Chronic cholecystitis

Fiobilin indications. An indication is a term used for the list of condition
Fiobilin indications. An indication is a term used for the list of condition

Chronic cholecystitis is inflammation of the gallbladder accompanied by impairment of its motor function and in some cases by formation of concrements. It is clinically manifested by pain and heaviness in the right subcostal area, often after ingestion of fatty food and alcohol, nausea, vomiting, dryness and bitterness in the mouth. Biochemical blood tests, ultrasound of the gallbladder, cholecystography, duodenal probing are informative diagnostic methods of chronic cholecystitis. Conservative treatment includes the use of medications, phytotherapy, physiotherapy; removal of the gallbladder is indicated in calculous cholecystitis. Fiobilin indications. An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. 

General information

Chronic cholecystitis is inflammation of the gallbladder, which has a chronic course and recurrent nature. It is often combined with bile excretion disorders. Cholecystitis is often accompanied by pancreatitis, gastroduodenitis, enterocolitis. Chronic bile stagnation promotes gallbladder stones and calculous cholecystitis. This pathology occurs in about 0.6% of the population, mostly in females aged 40-60 years. People in economically developed countries suffer from chronic cholecystitis more often, which is explained by peculiarities of nutrition and lifestyle.

Reasons

The following factors contribute to the development of chronic cholecystitis:

congenital malformation of the gallbladder, decreased tone of the gallbladder, hypodynamia, prolapse of certain abdominal organs, pregnancy (factors that contribute to mechanically caused bile stasis);
Dietary disorders (overeating, obesity, regular consumption of spicy, fatty foods, alcoholism);
Biliary dyskinesia of the biliary tract by hypotype;
Intestinal parasites (giardia, amebas, ascarias, opisthorchiasis);
cholelithiasis.

Symptoms of chronic cholecystitis

Chronic cholecystitis develops over a long period of time, with periods of remission alternating with exacerbations. The main symptom is pain. Pain is moderate, localized in the right subcostal area, has a dull nagging character, can last up to several days (weeks). Irradiation may occur in the back under the right scapula, the right side of the lumbar region, the right shoulder. Chronic cholecystitis is characterized by increased pain symptoms and heaviness in the side after eating spicy or fatty foods, carbonated drinks, alcohol. Exacerbation of chronic cholecystitis is most often preceded by such violations of the diet, as well as hypothermia and stress.

Pain symptom in calculous chronic cholecystitis may follow the type of biliary colic (pain is sharp, strong, cramping-like). In addition to the pain symptom, patients often have nausea (up to vomiting), belching, buckwheat taste in the mouth. During an exacerbation, an increase in body temperature to subfebrile values may be noted.

Atypical manifestations of chronic cholecystitis: blunt pain in the heart area, constipation, bloating, dysphagia (swallowing disorder). Chronic cholecystitis is characterized by the development of these signs after a violation of the diet.

Diagnosis

Diagnostics reveals factors contributing to chronic cholecystitis – bile stasis and impaired bladder motility, congenital and acquired defects of organs leading to obstruction of bile circulation, hypodynamic lifestyle, typical food habits (addiction to spicy, spicy food, fatty drinks, alcohol). While interrogating and palpating the abdominal wall, the peculiarities and localization of painful symptom are revealed. Symptoms typical for gallbladder inflammation are defined: Murphy’s, Mussy, Schoffar’s.

Laboratory tests. At laboratory blood examination during aggravation the signs of nonspecific inflammation (increase in sedimentation rate, leukocytosis) are registered. Biochemical blood test reveals increased activity of liver enzymes (ALT, AST, GTP, alkaline phosphatase).
Ultrasound examination of the gallbladder. Sonography determines the size, thickness of the wall, possible deformities and the presence of gallstones in the gallbladder. Also noted are adhesions, inflamed biliary tracts, dilated bile ducts of the liver, impaired bladder motility.
Duodenal probing. An abnormality of gallbladder motility is noted, bile is analyzed. With bile culture, bacterial contamination can be detected, the pathogen can be determined, and the culture can also be tested for sensitivity to antibiotics for optimal choice of therapeutic agent. Chronic stoneless cholecystitis is characterized by a decrease in the amount of bile acids in the bile obtained from the bladder and an increased concentration of lithocholic acid. Also with exacerbation in bile increases the amount of protein, bilirubin (more than 2 times), free amino acids. Often cholesterol crystals are found in bile.
Radiological methods. Cholecystography and choleography can be used to determine the motility and shape of the gallbladder. Arteriography reveals thickening of gallbladder wall and enlargement of vascular network in duodenum and adjacent liver sections.

