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Cholecystitis: forms, symptoms and treatment, diet

Cholecystitis can hide under many masks. And although his main sign is pain in the right hypochondrium , sometimes the disease simulates a heart attack, rheumatic pains, an allergic reaction.

In time to recognize cholecystitis and to appoint its correct treatment is the main goal of doctors. On this depends a successful outcome and the elimination of serious consequences.


Cholecystitis, what is it?


Cholecystitis is an inflammatory process in the gallbladder, which proceeds acutely or chronically. It is for cholecystitis that bitterness in the mouth, periodically arising pains in the right hypochondrium (the liver itself does not hurt!) And an unpleasant sensation of nausea are characteristic. Most often the disease is already in chronic form diagnosed in women after 40 years. However, cases of acute cholecystitis in children are not uncommon.

Mandatory factors for the occurrence of cholecystitis: violation of outflow of bile and reproduction of pathogenic microorganisms entering the gallbladder through the ducts and intestines, with blood or lymph from the foci of chronic infection.

Causes of cholecystitis:

  • dyskinesia of the biliary tract (with congenital abnormal structure of the bile ducts, liver infection with lamblia);
  • cholelithiasis (stones in the gallbladder can be both a cause and a consequence of cholecystitis);
  • pathology GASTROINTESTINAL TRACT - a hepatitis, a pancreatitis, a pancreatic reflux, an enterocolitis, a dysbacteriosis, an ascariasis ;
  • endocrine pathology - diabetes , obesity;
  • pregnancy and oral contraceptive use;
  • severe poisoning.

Causes of cholecystitis

The provoking factors include the following errors in lifestyle and some diseases:

  • low motor activity;
  • inefficient eating - excessive consumption of fatty and fried, snacks, addiction to fast food;
  • pernicious habits - alcohol, smoking;
  • increased emotionality, stress;
  • foci of infection in the body - pyelonephritis and cystitis, tonsillitis and sinusitis , adnexitis and prostatitis;
  • violation of the blood supply of the gallbladder (with atherosclerosis, hypertension);
  • taking certain medicines and allergic reactions.

An important role is played by hereditary predisposition. However, the risk of cholecystitis in such cases is minimal if a person leads a correct lifestyle.

Symptoms of cholecystitis by forms of the disease

Symptoms of cholecystitis

symptoms of pain in cholecystitis, photo

Cholecystitis (ICD K81) can start acutely after exposure to a provoking factor or slowly (a chronic form) with a gradual development of symptoms. The symptoms of the disease and the tactics of its treatment depend on the form of cholecystitis.

Acute cholecystitis (ICD 81.0)

Acute inflammation can occur in two ways: calculous cholecystitis (with the formation of concrements in the gallbladder) and acalculous (proceeds without stone formation).

bitterness in the mouth symptom of cholecystitis in adults

bitterness in the mouth - the first sign of cholecystitis

The main symptoms of acute cholecystitis :

  1. Pains in the right hypochondrium - periodically arising intensive character at a spasm of z / in ways, blunt constants - at a bubble hypotension. Often irradiate in epigastrium, lower back, shoulder blade. collarbone and neck on the right side.
  2. Dyspeptic phenomena - bitterness in the mouth, belching bitter, nausea and vomiting (yellow / orange vomit - a sign of the presence of bile), bloating.
  3. The general symptomatology is weakness, sweating, irritability, insomnia, fever.

Depending on the severity of the inflammatory reaction, cholecystitis is diagnosed:

  • catarrhal - non-intensive soreness, the temperature is normal or up to 37.5 ° C;
  • phlegmonous - pronounced pains that increase with a turn of the body or cough, the temperature reaches 38.0-39.0 ° C, pronounced tachycardia (110-120 per min) at rest, reflex lag when breathing the right side of the abdominal wall, weak intestinal noises;
  • gangrenous - the consequence of the absence of treatment in the phlegmonous stage, the rapid course and the severe condition of the patient, this condition threatens the patient's life.

Atypical variants of cholecystitis flow (ICD 81.8-81.9):

  • cardial - pain in the heart, arrhythmia;
  • rheumatic - joint and heart pain, characteristic for rheumatism changes on the ECG;
  • gastrointestinal - the predominance of symptoms from the gastrointestinal tract (broken stool, flatulence, nausea, vomiting);
  • thyrotoxic - high irritability, low-grade fever, intermittent rapid heartbeat;
  • neurogenic - migraine headaches, insomnia, depression, increased sensitivity and irritability;
  • allergic - recurrent urticaria, attacks of suffocation, eosinophilia in the blood.

