Cholecystitis: Symptoms and Treatment
Cholecystitis is an inflammatory disease that occurs in the gallbladder and is accompanied by severe manifestations of symptoms. Cholecystitis, the symptoms of which are found, as, indeed, the disease itself, of the order of 20% of adults, can occur in acute or chronic form.
Cholecystitis, as we have already noted, is a fairly common disease, which is explained, in particular, by a number of factors that provoke its development and directly their prevalence. Such factors include a sedentary lifestyle and eating habits (animal-saturated foods such as butter, eggs, meat, etc.), endocrine disorders (diabetes, overweight), etc. It is noteworthy that women are prone to cholecystitis several times more often — it is explained by the use of oral contraceptives, as well as by pregnancy.
Numerous diseases, concentrated in the biliary tract, can mean a violation of the functional scale (for example, dyskinesia), inflammatory disorders (actually, cholecystitis), as well as metabolic disorders (cholelithiasis).
Each of these states represents one of the phases in the whole pathological process. So, initially the motor activity of the gallbladder is disturbed, which manifests itself in the form of dyskinesia, after which the inflammatory process itself is connected, but already in the form of an acalculous cholecystitis, and already after this time the transformation of this form of cholecystitis into cholelithiasis (cholelithiasis)
As the main cause of the disease is often isolated infectious factor, which is getting through the lymph and blood infections to the gallbladder.
Primary sources of infection:
- Inflammatory processes in the gastrointestinal tract (acute or chronic nature of the course). In particular, it can be appendicitis, enterocolitis, dysbacteriosis, pancreatitis, etc.
- Inflammatory processes of the reproductive system (prostatitis, adnexitis, etc.)
- Liver lesions of a viral nature.
- Parasitic invasion in the biliary tract (this can be ascaridosis, giardiasis, etc.)
As additional factors, we can distinguish the following:
- Dyskinesia of bile ducts. Disease is noted in any course of chronic cholecystitis, is the main cause of bile duct stagnation and impairment of its outflow.
- Pancreatic reflux. In this case, the contents of the duodenum go directly to the bile ducts. The effect exerted in this case by active enzymes in combination with pancreatic juice causes, in turn, damage in the area of the gallbladder walls. Pancreatic reflux occurs usually in cases of duodenal ulcers, as well as in diseases of the pancreas.
- Congenital anomalies. In this case, we are talking about anomalies associated with the development of the gallbladder.
- Disorders associated with blood supply of the gallbladder. Such complications are caused by diseases such as diabetes mellitus, hypertension, atherosclerosis and others. Their course is accompanied by narrowing of the vascular lumen.
- Dyscholia. This disease is associated with a violation of the composition of the bile, which also damages the wall of the gallbladder. A similar result is given by the features of nutrition, in which it is characterized by a saturated fat and a general monotony.
- Immunological reactions, allergic reactions. Against this background, again, there is a corresponding type of change that also affects the gallbladder wall.
- Endocrine disruption. Here, as we noted above, we are talking about the use of oral contraceptives, as well as violations in the menstrual cycle, overweight and pregnancy.
It is the impact of additional factors considered by us that provides the formation of appropriate conditions against which inflammation subsequently develops, and infection occurs.
According to the nature of the course, cholecystitis can be acute or chronic, according to the peculiarities of the course — catarrhal, phlegmonous and gangrenous.
Acute cholecystitis: symptoms
About 95% of patients with the disease in this form are also sick and cholelithiasis, in which stones appear in the gall bladder. When a stone enters the vesicular duct, that is, into a channel that provides for the flow of bile from the gallbladder, its jam occurs there, which in turn leads to the accumulation of bile in the gallbladder. Against this background, an infection develops, because of which the gallbladder walls become inflamed, and, accordingly, acute cholecystitis develops.
Because of the actual stagnation of bile in this case, enzymes are isolated, because of which the inflammation intensifies. Affected mucous bladder emits a greater volume of fluid than against the background of the processes under consideration can be absorbed by it. For this reason, the fluid accumulates, promoting parallel stretching of the gallbladder walls and enhancing the inflammatory process.
Sometimes acute cholecystitis becomes the cause of the necrosis of the gallbladder and its rupture.
After the end of the episode with acute inflammation, the organ affected by it becomes dense and compressed, resulting in the loss of its characteristic capacity for bile concentration. Such a course, in turn, becomes the basis for the development of cholecystitis in a chronic form, which we also consider below. Now we will stop on the symptomatology accompanying acute cholecystitis. Before this, I would also like to note that cholecystitis can be stoneless, that is, the appearance of stones does not accompany its course. In cases of acute cholecystitis this form of the disease is about 10%.
Given the predominant appearance of acute cholecystitis in those patients who have gallstones, the symptomatology of this disease often manifests itself in combination with the symptoms noted in cholelithiasis. For example, patients with acute cholecystitis, as it turns out, had previously manifested symptoms of hepatic colic.
