Calculous cholecystitis is an inflammation of the gallbladder associated with the deposition of stones formed from cholesterol, bile dyes and calcium impurities. These deposits are localized in the biliary lumen and ducts.
Problems with the flow of bile cause deterioration of blood circulation in the walls of the gallbladder, resulting in the release of numerous substances that cause inflammation. Over time, this process is joined by the reproduction of bacteria.
The course of calculous cholecystitis is chronic with a periodic transition to an acute condition (in which biliary colic and jaundice can be observed). In contrast, non-calculous cholecystitis is not associated with the deposition of stones, and can be either acute or chronic.
Since the middle of the 20th century, the number of patients with HCH doubles every 10 years and makes up about 10% of the population of most developed countries: in our country, about 15 million people suffer from HCX; in the USA - over 30 million people.
Among patients older than 45 years, one third of the patients has cholelithiasis. As a result, the number of operations for HKH in the United States in the 70s was more than 250 thousand annually, in the 80s - more than 400 thousand, and in the 90s - up to 500 thousand.
Now in the US, the number of cholecystectomies and operations on the biliary tract is about 1.5 million per year and exceeds the number of all other abdominal interventions (including appendectomy).
Why does calculous cholecystitis appear, and what is it? The main cause of calculous inflammation of the gallbladder is the presence of calculus in its lumen. They are formed due to qualitative changes in the balance of bile: cholesterol crystallizes, general secretion stagnates with the addition of an inflammatory component. In the first place, a violation of the outflow of bile, that is, its stagnation, leads to the formation of the stones themselves.
Certain conditions contribute to the formation of stones:
- excessive consumption of fatty and carbohydrate foods;
- long breaks in the diet, starvation diets with a lack of vitamins;
- injuries and consequences of surgeries on the abdominal organs;
- violation of motor mode;
- acute viral hepatitis;
- genetic predisposition;
- endocrine disorders (diabetes, menopause, obesity, long-term use of contraceptives, treatment with hormonal drugs).
Also among the factors predisposing to the development of calculous cholecystitis are biliary dyskinesia, chronic gastritis, duodenitis, pancreatitis, liver cirrhosis, Crohn's disease, and helminthiasis.
Symptoms of calculous cholecystitis
Calculous cholecystitis has two forms - chronic and acute. The history of the disease with acute manifestation of calculous cholecystitis begins to develop with the following symptoms:
- most often, there is a so-called biliary colic. Severe pain, which begins on the right under the ribs, is transmitted to the right shoulder or arm;
- nausea, vomiting of bile;
- body temperature rises;
- you feel weak in your body;
- a cold sweat comes on;
- jaundice is possible;
- there is a sharp drop in blood pressure.
In chronic calculous cholecystitis, symptoms that are not in the acute stage are more mild. Patients may complain of:
- characteristic dull, nagging pain in the right hypochondrium of a constant nature or occurring 1-3 h after ingestion of plentiful and especially fatty and fried food.
- pain radiating up to the region of the right shoulder and neck, right scapula. Periodically there may be a sharp pain, resembling biliary colic. However, sometimes even pronounced inflammatory changes in the gallbladder may not be accompanied by symptoms of biliary colic.
- usually chronic calculous cholecystitis is not accompanied by fever.
- such phenomena as: nausea, irritability, sleeplessness are frequent.
- jaundice is not characteristic.
The period of exacerbation is complicated by additional symptoms:
- acute cutting pain in the liver, can give to the scapula, sternum, middle epigastric region, right shoulder;
- severe nausea and vomiting;
- a slight increase in body temperature;
- abdominal distension and tension;
- spasms of the peritoneal muscles;
- problems with stools, often constipation.
In accordance with ultrasound signs, 4 stages of calculous cholecystitis are distinguished:
- the initial or pre-stone stage is characterized by the presence of biliary stasis, thick bile and microliths in the gallbladder. In half of the cases, the pre-stone stage is reversible.
- concretion stage
- stage of chronic calculous cholecystitis
- stage of calculous cholecystitis complications
As can be seen, depending on the symptoms of calculous cholecystitis, the methods of treatment of the disease will differ significantly.
The diagnosis of calculous cholecystitis is made based on the symptoms mentioned in the patient and on clinical studies. For this purpose, complete blood count and urine. Ultrasound, CT (computed tomography) and x-rays (cholecystography). A study of the level of pancreatic enzymes and liver samples is carried out, an analysis of feces is done. In some cases, duodenal intubation may be indicated with sampling of bile.
Also, calculous cholecystitis should be differentiated from the following pathologies:
- biliary dyskinesia;
- stoneless cholecystitis;
- cholesterosis gallbladder;
- right renal colic;
- chronic hepatitis;
- gastroesophageal reflux;
- chronic pancreatitis;
- chronic gastritis;
- chronic colitis;
- irritable bowel syndrome;
- stomach ulcer and 12p. guts.
Treatment of chronic forms usually takes place at home, during exacerbations the patient is hospitalized or, depending on the condition, treated in the day hospital.
Among the complications of calculous cholecystitis, the most significant are:
- choledocholithiasis (congestion of the common bile duct);
- subphrenic abscess;
- empyema and perforation of the gallbladder;
- stenosis of the Vater papilla;
- acute or chronic pancreatitis;
- reactive cholangitis, hepatitis;
Only timely and competent treatment of the disease will help to avoid the unpleasant effects of cholelithiasis cholecystitis.
Treatment of calculous cholecystitis
Therapy depends on the form of the disease. Treatment of acute calculous cholecystitis is carried out in a hospital. Self-treatment at home is prohibited. As a rule, antispasmodic, antibacterial, detoxification therapy, anticholinergic, antiemetic agents are prescribed. After stabilization of the condition, surgical treatment is carried out in a planned manner.
If all the treatment undertaken is useless, then decide on the operation. During surgical treatment, both the organ itself with stones, and only stones can be removed. The choice of the type of operation depends on the state of the organ, the size and number of gallstones.
As for chronic calculous cholecystitis, the basis of treatment is strict adherence to the diet during periods of attack and interstitial periods, exclusion of foods rich in carbohydrates and fats, reduction to a minimum of salt and spices, and complete abandonment of alcohol.
After the exacerbation of the exacerbation, litholytic therapy is prescribed - the use of medications that dissolve gallstones - ursosan, henofalk, lithophalk. These drugs allow the treatment of calculous cholecystitis without surgery at home. Also, if necessary, prescribe antispasmodic drugs.
There are several types of surgery for the treatment of calculous cholecystitis:
- Laparoscopy. Several cuts are made on the abdomen, through which special tools and an optical device, the laparoscope, are inserted, which transmits an image to the monitor. Extensive opening of the peritoneum is not required, so the period of postoperative recovery is reduced and the appearance of the operated person does not suffer.
- Percutaneous cholecystostomy. A drainage tube is inserted into the gallbladder through a small incision in the abdomen. Used for the course of elderly and severe patients who have complications of acute cholecystitis.
If minimally invasive intervention is impossible, they resort to performing open cholecystectomy or cholecystectomy from mini-access. Open cholecystectomy is usually indicated for complicated forms of calculous cholecystitis. In some cases, in weakened or elderly patients with complications, a cholecystotomy or percutaneous cholecystostomy is performed.
With calculous cholecystitis, the prognosis for life is conditionally favorable, with adequate therapy, the ability to work will be fully preserved. Complications associated with the development of peritonitis due to gallbladder rupture are the most dangerous. In this case, even with adequate treatment, death is possible.