The main symptoms of cholecystitis in women: what are the features

Cholecystitis is a fairly common disease that occurs when the gallbladder is inflamed; the main symptom of the disease is acute pain, which is localized in the right side, the pain worsens when changing body position.

Statistics show that over the past few years, this disease has become registered 15% more often, while cholecystitis is less common in men than in women. The disease most often appears after fifty years of age. In this article we will talk in more detail about the symptoms and treatment of cholecystitis in adults.

Causes of the disease

The leading causes of the occurrence and development of acute or chronic inflammation of the gallbladder are bacterial infection and bile stagnation. Infection in the gallbladder can enter from the lumen of the duodenum or along with blood or lymph. The development of infection is facilitated by impaired bladder emptying.

The cause of the outflow disturbance may be congenital deformation of the cervical part of the gallbladder and cystic duct, as well as biliary dyskinesia (impaired neuro-reflex and humoral regulation of bile duct motility). Biliary dyskinesia is a fairly common functional disorder in children, especially those who have disrupted diet, study and rest, and who are subject to frequent nervous stress at home and at school.

The inflammatory process in the wall of the gallbladder leads to disruption of its function, stagnation of bile and changes in its physicochemical properties, which, in turn, maintains inflammation and contributes to the transition of acute inflammation to chronic, as well as stone formation.

Cholecystitis is predisposed by a sedentary lifestyle and rare, plentiful intake of food rich in protein and fat. The risk of acute cholecystitis also increases during pregnancy, when, due to an increase in intra-abdominal pressure, the evacuation of bile into the duodenum is disrupted. In addition, this disease is promoted by chronic constipation, excess weight, frequent accumulation of gases in the intestines, as well as roundworms and lamblia located in the bile ducts. Doctors consider women with the so-called “four Fs” to be a high-risk group - fat, over 40, who have children and who suffer from gas (in English fat, fortyish, fertile, flatulent).

Hereditary predisposition plays a decisive role in the occurrence of cholecystitis. It can be triggered by metabolic disorders, allergic factors, circulatory disorders of the gallbladder wall (with diffuse connective tissue diseases, atherosclerotic vascular lesions, etc.). Quite often, cholecystitis develops against the background of gastritis, gastric and duodenal ulcers, pancreatitis, and a tumor process in the abdominal cavity.

Signs of purulent form

This type of pathology can appear against the background of other diseases, for example, decompensated diabetes mellitus or against the background of dehydration. It is very important to treat purulent cholecystitis as quickly as possible, since it is dangerous for the body.

This form of pathology is characterized by an inflammatory process on the walls of the gallbladder; as the disease progresses, purulent contents are formed. The symptoms of the disease are as follows: the appearance of severe pain, frequent profuse vomiting, headaches, very high body temperature, acute pain in the stomach, upset stool, dizziness and fainting.

Classification

In gastroenterology, there are several classifications of the disease, each of which is of great importance, giving specialists the opportunity to attribute certain clinical manifestations to a specific type of disease and choose rational treatment tactics. Taking into account the etiology, two types of cholecystitis are distinguished:

Calculous
. Stones are found in the organ cavity. Calculous cholecystitis accounts for up to 90% of all cases of the disease. It may be accompanied by intense symptoms with attacks of biliary colic or be asymptomatic for a long time.
Non-calculous
(stoneless). Accounts for 10% of all cholecystitis. It is characterized by the absence of stones in the lumen of the organ, a favorable course and rare exacerbations, usually associated with nutritional errors.

Depending on the severity of symptoms and the type of inflammatory-destructive changes, cholecystitis can be:

Spicy
. Accompanied by pronounced signs of inflammation with a violent onset, vivid symptoms and symptoms of intoxication. The pain is usually intense and wave-like.
Chronic
. It manifests itself as a gradual, slow course without pronounced symptoms. The pain syndrome may be absent or aching and of low intensity.

Based on the severity of clinical manifestations, the following forms of the disease are distinguished:

Easy.
It is characterized by a low-intensity pain syndrome lasting 10-20 minutes, which is self-limiting. Digestive disorders are rarely detected. Exacerbations occur 1-2 times a year and last no more than 2 weeks. The function of other organs (liver, pancreas) is not changed.
Moderate weight.
The painful sensations are persistent with pronounced dyspeptic disorders. Exacerbations develop more often than 3 times a year and last more than 3-4 weeks. Changes in liver function are noted (increased ALT, AST, bilirubin).
Heavy
. Accompanied by pronounced pain and dyspeptic syndromes. Exacerbations are frequent (more than once a month), long-lasting (more than 4 weeks). Conservative treatment does not provide significant improvement in well-being. The function of neighboring organs is impaired (hepatitis, pancreatitis).

According to the nature of the course of the inflammatory-destructive process, they are distinguished:

Relapsing course
. It manifests itself as periods of exacerbation and complete remission, during which there are no manifestations of cholecystitis.
Monotonous flow
. A typical sign is the absence of remissions. Patients complain of constant pain, discomfort in the right abdomen, upset stool, and nausea.
Intermittent flow.
Against the background of constant mild manifestations of cholecystitis, exacerbations of varying degrees of severity periodically occur with symptoms of intoxication and biliary colic.

Complications of cholecystitis.

Complications include: pericholecystitis, pancreatitis, cholangitis, reactive hepatitis, duodenitis.

Pericholecystitis occurs when all the walls of the gallbladder and the serous membrane (peritoneum) are involved in the pathological process. In this condition, the pain syndrome is constant and intense, spreads to the right side, and intensifies when turning and bending the torso.

