Calculous cholecystitis - what is it? Symptoms, causes, treatment of calculous cholecystitis

Calculous cholecystitis is a form of a chronic process in which various stones (stones) are present in the gallbladder. Their number and size can vary. Sometimes this is one large enough stone, the diameter of which can reach 5-6 cm or more, and maybe a lot of very small stones with a diameter that is a fraction of a millimeter, in other words, sand. Calculous cholecystitis - what is it? This will be discussed in this article.

According to statistics, 10% of the adult population suffers from CSF. Chronic calculous cholecystitis of women worries five times more often than men. The age category of patients is from 40 years and older. Children and young people under the age of 30 this disease worries very rarely.

Gallstones. What is the danger?

It is the size of the gallstones and determines the symptoms, severity of the course, the clinic of the disease and possible complications of cholelithiasis (SCI). Chronic calculous cholecystitis is dangerous for its complications.

In most cases (75%), concrements are located in the body of the gallbladder, but sometimes small stones can get into the bile duct, thereby making it difficult or completely blocking it and causing bile colic attacks.

If concrements up to 3 mm in size can exit independently through the ducts, stones 3 to 7 mm in size may exit from the gallbladder to cover the bile duct, and this complication will require urgent surgical care.

The composition of gallstones also varies. They may be:

• Cholesterol - stones of this kind are not visible in radiography;
• Calcareous;
• Pigmented;
• Mixed.

Most often there are mixed types of gallstones, their shape is very diverse (rounded, polyhedral or even branched).

Causes of the problem

Calculous cholecystitis (SCI) is not formed immediately. Consider the factors that contribute to the formation of concrements in the gallbladder:

• Cholestasis, or stasis of bile, for example, can be with bends of the body of the gallbladder;
• Discholia, or altered bile composition, its thickening due to increased cholesterol content or impaired secretion;
• Cholecystitis, or inflammatory phenomena in the gallbladder.

In addition, it can provoke a calculous cholecystitis diet, more precisely, systematic disorders in nutrition (too high in calories, fatty and cholesterol-rich food, lack of vitamins in the diet). Systematic starvation and low-calorie diets, and even long-term use of contraceptive hormonal medications can also lead to SCI.

Among the diseases that often become the impetus for the formation of gallstones, it is known:

• Obesity and metabolic disorders;
• Endocrine diseases, for example, diabetes mellitus;
• Liver disease, for example, hepatitis and cirrhosis;
• biliary dyskinesia;
• Pancreatitis;
• duodenitis;
• Crohn's disease;
• Chronic gastritis;
• Helminthiases.

Pathogenesis of gallstones formation

The composition of bile includes acids, lipids, pigments and minerals. Normally, all these components are in a colloidal (dispersed) state. With the adverse factors listed above, the level of the cholesterol coefficient of bile is violated, i.e. the ratio of the concentration of its acids to the content of cholesterol. This contributes to the precipitation of cholesterol with subsequent crystallization. Thus, concrements in the gallbladder are formed.

Classification

Calculous cholecystitis - what is it? The clinical course of CLD can be acute or chronic. Depending on the symptomatology there is a typical, esophagal, cardiac, intestinal and atypical calculous cholecystitis. Symptoms and treatment may differ depending on the variant of the disease course.

There are four stages of CSF in accordance with ultrasound examination:

1. Pre-stone, or initial - its characteristic features are the presence of thick bile, biliary stasis and the formation of microliths (sand) in the gallbladder. This stage of the disease, with the right choice of treatment and normalization of nutrition in most cases, is reversible.
2. Formation of concrements - with ultrasound examination one or more small stones are detected.
3. Chronic calculous cholecystitis - this stage of the disease involves the presence of concrements of various sizes in the gallbladder. This can be as one large stone, and the formation of a small diameter or a few small ones.
4. Complicated calculous cholecystitis - this stage of the disease is characterized by the development of various complications, for example, obturation of the bile ducts.

Diagnostics

Ultrasound is the main method of diagnostic examination for diagnosing "calculous cholecystitis." What is it, the view has already formed. Using ultrasound, a specialist will determine the number and size of concrements in the gallbladder, and their location, as well as the condition of the walls of the bladder.

The instrumental methods of examination for calculous cholecystitis also include endoscopic retrograde cholangiopancreatography (ERCPG). This method allows you to examine the state of the biliary tract and determine the degree of obstruction, which will help the specialist choose the appropriate tactics of the operation. The method is reduced to radiocontrast filling of the bile ducts during the exercise of the GVD, after which an X-ray examination is performed.

