Symptoms of cholecystitis

The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: " Why not self-medicate?". Cholecystitis is an inflammation of the walls of the gallbladder, which manifests itself in a variety of clinical signs and occurs for a number of reasons related to processes inside the body and under the influence of external factors.

The main manifestation of cholecystitis is a pain syndrome localized in the right hypochondrium, with possible pain radiating to the right collarbone and right arm. Also, the pain syndrome is often accompanied by a variety of symptoms of dyspepsia: nausea, vomiting, impaired stool and excessive gas formation. The disease is most often provoked by a violation of the diet, alcohol abuse and, in some cases, in stressful situations. The disease is diagnosed during a physical examination of the patient, as well as during laboratory and instrumental examination, which includes ultrasound examination of the hepatobiliary zone, duodenal sounding, cholecystocholangiography, general and biochemical blood tests. Treatment of cholecystitis consists in following dietary recommendations, prescribing antispasmodics, analgesics, choleretic drugs and physiotherapeutic procedures. If indicated, antibiotic therapy is carried out, and if necessary, emergency or planned cholecystectomy is resorted to.

Classification of cholecystitis

There are several forms of the disease, according to the combination of certain symptoms, signs and characteristics. The classification of cholecystitis allows you to effectively select a treatment method depending on the form and stage of the disease.

Calculous and acalculous

According to clinical forms, two types of cholecystitis are distinguished - calculous and non-calculous (calculous). In calculous cholecystitis, stones form in the cavity of the gallbladder. This type of disease affects 90% of all patients with cholecystitis. Calculous cholecystitis manifests itself as attacks of biliary colic, and can also be asymptomatic for a long period.

Non-calculous cholecystitis affects about 10% of all patients with this diagnosis. In the case of acalculous form, calculi are not formed and the disease proceeds favorably, rarely has exacerbations.

Chronic cholecystitis

The chronic form is the outcome of acute cholecystitis or occurs against the background of some disease of the hepato-pancreatic region. Manifestations of chronic cholecystitis are dull pain in the right hypochondrium, provoked mainly by an error in nutrition, as well as nausea, increased gas formation and stool disorders that occur with a violation of the outflow of bile due to cholecystitis.

In this case, the symptoms of chronic cholecystitis can be both typical and atypical, with or without cholelithiasis.

Acute form

The acute form of cholecystitis has severe symptoms and an active onset of the disease, while inflammatory and intoxication processes are always observed. According to the severity of morphological changes, several types of acute cholecystitis are distinguished:

  1. The catarrhal form is characterized by intense and constant pain in the right hypochondrium and epigastric region with irradiation to the lumbar region, right shoulder blade, shoulder girdle, the right half of the neck.
  2. The phlegmonous form differs in the severity of symptoms, compared with the catarrhal form. In this disease, pain increases with coughing, changing body position, breathing, nausea with vomiting is very likely, the patient's general condition is poor, there is an increase in body temperature and accompanying tachycardia. Phlegmonous cholecystitis is accompanied by bloating due to intestinal paresis, lagging of the right half of the peritoneum from the left during breathing, tension of the right hypochondrium during palpation, weakening of intestinal noises.
  3. The gangrenous form of acute cholecystitis proceeds very rapidly in its clinical signs, often occurs as a result of the progression of the inflamed phlegmonous form with a decrease in the body's defenses and high virulence of the microbial flora.

Causes of inflammation

In the development of cholecystitis, the leading role is played by a violation of the outflow of bile and infection of the gallbladder. At the same time, pathological microorganisms are able to penetrate into the organ by the hematogenous or lymphogenous route, heading from other existing infectious foci (for example, with otitis, periodontal disease, and others), as well as directly - contact from the intestine. In this case, a violation of bile dynamics occurs in the body for a number of reasons.