Cholangitis is an inflammatory process in the bile ducts. The main symptom is an increase in temperature to 40 degrees with stunning repeated chills, nausea, vomiting, cramping pain in the right hypochondrium.

With non-calculous cholecystitis, other organs of the digestive system are often involved in the pathological process: if, along with pain in the right hypochondrium, painful sensations of a “girdling” nature appear, loose stools, the pancreas may be involved in the pathological process. If the pain spreads to the entire area of the liver and is accompanied by its enlargement, the addition of reactive hepatitis, the occurrence of late, hungry pain in the upper abdomen indicates the presence of duodenitis.

Complications not only cause loss of ability to work, but also pose a threat to the patient’s life, therefore, when the first symptoms of the disease appear, you should immediately consult a doctor - a therapist or gastroenterologist.

Symptoms of acute cholecystitis

This form of the disease goes through three stages in its development, each of which has its own clinical picture:

Catarrhal cholecystitis is manifested by constant severe pain in the right hypochondrium, radiating to the right half of the body - the shoulder blade, shoulder, and right surface of the neck. At the beginning of the disease, pain can be paroxysmal. Vomiting of stomach contents often occurs. Bile is almost always found in vomit. The temperature is low-grade, the pulse is normal.
With phlegmonous cholecystitis, inflammation penetrates deep into the wall of the gallbladder, affecting not only its mucous membrane, but also the underlying layers. The pain in this form is much more intense and intensifies with changes in body position, breathing, coughing, and straining. Vomiting is repeated, temperature is high (38-39°C). The pulse increases to more than 100 beats per minute. The abdomen is swollen and painful when palpated.
With gangrenous cholecystitis, which often occurs in older people, general symptoms come first. The pain subsides somewhat, but this is only apparent well-being. The reason for the decrease in pain is the death of nerve receptors under the influence of an infection that penetrates the entire thickness of the gallbladder wall. The patient's condition sharply worsens, he becomes lethargic and lethargic. The phenomena of general peritonitis—inflammation of the peritoneum, resulting from the spread of infection from the gallbladder into the abdominal cavity—are increasing. The temperature is high, there is strong tachycardia, it is sharply swollen, painful on palpation in all parts, and tense. This is an extremely dangerous form of the disease, often leading to a tragic outcome even with proper treatment.

Symptoms of chronic cholecystitis

The chronic form of the disease, as a rule, is not complicated by cholelithiasis and can proceed unnoticed in most people over 40 years of age, with women several times more likely to become victims of this insidious disease.

Pain

Pain is the main manifestation of the disease. Their intensity, location and duration depend on:

type of biliary dyskinesia;
the presence of concomitant diseases of the gastrointestinal tract;
presence of complications.

In chronic acalculous cholecystitis, pain is most often located in the right hypochondrium or epigastric region. Moreover, patients notice that they intensify after heavy meals, eating fried, fatty, spicy foods, abuse of alcohol, carbonated drinks or excessive physical activity.

Attention! As a rule, pain with cholecystitis is constant, nagging, but in certain cases it may be more reminiscent of a feeling of heaviness in the right hypochondrium.

It is fatty and fried foods that most often cause nagging, dull pain.

When complications arise, pain may become more pronounced and change location. Therefore, if during an uncomplicated course of chronic cholecystitis they can radiate only to the right scapula, shoulder or collarbone, then with the development of pericholecystitis they become constant, intensifying with bending or turning the body and sudden movements with the right hand, and so on.

Attention! If left untreated and not following a diet, chronic cholecystitis can become acute or cause the formation of stones in the gall bladder.

Dyspeptic disorders

During an exacerbation of the disease, most patients experience vomiting and other dyspeptic complaints, especially if they are caused by the development of concomitant pathology, for example, gastroduodenitis or pancreatitis. As a rule, vomiting is also provoked by errors in diet and alcohol intake.

During an exacerbation of the disease, patients may suffer from:

constant nausea;
bitterness in the mouth;
bitter belching with a rotten taste;
decreased appetite;
flatulence;
heartburn.

Particular attention should be paid to stool during cholecystitis, since changes in its consistency and frequency may indicate the addition of complications of the disease and the development of secondary infections. For example, constipation and bloating usually occur with intestinal paresis or hypokinetic conditions. Diarrhea with cholecystitis is also possible, especially if the patient develops secondary gastroduodenitis, gastritis, enteritis or pancreatitis. Thus, diarrhea with cholecystitis is a sign of the addition of other diseases.

The severity of the disease and the addition of concomitant diseases can be judged by changes in the nature of stool

The color of stool may also indicate the presence of the disease. The color of stool with cholecystitis is usually light, which is due to insufficient flow of bile into the intestinal lumen. In certain cases it can even be completely white.

Other signs

As a result of stagnation of bile in the gallbladder, irritation of the nerve endings occurs, which leads to skin itching. This is usually observed with cholelithiasis, although it is also possible with non-calculous cholecystitis. In addition, in allergy sufferers, cholecystitis often causes the development of urticaria, Quincke's edema, and so on.

The temperature with cholecystitis rarely remains unchanged. Slightly less than half of the patients experience a slight increase during an exacerbation of the disease, which is accompanied by chills. But jaundice, although it can occur, is still not one of the most common signs of the disease.

