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Chronic cholecystitis: symptoms and treatment, exacerbation, diet

Chronic cholecystitis is characterized by a long-term course, and it can develop after several cases of the acute form of the disease, or independently.

Correct and timely treatment allows achieving a stable remission, and its absence over time contributes to the complete loss of its functions by the gallbladder. I will describe in detail below what is chronic cholecystitis, its symptoms and treatment.


Chronic cholecystitis - what is it?

Chronic cholecystitis

gallbladder photo

Chronic cholecystitis is an inflammatory process in the gallbladder walls. This organ is located near the liver and is a reservoir for bile, which then enters the small intestine to digest food. Normally, its outflow occurs regularly and without difficulty, and if this process is disrupted, then its accumulation provokes thickening and inflammation of the bladder walls.

The main causes of chronic cholecystitis are infection and stagnation of bile. These factors are interrelated and any of them can be the first impetus to the formation of pathology. The accumulation of bile secretion increases the risk of infection, and infection and inflammation, in turn, contributes to the narrowing of the excretory duct and slow the release of bile into the intestine.

Chronic cholecystitis is often combined with cholelithiasis .

The following factors can provoke inflammation:

  • overweight and obesity, when the content of cholesterol in bile is increased, and this is one of the reasons for the development of cholelithiasis;
  • diabetes mellitus ;
  • starvation;
  • genetic predisposition;
  • pregnancy;
  • taking hormonal contraceptives, antibiotics, for example, Ceftriaxone, and other drugs (Octreotide, Clofibrate);
  • rare meals (1-2 times a day).

The risk of cholecystitis is increased in the elderly, old age and when infected with worms that live in the gall bladder and its duct (roundworm, Giardia). In women, the disease is diagnosed more often than among men, since female sex hormones affect the active production of cholesterol.

Chronic calculous type cholecystitis

Chronic calculous cholecystitis is a pathology that combines inflammation of the gallbladder and cholelithiasis, that is, stones and stones form in it and its duct. Pathology is also called cholelithiasis.

Symptoms - constant pain of different intensity on the right under the ribs and periods of increase in body temperature, followed by short-term normalization.

Chronic calculous type cholecystitis If the symptoms of chronic calculous cholecystitis do not appear, or the once-biliary colic does not recur, then conservative treatment is prescribed with the help of medicines and physiotherapy. Its goal is to reduce inflammation, restore bile outflow, treat existing pathologies and improve metabolism.

With strong changes in the walls and ducts, the presence of long-formed stones and involvement of the nearest organs in the pathological process, surgical intervention is prescribed.

The operation involves the removal of the gallbladder with stones, is carried out under general anesthesia.

Symptoms of chronic cholecystitis

Chronic cholecystitis symptoms

The main symptom of chronic cholecystitis is pain in the right hypochondrium, they are characterized by the following features:

  1. Arise and grow after eating fatty or fried foods;
  2. Most often aching, dull and last from 2-3 hours to 4-7 weeks and longer;
  3. May irradiate up to the shoulder or neck;
  4. The appearance of acute short-term or long-term pain sensations characteristic of the stages of exacerbation.

Other symptoms occurring in time of illness:

  • vomiting resulting from ingestion of fatty foods;
  • bitter taste or metal in the mouth;
  • deterioration and loss of appetite;
  • persistent nausea;
  • stool disorders - diarrhea or constipation;
  • bloating.

The last two symptoms of chronic cholecystitis are common and indicate comorbidities, such as pancreatitis or gastritis (dysfunction of the pancreas or stomach). Long-developing cholecystitis is also manifested by weakness, nervousness, fatigue, decreased immunity and, as a consequence, frequent colds.

Exacerbation of chronic cholecystitis

In the exacerbation of chronic cholecystitis, a symptom appearing in the first place is an attack of pain. Appearing suddenly in the right hypochondrium area, it can maintain its intensity for a long time.

Increased pain provoke sudden movements and pressure on the right side, so the person during the attack is trying to take a position that reduces any effects on the affected side.

Following the pain, digestive disorders develop - chaff, vomiting, diarrhea. If an acute infectious-inflammatory process takes place in the gallbladder, then chills and a significant increase in body temperature - up to 39-40 ° - are associated with these symptoms.

In overcoming the exacerbation, bed rest and an abundant flow of fluid into the body are required. In order to reduce pain, antispasmodics are shown, for example, 1 tablet of No-shpy, Analgin or Ketorol three times a day. While in the hospital, injections of Promedol, Papaverine, Platyphyllin, or Atropine are used.