Development against the background of cholelithiasis

As a result of cholelithiasis, up to 90% of all diagnosed cholecystitis occurs. At the same time, the formed calculi in the gallbladder interfere with the process of bile flow, clogging the neck of the organ or the bile duct, causing injury to the mucous membrane, forming adhesions, ulcerations and provoking the development of the inflammatory process. Against the background of cholelithiasis, an acute form of cholecystitis occurs, most often of a phlegmonous type.

Microorganisms and worms

Cholecystitis can be caused by pathogenic microorganisms and worms. Enterococcus, streptococcus, staphylococcus, Escherichia coli are able to penetrate the gallbladder through the biliary tract. Also, similar processes can be caused by Giardia, roundworms (worms), dysenteric amoeba, cat fluke. In 60% of cases of detection of pathologies in patients, concomitant infections are also observed, which, with the blood and lymph flow, spread to a healthy organ, affecting its functionality.

Psychosomatics of the disease

Modern medicine copes well with the manifestations and causes of cholelithiasis, but very often after cholecystectomy, the symptoms return in many patients. This is due to the fact that the treatment often does not take into account the psychological basis of the disease. In 1928, the English psychiatrist E. Witkover, as a result of several studies, established the influence of the emotion factor on the functioning of the liver.

Biliary tract disease affects two main categories of patients. The first category are conflicting and evil people who are trying with all their might to prove their own innocence and provoke conflicts out of the blue. Such people always find a reason to create a conflict, are very touchy, do not know how to admit defeat and savor the details of quarrels for a long time.

The second category of persons prone to problems with the biliary tract includes those who are prone to self-sacrifice for the sake of others, do not know how to live for themselves, constantly serve everyone around them. Any mistake on their part is very much experienced by them, by and large, such people generally do not give themselves the right to make mistakes. Such patients constantly suppress the negative in themselves, which leads to the development of pathology. In addition to diseases of the biliary system, people of this type have depression, panic attacks, and anxiety.

If the patient has the first bells (symptoms) indicating biliary dyskinesia, this is a signal to analyze his own life. First of all, psychologists recommend to forgive everyone who has once offended, especially if such an offense was formed exclusively in the patient's head or has no serious grounds.

Next, you need to learn to control irritability and anger within yourself. Understanding that absolute rightness does not exist in nature will help to cope with this, and if someone ever tries to prove the opposite, this does not mean that this opponent ignores the patient's personality, maybe he just expresses his opinion.

Any conflicts should not be taken personally, they must be resolved peacefully, sometimes with the help of concessions.

For the second type of people suffering from problems with the gallbladder, it is important to learn to pay attention to their own needs and desires, to listen to themselves. The ideal would be to find a golden mean between one's own interests and the interests of those whom a person so strives to support and satisfy all his life. It is also important to learn to understand that all people around have the right to make mistakes, and you should not exclude yourself from this circle.

It is important to remember that cholelithiasis is a hereditary pathology, so changing one's own way of life will also contribute to a more comfortable and healthy existence for future generations.

Factors affecting the development of cholecystitis

tract, Mirizzi's syndrome. All of the above factors deform the gallbladder, compress the ducts, and contribute to the stasis of bile.

In addition to etiological factors, the occurrence of cholecystitis is also influenced by other factors that regulate the process of bile utilization and changes in its composition. These factors include dyscholia or a violation of the composition of gallbladder bile and its consistency, pregnancy, menopause. Enzymatic cholecystitis develops with the regular process of reflux of enzymes from the pancreas into the cavity of the gallbladder. Also, the disease occurs with malnutrition, alcoholism, smoking, physical inactivity, a sedentary lifestyle, disorders of the autonomic system, trauma to the gallbladder or liver, long-term diets, pathological heredity.