With a long course of the disease, the solar plexus may be involved in the inflammatory process, which manifests itself:

sometimes burning pain in the navel area, which tends to radiate to the back;
dyspeptic symptoms;
tenderness of certain points upon palpation located between the xiphoid process and the navel;
soreness of the xiphoid process when pressed (Pekarsky's symptom).

If we talk about the characteristic symptoms of cholecystitis in women, then some women may develop a symptom of premenstrual tension due to hormonal imbalance. It manifests itself as metabolic-endocrine, vegetative-vascular and neuropsychological disorders, that is, the symptoms of premenstrual tension are:

mood instability, for example, depression, tearfulness, irritability, and so on;
headache;
breast engorgement and tenderness;
pastiness of the face and hands;
numbness of the limbs;
surges in blood pressure.

The well-known PMS may be one of the signs of cholecystitis

Important: all signs of premenstrual tension appear a few days before the onset of menstruation and disappear almost immediately after its onset.

In some cases, patients complain of irregular heartbeats, pain in the heart area, which can hardly be called severe, and diffuse changes in the myocardium can be clearly seen on the ECG. These symptoms usually appear after drinking alcohol or fatty foods. That is, they develop cholecystocardiac syndrome.

“Clinical masks” of cholecystitis

Thus, the manifestations of chronic cholecystitis are rarely pronounced; on the contrary, more often this disease seems to be disguised as others. Therefore, in different patients, the clinical picture is dominated by signs of a certain group, which makes diagnosis very difficult. Thus, the following groups of symptoms of cholecystitis or its “clinical masks” are distinguished:

Gastrointestinal, which is characterized by a predominance of dyspeptic complaints in the absence of pain characteristic of cholecystitis.
Cardiac, in which the main complaints of patients are cardialgia and angina. Most often, these symptoms of cholecystitis are observed in men after 40 years of age.
Neurasthenic, manifested by a pronounced neurotic syndrome.
Rheumatic, accompanied by interruptions in heart function, arthralgia, sweating, ECG changes.
Thyrotoxic, signs of which are increased irritability, sweating, trembling in the hands, weight loss and tachycardia.
Solar, which manifests itself as a predominance of symptoms of damage to the solar plexus.

Important: the symptoms of cholecystitis can only be assessed if the patient has not recently taken any medications.

However, no matter how pronounced the symptoms accompanying the patient’s pathological condition are, based on his examination and questioning, the doctor can only make an assumption about the diagnosis. In order to confirm it, it is necessary to conduct laboratory and instrumental studies, which we described in the article about the diagnosis of cholecystitis.

Calculous

The formation of a solid sediment in the form of stones in the gall bladder leads to the appearance of calculous cholecystitis. The disease mainly affects adults over 40 years of age. Women are susceptible to it more often than men. With rare exceptions, children get sick.

Concretions - stones of various shapes and diameters can be located both in the gallbladder and in the ducts, thereby complicating the outflow of bile, which causes an attack of biliary colic and a chronic inflammatory process. Stones form against the background of changes in the basic composition of bile, and also as a concomitant pathology with gastrointestinal diseases.

Factors that increase the risk of stone formation may include:

violation of diet;
excessive consumption of foods high in animal fats;
inactive lifestyle;
heredity.

The leading research method when symptoms of calculous cholecystitis appear is ultrasound diagnostics of the abdominal organs. Other research methods are prescribed according to indications. As a rule, surgery is required to remove the gallbladder, since the presence of stones in it leads to constant inflammation.

In case of chronic cholecystitis, the operation is carried out as planned, in case of acute cholecystitis - in an emergency. Existing methods of drug treatment aimed at dissolving stones are not justified.

Causes of cholecystitis

Diseases of the biliary tract are divided into 3 groups:

Metabolic – cholelithiasis develops.
Inflammatory – cholecystitis.
Functional – dyskinesia.

All these conditions accompany one pathological process - first the motility of the gallbladder is impaired - dyskinesia is diagnosed, after a while an inflammatory process develops - they talk about acalculous cholecystitis, which after a while can result in cholelithiasis (cholelithiasis).

In medicine, there are main and additional causes. The main ones include infection. It ends up in the gallbladder through lymph, blood, and intestines.

It is very important to find out about the primary source of the disease:

Chronic or acute inflammation of the intestines, stomach - enterocolitis, dysbacteriosis, appendicitis, pancreatitis.
Respiratory organs - tonsillitis, sinusitis, as well as oral cavity - periodontal disease.
Inflammation of the urinary tract – cystitis, pyelonephritis.
Viral liver damage.
Inflammation of the genital organs. For example, in women it is adnexitis, and in men it is prostatitis.
Damage to the biliary tract by parasites – ascariasis, giardiasis.

As for additional factors, we can talk about the following:

Dyskinesia of the biliary tract, in which the tone and motility of the gallbladder and ducts are disrupted. It all ends with a violation of the outflow, stagnation of bile.
Congenital anomalies in the gallbladder.
Pancreatic reflux, in which the contents of the duodenum are thrown into the bile ducts. Pancreatic juice contains active enzymes that lead to enzymatic damage to the gallbladder. The symptom is characteristic of diseases of the duodenum and pancreas.
Problems with blood supply to the gallbladder arise due to hypertension, atherosclerosis, and diabetes. It all ends with a narrowing of the vascular lumen.
Dyscholia, in which the composition of bile is disturbed. Due to changes in the main components, the walls of the gallbladder are damaged. This occurs when a person eats fatty, monotonous foods.
An immunological, allergic reaction ends in an inflammatory process.
Genetic predisposition.
Changes in the functioning of the endocrine system - taking contraceptives, pregnancy, obesity, menstrual cycle disruption.