In addition to these instrumental methods of examination, laboratory tests are used, such as general analysis and a biochemical blood test. With the help of the first in this disease, you can see increased ESR in the presence of an inflammatory process in the gallbladder, as well as an increase in neutrophils in the leukocyte analysis formula.

Biochemical blood test for this disease is reduced to determining the level of the following:

• ALT and AST;
• Bilirubin;
• Alkaline phosphatase;
• Total protein;
• CRP.

These indicators will be increased in case of stagnation of bile (cholestasis). Such a development of the disease is possible with obstruction by the concretion of any of the bile ducts.

There are other additional methods for diagnosing a disease such as calculous cholecystitis. Symptoms and treatment will depend on the condition of the biliary tract and the general condition of the liver as a whole. Such diagnostic methods include:

• Intravenous choleography;
• Oral cholecystography;
• Hepatobiliary scintigraphy.

Calculous cholecystitis. Symptoms and treatment. general information

In some cases, the patient does not suspect that he has calculous cholecystitis. What is it, he learns only after the onset of biliary colic. It is characterized by a sharp pain in the hypochondrium on the right, which can give in epigastrium, lower back, shoulder blade or neck.

Such seizures often occur after feasts and feasts, when the unsuspecting person of his illness allows himself to take alcohol and have a good meal with fatty, spicy, smoked or salty foods. Provoke such attacks can and physical exertion or strong emotions. After the patient is taken to a medical institution and examined, he learns about the diagnosis of "calculous cholecystitis." Exacerbation may be accompanied by nausea and vomiting.

To operate or not?

With the diagnosis of "calculous cholecystitis," the symptoms and treatment, depending on the stage of development of the disease and the state of the biliary tract, can vary. If reversible processes are still possible in the pre-stone or initial stage, then in all the others, when the formation of stones has already begun, the most correct decision will be in the diagnosis of "calculous cholecystitis" operation. And the faster the operation is performed, the less likely the occurrence of complications.

Preparation for the operation consists in taking antibiotics and rehydrating the body as needed. The fight against dehydration necessarily takes place if the patient at the time of the attack had repeated vomiting. These measures will help to significantly reduce the risk of sepsis development.

With the diagnosis of "chronic calculous cholecystitis," the operation is most often performed using a laparoscope. This modern method can reduce pain in the rehabilitation period and shorten the recovery time, as well as reduce the risk of postoperative complications.

Pain removal

Attacks of cholelithiasis can differ in the nature of the pain and its intensity. In severe cases, nausea and vomiting are possible, and if the stone completely blocks the common bile duct, the color of the stool may become light, There will be no bile pigment. With such severe attacks, you must urgently go to a medical institution or call an ambulance.

If the disease manifests itself exclusively painful attacks, you can try to remove the pain yourself. To do this, take a couple of tablets of the drug "No-shpa" or "Papaverin" and put the cold on the right hypochondrium. The meal should be stopped for at least 12 hours. If this does not work, you should seek medical help.

Calculous cholecystitis. Treatment without surgery

Without surgical intervention, this disease can be treated, but each of these methods has its contraindications and complications, and also does not guarantee that the recurrence of the disease will not occur. We list these methods:

• Treatment with acid-containing drugs;
• Contact destruction of gallbladder concretions;
• Extracorporeal shock wave lithotripsy.

Now let's talk specifically about each of them.

Acid-containing preparations

Currently, with the diagnosis of chronic calculous cholecystitis, treatment is possible without surgery, but this method is too expensive and there is no guarantee that there will not be a relapse. The course of therapy is long - at least 24 months. There are also necessary conditions related to the size of the stones, their composition, the state of the gallbladder and its ducts:

1. The size of the stones should not be more than 1.5 cm in diameter.
2. The composition of the stones is exclusively cholesteric.
3. The gallbladder and its ducts should function normally and be in good condition.

With the diagnosis of "calculous cholecystitis," treatment without surgery is carried out with drugs "Henofalk" and "Ursofalk" - it is chenodeoxycholic and urodeoxycholic acid, respectively.

The essence of the treatment is reduced to the fact that these acid-containing drugs accumulate in the bile and gradually dissolve the cholesterol stones. But there is no guarantee that the disease will never return. Relapses are possible.

