Chronic cholecystitis

Non-calculous (cholelithiasis) chronic cholecystitis is a chronic polyetiological inflammatory disease of the gallbladder, combined with motor-tonic disorders (dyskinesias) of the biliary tract and changes in the physicochemical properties and biochemical composition of bile (dyscholium). Duration of illness more than 6 months. Chronic cholecystitis is almost always the result of the presence of gallstones.

Coneless chronic cholecystitis is a widespread disease of the biliary tract, occurs with a frequency of 6-7 cases per 1000 population. Women suffer from chronic boneless cholecystitis 3-4 times more often than men.

ICD code: calculous chronic cholecystitis

According to the ICD, chronic calculous cholecystitis belongs to the class of diseases of the digestive tract organs, to the section “Diseases of the gallbladder, biliary tract and pancreas” (K80-K87).

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Chronic calculous cholecystitis

Chronic calculous cholecystitis is characterized by the formation of stones in the gallbladder, often affects women, especially those who are overweight.

The cause of this disease is the phenomenon of stagnation of bile and high salt content, which leads to a violation of metabolic processes. In turn, hormonal disruptions, including pregnancy-related pathological processes in the pancreas, overweight, unhealthy diet, biliary system disorders, can provoke bile stasis and high salt levels. The formation of stones leads to the disruption of the functioning of the gallbladder and bile ducts and the development of the inflammatory process, which subsequently spreads to the stomach and duodenum. At the very beginning of the disease, the stones in the gallbladder are small in size, but as the disease develops, they become larger and block the bile ducts. In the phase of exacerbation of the disease, the patient has hepatic colic, manifested as an acute pain syndrome in the upper abdomen and in the region of the right hypochondrium. The attack can last from a few moments to several days and is accompanied by nausea or vomiting, abdominal distension, a general state of weakness, and a bitter taste in the mouth.

[2], [3], [4], [5], [6]

Chronic stoneless cholecystitis

Chronic stoneless cholecystitis is characterized by the development of an inflammatory process in the gallbladder. This disrupts the functioning of the digestive system, combined with pain. It is believed that the disease often affects women. The reason for this pathology, some experts believe the impact of microorganisms. The main factors in the development of chronic, cholecystitis with no stones are damage to the walls of the gallbladder and the formation of congestion in it, the development of chronic infections, and a reduced level of body defenses. In turn, the stagnation of bile is formed in the pathology of the bile ducts, compression and bending of the biliary tract and gallbladder, which arise as a result of a decrease in their tone, endocrine disorders, and stress. The flow of bile worsens during pregnancy, with an improper diet and diet, low-active lifestyle. The basis of the therapy of the disease is the appointment of a therapeutic diet in accordance with the age factors of the patient, as well as with his gender, body weight and physical activity.

[7], [8], [9], [10]

Exacerbation of chronic cholecystitis

Exacerbation of chronic cholecystitis has similar symptoms with acute cholecystitis. Clinical manifestations include severe paroxysmal pain concentrated in the hypochondrium on the right side. It can extend to the shoulder and the scapula or collarbone area. With the exacerbation of the disease often vomiting occurs with the content of bile, bitterness is felt in the mouth. At the same time, there is a temperature reaction of the body with an increase to thirty-eight degrees, chills, increased heart rate. In some cases, with the development of complications may occur tachycardia. When probing the right hypochondrium there is pain, aggravated by inhalation. With a mild course of the disease, the exacerbation does not occur more than once a year, the symptoms are moderate, the appetite is normal, and the pain may increase if there is an abnormal diet and exercise. With moderate severity of the disease, exacerbations are recorded at least three times a year. The pain is combined with vomiting and fever and is not able to go away on its own. With a severe course of illness, exacerbations occur almost every month, one to two times, and the functioning of the pancreas is also impaired.

[11], [12], [13]

Chronic cholecystitis and pancreatitis

Chronic cholecystitis and pancreatitis can often be similar in symptoms, so a qualified diagnosis is necessary for the differentiation of these two diseases. Pancreatitis is most often the result of calculous cholecystitis, as well as excessive consumption of alcohol and fatty foods. Other causes of pancreatitis include intoxication, traumatic factors, viral infections, surgery, stress, nicotine addiction. At the same time, the causes of cholecystitis include the defeat of the gallbladder by microorganisms, food intoxication, adnexitis, worms, stagnation of bile, unhealthy diet, the formation of stones in the gallbladder, inflammation of the small intestine or liver, hereditary predisposition. With pancreatitis, pain is usually localized in the region of the epigastrium and left hypochondrium, accompanied by diarrhea, a general depletion of the body, and it can be given in the back and in the region of the heart.

Pain syndrome can be sustained or can appear in the form of attacks after eating fried or spicy dishes. For the prevention of the disease, it is recommended to eat a balanced and full-fledged diet, as well as to give up bad habits, such as alcohol abuse and smoking.

