Cholecystitis: signs, symptoms and treatment

Acute cholecystitis is an inflammation of the gallbladder, accompanied by a response from the whole body.

Pathology of the biliary tract and gallbladder is quite common among the population. Gallstone disease affects about 20% of adults.

Moreover, stones consisting of cholesterol are more often found in developed countries. Pigmented stones resulting from infection and inflammation are more common in Asia and Africa.

In the past few years, the number of patients with acute cholecystitis in Russia has increased 5 times. Every year, up to half a million people undergo gallbladder removal.

More often, acute cholecystitis occurs against the background of the closure of the cystic duct with a stone. Less often, the disease is formed after injury due to thickening of bile.

Pathologies are more susceptible to women under 50 years of age.

Varieties of acute cholecystitis

What are the types of acute cholecystitis? Cholecystitis is divided into:

• uncomplicated - calculous (with stones) and stoneless;
• complicated - if cholecystitis is complicated by the formation of an inflammatory fluid near the gallbladder, purulent inflammation, inflammation of the peritoneum, jaundice, inflammatory processes in the biliary tract, fistula, inflammation pancreas.

Uncomplicated cholecystitis is divided into:

• catarrhal - a mild form of inflammation;
• phlegmonous - pus is present in the gallbladder;
• gangrenous - the process ends with the "withering away" of the tissues of the gallbladder.

In terms of severity, inflammation of the gallbladder is divided into:

• mild degree - there is no damage to other organs;
• medium degree - exhibited if the patient has at least one of the listed signs: an increase in the number of leukocytes is more than 18, the gallbladder is felt, the process has developed more than 72 hours ago, there are signs of inflammation of the peritoneum, a suppurative process in the liver, or in the gallbladder bladder;
• severe - there is at least one of the following signs: damage to the cardiovascular system, low pressure, impaired consciousness, damage to the respiratory system, impaired urine flow, platelet count is lower 100.

According to the morphological classification, cholecystitis is divided into:

• edematous form - the process lasts from 2 to 4 days;
• necrotic form - inflammation lasts up to 5 days, there is hemorrhage and tissue death;
• purulent form - the inflammatory process lasts up to 10 days. The gallbladder is covered with leukocytes, there are areas of completely dead tissue;
• emphysematous form - the walls of the gallbladder are swollen due to gases generated during infection of the process. This picture is more typical for patients with diabetes mellitus;
• chronic form - the mucous membrane is thinned or absent, there are areas replaced by non-functioning tissue. It is characteristic of constantly recurrent inflammation.

Causes

What causes acute cholecystitis? The disease develops due to:

• the presence of stones in the gallbladder in the body;
• severe chronic pathologies and injuries. In this case, there is an insufficient supply of oxygen to the bile tissue, which leads to its inflammation;
• diseases of the cardiovascular system with episodes of low blood pressure;
• intravenous nutrition;
• low fiber in the diet;
• sedentary lifestyle;
• severe burns;
• taking Ceftriaxone, Cyclosporin;
• blockage by a thrombus or embolus of an artery that supplies the gallbladder;
• the presence of infection in the body (cytomegalovirus, salmonellosis, HIV infection).

Symptoms

How does acute cholecystitis manifest? The main symptom of the disease is biliary colic. It appears an hour and a half after eating fatty foods, fried or after overeating.

The pain builds up rapidly. It begins in the hypochondrium on the left or in the epigastric region (in the region of the navel and 2-3 cm above it), gradually turning into the right hypochondrium.

Soreness "gives" to the right shoulder blade, spine, right shoulder and neck.

Also, patients experience pain when probing the right hypochondrium, and with a simultaneous deep breath, the soreness increases.

Acute cholecystitis is characterized by lack of appetite, vomiting and nausea, which do not bring relief, fever (with a complicated course of the disease), jaundice.

In elderly patients, as well as in patients with diabetes mellitus, there may be no pronounced symptoms, an increase in body temperature.

Which doctor should I go to?

If discomfort appears in the right hypochondrium, it is necessary to visit a gastroenterologist or therapists.

If you experience acute pain, you need to call an ambulance or immediately contact a surgeon. If the patient is in serious condition, consultation with a resuscitator is needed.

Survey

What will help to diagnose "Acute cholecystitis"? Pathology can be identified using laboratory and instrumental research methods.

Laboratory includes:

• complete blood count - an increase in the level of leukocytes;
• biochemical blood test - an increase in the level of C-reactive protein, alkaline phosphatase, GGT, bilirubin;
• blood test for HIV, viral hepatitis.

Instrumental methods include:

• Ultrasound of the abdominal organs - signs such as an increase in the longitudinal and transverse dimensions will speak of acute cholecystitis gallbladder, thickening of its wall more than 3 mm, edema, heterogeneity, "double contour", the presence of a stone in the neck of the bladder, fluid around organ. Also, ultrasound helps to establish the gangrenous or catarrhal form of the process;
• survey radiography of the abdominal organs - will help to identify stones in the gallbladder only if they contain a large amount of calcium. X-rays are not used during pregnancy;
• percutaneous transhepatic cholangiography (PTCHG) - is used in cases where other research methods cannot be used. The contrast agent is injected with a needle into the lumen of the bile duct. Then x-rays are taken;
• magnetic resonance cholangiopancreatography (MR-CPG) is a highly accurate method for detecting stones in the bile ducts. But small stones (less than 3 mm) are sometimes not detected. There are contraindications for this method: the presence of a pacemaker, defibrillator;
• endoscopic ultrasound (endoscopy) - this study is more informative than MR-CPG. It allows you to detect even small stones, narrowing of the common bile duct;
• bilioscintigraphy - the study is carried out with labeled technetium molecules. The method is based on the introduction of contrast into the blood and its excretion into the bile. If the gallbladder is poorly visualized with such an examination, this indicates the presence of a stone in the common bile duct, and also indicates an inflammation of the gallbladder.
• intraoperative cholangiography (intraoperative ultrasound) – used to detect stones in the common bile duct during surgery.

