And whether you know...
Cholecystitis is the acute inflammatory process happening in a gall bladder of the person.
Normal the gall bladder has the volume which 40–70 cm3. In a liver of the person bile which is necessary for ensuring process of digestion is produced. It is stored in a gall bladder. If in an organism there is a disturbance of exchange processes, then in a gleam of a gall bladder there can be stones, and at simultaneous emergence of infectious inflammatory process there is a development of acute cholecystitis.
Hit of microbes in an organism and their subsequent development becomes the most frequent reason of development of cholecystitis. Streptococci, colibacillus, enterococci, staphylococcus can provoke cholecystitis. For this reason reception of antibiotics is often applied to treatment of acute or chronic cholecystitis. As a rule, penetration of microorganisms into a gall bladder comes on zhelchevyvodyashchy channels from intestines. Such phenomenon takes place as a result of insufficiency of function of muscle fibers which separate the general bilious channel from intestines. Similar is often observed as an effect of dyskinesia of a gall bladder and zhelchevyvodyashchy ways, too low secretory activity of a stomach, a high pressure in a duodenum.
Very often development of cholecystitis happens also as a result of the broken bile outflow. It can occur at the person who suffers from cholelithiasis. If are present at a gall bladder of the person a fireplace, then they not only create a mechanical barrier to bile outflow, but also walls of a gall bladder irritate. As a result in a gall bladder initially develops aseptic, and later — a microbic inflammation of a gall bladder. Thus, at the patient chronic cholecystitis which periodically becomes aggravated develops.
However, microbes can appear in a gall bladder, having got with a flow of blood and a lymph there, in a gall bladder the vascular grid is developed. In this regard symptoms of cholecystitis are often shown at people who have illnesses of intestines, bodies of urinogenital system or existence of other centers of an inflammation.
Sometimes cholecystitis is provoked by ascarids, lyambliya, existence of injuries of a liver and gall bladder, etc.
Symptoms of cholecystitis are accurately shown already at the earliest stages of development of an illness. Early displays of this disease are very various. As a rule, they arise after the person considerably broke a food allowance, usual for himself, for example, ate a lot of acute or very fat food, drank rather large amount of alcohol, etc. At the same time initially pain arises at the top of a stomach and gives to the area of the right hypochondrium. Pain can be either constant, or accruing periodically. Sometimes at cholecystitis there is very sharp pain which reminds bilious colic. As symptoms of acute cholecystitis also emergence of the dispepsichesky phenomena is possible. It is bitter and metal smack in a mouth, constant nausea, emergence of an eructation, a meteorism. The person becomes very irritable, often suffers from sleeplessness.
The patient with cholecystitis has a cholemesis from time to time, however after such vomiting it becomes easier for it not. Besides, symptoms of cholecystitis are often shown by the increase of body temperature increased by heartbeat, at the patient skin can turn yellow a little. The white plaque, dryness of language is noted.
If a disease not to treat at once after manifestation of the described symptoms, the peritonitis which is very dangerous state can develop afterwards.
Chronic cholecystitis proceeds is generally long, it can sometimes proceed many years. Chronic cholecystitis can be subdivided into several versions. At acalculous cholecystitis in a gleam of a gall bladder stones are not formed. At the same time calculous cholecystitis is characterized by emergence in a gleam of a bubble of stones. Therefore, calculous cholecystitis is a display of cholelithiasis.
At the person at the same time the aggravations alternating with remissions periodically develop. Aggravations of a chronic form of an illness, as a rule, become result of an overeating of heavy food, an alcohol abuse, physical overstrain, overcooling, intestinal infections. At chronic cholecystitis the symptoms similar to symptoms of an acute form of an illness are shown. However their intensity is less expressed, a condition of the patient not so heavy.
Diagnosis of cholecystitis
Diagnosis of cholecystitis is carried out by the specialist, first of all, by means of poll of the patient and acquaintance to its case history. The analysis of the anamnesis and the clinical course of a disease gives necessary information for the subsequent researches. Further to the patient appoint a special method of research which is used at cholecystitis — duodenal sounding. This method is applied in the morning, it is important to conduct such research on an empty stomach.
Besides, to the patient with suspicion on cholecystitis if necessary the cholecystography, ultrasonic research is carried out. Also clinical, and also biochemical analysis of blood is carried out.
It is also important to conduct careful bacteriological research (for this purpose carry out bile crops). It is especially important to make it if at the patient acid-forming function of a stomach is reduced. In the course of diagnosis holetsistitasledut to define physical and chemical properties of bile.
It is important to differentiate a chronic form of a disease from a chronic cholangitis, cholelithiasis.
Complications of cholecystitis
As complications of this disease define some illnesses which proceed in parallel with cholecystitis, joining it. It is a chronic cholangitis, pancreatitis, hepatitis. Quite often cholecystitis is the initial reason of emergence of stones in a gall bladder.