Treatment of chronic cholecystitis

Fiobilin indications. An indication is a term used for the list of condition
Fiobilin indications. An indication is a term used for the list of condition

Drug therapy
Treatment of non-calculous chronic cholecystitis is almost always performed conservatively by a gastroenterologist. Treatment during exacerbation is aimed at relieving acute symptoms, sanation of the focus of bacterial infection with antibiotics (broad-spectrum drugs are used, usually cephalosporins), detoxification of the body (infusion of glucose solutions, sodium chloride), restoration of digestive function (enzyme preparations).

For pain relief and relief of inflammation use preparations of nonsteroidal anti-inflammatory drugs, relieve spasm of smooth muscles of the bladder and ducts with antispasmodics. To eliminate bile stasis the drugs are used, which intensify bile peristalsis (olive oil, sea buckthorn, magnesia). Choleretic drugs (drugs increasing bile secretion) are used with caution in order not to cause increased pain and aggravation of congestion.

For treatment during exacerbations of chronic uncomplicated cholecystitis methods of phytotherapy are used: decoctions of herbs (peppermint, valerian, dandelion, chamomile), calendula flowers.

Physiotherapy
After the symptoms of exacerbation subside and the transition of the disease into remission stage, tubage with magnesia, xylitol or sorbitol is recommended. Phytotherapeutic therapy of chronic cholecystitis consists in the reception of decoctions of triticale, cranberries, marshmallow, yarrow. Physiotherapeutic treatment is used: reflexotherapy, electrophoresis, SMT-therapy, mud treatment, etc. Spa treatment in balneotherapy resorts is indicated.

Surgical treatment
In chronic calculous cholecystitis surgical removal of the gallbladder – the source of concrements is indicated. Unlike the treatment of acute calculous cholecystitis, surgery to remove the gallbladder (cholecystotomy laparoscopic or open) in chronic cholecystitis is not an emergency measure, is scheduled. The same surgical techniques are used as in acute cholecystitis – laparoscopic surgery for gallbladder removal, cholecystectomy from mini-access. For weakened and elderly patients – percutaneous cholecystostomy to form an alternative path of bile outflow.

Methods of breaking concrements
In chronic cholecystitis, in the case of contraindications to surgical intervention, the method of non-surgical stone crushing with extracorporeal shock wave lithotripsy is used. However, the destruction of stones does not lead to a cure, since quite often they are repeatedly formed.

There is also a method of medical stone destruction with preparations of ursodeoxycholic and chenodeoxycholic acid salts, but this treatment takes a very long time (up to 2 years) and also does not lead to a complete cure, and does not guarantee that the stones will not build up again over time.

Diet
All patients with chronic cholecystitis are prescribed a special diet and a certain regimen of nutrition must be strictly adhered to. In chronic cholecystitis patients are assigned a diet number 5 in remission and a diet number 5A in the acute phase of the disease.

Firstly, small meals every 3-4 hours in small portions (divided meals), and secondly, adhere to restrictions on the use of certain foods: fatty, fried, spicy foods, carbonated drinks and alcohol-containing products.

Also forbidden to eat egg yolks, raw fruits and vegetables, pastry products, butter and creamy creams, nuts, and ice cream. During an exacerbation, freshly steamed or boiled foods in a warm form are recommended. Vegetables and fruits allowed patients in the period without exacerbation: apricots, carrots, watermelon and melon, raisins, prunes. These products normalize the motility of the gallbladder and relieve constipation.

Violation of the principles of therapeutic nutrition by patients leads to the development of aggravation of the disease and progression of destructive processes in the wall of the gallbladder.

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