Chronic chronic cholecystitis: stages and treatment

Acidless chronic cholecystitis is an inflammation of the gallbladder without the formation of bile calculi. This form causes pain in the right hypochondrium and dyspeptic disorders.

In the field of gastroenterology, the proportion of chronic lesions accounts for 5 to 10% of cases. In women, chronic acalculous cholecystitis occurs about 4 times more often. These are the statistical data. Some researchers consider chronic acalculous cholecystitis as a transitional form to a disease such as cholesterol calculous. But, as shown by medical practice, patients in the future do not suffer from cholelithiasis.

Causes of the disease

The etiology of this ailment is various infections:

• E. coli;
• Enterococcus;
• Staphylococci;
• Proteus;
• Flora of mixed type.

The penetration of bacteria into the gallbladder through the intestine occurs under conditions such as:

• Dysbiosis;
• colitis;
• enteritis;
• hepatitis;
• Pancreatitis.

Less infectious disease spreads through the lymph or blood from infectious foci, being remotely.

For example, the infection is spread in such diseases as:

• Parodontosis;
• Tonsillitis in chronic form;
• appendicitis;
• pneumonia;
• pyelitis;
• Adnexitis.

To provoking factors that activate infectious processes, it is possible to attribute:

• Cholestasis;
• Dyskinesia of bile ducts;
• Invasion by parasites such as lamblia, ascarids, amoeba;
• Dysfunction of sphincters;
• obesity;
• Dysmenorrhea;
• Hypodynamia;
• Malnutrition;
• Nervous exhaustion, etc.

Chaotic chronic cholecystitis involves thickening and deformation of the gallbladder. The mucous membrane acquires a network structure due to the alternation of atrophic sites with polyps forming thick folds.

There is thickening of the muscular membrane. In it, there is scar tissue fibrous. With the prevalence of the inflammatory process, pericholecystitis may develop, spikes may appear with organs in the neighborhood, abscesses, pseudodiverticles.

Classification of the disease

The lesion can be mild, moderate and severe. The disease involves three stages:

• Exacerbation;
• Stagnation and exacerbation;
• Persistent and unstable remission.

Choledale chronic cholecystitis can occur with relapses. The disease is also monotonous and intermittent.

Depending on the degree of damage, it is customary to distinguish between a complicated and uncomplicated form of chronic noncalculous cholecystitis. It is also common to distinguish between a typical and atypical species. The latter form is divided into intestinal, cardial and esophagal type.

Symptoms of chronic acalculous cholecystitis manifest themselves in different ways depending on the degree of gallbladder involvement.

How does the disease manifest in an easy degree?

For cholecystitis, which proceeds in a mild form, short exacerbations lasting 2-3 days are characteristic. Basically, they are triggered by improper diet and are easily eliminated if a proper diet is observed.

The general condition of the body is normal, the body temperature is normal. The examination does not reveal a functional disorder of the liver, gallbladder and pancreas. Microscopic examination of bile does not show any abnormalities.

How is the average shape?

With the average form of such a disease as chronic acalculous cholecystitis, remission and exacerbation replace each other. The duration of exacerbations is 2-3 weeks. Usually the patient is concerned about pain and dyspeptic disorder. Typically, this condition is caused by the intake of fatty foods or by overeating. In some cases, a respiratory infection infection acts as a provocateur of aggravation.

How does chronic cholecystitis occur in this case? Symptoms are varied. With exacerbation, patients have no appetite, body weight decreases, intoxication occurs, manifested in asthenia and migraine. Arthritis pain may also be troubling.

Some patients, in addition to pain in the right upper quadrant, can complain of dull pain in the left hypochondrium and upper abdomen. Pain sensations often spread to the heart. Patients are concerned about nausea, constipation, or diarrhea.

In the laboratory study of bile, there is an increase in the amount of mucus, leukocytes, cholesterol, bilirubinate Ca, bile salts, in some cases microliths. It is also possible to detect microflora.