Besides, at the patient the secondary inflammation of a pancreas can develop. In this case the person feels also pain in left hypochondrium. Such inflammation by carrying out ultrasonography is diagnosed.
At patients with calculous cholecystitis because of obstruction of the general bilious channel subhepatic jaundice with the subsequent cholestasia can be shown. Also complications of cholecystitis often are an edema and perforation of a gall bladder. The last the disease is very dangerous and hardly gives in to therapy.
Treatment of cholecystitis
If at the patient acute cholecystitis is shown, then in most cases he is hospitalized at once in a surgical hospital. Generally treatment of cholecystitis begins with use of conservative therapy. It is important that the patient constantly stayed in a condition of absolute rest. Initially to the patient forbid to eat food: its food is carried out by intravenous administration of nutritious mixes.
If the strong inflammation with the corresponding symptoms and jumps of body temperature takes place, then complex treatment of cholecystitis can include also reception of antibiotics of a broad spectrum of activity. It is especially important to appoint therapy antibiotics to patients of advanced age, and also people who are ill a diabetes mellitus.
At an aggravation stage treatment of cholecystitis first of all is directed to removal of severe pain, reduction of an inflammation, and also elimination of displays of the general intoxication. In the course of use of conservative treatment behind a condition of the patient careful supervision is conducted. And if improvement takes place, then the patient continues to be treated by means of conservative methods.
However in case of absence of effect of similar treatment the attending physician often makes the decision on an operative measure. If there is a suspicion on phlegmon of a gall bladder, gangrene, perforation, peritonitis, then operation is performed urgently.
If calculous cholecystitis is diagnosed for the person and, therefore, are present at a gall bladder a fireplace, then treatment of a disease makes more difficult task. Respectively, the forecast of a course of a disease worsens.
At a calculous form of cholecystitis very painful hepatic colic is quite often shown. This phenomenon to some extent reminds symptoms of acute cholecystitis, but the patient suffers from more megalgia. As a rule, such attacks begin at night or in the morning. A little later at the patient symptoms of jaundice are shown: the shade of skin, urine, mucous membranes changes. At the same time the kcal gains from the person light, sometimes white color. At similar symptoms hospitalization needs to be carried out immediately.
Treatment of chronic cholecystitis, first of all, is directed to stimulation of process of an otkhozhdeniye of bile, elimination of the spasmodic phenomena in zhelchevyvodyashchy ways and a gall bladder. Also the package of measures which are urged to destroy the inflammation activator is carried out. At calculous cholecystitis also smashing of stones by means of different methods is carried out. The subsequent measures of therapy are directed on and prevention of emergence of new stones.
Prevention of cholecystitis
As preventive measures which are applied for the purpose of the prevention of display of acute cholecystitis it is important to adhere to all hygienic actions of the general character. An important point in this case is following to norms of healthy nutrition: it is necessary to eat food at the same time, not less than four times a day, at the same time the caloric content of day volume of food should not be exceeded. It is impossible to accept a large number of food for the night, especially negatively such meals affect if alcohol intake in parallel takes place. An important preventive measure – the use of enough liquid every day. It is necessary to drink not less than one and a half-two liters of water or others drink, at the same time for day drink has to be distributed evenly.
One more important point – ensuring regular bowel emptying. This process needs to be controlled not to allow developing of dyskinesia of zhelchevyvodyashchy ways, and also cholesterol removal.
Specialists recommend perodichesk to carry out fasting days throughout which it is necessary to use one type of products (for example, milk, apples, cottage cheese, fruit, meat, etc.). Each person has to know what products cause in him allergic reaction, and to exclude them from a diet.
To stimulate a bile passage, it is important to do every day gymnastic exercises and to adhere to active lifestyle in general.
Besides, it is important to undertake all measures in time to cure the shown inflammations of abdominal organs.
Diet at cholecystitis
Both during treatment, and during the remission periods at a chronic form of a disease the special diet at cholecystitis is shown to the patient. Specially picked up food allowance at observance of such diet is directed to stimulation of biliation from a bubble and suspension of inflammatory process.
It is important that the diet at cholecystitis included exclusively digestible fats. In this case patients suit vegetable oils (oil from a sunflower, corn, olives), butter. Such fats activate process of biliation.
Besides, it is necessary to include a product in a diet, containing a large amount of salts of magnesium. These are fruit, vegetables, buckwheat. They not only accelerate biliation, but also kill pain and a spasm.
The diet at cholecystitis should not contain products which work annoyingly: these are meat and fish broths, sauces, smoked, fat products, too acid and hot dishes. It is impossible to take alcohol, very cold food and drinks. Fried dishes are excluded. It is important to adhere to a due diet, eating food five times a day.
The diet at cholecystitis includes soups, fast meat and fish, crackers from white bread, an omelet, boiled vegetables, grain, dairy products. Fruit juice is also included in a diet, and as sweets it is recommended to use kissels, gingerbreads, jelly, jam, honey.