Chronic cholecystitis

Non-calculous (stone-free) chronic cholecystitis is a chronic polyetiological inflammatory disease of the gallbladder, combined with motor-tonic disorders (dyskinesia) of the biliary tract and changes in the physicochemical properties and biochemical composition of bile (dyskole). The duration of the disease is more than 6 months. Chronic cholecystitis is almost always a consequence of the presence of gallstones.

Acalculous chronic cholecystitis is a widespread disease of the biliary tract, occurring with a frequency of 6-7 cases per 1000 population. Women suffer from chronic acalculous 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, to the section “Diseases of the gallbladder, bile ducts and pancreas” (K80-K87).

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Chronic calculous cholecystitis

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

The cause of this disease is considered to be the phenomena of bile stagnation and high salt content, which leads to disruption of metabolic processes. In turn, hormonal disruptions, including those associated with the onset of pregnancy, pathological processes in the pancreas, excess body weight, poor nutrition, and disorders of the biliary system can provoke bile stagnation and high salt content. The formation of stones leads to disruption of the functioning of the gallbladder and bile ducts and the development of an 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 obscure the bile ducts. In the acute phase of the disease, the patient experiences hepatic colic, manifested in the form of acute pain in the upper abdomen and in the right hypochondrium. The attack can last from a few moments to several days and be accompanied by nausea or vomiting, bloating, a general feeling of weakness, and a bitter taste in the mouth.

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Chronic acalculous cholecystitis

Chronic acalculous cholecystitis is characterized by the development of an inflammatory process in the gallbladder. In this case, the functioning of the digestive system is disrupted, combined with pain syndrome. It is believed that the disease more often affects women. Some experts believe that the cause of this pathology is the effect of microorganisms. The main factors in the development of chronic acalculous cholecystitis are damage to the walls of the gallbladder and the formation of stagnation in it, the development of chronic infections, and a reduced level of the body's defenses. In turn, bile stagnation is formed with pathology of the bile ducts, compression and bends of the bile ducts and gallbladder, which occur due to a decrease in their tone, endocrine disorders, and stress. Bile outflow worsens during pregnancy, with an improper diet and diet, and a sedentary lifestyle. The basis of the treatment of the disease is the appointment of a therapeutic diet in accordance with the age factors of the patient, as well as his gender, body weight, and physical activity.

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Exacerbation of chronic cholecystitis

Exacerbation of chronic cholecystitis has symptoms similar to acute cholecystitis. Clinical manifestations include severe paroxysmal pain, concentrated in the hypochondrium on the right side. It can radiate to the shoulder and the scapula or collarbone. During an exacerbation of the disease, vomiting containing bile often occurs, and there is a bitter taste in the mouth. At the same time, a temperature reaction of the body is noted with an increase to thirty-eight degrees, chills, and increased heart rate. In some cases, with the development of complications, tachycardia may occur. When palpating the right hypochondrium, pain is felt, which intensifies when inhaling. With a mild course of the disease, an exacerbation occurs no more than once a year, the symptoms are moderate, appetite is normal, the pain can intensify with a violation of the diet and physical activity. With a moderate severity of the disease, exacerbations are recorded at least three times a year. The pain is combined with vomiting and fever and cannot go away on its own. In severe cases of the disease, exacerbations occur almost every month, one or two times, and the functioning of the pancreas is also disrupted.

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Chronic cholecystitis and pancreatitis

Chronic cholecystitis and pancreatitis can often be similar in symptoms, so qualified diagnostics are necessary to differentiate these two diseases. Pancreatitis is most often the result of calculous cholecystitis, as well as excessive consumption of alcoholic beverages and fatty foods. Also, the causes of pancreatitis include intoxication, traumatic factors, viral infections, surgical interventions, stress, nicotine addiction. At the same time, the causes of cholecystitis include damage to the gallbladder by microorganisms, food poisoning, adnexitis, worms, bile stasis, poor nutrition, the formation of stones in the gallbladder, inflammatory processes of the small intestine or liver, hereditary predisposition. With pancreatitis, pain is usually localized in the epigastric region and left hypochondrium, accompanied by diarrhea, general exhaustion of the body, and can radiate to the back and heart area.

