- Acute catarrhal cholecystitis. Inflammation is limited to the mucosa and submucosa
- Phlegmonous cholecystitis is a purulent inflammation with infiltration of all layers of the gallbladder. Possible mucosal ulceration with subsequent exudation of inflammatory fluid into the intravesical space
- Gangrenous cholecystitis is partial or total necrosis of the gallbladder wall. When the wall of the bladder is perforated, bile flows into the abdominal cavity (gangrenous-perforative cholecystitis). Empyema of the gallbladder is a purulent inflammation of the gallbladder. Etiology
- In 90-95% of cases, it develops with obstruction of the duct by a stone
- Acalculous cholecystitis occurs secondary to salmonellosis, sepsis, and trauma.
- Edema of the gallbladder wall
- Hemorrhages in the submucosa
- Ulceration of the submucosa
- Polymorphonuclear wall infiltration.
- Colicky pain (hepatic colic)
- Localized in the epigastric or right hypochondrium
- Irradiation – shoots into the back within the lower angle of the right shoulder blade, the right supraclavicular region, the right half of the neck
- It often occurs after eating, especially after fatty, spicy, spicy foods, drinking alcohol, emotional experiences.
- Nausea, vomiting, sometimes with an admixture of bile.
- Murphy’s symptom – involuntary holding of breath on inspiration with pressure on the area of the right hypochondrium.
- Soreness when tapping along the edge of the right costal arch (Ortner’s symptom).
- Pain when inhaling during palpation of the right hypochondrium (Ker’s symptom).
- Symptom de Muss-Georgievsky (phrenicus-symptom) – soreness when pressed with a finger between the legs of the right sternocleidomastoid muscle.
- The Shchetkin-Blumberg symptom becomes positive when the visceral or parietal peritoneum is involved in the inflammatory process (peritonitis).
- Jaundice (in 20% of patients) – caused by obstruction of the common bile duct by stones or edema.
- With percussion of the abdomen – tympanitis (reflex intestinal paresis).
- Blood test – leukocytosis, shift of the leukocyte formula to the left
- Biochemical blood test: elevated serum ALP in 23% of cases, bilirubin – in 45%, ACT – in 40%, amylase – in 13%
- Urinalysis without characteristic changes. With obstructive jaundice, bilirubin appears in the urine, with complete obstruction, urobilin disappears.
- Radiography is uninformative. Most gallbladder stones are radiolucent and composed of cholesterol, 10-15% of gallbladder stones contain enough calcium to contrast on x-rays
- Ultrasound of the gallbladder: detect the presence of stones, determine the size of the organ and the thickness of its wall, the presence within the gallbladder infiltrate and the consistency of the contents of the gallbladder
- radioisotope scanning. In the absence of visualization of the gallbladder on radioisotope scanning after intravenous administration of iminodiacetic acid, obstruction of the cystic duct is suggested
- ECG and chest x-ray for differential diagnosis.
- Perforated or penetrating ulcer of the stomach and/or duodenum
- hiatal hernia
- Right lower lobe pneumonia
- Acute appendicitis
- Infectious diseases.
Diet. At the beginning of an attack of acute cholecystitis – a water-tea pause
- After 5-10 days, diet No. 5a is prescribed.
- With the disappearance of all acute events after 3-4 weeks – the transition to diet number 5. Conservative treatment
- Bed rest
- Bilateral pararenal novocaine blockade according to Vishnevsky
- Intravenous fluids and nasogastric removal of intestinal contents within 24-48 hours
- During the period of remission – the dissolution of cholesterol stones to prevent the chronicity of the process. The drugs of choice are ursodeoxycholic acid (ursofalk) and chenodeoxycholic acid (chenofalk). If there are several small floating stones in 50-70%, they can be expected to dissolve in 12-24 months.
- Lithotripsy is possible in 20-25% of patients with a functioning gallbladder, small stones (