So, the main symptom that accompanies such a disease as acute cholecystitis is the appearance of acute pain in the right hypochondrium. Such pain is similar to the pain that occurs with biliary colic, both in the strength of manifestation and in localization, but with cholecystitis it lasts much longer (up to 6 hours or more), accordingly, it has a stronger character of manifestation. In addition, the attack of the disease is also manifested in combination with nausea and vomiting.
Within a few hours of the onset of the disease, the patient has a symptom of Murphy, which is to increase pain with deep inspiration at the time of palpation of the area of the gallbladder, besides this, there is a characteristic muscle tension in the region of the right side of the upper abdomen. The temperature for cholecystitis generally increases slightly, but as a rule, its change is noted in the majority of patients.
Elderly people often face the first, and often the only symptoms of this disease in the form of lack of appetite and general malaise, temperature, weakness and vomiting.
Acute galloping cholecystitis characterizes the symptoms similar to the course of the disease that arose as a result of the appearance of gallstones. In some cases, fever and bloating are the only manifestations of the disease.
It should be noted that the absence of treatment can lead to gangrene and perforation of the gallbladder followed by sepsis, shock and peritonitis. This development of cholecystitis determines a rather high mortality rate, which reaches about 65%.
If in general treatment of cholecystitis is done in the right way, then the predictions for it are determined as favorable. Symptomatic symptoms of acute cholecystitis worsen after only 2-3 days, completely disappearing within one week (in 80% of cases).
Acute cholecystitis and pregnancy
Acute cholecystitis develops during pregnancy much more often than in other cases, which is explained by the squeezing of the entire digestive tract by the uterus. Accordingly, within the region of interest to us, there is a stagnation of bile in the complex with the formation of stones for this reason, all this, as we noted above, leads to the development of cholecystitis.
The course of acute cholecystitis during pregnancy is associated with certain risks. First of all, pregnancy sharply limits the possibility of using antibiotics, which in the treatment of cholecystitis are the main decision. Naturally, and surgical intervention to remove the inflammatory gallbladder is extremely undesirable.
Catarrhal cholecystitis: symptoms
Catarrhal cholecystitis is characterized by the appearance of permanent and fairly intense pains, centered in the right hypochondrium and epigastrium. There is a spread of pain to the right shoulder blade, waist, neck and shoulder strap.
The onset of the disease to this form can be manifested in the form of paroxysmal pains resulting from an increase in the contraction of the walls of the affected organ. Vomiting is often noted, after which patients are not relieved. Initially, vomit masses include only gastric contents, after — and duodenal.
The temperature rises to subfebrile values, tachycardia is characterized by moderate manifestations (about 100 bpm), in some cases, the pressure may increase. The tongue becomes wet in patients, a whitish coating appears on it. The act of breathing is broken, the stomach takes part in it.
The palpation of the abdomen reveals a sharp soreness in the region of the right hypochondrium, especially in the area of the gallbladder. Ortner and Murphy syndromes also appear, which imply the appearance of painful sensations when tapping along the right costal arch with the palm of the hand and intensifying the pain sensations during the palpation of the gallbladder area with deep inspiration. There is also soreness in the area above the right collarbone (Mussi-Georgievsky syndrome).
Phlegmonous cholecystitis: symptoms
This form of the disease is somewhat more severe than in the case of the previous form. So, the symptoms of phlegmonous cholecystitis consist in the appearance of severe pain in the region of the right hypochondrium, in severe weakness, high temperature (up to 39 ° C), loss of appetite, chills. Blood tests determine increased levels of white blood cells.
The emerging pain is more intense than in the previously considered form of cholecystitis, its intensification is noted with coughing and breathing, and also with changes in the occupied position of the body.
Nausea occurs more often, vomiting is multiple. The general condition also worsens. Again, with palpation, markedly pronounced soreness is noted. The symptoms of Murphy, Ortner and Mussi-Georgievsky are also relevant.
The gallbladder increases in size, when examined at this stage, there is a thickening of its wall, the presence of purulent exudate in the lumen. In some cases, the wall of the gallbladder can be characterized by the appearance on it of abscesses.
Gangrenous cholecystitis: symptoms
This form of cholecystitis, as a rule, develops against the background of the previous form, that is, the phlegmonous form. In this case, it is determined that the exhausted organism can not fight microorganisms, the impact of which accompanies the course of the pathological process.
Gangrenous cholecystitis is accompanied by the severity of symptoms of intoxication, which, again, are manifested in the form of general weakness, temperature, and sweating. There are also manifestations characteristic of general or local peritonitis (its purulent form).