The main signs of the disease

The clinic of the disease is determined by the nature of the inflammatory process and the presence of calculi. In chronic cholecystitis, the course of the disease is undulating. With exacerbations of the acalculous and calculous forms, paroxysmal pain of varying intensity occurs in the region of the right hypochondrium. Such pain can radiate to the area of ​​​​the right shoulder, collarbone, scapula. At the same time, malnutrition, severe stress, and heavy physical exertion provoke pain. Pain in this case is often accompanied by vegetative-vascular pathologies - sweating, weakness, neurosis, insomnia. Nausea and vomiting with bile, bloating, and disturbed stools may also be present.

Patients often have fever, chills, bitterness in the mouth and may belch with bitterness.

In severe forms, the symptoms are aggravated by intoxication manifestations - hypotension, shortness of breath, tachycardia. In the case of calculous cholecystitis, due to the persistence of cholestasis, obstructive jaundice occurs, manifested by yellow staining of the skin, sclera, itching of the skin appears due to the accumulation of bile pigments in the blood. With the onset of remission, the symptoms begin to fade and disappear completely, but sometimes there is heaviness and discomfort in the right hypochondrium, nausea and upset stool. Cholecystocardial syndrome may also occur with pain in the sternum, heart rhythm disturbance, tachycardia.

In acute acalculous cholecystitis, which is observed infrequently in patients, sometimes there are pulling pains in the hypochondrium on the right side after an error in nutrition, or heavy intake of food and alcohol. Usually, with this form of cholecystitis, there are no pronounced digestive disorders. And with an exacerbation of calculous cholecystitis, cholestasis, itching of the skin, soreness, a bitter taste in the mouth, jaundice, digestive disorders and stool disorders develop. Bile colic can also occur, which can only be stopped with antispasmodics.

Acute inflammation in the gallbladder should be treated only in a hospital, as there is a high risk of spreading the infection to other organs and aggravating the course of the disease. The general symptoms of cholecystitis can pester the patient for many years.

The course of cholecystitis

The clinical picture of acute cholecystitis is diverse, depending on the form of inflammation of the gallbladder, complications and the presence of concomitant changes in the bile ducts. Usually acute cholecystitis begins suddenly. The first symptom is pronounced paroxysmal pain in the right hypochondrium, radiating to the back, scapula and supraclavicular region. When involved in the process of secondary pancreatitis, pain extends to the region of the left hypochondrium.

In the elderly, in the presence of coronary heart disease with cholecystitis, pain can occur both behind the sternum and to the left of it, provoking reflex angina in the body. Symptoms in this case are nausea and vomiting of food consumed, and later - bile, which does not bring relief to the patient. Possible increase in body temperature. On palpation of the abdomen, one can detect pain in the right hypochondrium, under the pit of the stomach, tension in the muscles of the abdominal wall. The gallbladder can be palpated in destructive forms of acute cholecystitis, when it increases in size and becomes dense. But with significant muscle tension, it is not always possible to palpate it. Against the background of the unfolding inflammatory process, the pulse quickens and pressure changes. Most patients with cholecystitis show a gradual yellowing of the skin and sclera 3 days after the onset of the disease, due to obstructive jaundice in calculous cholecystitis.

Acute cholecystitis occurs more often in middle-aged patients and is provoked by cholelithiasis, although it is not uncommon for the disease to develop in the absence of stones, but in violation of the blood supply to the gallbladder, bile stasis or bacterial colonization.

Features of the course in women

Female cholecystitis is a more common version of this pathology that occurs in middle age. Symptoms of female cholecystitis are familiar to doctors 8 times better than male ones. At the same time, women often develop cholangitis, that is, inflammation of the bile ducts.

Signs of the disease in women are not much different from those in men. Others are the causes of the disease in the beautiful half of humanity. The main reasons for a woman's predisposition to pathology are:

  1. Pregnancy, during which the gallbladder can be strongly compressed, which leads to a violation of the content of acids in it and stagnation of bile. This provokes the appearance of standard symptoms of the disease, upon detection of which you should immediately seek medical help.
  2. Hormonal surges in which the production of progesterone is activated. This hormone in the female body is produced in excess during menopause and pregnancy, as well as in some other diseases. It leads to malfunction of the gallbladder.
  3. Diets and other dietary restrictions contribute to disorders in the contraction of the gallbladder, which provokes the occurrence of cholecystitis.

