Acute cholecystitis: a case history and types of cholecystitis

Acute cholecystitis is a serious disease that is characterized by an inflammatory process in the gallbladder. This pathology is considered quite dangerous and requires immediate hospitalization of the patient. What features does the history of acute cholecystitis have and how to act when detecting symptoms of the disease?

Location and function of the gallbladder

In the human body, the gallbladder plays an important role. This small organ located under the liver is involved in the digestion process - it accumulates bile.

Bile is called a special secretion (fluid), which is produced in the liver. It is this liquid that contributes to the correct and faster breakdown of fats entering the food.

After bile is produced by the cells of the liver, it is sent to the gallbladder through special tubules and stored for a certain time. The longer the bile is in the gallbladder, the higher its concentration becomes, and this over time can lead to the formation of stones and the appearance of an inflammatory process.

The essence of the disease

With an increased concentration of bile and the presence of stones (stones) in the gallbladder, the work of this internal organ is disrupted, bile ceases to accumulate and exit through the duct. Or, during the movement of the fluid, the calculi move from their place and block the mouth of the gallbladder duct.

Such changes lead to stretching of the organ, deformation of its walls, which are accompanied by severe pain. Quite often, inflammation joins such a pathology. If the patient is not prescribed the right treatment on time, neighboring organs are involved in the process: the pancreas, duodenum and stomach suffer.

Causes of stagnation of bile

In the history of acute cholecystitis with cholelithiasis (gallstone disease) , the following may be the cause:

• improper nutrition (consumption of spicy, fatty and smoked food, overeating);
• pregnancy (during this period, the woman’s body undergoes serious changes and restructuring);
• prolonged use of oral contraceptives or their improper selection (often such a pathology becomes the result of an independent choice of drugs);
• various diseases of the digestive system (including the pancreas);
• violation of the immune status;
• lack of physical activity, low mobility;
• pathologies of the development of the gallbladder or a predisposition to stagnation of bile.

The presence of at least one of the above factors significantly increases the risk of developing pathology. In the event that a person has several such factors at once, he should take his health very seriously and, at the slightest suspicion of a pathological condition, contact the clinic.

It is noted that the majority of patients with this diagnosis are people over the age of 50 and women. In the vast majority of cases, acute cholecystitis develops at the age of 40-60.

Calculous cholecystitis

Depending on the root cause of the pathology, cholecystitis is calculous and non-calculous.

The calculous type is that kind of disease that is characterized by the presence of calculi (stones) in the gallbladder. Thus, this pathology is considered a complication of cholelithiasis. Case reports of acute calculous cholecystitis account for approximately 95% of all cases of acute gallbladder inflammation.

Inflammation in all these cases provokes blockage of the outlet with a stone or biliary sludge. The term "biliary sludge" is understood as a dense suspension consisting of concentrated bile and small crystals of cholesterol.

The absence of a free duct creates increased pressure in the gallbladder. In addition, in some cases, the attachment of bacteria is possible. Such a pathology is considered especially dangerous, as it can lead to a gangrenous form in which the gallbladder tissue dies.

Non-calculous cholecystitis

The case history of acute non-calculous cholecystitis is characterized by a more severe condition of the patient. Such a pathology happens quite rarely. A distinctive feature of this disease is the absence of gallstones.

The cause of this pathology is infection or trauma of the gallbladder, including:

• mechanical injury (fall from a height, heavy blow) or burn;
• damage to the gallbladder during surgery on internal organs;
• strict diet, starvation, severe malnutrition;
• sepsis (blood poisoning);
• human immunodeficiency virus (HIV) or AIDS.

Catarrhal form

In addition to the causes of the development of the disease, the medical history of acute cholecystitis is customary to differentiate according to the severity of the destructive processes that occur in the tissues of the gallbladder.

The catarrhal form is considered the easiest. Such a diagnosis is made if the gallbladder has a slightly enlarged size, and its cavity is filled with watery bile. The mucous membrane may be somewhat swollen and covered with a small amount of cloudy mucus. In cases of proper treatment, the condition quickly stabilizes.

Destructive form

This form of the disease is characterized by a more severe course and the presence of destructive processes in the gallbladder. In other words, the tissues of the organ have already begun to collapse (die). Depending on the characteristic of the history of the disease, cholelithiasis, acute calculous cholecystitis of a destructive form can be:

• phlegmonous - characterized by inflammation of all layers of the gallbladder and the presence of pus;
• gangrenous - in this case, the presence of dead tissue and a high risk of serious complications are noted.

