Cholecystitis is an acute inflammation of the gallbladder.
The normal gallbladder is a reservoir with a capacity of 40–70 cm3. It is a repository of bile produced in the liver, which will be necessary for the normal process of digestion. With metabolic disorders, the composition of bile is disturbed, and stones can form in the lumen of the gallbladder. If infectious inflammation joins this process, then acute cholecystitis develops.
This disease often occurs in women over 40 years of age. There is even a special triad of risk factors for cholecystitis, referred to as “Triple “EF”:
- female (woman);
- fat (with increased body weight);
- fertile (having babies).
Most often, cholecystitis develops with the penetration and development of viruses (E. coli, streptococci, staphylococci, enterococci) in the gallbladder and this justifies the use of antibiotics in the development of acute or exacerbation of chronic cholecystitis. Microbes enter the gallbladder mainly from the intestines through the bile ducts – ascending. This is facilitated by the insufficiency of the function of the muscle fibers that separate the common bile duct from the intestines (sphincter of Oddi), which is observed in violations of the motor activity of the gallbladder and biliary tract (dyskinesia), increased pressure in the duodenal cavity, reduced secretory activity of the stomach (hypoacid gastritis).
Often cholecystitis develops in violation of the outflow of bile, as, for example, in gallstone disease. It should be noted that the presence of stones in the gallbladder, regardless of their origin, in addition to a mechanical obstruction to the outflow of bile, leads to irritation of the walls of the gallbladder and the development of aseptic inflammation at first, and when the contents of the gallbladder are infected, microbial inflammation, which in turn leads to a chronic process and periodic development exacerbations of the disease.
Microbes enter the gallbladder not only from the intestines, often the infection is carried with the blood and lymph flow, which is facilitated by its rich vascular network. Therefore, in patients with diseases of the intestines, organs of the genitourinary system, or other foci of chronic inflammation, cholecystitis is not often detected. How can one not recall the sacramental phrase of the sick: “and why everything sticks to me.”
Cholecystitis, in addition to viruses, can also be caused by such parasites as Giardia, ascaris, injuries of the gallbladder and liver, and other diseases of the gastrointestinal tract.
Early manifestations of this disease are very diverse. Most often, as a result of violations in the diet (intake of spicy and fatty foods, alcohol), there are severe pains in the upper abdomen with spread to the right hypochondrium. Pain, constant or increasing in intensity, may radiate to the right shoulder. There is vomiting of bile, which does not bring relief. There are rises in body temperature, palpitations, slight yellowing of the skin. The tongue becomes dry, with a white coating.
The progression of the disease can lead to a formidable complication – peritonitis.
The classic method for diagnosing chronic cholecystitis is duodenal sounding.
It is also necessary to conduct a bacteriological study (bile culture), especially with a decrease in the acid-forming function of the stomach.
Important in the diagnosis of cholecystitis is the study of the physicochemical (lithogenic) properties of bile. In chronic acalculous cholecystitis in the acute stage, the total amount of bile acids in gallbladder bile is reduced to 70%. In most patients, there is a more significant decrease in the level of tauroconjugates, which leads to an increase in the glycotaurocholate ratio. With a decrease in total bile acids by 2 times, the level of tauroconjugates is reduced by 4 times. Along with this, a more intense decrease in the level of glycocholic acid in bile is revealed than taurocholic acid. In the bulk of cases, there is a significant decrease in the concentration of trioxycholanic bile acids (tauro- and glyco-) and an increase in the dioxycholate-trioxycholate ratio, which indicates a decrease in the synthesis of trioxycholates in the liver. In more than half of the cases, a high concentration of lithocholic acid is found. Violation of conjugation processes leads to an increase in bile and blood of free bile acids. Violation of the excretory function of the liver in patients with cholecystitis is manifested by a decrease in the coefficient of extraction of cholates into bile, which leads to an increase in the level of cholates in the blood. A clinical and biochemical study revealed an increase in cholesterol in the blood, in cystic and hepatic bile by 2-3 times, which, with a decrease in total bile acids, leads to a significant decrease in the cholate-cholesterol coefficient, a violation of the colloidal stability of bile and contributes to the formation of cholesterol calculosis – gallstone disease . Assume that a temporary increase in the level of cholesterol in bile with a decrease in the content of bile acids in it is associated with a decrease in the synthesis of bile acids from cholesterol. This may be due to a decrease in the level of the liver microsomal enzyme – cholesterol-7d-hydroxylase, as well as a violation of the absorption of bile acids in the small intestine, which reduces their enterohepatic circulation.
Prevention of chronic cholecystitis is reduced to the implementation of general hygiene measures. Among them, the main place should be given to the correct diet (4-5 meals a day) with a calorie content of the diet corresponding to the ideal weight, taking into account age, gender and profession. In this case, it will be necessary to exclude a plentiful meal at night, especially fatty and in combination with alcoholic beverages. An equally important condition for the prevention of cholecystitis is sufficient fluid intake, at least 1.5-2 liters throughout the day, evenly. It is also necessary to observe the diet – eating at the same time.
A prerequisite for prevention is regular bowel movements in order to prevent biliary dyskinesia (viscerovisceral reflexes) and cholesterol excretion.
Weight loss through subcaloric nutrition (reduced diet), the inclusion of fasting days (dairy-curd, fruit, vegetable, oatmeal, meat), drug therapy (anorexigenic products) is included in the complex of general hygiene measures.
Daily morning exercises and a sufficient motor regimen throughout the day (walking, light sports, swimming, skiing, for the elderly – attending health improvement groups at stadiums) contribute to the passage of bile through the biliary tract.
Serious attention should be paid to the treatment of inflammatory diseases of the abdominal organs, helminthic and protozoal invasion. Timely detection of products that have an allergic effect, and their exclusion from the diet are included in the set of measures to prevent cholecystitis.
Patients with acute cholecystitis require emergency hospitalization in the surgical department. As a rule, they begin with conservative treatment. Its basis is complete rest and, at first, exclusively parenteral nutrition (intravenous administration of nutrient mixtures). Broad-spectrum antibiotics are indicated for acute inflammation with high fever, especially in elderly patients and those suffering from diabetes mellitus. At this stage, the goal of treatment is to eliminate pain, reduce inflammation and general intoxication. If, as a result of the conservative treatment, the condition improves, then the treatment is continued conservatively. If, despite the measures taken, the patient’s condition causes concern, they decide on the need for surgical treatment.