Symptoms of chronic cholecystitis

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Diet for chronic cholecystitis

Diet for chronic cholecystitis is designed to ensure the normalization of work and the liver and gall bladder, as well as other organs of the digestive system. Dietary table number 5 or 5a is prescribed as a therapeutic food for chronic cholecystitis. The patient should limit the consumption of fatty and too salty foods, as well as foods that stimulate active bile secretion, increase fermentation in the intestines and adversely affect the functioning of the liver. Cooking should be steamed, you can eat boiled food. Nutrition fractional - up to five or six times a day.

Products recommended for use in chronic cholecystitis:

1. Dried wheat bread.
2. Low-fat chicken and beef, boiled or steamed.
3. Boiled and steam lean fish.
4. Steamed egg omelette.
5. Dairy products, low-fat cottage cheese, grated cheese.
6. The semolina boiled on water, as well as ground rice and buckwheat porridge.
7. Pumpkin or zucchini steamed or boiled (preferably in the form of mashed potatoes).
8. Vegetable stewed soups.
9. Kissel, jam.

When treating cholecystitis, mineral waters (Borjomi, Essentuki, Narzan) have a positive effect. Their use contributes to the natural cleansing of the gallbladder, reducing viscosity and preventing bile stagnation, has an anti-inflammatory effect and reduces the risk of stone formation, improves metabolism in the liver.

[20], [21], [22]

Chronic cholecystitis: treatment

The gastroenterologist deals with the treatment of such diseases as chronic cholecystitis. After the diagnosis, which includes ultrasound and palpation, choleography (x-ray of the gallbladder, is contraindicated during pregnancy and exacerbation of the disease), as well as blood and feces, the following drugs may be prescribed to the patient, depending on the form and type of the disease:

• Antibacterial agents (prescribed for exacerbation of the disease, the development of inflammatory processes) - ciprofloxacin (taken orally at 0.125-0.5 g twice a day), ampicillin (taken orally, regardless of food intake of 0.5 g, the daily dose is 2-3 d). The duration of treatment depends on the severity of the disease and the effectiveness of therapy. The minimum course of treatment is five days.
• Choleretic means - allohol (2 tablets three times a day after meals.

The duration of treatment is three to four weeks. If necessary, the course is repeated two or three times with a break of three months). Hofitol prescribed for ingestion of one or two tablets three times a day. The duration of therapy is two to three weeks. Hofitol is also available as an oral solution, which is taken in 2.5-3 ml three times a day before meals. The course of therapy is two to three weeks. Hofitol in the form of injections administered both intramuscularly and intravenously - 1-2 ampoules / day for one to two weeks. After the onset of improvement, the patient is transferred to tablets or solution for internal use. Hepabene is administered one capsule three times a day. If the pain is bothering the patient at night, it is advisable to take another capsule at bedtime. The duration of treatment is from three months.

• Antispasmodics - no-shpa (taken orally by 0.04-0.08 g two or three times a day).
• Painkillers (prescribed only in cases of lack of evidence for surgical intervention).
• Antacids (shown for heartburn) - Almagel (taken orally for one or two teaspoons for half an hour before meals and at night, shaken before use). Phosphalugel prescribed one or two sachets two or three times a day for half an hour before meals.

[23], [24], [25]

Chronic cholecystitis: treatment with alternative means

Chronic cholecystitis is also treated with the use of alternative agents with bile-expelling, anti-inflammatory, antimicrobial and antispasmodic effects.

Choleretic agents contribute to the removal of sand from the gallbladder and prevent the formation of stagnation. The roots of barberry contribute to the active separation of bile, reducing the tone of the gallbladder. Birch leaves have a choleretic and diuretic effect, as well as anti-inflammatory and antiseptic effects. The flowers of immortelle, due to its constituent substances, increase the separation of bile, have antispasmodic and antimicrobial effect. Corn silk, as a rule, is used in the stagnation of bile, as well as to reduce cholesterol. Juniper can also neutralize stagnation of bile, but it should be noted that it is contraindicated in case of renal inflammation. Peppermint leaves also have a wide range of effects, they help to soothe pain, have a choleretic, antiseptic and antimicrobial effect.

A common positive effect on the work of the digestive tract is the use of wormwood, which has anti-inflammatory and choleretic effects.

All medicinal herbal remedies are taken orally in the form of infusion or decoction. To prepare the infusion, they must be boiled for fifteen minutes, then cooled at room temperature. The broth is boiled for half an hour and taken warm ten to fifteen minutes after preparation. Keep these medicines recommended in the refrigerator for three days.

When exacerbating the disease, it is recommended to prepare the following harvest: madder root, mint leaves, wormwood, immortelle flowers, buckthorn bark and dandelion root are taken in equal proportions, the mixture is poured with hot boiled water and boiled for thirty minutes over a slow fire, then allowed to cool and take inside.

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