According to medical data, the phlegmonous form is a continuation of catarrhal cholecystitis and represents the very beginning of an active inflammatory process. In the absence of treatment, the condition flows into a more severe - gangrenous acute cholecystitis. The history of the disease is complicated by extensive inflammation.

In this case, ulcers appear on the walls of the gallbladder, which can lead to rupture of the organ. If this happens, concentrated bile with pus spills into the abdominal cavity and causes inflammation of neighboring organs.

First symptoms

Symptoms of gallbladder inflammation appear suddenly and develop rapidly. At the same time, similar characteristics of most case histories are observed. Complaints in acute cholecystitis include:

• pain in the right hypochondrium (they have an acute cramping look);
• an increase in the frequency of seizures (initially occur from time to time, but soon become more frequent and turn into ongoing pain);
• pain under the shoulder blade or in the back (in some cases, the pain can give back)
• dry tongue, the appearance of plaque;
• bouts of vomiting with severe pain;
• a slight increase in temperature (37.5-38 degrees);
• the appearance of chills;
• deterioration in general condition.

Upon examination, the doctor may notice a restriction of the mobility of the abdominal wall on the right side.

The diagnosis in elderly patients may be somewhat difficult, since the history of diseases of the cholelithiasis and acute cholecystitis in this case are characterized by the absence of vivid symptoms.

Late symptoms

If treatment of acute cholecystitis has not been started in the early stages of development, the medical history is complicated by the appearance of other symptoms. This is because the lumen of the gallbladder remains clogged, and infected bile affects the walls of the organ. With this clinical picture, they often talk about the onset of a destructive form of the disease. Patients note a general deterioration and the appearance of the following symptoms:

• frequent bouts of nausea;
• bloating, feeling of fullness;
• bitter taste in the mouth;
• frequent burping;
• bouts of vomiting (in the vomit, bile is usually present, which can be recognized by a yellow tint and a bitter aftertaste);
• dry mouth
• the appearance of a yellow shade of the skin;
• signs of tachycardia (rapid painful heartbeat);
• a possible sense of disorientation in space.

First aid

When the above symptoms appear, a person should immediately perform several important actions.

1. Call an ambulance and only then provide first aid. This will somewhat alleviate the patient’s condition and help wait for medical workers.
2. Take a horizontal position on the right side and move as little as possible.
3. Periodically drink non-carbonated mineral water at room temperature. This must be done in small sips.

Prior to the arrival of an ambulance, it is better not to take painkillers, as this makes it difficult to make a preliminary diagnosis.

The value of a complete diagnosis

If the above symptoms are identified, a person should immediately contact a clinic. Self-treatment in this case is strictly prohibited. This is explained not only by the level of risk for inflammation of the gallbladder, but also by the need for an accurate diagnosis. The fact is that both at the initial and late stages the history of the disease of acute cholecystitis is similar to the manifestations of other pathologies:

• urolithiasis disease;
• acute appendicitis;
• pyelonephritis;
• pancreatitis
• pleurisy;
• duodenal ulcer or stomach ulcer;
• liver abscess.

An incorrectly chosen course of therapy will not only not alleviate the condition, but will also aggravate it.

Initial inspection

The first thing that the patient will face when contacting the clinic is an initial examination. Based on the data received, the doctor will prescribe laboratory tests and hardware diagnostics. During the examination, the patient is questioned for the presence and nature of the symptoms, the presence of one or more risk factors is checked.

Palpation is an extremely important element in identifying the medical history of acute cholecystitis. A preliminary diagnosis will help to test for the following symptoms.

• Symptom of Ortner-Grekov. When you tap the edge of the palm of your hand on the right edge of the costal arch, pain appears. For comparison, tapping on the left edge of the costal arch is performed.
• Symptom Kera. This test is performed on inhalation. Pain occurs during palpation of the projection area of ​​the gallbladder.
• Symptom Murphy. On exhalation, the doctor begins to apply even pressure to the gallbladder, after which the patient takes a deep, slow breath. In this case, the stomach increases. If pain occurs at the time of inspiration, the test is positive.

Laboratory tests

In order to exclude kidney pathologies from the medical history, in acute cholecystitis, urinalysis is included in the differential diagnosis.