In acute condition, the patients are exposed to a change in functional liver samples. Often there is moderate hypoalbuminemia, a slight increase in the activity of transaminases, mainly AJIT, a moderate increase in thymol test and alkaline phosphatase activity .

The parameters of the laboratory examination of the liver become normal during the period of remission. The patient may be disturbed by a feeling of heaviness in the upper half of the abdomen and bloating after eating. Often, a person is concerned about constipation or diarrhea.

Dyspeptic manifestations are worse when taking fatty foods or rough fiber. Such food can provoke an exacerbation of the disease.

How is the heavy form?

Chronic chronic cholecystitis in severe form is characterized by a course with constant relapses without remission. The disease extends beyond the gallbladder. Hepatitis in chronic form, as well as pancreatitis, joins the main disease.

Patients complain of lack of appetite, unceasing nausea, heaviness in the upper abdomen. Sometimes the pain is shrouded in nature. Patients are recommended a strict diet, which leads to a decrease in body weight and asthenia. In a number of cases, sepsis appears in a chronic form.

The functionality of the gallbladder is severely impaired. The wall of the organ thickens. If, with an average degree, the functionality of the liver is partially broken, then in severe cases, hepatitis is often manifested in chronic form or cholangitis.

The following processes occur:

• The liver increases in size;
• Decreased serum albumin;
• Increase globulin fractions and the concentration of total bilirubin.

When the ultrasound of the abdominal cavity is performed, the ducts of the gallbladder are enlarged, a "stagnant" gallbladder, chronic pancreatitis with a decrease in the functionality of the pancreas is revealed.

Patients often complain of dyspeptic disorders, nausea, weight loss. They have an increase in the volume of feces, steatorrhea, creatorrhea and amylorea.

When the disease is severe, the work of the vessels and heart is disrupted, vegetative vascular dystonia, coronary insufficiency, with appropriate changes on the ECG.

How is the atypical form?

How is the atypical form of chronic acalculous cholecystitis characterized? The patient is worried about constant heartburn, heaviness, pain behind the sternum, transient dysphagia. At an intestinal type on the foreground the pain in the field of an intestine, a bloating, a constipation acts.

At a young age, chronic acalculous cholecystitis is similar to rheumatism in a latent form. Patients complain of asthenia, pain in the joints. Auscultation reveals lowered heart tones.

The atypical course of the disease includes the lumbar and pyloradenal type of chronic cholecystitis. In the lumbar form, patients experience pain in the spine. In such cases, radiography of the spine is shown.

Symptomatic of the cardiac form

This form of the disease is inherent in arrhythmia (extrasystole) or pain behind the sternum. The ECG also changes.

In the middle and elderly age, the cardiac form is similar to angina or coronary insufficiency occurring in a chronic form. Patients complain of pain in the heart, tachycardia.

Gastroduodenal form

Clinic of chronic cholecystitis in this case resembles a peptic ulcer or gastroduodenitis with an increased level of gastric acid. Patients complain of stomach pain at night.

Methods of diagnosis

When palpation of the abdomen in the area of the gallbladder, pain is noted, which is enhanced by inhaling or by efflorescence of the right costal arch.

At laboratory research the raised indicator is defined:

• Transaminases;
• Alkaline phosphatase;
• Γ-glutamyl transpeptidase.

To very important diagnostic methods include:

• Ultrasound;
• Cholecystography;
• Celiacography;
• Cholescintigraphy;
• Duodenal sounding.

Based on the latest study, we can talk about the intensity of the inflammatory process.

Typical changes at the macroscopic level are manifested in the turbidity of bile, as well as the presence of flakes and mucus.

When microscopic examination there is an increased number of leukocytes, bilirubin, protein, cholesterol, etc.

In bacteriological sowing of bile, its microbial flora is investigated.

