Chronic acalculous cholecystitis - an inflammatory disease of the mucous membrane of the gall bladder. The disease manifests pain, disorders of the digestive functions and common manifestations of inflammatory reactions. This disease belongs to the common diseases of the gastrointestinal tract. Women suffer more often than men by 3-4 times.
Causes of chronic cholecystitis various microorganisms (Escherichia coli, staphylococci, enterococci, Proteus, mixed flora). However, at present it is believed that the microorganisms themselves can not cause inflammation in the gallbladder wall, for it must needs predisposing factors. These factors include stagnation of bile in the gall bladder, damage to the walls of the gall bladder, decreased immunity, the presence of foci of chronic infection.
Stagnation of bile in the gall bladder by a variety of anatomical abnormalities of the gall bladder (bladder bends, constrictions in the gall bladder), and ducts, bile duct bends, compression of the biliary tract. To bile stasis may decrease the tone of the gallbladder and biliary tract caused by endocrine disorders, emotional stress, exposure to ongoing inflammatory processes in the organs of the gastrointestinal tract.
Contribute to disruption of the outflow of bile sedentary lifestyle, the omission of abdominal pregnancy is rare, but frequent meals. One of the factors of the inflammatory process in the gall bladder is the presence of hypotonic-hypokinetic dyskinesia of the gallbladder and biliary tract. Injury and irritation of the mucous membrane of the gall bladder occurs when the physical and chemical properties of bile, under the influence of enhanced stimulation of fried spicy food, with traumatic stones, when flowing into the gallbladder pancreatic juice, which is possible in case of violation of motor function of the biliary tract.
Usually at the beginning of the disease is damage to the mucous membrane of the gall bladder, and in terms of impaired outflow of bile, a process joins the microbial flora. As the severity of chronic cholecystitis is divided into easy, medium, heavy on the stage - the stage of exacerbation and remission.
Patients complain of pain in the right hypochondrium, extending to the chest, right shoulder, right side of the neck, collarbone, shoulder. The pain can be severe, but more often has the character of a dull constant pain. Enhanced pain after eating, especially fatty, fried, spicy. The reason for amplification of pain reduction in the stimulation of the gall bladder under the influence of food. If the flow of bile is difficult, painful attacks can be quite strong. In the right upper quadrant there is a sense of gravity.
Often patients complain of a metallic taste or a sense of bitterness in his mouth, belching air, bloating, nausea, increased separation of gases. Lack of bile acids in the intestine leads to malabsorption of fats, cholesterol, calcium and occurrence of constipation, which can be replaced by diarrhea, with abundant release of bile from the gall bladder under the influence of any reason. Appetite for patients maintained and often increased, especially in the acute stage of decay.
Common manifestations of the disease is usually limited by weakness, headache, joint pain, sometimes a slight fever. In the acute stage of pain worse, there is a rise in body temperature, sometimes there is itching, jaundice is very rare. During exacerbations sometimes in the biochemical analysis of blood shows signs of liver problems.
Chronic acalculous cholecystitis may be complicated by the emergence of chronic cholangitis, hepatitis, pancreatitis, and promote the formation of stone in the gallbladder and biliary tract. Dangerous complication may be perforation of the gallbladder wall with rupture of the bile into the abdominal cavity and the development of severe peritonitis, and empyema of the gallbladder, in which the gall bladder into a bag with purulent contents.
Treatment of chronic acalculous cholecystitis.
Treatment of chronic cholecystitis - a lengthy process and is the basis of his diet. The diet should be made individually, taking into account gender, age, weight, physical activity the patient. 5.4 It is recommended meals per day, excluding roasted, fried in fat, especially food.
Suitable antibiotic therapy, although recently its effectiveness is questioned. Antibiotics and antibacterial agents that may be concentrated in the bile (erythromycin, rifamycin, tetracycline, nitrofuranovogo drugs, chloramphenicol, kanamycin, metatsiklin). Antibacterial drugs are prescribed for 10 days.
Used physiotherapy. In the remission phase of the appointed agents that stimulate the formation of bile - choleretic (allohol, holenzim, Nicodin, holagon, corn silk), if the patient revealed hypotonia of the gall bladder - prescribers, reinforcing the reduction of the gallbladder and bile excretion contribute - holekinetiki (magnesium sulfate, Carlsbad salt, xylitol, sorbitol).
With persistent inflammation during the transition accompanied by inflammation of the gall bladder to the surrounding tissue (periholetsistit), turning off the gallbladder, the accession of inflammation of the pancreas there is a need for surgical treatment and removal of the gallbladder.