Exacerbation of chronic cholecystitis

In addition to diet and painkillers in the treatment of acute exacerbation of chronic cholecystitis apply:

  1. Broad-spectrum antibiotics to fight infection that caused inflammation — Erythromycin, Ampicillin, or other drugs prescribed by a doctor;
  2. Choleretic drugs - Holenzim, Allohol, Flamin;
  3. Ursosan, which has an immunomodulatory and hepatoprotective effect, is indicated in severe cases when the liver is involved in the inflammatory process.

The duration of therapy is 1 month, while the pain syndrome can be eliminated within 7-10 days. If the drug treatment of an exacerbation has no effect, then surgical removal of the gallbladder is indicated.

- For details, see: acute cholecystitis .

Diagnostic methods

In a conversation with the patient and in the study of the medical history, the doctor draws attention to the causes that could lead to the development of chronic cholecystitis - pancreatitis, other pathologies. Palpation of the right side of the ribs causes pain.

One of the characteristic is the symptom of Mussi, or phrenicus-symptom, - the appearance of pain when pressing on the naive muscles over both clavicles (see figure).

frenicus symptom Laboratory tests reveal:

  • In the blood - increasing the erythrocyte sedimentation rate, high activity of liver enzymes - alkaline phosphatase, GGTP, AlT and AST;
  • In bile, if there are no stones, there is a low level of bile acids and an increase in the content of lithocholic acid, cholesterol crystals, an increase in bilirubin, protein and free amino acids. Also in the bile are detected bacteria that caused inflammation.

Instrumental and hardware methods for the diagnosis of chronic cholecystitis:

  • Ultrasound;
  • cholegraphy
  • scintigraphy;
  • duodenal intubation;
  • arteriography;
  • cholecystography.

Tactics of treatment of chronic cholecystitis

treatment of chronic cholecystitis

Surgical treatment is used to treat calculous chronic cholecystitis of the gallbladder and non-calculous (stoneless) in severe forms. In other cases, conservative therapy is indicated, including:

  1. Antibacterial drugs for the rehabilitation of the inflammation;
  2. Enzyme means - Panzinorm, Mezim, Kreon - for the normalization of digestion;
  3. NSAIDs and antispasmodics to eliminate pain and relieve inflammation;
  4. Means that enhance the flow of bile (choleretics) - Liobil, Allohol, Holosas, corn silk;
  5. Droppers with sodium chloride, glucose to detoxify the body.

In the remission stage with cholecystitis without complications after the removal of the main symptoms, you can take decoctions of camomile, peppermint, tansy, dandelion, yarrow, calendula.

Physiotherapeutic methods include electrophoresis, SMT therapy, reflexotherapy, mud applications, and balneological procedures.

Since chronic calculous cholecystitis is associated with the formation of stones in the gall bladder, its treatment is carried out through surgery.

If surgical intervention is contraindicated, then an extracorporal shock wave lithotripsy used for crushing stones is an alternative method. However, after this procedure, the formation of calculus is possible over time.

Diet for chronic cholecystitis

The nature of the diet in chronic cholecystitis provides a number of restrictions. During remission, table No. 5 is shown, in the acute stage, No. 5a, and the general principles of nutrition are as follows:

  • frequent meals in small portions at the same time;
  • reduce to a minimum simple carbohydrates - sweets, honey, sweet pastries;
  • refusal of carbonated beverages, alcohol and coffee in favor of weak tea, compotes, natural juices, herbal decoctions, mineral water;
  • vegetable oils, lean meat, low-fat dairy products, oatmeal and buckwheat cereals, vegetables and fruits are allowed;
  • fatty meat and broths, nuts, fried foods, egg yolks, sour cream, cottage cheese and high-fat milk, sausage, ice cream are prohibited;
  • permissible methods of cooking - steamed, by boiling and baking.

Which doctors should be consulted if you suspect?

If you experience any symptoms similar to cholecystitis, especially with acute pain in the right side, consult a gastroenterologist as soon as possible.

Otherwise, exacerbation or prolonged course of the chronic form of the disease can lead to serious complications - peritonitis, sepsis , inflammation of the neighboring organs, rupture of the gall bladder, disability, and even death.

Negative consequences can be avoided by timely diagnosis and treatment selected by a specialist.


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