Contact destruction of gallstones concretions

This method of treatment involves not one but several procedures. They are conducted as follows. During the ultrasound, the doctor pierces the anterior abdominal wall with a long needle in the area of the gallbladder projection, and the catheter introduces itself into the bladder itself, through which special preparations are received that can dissolve the gallstones. These procedures are carried out several times. It should be borne in mind that they are not suitable for everyone. There are certain limitations, the same as in the method described above. In addition, there may be complications, for example, inflammation of the intestinal mucosa.

Extracorporeal shock wave lithotripsy

In this procedure, a sensor is placed on the patient's skin in the area of the gallbladder projection on the anterior abdominal wall, shock waves will emerge from it and act on the gallstones. To perform this procedure, the following conditions are necessary:

• In the gallbladder, there should be no inflammatory processes;
• The size of the stones is not more than 3.5 cm;
• The gallbladder and ducts should work well.

This method is not completely safe. The following complications are possible:

• Stone closure of the ducts of the gallbladder;
• Obstructive jaundice;
• Development of acute pancreatitis or diabetes.

Until now, the cholecystectomy has remained the safest method of treating calculous cholecystitis with regard to complications, ie, cholecystectomy, ie, cholecystectomy. Removal of the gallbladder.

Possible complications

Calculous cholecystitis must be treated, because it is dangerous for its complications. We list the most common of them:

1. Acute pancreatitis.
2. Empyema of the gallbladder (inflammation with subsequent filling of the blister with purulent contents).
3. Destructive cholecystitis.
4. Cholangitis (inflammatory process in the bile ducts).
5. Secondary biliary cirrhosis of the liver.
6. Formation of fistulas between the bile ducts and the bladder.
7. Intestinal obstruction.
8. Oncology of the gallbladder.
9. Choledocholithiasis (concrements in the bile ducts).

Diet

Ideally, you need to eat right and before the patient is diagnosed with chronic calculous cholecystitis. Diet, properly selected, can serve as a preventive of the disease in question. We denote its main goals:

1. Reducing the lipid content of the blood. This mainly applies to cholesterol and its fractions.
2. Ensure the normal functioning of the gallbladder and prevent stagnant phenomena in it.
3. Gradually strive to reduce weight, if necessary. Losing weight should be smooth, in a month you can lose no more than 2-3 kg.
4. Drink plenty of fluids, up to 2 liters per day.
5. To consume enough vitamins and microelements with food, the diet should contain vegetables, fruits and lots of greens.
6. To ensure good intestinal motility, eat foods rich in fiber, as well as whole wheat bread and wheat bran.
7. Give up animal fats.
8. Vegetable fats should be present in the diet, but not more than 80 grams per day.
9. Meat, used for food, should be lean (not fat).
10. Refuse salty and spicy foods, as well as from fried foods. Dishes must be boiled or cooked on a steak, also the use of salads from raw vegetables is also welcomed.
11. Eat small meals 5-6 times a day.

The same rules apply to food after cholecystectomy (removal of the gallbladder).

Alcohol should be mentioned separately. Any alcoholic beverages are strictly prohibited in this disease. As shown by more than one medical history, acute calculous cholecystitis very often arises precisely after the adoption of alcohol. Very often patients are hospitalized directly because of the festive table.

Recipes of Alternative Medicine

With the diagnosis of "calculous cholecystitis," folk remedies can also be used for treatment. Apply medication, infusions and decoctions, which have choleretic effect, to reduce the concentration of bile and reduce congestion in the gallbladder.

An effective means in the people is the decoction of the flowers of the immortelle. For its preparation, 15 g of dry raw material is poured into 80 ml of hot water and boiled in a water bath for 30 minutes. The drink is allowed to cool and filtered, then add up to 100 ml of cold boiling water and take 50 ml twice a day before meals.

For the treatment of CSF in the people widely used infusion of cowberry leaf. To prepare the medicine 3 tablespoons of raw materials are covered in a thermos and poured with steep boiling water of 1 liter. If these manipulations are done in the evening, then by the morning the therapeutic tea will be ready.

Conclusion

It is believed that the best treatment is the prevention of disease. This fully applies to a disease such as calculous cholecystitis. Proper nutrition and healthy lifestyle will help to avoid this unpleasant disease. And if it so happened that the SCM still formed, then urgent measures should be taken to eliminate it. Recall that at the initial stage, when the gallbladder contains sand, rather than large stones, the process can still be reversed.