We note that all factors lead to inflammation, activation of bacterial flora and the development of the disease.

Non-calculous

Inflammation of the gallbladder against the background of obstructed outflow of bile without cholelithiasis is called acalculous cholecystitis. This disease is always combined with hepatitis, inflammation of the bile ducts and pancreas.

Non-calculous cholecystitis can develop under the influence of:

Microbial infection of the gallbladder;
Corrosion of the mucous membranes of the organ by pancreatic enzymes;
Circulatory disorders in the walls of the gallbladder.

Non-calculous cholecystitis is manifested by typical and atypical symptoms:

Typical form. The disease is characterized by dull, monotonous pain in the right hypochondrium forty to ninety minutes after eating, driving off-road or carrying heavy objects. The pain increased in the sitting position and calmed down in the lying position. The pain is combined with heartburn, nausea and belching;
Cardialgic syndrome. Dull pain in the precordial region, arrhythmias and extrasystoles that occur after eating. The electrocardiogram shows a negative T wave, smoothed QRS waves;
Esophagic syndrome. Persistent heartburn, dull pain and sensation of a foreign body behind the sternum. Temporary dysphagia (difficulty swallowing food);
Intestinal syndrome. Abdominal bloating with non-localized pain and persistent constipation.

Chronic noncalculous cholecystitis is an inflammation of the gallbladder that occurs as a result of microbial infection, accompanied by the proliferation of connective tissue and stagnation of bile without the formation of stones.

Penetration of microflora into the focus of pathogenesis occurs along an ascending or descending path, or lymphogenously:

The ascending path is from the intestine to the neck of the bladder and higher. Promotes dysfunction of the sphincter, which prevents the reverse flow of bile from the intestine;
The descending path is when the infectious agent circulates in the bloodstream. Some sources call it the “hematogenous” route of infection;
Lymphogenic. Lymph is a biological fluid of the body that is involved in many functions, including neutralizing inflammatory reactions. In case of massive purulent infections (genitourinary, respiratory, digestive), lymph fails to cope with its role and becomes a factor in the transmission of infection.

The development of the pathogenesis of chronic acalculous cholecystitis is accompanied by a loss of contractile and absorptive functions of the gallbladder, which leads to stagnation (occlusion) of bile, thickening of the walls and shrinkage of the organ.

Features of the disease

The nature of the clinical picture is determined by the role played by the gallbladder in the digestive system. This organ is located in the right hypochondrium. The bladder accumulates bile produced by the liver, which:

stimulates perilstatics of the small intestine;
changes the properties of food entering the small intestine;
stimulates the production of mucus, which protects the small intestine;
suppresses the activity of bilirubin, cholesterol and some other substances;
stimulates the synthesis of enzymes responsible for food processing.

The main reason for the development of cholecystitis is a violation of the outflow of bile , which is caused by exposure to various factors.

Provoking factors

More often, inflammation in the gallbladder develops under the influence of the following factors:

cholelithiasis;
atherosclerosis, due to which the blood supply to the walls of the gallbladder is disrupted;
reflux esophagitis, accompanied by the reflux of pancreatic juice into the bile ducts;
infection of the bile ducts with pathogenic microflora.

Possible causes of cholecystitis include:

unhealthy diet (abuse of fatty foods, fast food);
severe stress;
abnormal structure of the gallbladder and ducts;
hormonal imbalance;
intense allergic reaction (mainly to food);
immune diseases;
sudden weight loss.

The risk group for developing cholecystitis includes women over 40 years of age. During this period, hormonal changes in the body occur, causing disruptions in the functioning of the gallbladder. In addition, signs of the disease are often observed during pregnancy. The growing abdomen compresses the bile ducts and bladder, which contributes to inflammation of local tissues.

Classification

Cholecystitis can be acute or chronic . The first form of the disease is characterized by dull pain that is localized in the right hypochondrium and radiates to the scapula or shoulder. At the same time, the patient is often bothered by nausea, vomiting and chills. The development of the inflammatory process causes an increase in body temperature. And gallbladder dysfunction contributes to an increase in the concentration of bilirubin in the blood, which manifests itself in the form of yellowing of the skin.

The chronic form of the disease is characterized by an asymptomatic course. Typically, pain in the right hypochondrium occurs when the body experiences severe shaking. Sometimes the patient is bothered by bloating, which mainly manifests itself after consuming fried and fatty foods. Poor nutrition due to cholecystitis also provokes diarrhea.

In the calculous form of the disease, caused by the penetration of stones into the bile ducts, colic-type pain occurs. Over time, when the inflammatory process develops, other signs of pathology join the initial symptom.

Depending on the nature of the clinical picture, the following forms of cholecystitis are distinguished:

catarrhal;
phlegmonous;
gangrenous.

With catarrhal cholecystitis, pain is noted in the right hypochondrium, radiating to the scapula, neck and lower back. At the initial stage of development of the inflammatory process, this symptom is disturbing during the period of active work of the gallbladder.

Over time, the pain syndrome becomes permanent.

In advanced cases, the course of catarrhal cholecystitis is accompanied by frequent vomiting (stomach and duodenal contents), after which the patient does not experience relief.