Treatment

What to do with acute cholecystitis? Pathology is treated only by surgery. The goal of treatment is to quickly eliminate the inflammatory process by removing the gallbladder.

What kind of diet should you follow? During treatment, the patient is shown hunger. Drinking water is also not allowed.

Before the operation, the patient may be prescribed antispasmodics, antibiotics, non-steroidal anti-inflammatory drugs and solutions of glucose or sodium chloride.

The operation must be completed within 72 hours. Surgical treatment begins immediately after all diagnostic procedures have been performed.

Basically, surgery is performed using laparoscopic techniques. That is, the patient is given three punctures in the abdomen, through which the gallbladder is removed.

Such treatment allows you to quickly return to work, shortens the recovery time, and reduces the likelihood of a fatal outcome.

There are several types of surgical treatment for acute cholecystitis:

• early cholecystectomy - the operation is performed within 72 hours from the onset of the disease;
• delayed cholecystectomy - first, the patient is prescribed antibiotics, then after 8-12 hours the gallbladder is removed;
• standard open cholecystectomy - an incision is made along the midline or in the right hypochondrium;
• minilaparotomic cholecystectomy - the incision is performed in the right hypochondrium. The length of the cut is less than 6 mm;
• laparoscopic cholecystectomy – removal of an organ through 3 holes.

If the patient is admitted later than 72 hours from the onset of the disease, then an open operation is performed (an incision is performed along the midline or a transverse incision is made in the right hypochondrium).

The same method of treatment is indicated for elderly patients with an increase in the level of leukocytes above 13, cirrhosis, tumors gallbladder, pregnancy, signs of gangrenous inflammation, bleeding, adhesions.

Minilaparotomic cholecystectomy is safer than open gallbladder removal. In addition, with this type of intervention, the patient recovers faster.

Percutaneous puncture cholecystectomy is performed if the risk of surgery is high (the patient's age more than 70 years, the presence of diabetes mellitus, a high likelihood of complications, no effect from medication treatment).

The doctor chooses the subhepatic approach if it is necessary to remove stones.

Endoscopic drainage of the gallbladder is a temporary measure. After normalization of the patient's condition, the bladder is removed. The operation ends with the setting of drains for up to two days.

Postoperative period

What to do after surgery? There are some rules to follow:

• you need to get up on the first day after the operation;
• you should drink water from the first day. After the beginning of the discharge of intestinal gases, you can eat liquid food;
• the sutures are removed and discharged on the 4th day after the laparoscopic intervention, on the 7th day after the open surgery.
• within 14 days after the operation, the patient must be observed by a doctor.

If there are no symptoms of acute cholecystitis, the wound healed without complications, jaundice did not develop, then the treatment is considered successful.

Possible complications

What can acute cholecystitis lead to?

During the operation, bleeding may occur, trauma to the bile ducts.

After the operation, complications such as pneumonia, myocardial infarction, pulmonary embolism, vein thrombosis may appear.

To prevent these situations, laparoscopic cholecystectomy, early activation, early nutrition, and adequate pain relief are used. Also, after the operation, certain medications are prescribed to prevent complications.

Prophylaxis

What to do to avoid the development of acute cholecystitis? First of all, it is necessary to lead an active lifestyle, reduce weight, include in the diet as much fiber as possible, and prevent prolonged fasting.

All these activities prevent the formation of gallstones. If gallstone disease has already developed, it is necessary to take ursodeoxycholic acid.

With frequent exacerbations of gallstone disease, planned removal of the gallbladder is necessary.

Conclusion

Acute cholecystitis is an inflammation of the gallbladder, accompanied by a response from the whole body. Gallstone disease affects about 20% of adults.

In the past few years, the number of patients with acute cholecystitis in Russia has increased 5 times. Every year, up to half a million people undergo gallbladder removal.

Pathologies are more susceptible to women under 50 years of age. The cause of acute cholecystitis can be the presence of stones, chronic diseases, trauma, intravenous nutrition, a sedentary lifestyle, low fiber in the diet, severe burns, taking certain medications, infections.

Inflammation of the gallbladder is manifested by biliary colic. It appears an hour and a half after eating fatty foods, fried or after overeating and begins in hypochondrium on the left or in the epigastric region (in the region of the navel and 2-3 cm above it), gradually turning into the right hypochondrium.

Diagnosis of pathology is based on laboratory and instrumental methods. Laboratory tests include general and biochemical blood tests, blood tests for HIV and hepatitis.

To make a diagnosis, instrumental methods are used: ultrasound and X-ray of the abdominal organs, percutaneous transhepatic cholangiography, magnetic resonance cholangiopancreatography, endoscopic ultrasound, bilioscintigraphy, intraoperative cholangiography.

Treatment of acute cholecystitis is aimed at removing the gallbladder.

Prevention of pathology includes an active lifestyle, weight loss, inclusion of fiber in the diet, taking ursodeoxycholic acid in the presence of stones in the gallbladder and performing a planned cholecystectomy.