Another mandatory laboratory analysis is a general blood test. During the test, take into account the level of leukocyte count. This indicator indicates the presence of inflammatory foci in the patient's body.

Hardware Diagnostics

One of the main diagnostic methods in the history of acute cholecystitis is ultrasound. Ultrasound examination of the gallbladder is an informative way to obtain information about the condition of the internal organs of the patient.

Data in this case is obtained using a special apparatus that emits ultrasonic waves. The information received is transmitted to a computer monitor in the form of a picture, so that the doctor can judge the size of the organ and its shape. With the inflammatory process or the presence of stones, the pathology will be immediately detected.

There are other diagnostic methods that can complement the information obtained by ultrasound.

• Abdominal radiography. Under this procedure is understood an x-ray of the abdominal cavity.
• CT scan (computed tomography test). Such an examination allows you to get a three-dimensional image of the gallbladder.
• MRI (magnetic resonance imaging). Diagnosis is by radio waves and magnetic field.
• Cholecystography. In some cases, the history of acute cholecystitis is somewhat atypical, and ultrasound and CT do not provide the necessary information. In this case, doctors resort to cholecystography. This procedure is a radiography using a contrast agent. It can be introduced into the patient's body in several ways (oral, intravenous and infusion). Thanks to this check, it is possible to obtain information about the state of the bile duct. So, if there is gallstone at the mouth, it will be immediately detected.

Drug treatment

In the history of the disease of acute obstructive cholecystitis, the use of drug therapy is allowed. This is possible only in cases where obstruction of the bile duct is not complicated by extensive inflammation, ulcers and other processes of tissue death. In this case, the patient is prescribed drugs related to different groups of drugs:

• analgesics;
• anticholinergics;
• antispasmodics;
• broad-spectrum antibiotics;
• antihistamines;
• antioxidants.

The goal of treatment is to eliminate the inflammatory process in the gallbladder, block pain symptoms and restore the proper functioning of the body.

The complexity of therapy lies in the fact that this approach is not possible at all stages of acute cholecystitis. Treatment with a medical history complicated by purulent discharge and a serious condition of the patient requires exclusively surgical intervention. Only in this case will it be possible to achieve a lasting effect.

ZhKB and acute cholecystitis: a medical history of surgery

Surgical treatment is understood to mean an operation to remove the gallbladder. This is a radical measure, however, it is precisely such medical actions that can eliminate the disease and protect the patient from relapse (re-development of pathology).

Surgery does not pose a particular risk to the patient. The gall bladder is a fairly important organ in the body, however, its removal does not bring a person big problems.

Modern medicine uses two methods of surgery. In the history of acute cholecystitis, the following can be used for treatment:

• laparotomy (cavity) cholecystectomy;
• laparoscopic cholecystectomy.

Laparotomy cholecystectomy

By the medical term “laparotomic cholecystectomy” is meant the traditional operation, during which the surgeon removes the gallbladder. A feature of such an operation is that the surgeon makes an incision on the abdomen for manipulation. This procedure has both advantages and disadvantages.

As advantages, it should be noted:

• high efficiency;
• the possibility of surgery even in cases where laparoscopy is contraindicated.

Abdominal surgery is recommended for case histories of acute cholecystitis with the following features:

• pregnancy in the third trimester;
• cirrhosis of the liver with severe scarring of tissues.

The list of disadvantages of this type of surgical operation is called:

• long recovery period (up to 6 weeks);
• the risk of complications and inflammatory processes;
• cosmetic defect (after surgery, a noticeable suture remains on the abdomen).

Laparoscopy

Recently, in the case histories of acute cholecystitis in surgery, the laparoscopic method is increasingly used. This operation is considered minimally invasive (or gentle) and differs from the traditional cavity technique.

For surgical manipulations in this case, it is not necessary to make an incision in the abdominal wall and abdomen - just make a few small punctures (no more than 1 cm).

One of them is produced near the navel, and the other 3 are located in the upper abdomen. Through these openings, the abdominal cavity is filled with carbon dioxide. These are necessary steps to make it easier for the surgeon to operate. The whole procedure is carried out under general anesthesia, so the patient will not experience pain and discomfort.

A special instrument is inserted into one incision - a laparoscope, which is a rigid tube equipped with a backlight and a micro camera. Surgical instruments are inserted into the remaining openings. After the operation, the incisions are sutured.

There are several advantages of this type of surgery in the history of acute calculous cholecystitis:

• low risk of complications and infection in the postoperative period;
• quick recovery process after surgery;
• lack of cosmetic defect.