Also at risk may be those women who have a history of liver or intestinal infections, patients diagnosed with parasites, patients with gallstone disease.

Diagnosis of the disease

Diagnosis of classical forms of cholecystitis usually does not cause difficulties, with timely access to a specialist. Difficulties may arise in an atypical course, when clinical symptoms do not reflect morphological changes in the gallbladder. Thus, if there is pain or discomfort in the abdomen, the patient must visit a gastroenterologist, who, based on complaints, physically examines the patient and makes a preliminary diagnosis. To clarify this diagnosis, the patient is recommended an additional laboratory and instrumental examination, the results of which will establish the final diagnosis.

Instrumental diagnosis of cholecystitis

Most often, due to the speed, simplicity, non-invasiveness, absence of radiation exposure and low cost, ultrasound is considered the first stage of instrumental diagnosis. On ultrasound, you can establish the shape and size of the gallbladder, the thickness of its walls, the presence of contractile function and calculi, sclerosis of the walls of the bladder.

Computed tomography has an advantage over ultrasound in that it allows examination of the entire chest and abdomen. The disadvantage is the need for transportation to the scanner, radiation exposure and high cost. As an additional examination, fibrogastroduodenoscopy is used to exclude peptic ulcer, as a possible source of pain, as well as ECG, to diagnose retrosternal localization of pain, which is possible with cholecystitis.

Laboratory diagnosis of cholecystitis

Carrying out general and biochemical blood tests in case of suspected cholecystitis helps to detect an increase in the neutrophil level of leukocytes in the blood, an acceleration of ESR, which will indicate the presence of an infectious process. Also, these tests will help to establish an increase in bilirubin in the blood, cholesterol, AST, ALT and produced liver enzymes, which is evidence of inflammation of the gallbladder, blockage of the bile ducts.

Urinalysis in case of suspected pathology is performed to determine the activity of amylase, to diagnose secondary pancreatitis.

The results of the laboratory examination should only be interpreted in conjunction with clinical and instrumental data.

Treatment of the disease: methods of traditional medicine

Medical products (preparations, medicines, vitamins, medicines) are mentioned for informational purposes only. We do not recommend using them without a doctor's prescription. Recommended reading: " Why can't you take medications without a doctor's prescription?". The mainstay of treatment for acute and chronic non-calculous cholecystitis is drug therapy and appropriate diet. If the chronic form has frequent relapses or there is a threat of complications of such a disease, surgical treatment is performed - cholecystectomy.

As a dietary food, the therapeutic diet No. 5 according to Pevsner is recommended, the essence of which is frequent fractional meals in small portions at any stage of the disease. At the same time, it is necessary to consume certain foods in boiled, baked or stewed form 5-6 times a day. Between each meal should not pass more than 4 hours, and from the diet it is absolutely worth removing alcohol, mushrooms and legumes, mayonnaise, fatty meat, cakes and other products that are aggressive for the gallbladder and require its active function.

Drug treatment consists in prescribing antispasmodic and analgesic drugs to the patient in the acute form of cholecystitis and exacerbation of chronic cholecystitis. With severe inflammation, diagnosed by ultrasound, antibiotic therapy is prescribed. During the period of remission of chronic cholecystitis, choleretic agents are prescribed - choleretics and cholekinetics, which are responsible for the processes of formation and outflow of bile in the body.

Physiotherapeutic techniques for cholecystitis can be used throughout the treatment to relieve pain, reduce inflammation, and restore the tone of the gallbladder.

The most effective methods of physiotherapy for cholecystitis are electrophoresis, UHF and inductothermia.