An exacerbation of the disease lasts several days. During this period, the temperature rises to 37.5 degrees. Also, the clinical picture of catarrhal cholecystitis is often supplemented by the following phenomena:

increase in heart rate up to 100 beats per minute;
slight increase in blood pressure;
whitish coating on the tongue (rare);
hyperemia;
moderate increase in leukocytes in the blood.

Phlegmonous cholecystitis is characterized by more intense pain in the right hypochondrium. This symptom occurs when changing body position , frequent and deep breathing, and coughing. Body temperature with phlegmonous cholecystitis rises to 38-39 degrees. The course of the disease is accompanied by:

rapid heartbeat (up to 120 beats per minute);
attacks of nausea with vomiting;
chills;
deterioration of general condition;
slight bloating;
enlargement of the gallbladder (palpable upon palpation).

Phlegmonous cholecystitis is characterized by thickening of the walls of the gallbladder, on which plaque with purulent inclusions often forms.

The gangrenous form of the disease occurs at the last stage of development of the inflammatory process. The overall intensity of the pathology increases. The danger of this condition lies in the fact that with gangrenous cholecystitis, the immune system is not able to resist pathogenic microorganisms, and the latter affect internal organs.

The advanced form of the disease is characterized by the following symptoms:

pronounced signs of general intoxication of the body;
increase in body temperature to 38-39 degrees;
rapid heartbeat (up to 120 beats per minute);
rapid and shallow breathing;
dry tongue;
severe bloating;
dysfunction of the small intestine (the organ practically stops working).

With gangrenous cholecystitis, the alkaline and electrolyte balance of the blood is disturbed. This form of the disease develops mainly against the background of atherosclerosis, and therefore older people are more susceptible to the development of pathology.

Attack of cholecystitis

Attacks are characteristic of both primary cholecystitis and exacerbations of the chronic form of the disease. Harbingers of attacks are discomfort in the stomach after eating fatty, spicy foods or alcohol.

Symptoms of an acute attack of cholecystitis:

Sharp cramping pain in the right hypochondrium, epigastrium or navel;
Nausea and vomiting, gas belching, bitter taste in the mouth;
Low-grade or febrile body temperature (37-38 0 C or 38-39 0 C).

How to relieve an attack of cholecystitis?

To relieve an attack of cholecystitis it is necessary:

Call an ambulance;
Lie in bed and apply cold to your stomach;
Take an antispasmodic (papaverine, no-shpa) and an analgesic (analgin, baralgin);
To reduce nausea, drink mint tea or still mineral water at room temperature;
If there is vomiting, ensure that the vomit is collected for analysis.

Symptoms of cholecystitis

Acute cholecystitis, the symptoms of which often develop in the presence of gallstones and are a complication of cholelithiasis.

Symptoms of acute cholecystitis develop rapidly; they are often called “liver colic”, since the pain syndrome is localized specifically in the liver area.

The main signs of the acute stage of the disease are:

Incessant pain in the right hypochondrium, which can radiate to the right side of the chest, neck, or right arm. Often, before the onset of pain, an attack of biliary colic occurs;
Nausea and vomiting, after which there is no relief;
Feeling of bitterness in the mouth;
Increased body temperature;
In case of complications – jaundice of the skin and sclera.

The pain is often accompanied by nausea and vomiting of bile. Usually there is an increase in temperature (up to 38 C and even up to 40 C), chills. The general condition worsens significantly.

The provoking factor that gives rise to the development of an acute attack of cholecystitis is severe stress, overeating spicy, fatty foods, and alcohol abuse. If you don’t figure out how to treat cholecystitis in time, it will become chronic and will bother you for a long time.

Complications

The presence of any cholecystitis is always fraught with the possible development of complications. Some of them are very dangerous and require immediate surgical intervention. Thus, as a result of cholecystitis, patients may experience:

pericholecystitis (transition of inflammation to nearby tissues and organs);
cholangitis (spread of inflammation to intra- and extrahepatic bile ducts of different sizes);
blockage of the bile ducts;
“porcelain” gallbladder (the result of deposition of calcium salts in the wall of the bladder);
empyema of the gallbladder (purulent inflammation);
necrosis of the wall (necrosis) of the gallbladder due to inflammation and pressure on it from stones (stone);
perforation of the wall (formation of a hole in it) as a result of necrosis, as a result its contents end up in the patient’s abdominal cavity and leads to inflammation of the peritoneum (peritonitis);
the formation of fistulas between the bladder and the intestine, the bladder and the renal pelvis, the bladder and the stomach (the result of necrotic changes in the gallbladder wall;
“disabled” (non-functioning) gallbladder;
secondary biliary cirrhosis (a consequence of prolonged calculous cholecystitis);
gallbladder cancer.

Danger of disease

If acute and chronic cholecystitis is not treated, it will lead to the development of severe consequences, including death. Serious complications of the disease are infection, tissue necrosis, perforation of the walls. If characteristic symptoms of inflammation appear, you should immediately consult a doctor and undergo treatment under his supervision.

Infection

Stagnation of bile leads to impaired blood circulation, creating conditions for the addition of a secondary infection caused by bacteria and fungi. Purulent contents can spread throughout the body through the bloodstream. This is fraught with the development of sepsis and infection of other organs.

Blood poisoning often ends in the death of the patient.

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Tissue necrosis

If treatment is not carried out, gangrene of the gallbladder may begin, during which the tissue of the organ is destroyed. Necrosis threatens to rupture the walls and develop peritonitis (purulent inflammation of the abdominal cavity). The situation requires immediate surgery.