Percutaneous Cholecystectomy

In some cases, surgery cannot be used immediately. Case histories of cholelithiasis and acute calculous cholecystitis, complicated by the severe condition of the patient, require a slightly different approach. At the same time, drugs will also be useless.

Percutaneous cholecystectomy is used to temporarily alleviate the patient's condition. Under this procedure, it is understood to remove bile from the gallbladder using a special syringe with a long needle. An ultrasound machine will help determine the location of the gallbladder.

The entire procedure is performed under local anesthesia. As soon as the fluid is pumped out, the inflammation will decrease, which will reduce the manifestation of symptoms and improve the general condition of the patient. After that, you can resort to surgery. The history of the disease of acute calculous cholecystitis will also need to be taken into account: in each case, the doctor chooses the appropriate method of operation.

Diet for exacerbation of inflammation

When inflammatory processes occur in the gall bladder, it is extremely important for a patient to follow a special therapeutic diet. Depending on the severity of the pathology and the presence of complications, the doctor may recommend abstinence from food for a certain time. The first 1-2 days you can drink only water. This will not harm the body, but rather reduce the burden on the digestive system.

In other cases, refusal of heavy food, hot and cold foods, fatty, sweet, flour dishes is desirable. For patients with liver and gall bladder diseases, diet number 5 is recommended.

Allowed meals:

• pureed vegetarian soups, milk soups, pea soup with a minimal addition of peas, soup without broth;
• semi-viscous cereals, boiled in water or water with milk (rice, oat, buckwheat, semolina);
• cereal casseroles, cereals + cottage cheese, pasta;
• pilaf with dried fruits;
• low-fat pasta (they can not be combined with foods prohibited in the diet);
• hake, tuna, pollock and other low-fat fish species (you can make steamed cutlets, meatballs or bake whole) from it;
• squids, mussels, oysters (in limited quantities);
• boiled or steamed chicken breast;
• low-fat horsemeat;
• bran or rye bread, crackers, yesterday’s wheat bread from flour 1 and 2 varieties;
• low-fat yogurt, cottage cheese, sour cream, milk;
• boiled or steamed vegetables (exclude tomatoes, corn, radish, radish, eggplant);
• fruits and berries in limited quantities, baked apples (exclude sour fruits and berries);
• egg whites as an additive to salads and protein omelettes;
• of sweets allowed jelly, mousse, jelly, marshmallows, marmalade, candy;
• from drinks weak tea with sugar, milk or a small amount of lemon, compote (including dried fruit), a broth of wild rose and chamomile.

Possible complications

As the history of acute cholecystitis shows, not every person goes to the clinic with the appearance of pain and other symptoms. The reasons may be different. Some consider the manifestations of such a pathology as a digestive upset and try to treat themselves.

Doctors warn: doing this categorically is not recommended. Complications of gallbladder inflammation can be extremely severe:

• gallbladder emphysema;
• pancreatitis
• cholangitis;
• hepatitis;
• fistulas;
• sepsis (blood poisoning);
• peritonitis is one of the most dangerous options for the development of the disease, which occurs when the gall bladder ruptures and inflammation of the peritoneal tissue (leads to death).

Prevention

Avoiding gallbladder disease is quite difficult, but possible. To do this, you need to reconsider habits and lifestyle.

• Food. In order to avoid the appearance of gallstones, it is extremely important to adhere to proper nutrition. It is best to eat in small portions 4 or 5 times a day. At the same time, it is necessary to ensure that a sufficient amount of fruits, vegetables, cereals, fish and lean meat are present in the diet. The amount of alcohol, carbonated drinks and smoked foods should be reduced.
• Physical activity. Doctors recommend daily walks, regular running, swimming, or other sports.
• Timely treatment of inflammatory diseases.
• Annual medical diagnosis. During such tests, all available foci of inflammation will be identified (even those that are small in size and so far do not cause vivid symptoms).

Given all of the above, we can conclude: inflammation of the gallbladder is a rather dangerous disease that can lead to numerous complications. However, timely diagnosis and proper treatment completely eliminate the pathology and return the patient to a full life (even after cholecystectomy). The only thing the patient needs to remember: do not treat yourself. Therapy should be selected individually for each medical history of acute cholecystitis. The justification should be a thorough diagnosis: in this case, the result is achieved quite quickly.