Surgical techniques are used in case of complications of cholecystitis and in the absence of effectiveness from drug treatment. Surgery is also indicated for the calculous form of cholecystitis. The most common when removing the gallbladder are abdominal and laparoscopic cholecystectomy. In complicated forms of the disease, an abdominal operation is performed, which allows for a complete revision of the inflammation zone and the condition of neighboring organs. Laparoscopy as a modern low-traumatic surgical method is used to reduce the risk of postoperative complications and shorten the rehabilitation period after removal.

How to protect the gallbladder from inflammation

For the prevention of cholecystitis at any age, it is important to maintain a proper diet. You should also avoid factors that will contribute to the occurrence of an inflammatory process in the gallbladder. These factors include obesity, physical inactivity, intestinal infections, stress.

To maintain the body in a healthy state and control the functionality of the biliary system, it is necessary to adhere to a healthy diet, avoid overeating, rapid weight loss, move a lot (and regularly, which is important), and avoid stressful situations.

Power Features

The text is for reference only. We urge you not to use diets, do not resort to any medical menus and fasting without medical supervision. Recommended reading: " Why you can't go on a diet on your own". The main goal of the diet in this disease is to limit the load on the organs of bile secretion, improve the process of bile production, and normalize the work of all organs of the gastrointestinal tract.

The nutritional features of cholecystitis include the requirement for frequent (at least 5 times a day) meals, and at a strictly set time.

The fragmentation of nutrition and its structured time will have a beneficial effect on the production of bile in the gallbladder. It is also necessary to build your diet in such a way that the daily calorie content of food is within 2100-2500 kilocalories, which would be distributed in the required proportions to all the substances necessary for human life - proteins, carbohydrates, fats, vitamins and trace elements.

When eating food, it is important to observe its temperature, which should not be too high or low. The fact is that the thermal regime of food is very important for the normal functioning of the entire gastrointestinal tract, so it is worth eating only food that is comfortable in temperature. At the same time, it is necessary to drink enough pure water throughout the day, since it activates choleretic processes and stabilizes renal function. The most optimal dosage is the use of 2.5 liters of water per day.

In addition to the above restrictions, it is worth mentioning the excess salt content in cooked food and prepared foods. With cholecystitis, it contributes to the thickening of bile, which prevents its outflow from the gallbladder, provoking bouts of biliary colic and increasing the risk of stone formation, so salt restriction in the diet should be observed. Very bad can affect the development of cholecystitis and alcohol. It contributes to the formation of calculi and, as a result, the occurrence of complications in cholelithiasis.

Complications and consequences of the disease

Cholecystitis has many complications and consequences if the disease is not treated in time. With prolonged cholecystitis, perforation of the gallbladder may occur, resulting in biliary peritonitis, a dangerous, life-threatening condition that requires immediate surgical intervention. Also, as a result of the above processes, an abscess may occur, which differs from biliary peritonitis in that bile does not enter the abdominal cavity, but into a cavity that is limited by existing adhesions.

Also, a dangerous consequence of cholecystitis can be the spread of the inflammatory process to the surrounding tissue and organs, which leads to pericholecystitis. This pathology is dangerous with emerging fistulas, for example, vesico-intestinal. The development of malignant neoplasms is also possible.

In the absence of appropriate therapy for cholecystitis, hydrops of the gallbladder, ascending cholangitis, subdiaphragmatic or hepatic abscess can occur, and after the age of forty, heart attacks, angina pectoris and other pathologies of the cardiovascular system can be observed as consequences of cholecystitis. That is why, when diagnosing cholecystitis in an acute form, treatment is recommended to be carried out in a hospital, and if any of the above complication threatens, doctors talk about emergency surgery.

All of these consequences can also occur in the chronic course of the disease. If the patient's condition is not constantly monitored, then even with remission, relapses and parallel pathological processes are possible. All therapy, which is usually prescribed for chronic forms of cholecystitis, is suitable for use only outside of exacerbations, but if the disease progresses, it is important to consult a doctor in a timely manner for a new treatment regimen.

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