Gallbladder perforation

Untreated inflammation can lead to rupture of the organ walls. If the perforation is local, it causes the development of a paravesical abscess with tissue suppuration.

A rupture into the abdominal cavity can lead to death.

Sometimes perforation of an adjacent organ occurs. If at the same time a large stone migrates into the intestines, which can cause its blockage and dysfunction.

Diagnostics

A gastroenterologist treats cholecystitis. In the chronic form of the disease, it will be useful to consult a nutritionist. A physical therapist may provide additional assistance.

To make a diagnosis, the following activities are carried out:

taking anamnesis;
examination of the patient;
laboratory examinations;
instrumental studies.

Laboratory research:

General blood analysis. Reveals signs of inflammation.
Biochemical blood test: total bilirubin and its fractions, transaminases, alkaline phosphatase, cholesterol. Their moderate increase is observed.
Blood sugar. For the diagnosis of diabetes mellitus.
General urine analysis. For differential diagnosis with kidney diseases.
Feces for worm eggs. To identify Giardia, Ascaris.
Microscopic and bacteriological examination of bile.
Immunoenzymatic blood test for giardiasis.
Fecal elastase analysis 1. To diagnose pancreatitis.

The following diagnostic methods are used:

Ultrasound diagnostics. It is carried out to detect signs of pathologically altered gallbladder tissue, in some cases, stones;
Holegraphy. An X-ray examination method that complements ultrasound. Used to identify hidden pathologies of the gallbladder;
Probing of the duodenum. Used to sample the contents of the small intestine.

The best way to determine the presence of the disease is early research. Most often, identifying certain deviations in the chemical composition of bile may only require adherence to a non-strict diet.

How to treat cholecystitis?

Since the cause of cholecystitis is an infection, if there are signs of its exacerbation (pain, fever, changes in blood tests), antibiotics are prescribed, but it is better to entrust this to a doctor, who ideally has the results of bile culture on hand.

But at home you can and should be treated with the following means:

Follow a diet. During an exacerbation, you can generally fast for a day or two, but at the same time drink weak tea, juices or fruit drinks diluted with water 1:1, or still mineral water. Then add puree soups and porridges, then low-fat cottage cheese, boiled meat and steamed fish, and after 5-7 days you can switch to a gentle, but completely physiological diet, excluding fried foods, fatty foods, such as goose or cream cakes, smoked and spicy foods. seasonings (for example, horseradish or mustard). It is better to eat often, every 3 hours, but little by little.
For pain, take antispasmodics. This is a traditional no-spa (2 tablets three times a day, but no more, read the side effects in the annotation and make sure that this is a serious drug and an overdose is unacceptable), papaverine (can be taken in suppositories - many note that the effect is even better than from tablets), duspatalin 1 tablet 2 times, 20 minutes before meals.
The choice of choleretic drugs depends on the motility of the biliary tract.

In general, the basis for the treatment of acute and chronic non-calculous cholecystitis is complex drug and diet therapy. In case of a frequently recurrent calculous form of the disease or when there is a threat of complications, surgical intervention on the gallbladder is resorted to.

Treatment of chronic cholecystitis

Treatment of a chronic process without the formation of stones is always carried out by conservative methods, the main of which is dietary nutrition (diet 5 - fractional meals with a sufficient volume of liquid, mineral water). If there are gallstones, limit hard work, physical overload, and bumpy driving.

The following drugs are used:

Antibiotics, most often broad-spectrum or cephalosporins
Enzyme preparations - Pancreatin, Mezim, Creon
Detoxification - intravenous infusions of sodium chloride, glucose solutions
NSAIDs - sometimes used to relieve inflammation and pain

Choleretic drugs are usually divided into:

Choleretics are drugs that enhance the formation of bile. Preparations containing bile and bile acids: allohol, lyobil, vigeratin, cholenzyme, dihydrocholic acid - hologon, sodium salt of dehydrocholic acid - decholin. Herbal preparations increase the secretion of bile: flakumin, corn silk, berberine, convaflavin. Synthetic drugs: osalmide (oxafenamide), hydroxymethylnicotinamide (nicodine), cyclone, gymecromone (odeston, holonerton, cholestil).
Cholekinetics are divided into: promoting the secretion of bile and increasing the tone of the gallbladder (magnesium sulfate, pituitrin, choleretin, cholecystokinin, sorbitol, mannitol, xylitol) and cholespasmalytics, reducing the tone of the biliary tract and sphincter of Oddi: drotaverine hydrochloride, no-spa, olimethine, atropine, platiphylline, aminophylline, mebeverine (duspatalin).

During periods of exacerbation, herbal medicine is very widely used, in the absence of allergies to it - decoctions of chamomile, dandelion, peppermint, valerian, calendula. And during periods of remission, it is possible to prescribe homeopathic treatment or herbal medicine, but with other herbs - yarrow, marshmallow, tansy, buckthorn.

It is very important to follow a strict diet after an exacerbation of cholecystitis, then the symptoms gradually subside. In addition to a diet for gallstones and cholecystitis, it is also recommended to periodically apply tubages with xylitol, mineral water or magnesium; physical therapy is effective - electrophoresis, reflexology, SMT therapy.

In case of calculous chronic cholecystitis with pronounced symptoms, it is recommended to remove the gallbladder, the source of the growth of stones, which can pose a threat to life if they move. The advantage of chronic cholecystitis with stones from acute calculous cholecystitis is that this operation is planned, it is not an emergency measure and you can safely prepare for it. Both laparoscopic surgery and cholecystectomy from a mini-access are used.

