder, chronic pancreatitis with a decrease in pancreatic functionality are detected.
Patients often complain of dyspeptic disorders, nausea, weight loss. They have an increase in feces, steatorrhea, creatorrhea and amilorrhea.
With a severe form of the disease, the functioning of blood vessels and the heart is disturbed, vegetovascular dystonia, coronary insufficiency appears with corresponding changes in the ECG.
How does the atypical form proceed?
How is the atypical form of chronic stoneless cholecystitis characterized? The patient is disturbed by constant heartburn, heaviness, pain behind the sternum, transient dysphagia. With the intestinal type, pain in the intestine, bloating, constipation come to the fore.
At a young age, chronic stoneless cholecystitis is similar to latent rheumatism. Patients complain of asthenia, pain in the joints. Auscultation reveals lowered heart sounds.
The atypical course of the disease includes the lumbar and pyloric-venal type of chronic cholecystitis. With a lumbar form, patients experience pain in the spine. In such cases, radiography of the spinal column is indicated.
Symptoms of a cardialgic form
This form of the disease is characterized by arrhythmia (extrasystole) or pain behind the sternum. The ECG also changes.
In middle and old age, the cardiac form is similar to angina pectoris or coronary insufficiency, proceeding in a chronic form. Patients complain of heart pain, tachycardia.
Gastroduodenal form
The clinic of chronic cholecystitis in this case resembles a peptic ulcer or gastroduodenitis with an increased level of formation of stomach acid. Patients complain of stomach pain at night.
Diagnostic Methods
On palpation of the abdomen in the area of ββthe gallbladder, pain is noted, which increases with inhalation or with tapping of the right costal arch.
In a laboratory study, an increased indicator is determined:
- transaminase;
- alkaline phosphatase;
- Ξ³-glutamyl transpeptidases.
Very important diagnostic methods include:
- Ultrasound
- cholecystography;
- celiography;
- cholesintigraphy;
- duodenal sounding.
Based on the latest research, we can talk about the intensity of the inflammatory process.
Typical changes at the macroscopic level are manifested in the turbidity of bile, as well as the presence of flakes and mucus.
Microscopic examination shows an increased number of leukocytes, bilirubin, protein, cholesterol, etc.
With bacteriological sowing of bile, its microbial flora is examined.
Using cholecystography in patients suffering from a chronic form of stoneless cholecystitis, the motor and concentration functionality of the gallbladder, its contours and position are evaluated.
Sonography reveals the deformation of the gallbladder, atrophic processes in its walls, unevenness of the internal epithelium, the presence of inhomogeneous contents with inclusions of bile of an inhomogeneous consistency.
Differential diagnosis is carried out with biliary dyskinesia, chronic cholangitis, ulcerative colitis of a non-specific nature, as well as Crohn's disease.
Therapies
How is chronic stoneless cholecystitis eliminated? Treatment is usually carried out conservatively. Doctors recommend a diet. It is advised to exclude fatty and fried foods, spicy dishes, soda and alcohol from the diet.
In case of abdominal pain, it is recommended to take such antispasmodics as Platifillin, Drotaverin, Papaverin, etc.
With an exacerbation of the disease or in combination with cholangitis, the antibacterial treatment of Cefazolin, Amoxicillin, Erythromycin, Ampicillin, Furazolidone and others is used.
To normalize the gastrointestinal tract, it is advised to take "Festal", "Mezim-forte", "Pancreatin".
To increase the secretion of bile, they usually resort to choleretics ("Allohol", "Cholenzym", "Oxafenamide").
Magnesium sulfate and sorbitol are used to stimulate the contraction of the gallbladder.
During an exacerbation or remission, it is advisable to conduct a course of herbal therapy. Decoctions of chamomile, calendula, rose hip, licorice, mint are taken.
During remission, they spend tubage, drink mineral water, conduct exercise therapy.
Surgical intervention
With surgical intervention, a medical history is taken into account. Chronic stoneless cholecystitis, which is expressed in the deformation of the walls of the gallbladder and inappropriate correction of cholangitis and pancreatitis, requires surgery.
In this case, cholecystectomy is performed by open intervention, laparoscopy or mini-access.
The use of folk methods
How else is chronic stoneless cholecystitis eliminated? Treatment with folk remedies also has a positive effect.
The roots of calamus swamp, valerian, dried inflorescences of St. John's wort, calendula, nettle, corn, and flax seeds are used. It is also advisable to use linden, peppermint, motherwort, chamomile, dill, horsetail, wild rose.
When using alternative methods for the chronic course of the disease, phytotherapy is added to the flowers of the immortelle and elderberry.
Phytotherapy
Herbal medicine involves the use of a cocktail of the following herbs:
- peony - 20 ml;
- valerian - 20 ml;
- hawthorn - 20 ml;
- mint - 20 ml;
- belladonna - 10 ml;
- motherwort - 20 ml;
- calendula - 30 ml;
- wormwood - 20 ml.
In the presence of glaucoma belladonna is not added.
Drink the drug should be 1-8 drops three times a day five minutes before taking the infusion of herbs for 1 tbsp. l of water for 4-6 weeks. A mixture of calamus tincture and elecampane is taken in equal amounts. Also, 1-8 drops are drunk three times a day two minutes before taking an infusion of herbs for 1 tbsp. l water for 4-6 weeks.
It should be remembered that the phytotherapeutic collection is connected at a dose of 0.00325, i.e., the 14th dilution, and daily increases by 1-2 dilutions until the optimal dose is reached.
A suitable dose is one that does not cause dyspeptic disorders, but rather reduces the degree of manifestations. Such a dose is taken during the course, but if discomfort appears, then it decreases by 1-2 units.
Forecast
What is the prognosis of a disease like chronic stoneless cholecystitis? Mild exacerbation is rare. The disease has a favorable course. The prognosis worsens if exacerbations often occur with moderate disease.
Prevention
Preventive measures include timely treatment of the disease, sanitation of foci of infection, elimination of disorders in the nervous system, as well as restoration of normal metabolism. You should also follow a proper diet, fight intestinal infections and helminth infections.