Chronic cholecystitis (ICD 81.1)

Symptoms of cholecystitis in adults often develop gradually due to a prolonged disruption of diet or with the formation of gallstones. Exacerbations of chronic cholecystitis proceed according to the type of acute inflammation.

However, even during the period of remission (temporary improvement), the patient often has subfebrile condition, mild jaundice of the skin and sclera, skin itching (as a result of the entry of bile pigments into the blood).

Treatment of cholecystitis in adults

Treatment of cholecystitis in adults

The diagnosis of "cholecystitis" is based on the patient's characteristic complaints and the results of diagnostic studies (ultrasound, blood tests - general and biochemistry, X-ray contrast, fibrogastroduodenoscopy, computed tomography, bile seeding).

Drug treatment for cholecystitis in adults includes:

  1. To eliminate spasm - No-shpa, Papaverin, Platifillin, Analgin, Baralgin;
  2. With the detected hypotension of the gallbladder - cholagogue (Allochol, Holenzym);
  3. With severe inflammation, broad-spectrum antibiotics;
  4. With cholestasis and the beginning of stone formation - Ursodeoxycholic acid, 1-3 months;
  5. To normalize the synthesis of bile - hepatoprotectors (Hofitol, Gepabene, Karsil);
  6. With pronounced autonomic dystonia - soothing (Motherwort, Valerian).

Additional activities:

  • phytotherapy - teas with immortelle, St. John's wort, corn stigmas, mint;
  • procedure of blind sounding (tjubazh) - is carried out once in 7 days, only in the absence of adhesions and expressed narrowing of the bile ducts;
  • physiotherapy - electrophoresis, diathermy, mud therapy, inductothermy;
  • cholecystectomy - surgical treatment is indicated only with complicated calculous cholecystitis (large stones), gangrenous form with peritonitis threat.

Exacerbation of cholecystitis - therapeutic tactics

Often, chronic cholecystitis gives an exacerbation in the form of biliary colic. Acute pain in this case is accompanied by increased jaundice, a drop in pressure, indomitable vomiting, discoloration of feces and darkening of urine.

For rapid relief of pain, Platifillin is used, and antispasmodics are used intravenously.

If biliary colic is caused by blockage of the bile duct with large stones (more than 2 cm) and is not stopped in the shortest possible time by medicines, the risk of peritonitis is significantly increased.

In such cases, an emergency laparoscopic (through minisections) or an open (wide dissection of the abdominal wall in the right upper quadrant) is performed.

Diet: features of nutrition in cholecystitis

Dietary nutrition is an integral part of the successful treatment of cholecystitis. The diet for cholecystitis is observed for a long time in order to avoid relapse of the disease and prevention of stone formation.

Prohibited products:

  • fatty meat and fish, fat, by-products (liver, kidneys);
  • fried food, egg yolk;
  • beans (peas, beans);
  • baking, cakes;
  • marinades and homemade pickles, sauces (ketchup, mayonnaise);
  • fruit with a sour taste;
  • garlic, sorrel, radish, onion, spinach;
  • mushrooms;
  • spices, vinegar, mustard, horseradish;
  • alcohol;
  • lemonades, coffee, chocolate, cocoa, ice cream;
  • sugar (limit use to avoid changing the composition of bile).

The resolved products at a cholecystitis:

  • lean meat, fish and sausages;
  • low-fat dairy products (low-fat cottage cheese, sour cream, cheese, yogurt);
  • grain bread, unhealthy cookies;
  • unrefined oils (olive);
  • some sweets - jam, natural marmalade, marshmallow, honey (has a pronounced choleretic effect);
  • non-acidic fruit;
  • oats, buckwheat, macaroni;
  • kissels, compotes, sweet juices, weak tea, coffee with the addition of milk;
  • Curcuma as a condiment to dishes.

In chronic non-calculous cholecystitis, dietary nutrition can help prevent the development of acute colic attacks and severe complications. Even after cholecystectomy, the patient must follow a diet to maintain normal digestion.


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