When surgery is contraindicated, sometimes with chronic cholecystitis, treatment may consist of the method of crushing stones - shock wave lithotripsy; this extracorporeal procedure does not remove stones, but simply crushes, destroys them, and often causes them to re-grow. There is also a method for destroying stones using salts of ursodeoxycholic and chenodeoxycholic acids; in addition to the fact that this therapy does not lead to a complete cure, it is also quite long in time and lasts up to 2 years.

Nutrition and diet

During the period of severe exacerbation of cholecystitis, patients are recommended to undergo treatment in a hospital - therapeutic or gastroenterological, adherence to bed rest, and a state of psycho-emotional rest. After the elimination of pronounced signs of exacerbation, the patient’s regimen is expanded to general.

During an exacerbation, in the first two days, only warm liquids are prescribed (weak sweet tea, fruit and vegetable juices diluted with water, still mineral water) in small portions up to 1.5 liters per day and several crackers. As the pain subsides and the general condition improves, the dietary table expands. Recommend:

pureed soups from vegetables and cereals,
porridge (oatmeal, rice, semolina, buckwheat),
jelly, mousse, jelly, low-fat cottage cheese,
lean boiled fish,
pureed and boiled meat, steamed cutlets (veal, chicken, turkey, rabbit),
white crackers.

Food is taken in fractional portions 5-6 times a day.

During an exacerbation period, it is recommended to carry out fasting days 1 day a week:

cottage cheese - kefir day. 900g kefir for 6 doses, 300g low-fat cottage cheese for 3 doses and 100g sugar;
rice - compote. 1.5 liters of compote prepared from 1.5 kg of fresh or 240 g of dry fruits for 6 servings, rice porridge cooked in water from 50 g of rice - for 3 servings.

After stopping the exacerbation of cholecystitis, a diet is prescribed, table No. 5, which is the main one for this disease.

Patients are recommended:

milk, fruit, vegetable broth soups with cereals, noodles;
boiled meat, steam cutlets, meatballs (beef, rabbit, chicken, turkey);
low-fat varieties of sea or river fish, boiled or baked, without crust;
eggs, up to 1-2 per day – soft-boiled, in the form of steam omelettes;
dairy products: low-fat milk, cottage cheese, kefir, yogurt, yogurt, butter (limited);
vegetables boiled, baked, partially raw. Potatoes, beets, carrots, tomatoes, cucumbers, pumpkin, sweet peppers, eggplants, cauliflower, zucchini;
fruits and berries. Pears, melons, bananas, peaches, apricots, watermelons, sour apples;
porridge – buckwheat, oatmeal, rice, semolina, with the addition of milk, if tolerated;
sweet dishes - marshmallows, marmalade, honey, jams, preserves, jelly;
flour products - wheat and rye bread, yesterday's bread, white bread crackers, dry unsweetened cookies.

You need to eat food in small portions, slowly 5-6 times a day. Long breaks between meals and fasting are not recommended. Breakfast is required, dinner 2-3 hours before bedtime, not much. The amount of liquid is not limited. A large amount of food, taken once, disrupts the rhythm of bile secretion, causes spasm of the gallbladder and provokes pain.

In case of chronic cholecystitis, it is necessary to increase the consumption of foods that improve the flow of bile and reduce cholesterol levels:

rich in dietary fiber (bran, vegetables, fruits, berries). The bran is pre-steamed and added to dishes, 1-1.5 tablespoons 3 times a day;
rich in magnesium salts (buckwheat and oatmeal, dried fruits, bran);
containing essential polyunsaturated fatty acids, phospholipids, vitamin E (corn, olive, sunflower and other oils);
containing lactic acid bacteria (fermented milk drinks, cottage cheese).

Products not recommended

with a high content of animal fats (fried foods, fatty fish, pork, lamb, duck, sausages, smoked meats, mayonnaise, creams, cakes, pastries);
raw onions, garlic, radishes, sorrel, spinach, mushrooms, bean dishes (peas, beans);
cold and carbonated drinks, concentrated juices, coffee, cocoa, alcoholic drinks.

Diet

In case of exacerbation of cholecystitis, it is recommended to spend several days without food. You are allowed to drink weak warm tea or rosehip decoction. Next, you should adhere to a strict diet until all symptoms of cholecystitis disappear.

You need to eat small portions 6 times a day. Food should be steamed or boiled, pureed in a blender. The menu usually consists of the following products:

vegetarian slimy cereal soups;
liquid cereal porridges;
boiled fish;
steamed lean fish cutlets;
low-fat dairy products, liquid cottage cheese;
jelly;
white bread crackers.

For cholecystitis, the following products are prohibited:

spicy, smoked, salted, fatty, fried;
rich broths;
fatty meat and fish;
mayonnaise and fatty sauces;
sausage products;
chocolate;
cocoa and chocolate;
carbonated drinks;
food that contains preservatives.

After remission, you must adhere to the 5A diet menu. The health status of cholecystitis largely depends on nutrition. The healthier it is, the better all systems and organs will work, especially the biliary system.

Folk remedies

Traditional treatment for acute and chronic cholecystitis involves the use of herbal decoctions.