The pain syndrome may be persistent or may appear in the form of attacks after eating fried or spicy foods. To prevent the disease, it is recommended to eat a balanced and nutritious 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

The diet for chronic cholecystitis is designed to ensure the normalization of the liver and gallbladder, as well as other organs of the digestive system. Diet table No. 5 or 5a is prescribed as a therapeutic diet for chronic cholecystitis. The patient should limit the consumption of fatty and too salty foods, as well as products that stimulate active bile secretion, increase fermentation in the intestines and negatively affect the liver. Meals should be steamed, you can eat boiled food. Fractional meals - up to five to six times a day.

Products recommended for consumption in chronic cholecystitis:

1. Dried wheat bread.
2. Lean chicken and beef, boiled or steamed.
3. Boiled and steamed lean fish.
4. Steamed egg omelette.
5. Fermented milk products, low-fat cottage cheese, grated cheese.
6. Semolina boiled in water, as well as ground rice and buckwheat porridge.
7. Pumpkin or zucchini, steamed or boiled (preferably pureed).
8. Vegetable pureed soups.
9. Kissel, jam.

Mineral waters (Borjomi, Essentuki, Narzan) have a positive effect in the treatment of cholecystitis. Their use promotes natural cleansing of the gallbladder, reduces viscosity and prevents bile stagnation, has an anti-inflammatory effect and reduces the risk of stone formation, improves metabolic processes in the liver.

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Chronic cholecystitis: treatment

Treatment of such a disease as chronic cholecystitis is carried out by a gastroenterologist. After diagnostics, including ultrasound and palpation examination, choleography (X-ray of the gallbladder, contraindicated during pregnancy and exacerbation of the disease), as well as blood and stool tests, depending on the form and type of disease, the patient may be prescribed the following drugs:

• Antibacterial agents (prescribed for exacerbation of the disease, development of inflammatory processes) - ciprofloxacin (taken orally 0.125-0.5 g twice a day), ampicillin (taken orally regardless of food intake 0.5 g, daily dose is 2-3 g). 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 agents - allochol (2 tablets three times a day after meals.

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

• Antispasmodics – no-shpa (taken orally at 0.04-0.08 g two to three times a day).
• Painkillers (prescribed only in cases where there is no indication for surgical intervention).
• Antacids (indicated for heartburn) - Almagel (take orally one to two teaspoons half an hour before meals and at night, shake before use). Phosphalugel is prescribed one to two packets two to three times a day half an hour before meals.

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Chronic cholecystitis: treatment with folk remedies

Chronic cholecystitis is also treated using folk remedies that have choleretic, anti-inflammatory, antimicrobial and antispasmodic effects.

Choleretic agents help remove sand from the gallbladder and prevent stagnation. Barberry roots promote active secretion of bile and reduce the tone of the gallbladder. Birch leaves have a choleretic and diuretic effect, as well as anti-inflammatory and antiseptic action. Immortelle flowers, due to the beneficial substances included in its composition, increase the secretion of bile, have an antispasmodic and antimicrobial effect. Corn silk is usually used for bile stagnation, as well as to reduce cholesterol levels. Juniper can also neutralize bile stagnation, but it should be borne in mind that it is contraindicated in kidney inflammation. Peppermint leaves also have a wide range of effects, they help relieve pain, have a choleretic, antiseptic and antimicrobial effect.

The use of wormwood, which has anti-inflammatory and choleretic effects, has a general positive effect on the functioning of the digestive tract.

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

In case of exacerbation of the disease, it is recommended to prepare the following collection: take madder root, mint leaves, wormwood, immortelle flowers, buckthorn bark and dandelion root in equal proportions, pour the resulting mixture with hot boiled water and cook for thirty minutes over low heat, then let it cool and take it internally.

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