With the help of cholecystography in patients with chronic form of acanthocephalic cholecystitis, the motor and concentration functionality of the gallbladder, its contours and position are evaluated.

Echography reveals deformation of the gallbladder, atrophic processes in its walls, unevenness of the inner epithelium, the presence of inhomogeneous contents with inclusions of bile of a heterogeneous consistence.

Differential diagnosis is performed with biliary dyskinesia, chronic cholangitis, ulcerative colitis of nonspecific character, and Crohn's disease.

Methods of therapy

How is chronic cholecystitis permanent? Treatment, as a rule, is conservative. Doctors recommend adhering to a diet. It is advised to exclude from the diet fatty and fried foods, spicy foods, carbonated and alcoholic beverages.

When abdominal pain is recommended taking such antispasmodics as "Platifillin", "Drotaverin", "Papaverin", etc.

When the disease worsens, or in combination with cholangitis, antibacterial treatment is used with "Cefazolin", "Amoxicillin", "Erythromycin", "Ampicillin", "Furazolidon", etc.

To normalize the work of the gastrointestinal tract, it is advised to take "Festal", "Mezim-forte", "Pancreatin".

To increase the secretion of bile usually resort to taking choleretics (Allochol, Cholenzim, Oxafenamid).

To stimulate the contraction of the gallbladder, magnesium sulfate and sorbitol are used.

In the period of exacerbation or remission, it is advisable to conduct a course of herbal therapy. Broths of chamomile, calendula, dogrose, licorice, mint are accepted.

During the period of remission, the tuba is carried out, mineral water is drunk, exercise therapy is performed.

Surgical intervention

Surgical intervention takes the history of the disease into account. Chronic galloping cholecystitis, expressed in the deformation of the walls of the gallbladder and unchanged correction of cholangitis and pancreatitis, requires surgery.

In this case, cholecystectomy is performed through open intervention, laparoscopy or mini-access.

The application of folk methods

How else to eliminate chronic acalculous cholecystitis? Treatment with folk remedies also has a positive effect.

The roots of the aura of the marsh, valerian, dried inflorescence of St. John's wort, calendula, nettle, corn, flax seeds are used. It is also advisable to use linden, peppermint, motherwort, chamomile, dill, horsetail, rose hips.

When using folk methods in the chronic course of the disease, flowers of immortelle and elderberry are supplemented with phytotherapy.

Phytotherapy

Phytotherapy involves the use of a cocktail of the following herbs:

• Peony - 20 ml;
• Valerian - 20 ml;
• Hawthorn-20 ml;
• Mint - 20 ml;
• Krasavka - 10 ml;
• Motherwort - 20 ml;
• Calendula - 30 ml;
• Wormwood - 20 ml.

In the presence of glaucoma, belladonna is not added.

Drink the drug should be 1-8 drops three times a day for five minutes before taking the infusion of herbs at 1 tbsp. L of water for 4-6 weeks. A mixture of tinctures of ayr and elecampane is taken in equal quantities. Also drunk 1-8 drops three times a day for two minutes before ingestion of herbs for 1 tbsp. L. Water for 4-6 weeks.

It should be remembered that phytotherapeutic collection is connected at a dose of 0.00325, i.e., the 14th dilution, and is daily increased by 1-2 dilutions until the optimal dose is achieved.

A suitable dose is one that does not cause dyspeptic disorders, but, on the contrary, reduces the extent of the manifestations. This dose is taken during the course, but if there is discomfort, it decreases by 1-2 units.

Forecast

What is the prognosis of such a disease as chronic acalculous cholecystitis? Exacerbation in mild form is rare. The disease has a favorable course. Deterioration of the prognosis occurs in the event that the exacerbations occur often at an average severity of the disease.

Prevention

Preventative measures are concluded in the timely treatment of the disease, sanation of foci of infection, elimination of disturbances in the nervous system, and restoration of normal metabolism. Also it is necessary to observe a correct diet, to struggle with intestinal infections and helminthic lesions.