The most widely used collection for cholecystitis is according to N. G. Kovaleva:

calendula officinalis (aerial part),
dill (seeds) – 10 g, white birch (leaves) – 10 g,
forest cudweed (grass) – 10 g,
common juniper (fruit) – 10 g,
chamomile (flowers) – 20 g,
wild strawberries (berries) – 20 g,
white rose (petals) – 20 g,
horsetail (shoots) – 30 g,
corn silk – 30 g,
brown rose hips (crushed fruits) – 40 g.

5–6 g of the collection are brewed with 500 ml of boiling water, infused and taken 50–150 ml 3 times a day for 10–15 minutes. before meals. The taste of the infusion is bitter, the smell is pleasant.

In recent years, preparations containing essential oils (in particular German ones - Rovahol and Enatin) have found widespread use in the treatment of patients suffering from diseases of the gallbladder and biliary tract. As a choleretic agent, you can use black radish juice, 1 tablespoon 3 times a day before meals for 10–20 days.

The choleretic effect of polyhydric alcohols (sorbitol, mannitol and xylitol) has been convincingly proven. Sorbitol stimulates the production of endogenous cholecystokinin, increases the bacterial synthesis of vitamins B1 and B2, and enhances the absorption of vitamin B12. Sorbitol can be used in the form of a 10–15% solution of 50–75 ml 3 times a day instead of magnesium sulfate. Xylitol is also prescribed in a similar dose.

For chronic cholecystitis

Drinking mineral waters of low and medium salinity with a predominance of bicarbonates, sulfates, chlorine, magnesium, sodium, and calcium is widely prescribed. Use water at thermal (35–42 °C) or hyperthermal (42–50 °C) temperatures.

Mineral waters stimulate bile secretion, secretion, decrease in viscosity and liquefy it. Drink water in the amount of 3 ml per 1 kg of body weight in small sips. More often they use Essentuki No. 4, 17, 20, Smirnovskaya, Borzhom, Slavyanovskaya.

If cholecystitis is complicated by gastritis with high acidity, then mineral water is given 1–1.5 hours before meals, with gastritis with normal or low acidity - 40 minutes before meals. before meals. The course of treatment with mineral waters is 1–1.5 months. with a break between the next course of 3–6 months.

Prevention

To prevent cholecystitis, it is important to follow simple recommendations:

Eat right, exclude spicy, fatty, fried foods from your diet.
Don't skip main meals.
Control your drinking regime, try to drink 1.5–2 liters of water per day.
Give up alcohol, cigarettes and other bad habits.
Treat diseases of the gastrointestinal tract in a timely manner.
Control your weight and avoid sudden changes.
Lead an active lifestyle.
Get rid of parasites.
Do therapeutic exercises that promote bile secretion.

To prevent relapses, visit a doctor and undergo examinations. It is useful to periodically support the gallbladder. To do this, under the supervision of a doctor, take choleretic drugs, drink mineral waters, and take herbal medicine courses.

Surgical treatment

Removal of the gallbladder is carried out in case of advanced cholecystitis, ineffectiveness of conservative treatment methods, or calculous form of the disease. Two techniques for organ removal have found widespread use: open and laparoscopic cholecystectomy. Open surgery is performed for complicated forms, the presence of obstructive jaundice and obesity.

Videolaparoscopic cholecystectomy is a modern, low-traumatic technique, the use of which can reduce the risk of postoperative complications and shorten the rehabilitation period. In the presence of stones, non-surgical crushing of stones using extracorporeal shock wave lithotripsy is possible.

Treatment of cholecystitis in adults

Depending on the form of the disease and the patient’s condition, treatment may vary. In the acute form, treatment in a hospital is indicated; in the chronic form, this is not a necessary condition.

For the medical treatment of cholecystitis, the following drugs are prescribed:

Antibiotics and antibacterial agents. These medications should destroy the infection that is in the gallbladder.
Analgesics and antispasmodics that relieve spasms and pain.
Choleretic drugs.
Antiparasitic drugs, if necessary.
Medicines for dissolving stones.

In cases of cholelithiasis, shock wave therapy is prescribed to break up the stones.

If the disease is complicated, for example, gangrenous cholecystitis, treatment is carried out with surgical intervention. As a rule, in these cases, removal of the gallbladder is indicated. This operation - cholecystectomy - is performed in several ways: traditional operation, when the anterior abdominal wall is cut, and using laparoscopy, when several small holes are made in the abdominal cavity.

Rehabilitation

Physiotherapy and spa treatment is an important component of comprehensive rehabilitation of patients. Inductothermy and a UHF electric field are used as thermal procedures to correct hypertonicity of the gallbladder and have anti-inflammatory and analgesic effects. The course of treatment is 12-15 procedures, daily. In order to stimulate the emptying of the gallbladder, a low-frequency pulsed current is prescribed. To reduce dyskinetic phenomena, electrophoresis of 5% novocaine, 2% papaverine is recommended.

To normalize the functional state of the nervous system, a galvanic collar according to Shcherbakov and electrophoresis with bromine are used. For the same purpose, coniferous, oxygen and carbon dioxide baths are prescribed. Sanatorium-resort treatment is indicated no earlier than 2-4 months after an exacerbation of cholecystitis. Patients are sent to balneo-mud resorts: Essentuki, Zheleznovodsk, Truskavets, Morshin.

Forecast

The prognosis is conditionally favorable; with adequate treatment, the patient’s ability to work will be fully preserved. The greatest danger may be complications associated with rupture of the gallbladder and the development of peritonitis. If it develops, even with adequate treatment, death is possible. It is also necessary to pay great attention to the observations of the attending physician, since clinical dynamics have their own characteristics in each specific case.

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