As a rule, gangrenous cholecystitis appears in the elderly, which is due to deterioration of the protective properties inherent in the body, as well as disorders noted in the peculiarities of the blood supply to the walls of the gallbladder arising from the effects of atherosclerosis.
With the transition of the inflammatory process to the considered form of the course of the disease, abdominal pains may decrease somewhat, because of which there is an erroneous assumption regarding the improvement of one’s own state (so-called imaginary well-being). In fact, the weakening of this symptom is the result of the death of the nerve endings of the affected organ.
After some time, after a period of imaginary well-being, the symptoms of intoxication are again aggravated, besides this, symptomatology of common peritonitis also appears. This condition is accompanied by an increase in the frequency of cardiac contractions (about 120 beats per minute), an increase in temperature.
Inspection determines the dryness of the tongue. Because of the urgency of the paresis of the intestine, abdominal distension arises, its right sections do not participate in breathing. In general, breathing is characterized by increased frequency and superficiality.
The palpation reveals the severity of protective muscular tension in the anterior abdominal wall.
Chronic cholecystitis: symptoms
Predominantly chronic cholecystitis develops as an independent disease, which is especially important in the presence of predisposing factors to it. Somewhat less often chronic cholecystitis develops on the background of a preliminary manifestation of episodes of this disease in acute form.
The course of chronic cholecystitis is characterized by its own duration, that is, it can last for many years. Qualitative, timely and effective treatment allows to achieve remission of the disease, in which, accordingly, the disease «fades» for a long time. If there is no treatment, the organ affected by the disease is gradually wrinkled, as a result of which it completely loses its characteristic functions. Now let us dwell on the symptomatology accompanying chronic cholecystitis.
- Pain in the right upper quadrant (abdominal pain). The chronic form of cholecystitis is accompanied by aching and dull pain, which can last for several hours or several days in a row . A characteristic feature of such pain in chronic cholecystitis lies in its appearance or in strengthening as a result of consuming fried or fatty foods. Chronic form of the disease and pain in it in particular is characterized by its spreading upwards, that is, to the neck and to the right shoulder. Also, pain can give to the heart, to the waist.
- Vomiting. This symptom of chronic cholecystitis is not mandatory in the manifestation, however, it is also not possible to exclude it. Typically, vomiting appears similar to pain, namely when eating foods that are excluded by the appropriate diet for cholecystitis. There is a presence of bile in the vomit masses.
- «Saline syndrome.» It appears as a result of a prolonged course of cholecystitis. Its main feature is the appearance of intense and burning pain, concentrated in the navel with irradiation (spread) to the back.
- Bitterness in the mouth, belching bitter .
- Skin itch . It occurs as a result of the actual disturbance of bile secretion, is a kind of result of the irritation to which the skin receptors are exposed due to bile acids accumulating in the blood.
- Jaundice . Has a short-term character, appears, again, due to disorders associated with the outflow of bile.
- Temperature, chills . These manifestations are relevant for exacerbation of the chronic form of cholecystitis.
- Vegeto-vascular dystonia .
- Sweating, weakness .
- Mood instability .
- Headache .
- Sleep Disorders .
In patients with allergies, the aggravation of the disease in question is accompanied by the appearance of allergic reactions (Quincke’s edema, urticaria).
Women may experience premenstrual tension. So, for a period of 2 to 10 days before the onset of menstruation, they may exhibit unstable moods, headaches, swelling (swelling) of the face, legs, hands. At the same time, there are symptoms that indicate an exacerbation of chronic cholecystitis.
The conducted laboratory studies are as follows:
- Blood analysis (general) — allows to determine the presence of signs associated with inflammation.
- Blood test (biochemical)
- Blood sugar analysis (focuses on the diagnosis of diabetes mellitus)
- Urine and feces analysis
- Bacteriological and microscopic examination of bile
- Blood test for lambliosis.
The following are used as instrumental methods for diagnosing cholecystitis:
- Ultrasonography of the gallbladder
- duodenal sounding (multifractional).
- X-ray examination
- esophagogastroduodenoscopy (abdominal EGDS)
- CT, MRI (for complicated cases of diagnosis)
Treatment of cholecystitis
In case of actual clinical manifestations and the results of laboratory tests indicating the presence of inflammation, the doctor prescribes specific antibacterial therapy. Selection of antibiotics is made only by a physician based on the ability of the selected drug to concentration in the bile.
In addition, the treatment is also focused on the elimination of concomitant symptoms, that is, on the normalization of the functions inherent in the biliary tract and on the removal of pain that occurs with cholecystitis.
In addition to specific measures of therapy, a diet is also being developed. A definite effect gives treatment of cholecystitis with folk remedies.
The diagnosis of cholecystitis is made at the reception of the therapist and gastroenterologist, in addition the testimony may consist in the consultation of a surgeon, cardiologist, gynecologist and psychotherapist.