Cholecystitis
Cholecystitis is an inflammation of the gallbladder.
Recently, the incidence of cholecystitis has been increasing, which is associated with physical inactivity and malnutrition, which are the consequences of a modern lifestyle. The incidence is 3 times higher in the elderly, 5 times higher among the female population.
The mortality rate has decreased significantly in recent years due to progress in the field of diagnosis and treatment and is 2.5%. Mortality is higher among elderly patients.
Cholecystitis is divided into acute and chronic.
Acute cholecystitis develops primarily; depending on the composition of the inflammatory exudate, catarrhal, fibrinous and purulent (phlegmonous) cholecystitis are isolated.
A life–threatening complication – biliary peritonitis – can develop in case of perforation (rupture) of the organ wall (possibly in the presence of a stone). If it is impossible to evacuate purulent contents from the bladder cavity, empyema of the gallbladder develops. The inflammatory process can capture the bile ducts and surrounding tissues with the development of cholangitis, cholangiolitis or pericholecystitis. After the resolution of the inflammatory process, adhesions form in the affected parts.
The transition of acute cholecystitis to chronic is possible. Chronic cholecystitis leads to atrophy of the gallbladder wall, replacement of muscle elements with connective tissue.
CAUSES OF CHOLECYSTITIS
The development of cholecystitis presupposes the presence of two factors in the patient’s body: pathogenic microflora and difficulty in evacuating bile from the gallbladder. These 2 processes work as a self-sustaining system: a violation of the outflow of bile creates favorable conditions for the development of the inflammatory process, and inflammation leads to a change in the properties of bile, provoking stone formation. Stagnation of bile in most cases accompanies gallstone disease (cholecystitis, which arose on the basis of the formation of concretions in the gallbladder, is called calculous), but it can also develop due to hereditary features of anatomy and physiology.
Microorganisms that trigger the inflammatory process in the bladder cavity usually enter the organ from the intestine. A downward path is also possible when pathogenic bacteria are brought with the blood flow from chronic foci in the patient’s body (inflammatory diseases of the pelvic organs, ENT organs, oral cavity, etc.).
Less often, the cause of the disease is a violation of local blood circulation due to atherosclerotic lesion of the arteries or the throwing of pancreatic juice into the biliary tract, protozoal and parasitic diseases (opisthorchiasis, giardiasis).
SYMPTOMS OF CHOLECYSTITIS
Acute cholecystitis manifests itself as a colicky pain (hepatic colic) in the epigastric region or in the right side. Hepatic colic is often provoked by the intake of fried, fatty or spicy food, alcoholic beverages, stress. Pain can radiate to the heart area, which can be perceived as angina pectoris.
There may be an increase in body temperature, nausea, repeated vomiting, which does not bring relief. Bile impurities may be present in the vomit.
If the common bile duct is blocked by a stone or edema, it is possible to develop mechanical jaundice, which is manifested by a yellow coloration of the skin at a bilirubin level above 34 mmol / L.
The appearance of a yellow tint of the sclera without yellowing of the skin may indicate either the development of minor mechanical jaundice, or the transition of inflammation to the liver with the development of local hepatitis.
A symptom of severe cholecystitis is a significant increase in heart rate (over 120 beats per minute).
DIAGNOSIS OF CHOLECYSTITIS
If acute cholecystitis is suspected, it is necessary to conduct such laboratory and instrumental studies as clinical blood analysis, biochemical blood analysis (the levels of alkaline phosphatase, bilirubin, AST and amylase are evaluated), ultrasound of the gallbladder (central to the diagnosis), CT or MRI of the abdominal organs, radioisotope scanning. Of the invasive methods, laparoscopy and laparotomy are used. In the presence of complications in the form of mechanical jaundice, ERCP is performed.
DIFFERENTIAL DIAGNOSIS OF CHOLECYSTITIS
Acute cholecystitis has similar symptoms in the clinical picture with gastric or duodenal ulcers, myocardial infarction, acute pancreatitis and appendicitis, hepatitis, right-sided pneumonia and other diseases.
TREATMENT OF CHOLECYSTITIS
Patients with acute cholecystitis require urgent hospitalization and constant supervision by a surgeon.
Treatment tactics depend on the form of cholecystitis.
A patient with acute cholecystitis is shown fasting (allowed to drink tea), local cooling procedures – an ice bubble on the area of the right hypochondrium.
Catarrhal cholecystitis is treated conservatively in a hospital setting (antispasmodics, antibiotics, infusion therapy, removal of intestinal contents through a nasointestinal probe).
Destructive forms of cholecystitis (phlegmonous and gangrenous) require urgent surgical intervention (within a day from the moment of onset of symptoms). A complication in the form of peritonitis requires surgery within 6 hours.
If the patient has mechanical jaundice and there are no indications for emergency surgery, ERCP and endoscopic removal of a stone from the common bile duct in the area of its confluence with the duodenum are performed.
