How is chronic cholecystitis treated?

Creation of a rational for the child's age regime of the day, the appointment of adequate nutrition, medicamentous and non-medicament means - the goal of treatment of chronic cholecystitis in children.

During the exacerbation of chronic cholecystitis, especially with severe pain, children are hospitalized. Assign bed rest, the duration of which depends on the general condition of the patient. When the aggravation subsides, taking into account the chronic course of the disease, therapeutic measures are carried out on an outpatient basis, for example, in a one-day hospital.

[1], [2], [3], [4], [5], [6]

Non-drug treatment of chronic cholecystitis in children

It is important to ensure adequate sleep, stay in the fresh air, motor activity, regularity of food, feasible school and home classes. For schoolchildren are contra-indicated sports competitions, misuse of audiovisual information. It is necessary to create a friendly environment in the family, exclude stressful situations, physical and neuro-psychological overload.

The food should correspond to the table number 5. Food is taken fractionally (5-6 times), in small portions, at a strictly prescribed time, which ensures regular evacuation of the gallbladder. The ratio of proteins, fats, carbohydrates should be 1: 1: 4. It is important to ensure a sufficient number of vitamins and trace elements.

Exclude canned or long-term stored foods, especially meat and milk and fish. Unacceptable intake of cold food, the use of carbonated and tonic drinks, salty foods, spices, etc. Do not allow fried, fatty, spicy food, smoked products, sauces, buttery confectionery, ice cream. Food allergens are not shown: chocolate, nuts, citrus fruits, some berries and fruits, some types of fish.

Due to the violation of enterohepatic circulation of bile acids and digestive disorders in children, constipation often occurs, which means that vegetables (carrots, pumpkins, eggplants, beets) and fruits (raisins, dried apricots, prunes, watermelon, melons) bowel function. When appointing a diet, you must take into account the state of the gastrointestinal tract, as well as the individual intolerance of certain foods.

Drug treatment of chronic cholecystitis in children

Antibacterial drugs are prescribed only during a period of exacerbation of the disease. It should take into account the severity of pain and dyspeptic syndromes, changes in blood tests (leukocytosis, increased ESR), as well as the results of ultrasound or other instrumental methods. Apply antibiotics, accumulating in the bile. The duration of antibacterial treatment should not exceed 10-12 days, because the side effects of antibiotics (allergies, changes in the intestinal microflora, effects on the mucous membrane of the gastrointestinal tract) often exceeds the need for complete sterilization of bile ducts.

Sulfanilamide preparations are rarely used, as they are inferior in effectiveness to antibiotics and adversely affect the liver. Nevertheless, with intolerance to antibiotics in cases of concomitant colitis or acute diarrhea, presumably caused by Salmonella, Shigella, Yersinia and other sensitive pathogens, sulfonamides can be given a short course (co-trimoxazole for 5 days).

With giardiasis, nitrofuran preparations (furazolidone, furaltadone, nitrofurantoin) are shown - 2-3 courses with a break of 5-7 days. Metronidazole (trichopolum, clion) for children 2-5 years of age appoint 250 mg, 5-10 years - 375 mg, over 10 years - 500 mg in 2 meals after meals for 5-10 days.

The emergence of neurovegetative and psychoemotional changes in the patient, "withdrawal to illness" (mainly in adolescent girls) requires the appointment of sedatives - tazepam, ore worker, seduxen, etc.

To relieve pain using antispasmodics (drotaverin, platifillin, papaverine, pyrenazepine). In the case of hypertonic sphincter of Oddi, atropine, metacin, belladonna preparations can be prescribed to patients.

Cholagogue funds are used depending on the characteristics of the course of chronic cholecystitis, concomitant diseases of the digestive tract. Cholecystokinetics are effective for dysfunctional disorders of the biliary tract according to the hypotonic type, often combined with esophagitis, gastritis, duodenitis. Assign xylitol, mannitol, sorbitol, magnesium sulfate or sunflower, olive, sea buckthorn oil. To strong holekinetics include egg yolks. A powerful drug is cholecystokinin.

In hypertensive dyskinesia of the gallbladder, the use of true choleretics (lobil, allochol, cholenzym, etc.) is shown, which have a positive effect on the secretory and filtration process of bile formation in the liver. In addition, the use of drugs containing bile or bile acids plays the role of substitution treatment: in patients, the content of certain bile ingredients, including lipid complex, cholic acid and cholesterol, is reduced, which leads to changes in substrate relations in the proximal parts of the intestine and disruption of resorption processes fat. The latter circumstance significantly inhibits the absorption of fat-soluble vitamins.

Synthetic drugs (oxaphenamide, cycovaloval, nicodine) have choleretic properties, and decomposing in the body into constituent parts, have bacteriostatic and bactericidal action. The latter is important, taking into account the movement of absorption processes from the proximal parts of the gastrointestinal tract into the distal, where the leading role is played by bacterial microflora.

[7], [8], [9], [10], [11]

Alternative treatment of chronic cholecystitis in children

Vegetable preparations are non-toxic, have a mild effect. Practically have no contraindications to use, they contribute to the normalization of metabolic processes. These include holosas, cholagol, rozanol, flamin, corn stigma extract, etc. The plant drug gepabene contains the fruits of the milk thistle and the extract of the commissary. In addition to choleretic action, the drug has spasmolytic and hepatoprotective effects, reduces the tone of the sphincter of Oddi. One of the pathogenetic links in the treatment of chronic cholecystitis is vitamin therapy.

In complex treatment, taking into account the incidence of mucous membrane damage in the upper gastrointestinal tract, antacid non-adsorbable drugs, mainly aluminum and magnesium preparations, are used.

When the external secretory function of the pancreas is disturbed, as well as for the normalization of cavitary digestion, enzyme preparations (festal, enzyme, digestal, mezim-forte) and other medications are recommended. Do not lose their value therapeutic deadbeat to Demyanova with xylitol, sorbitol, 30% solution of magnesium sulfate. Since children notice an increase in gastric secretion and acid formation, it is advisable to assign slightly mineralized alkaline waters in a heated form (35-45 ° C).

Effective phytotherapy with the appointment of decoctions of chamomile pharmacy, calendula flowers, buckthorn, tansy, valerian officinalis, etc. It is convenient to use the instant cholate tea, which is a combination of extract of spinach leaves, thistle fruits, goose goose grass, celandine, yarrow, licorice root , rhubarb, root and leaves of dandelion, rhizomes of turmeric, aloe.

[12], [13], [14], [15]

Spa treatment

After the abatement of exacerbation are shown physiotherapeutic measures that provide warming, spasmolytic, sedative effect, enhancing the formation and separation of bile. Widely used inductothermia, diathermy, UHF currents, therapeutic mud. When dyskinesia of the gallbladder is shown electrophoresis of magnesium sulfate, papaverine, novocaine on the liver region. Assign microwave and ultrasound treatment. Pathogenetically justified use of oxygen therapy - the so-called oxygen cocktails. Extensive use of physical therapy and massage.

The patients are shown sanatorium-resort treatment of chronic cholecystitis not earlier than 3 months after exacerbation. Recommend balneological resorts with mineral waters for drinking (Belokurikha, Berezovsky mineral waters, Hot Key, Essentuki, Zheleznovodsk, Izhevsk Mineral Waters, Nalchik, Pyatigorsk, Staraya Russa, Lake Shira).