- Holetsistokholangit's symptoms
- Holetsistokholangit's reasons
- Holetsistokholangit's treatment
Holetsistokholangit (chotecysto-cholangitis) - a chronic recurrent inflammation of a gall bladder (cholecystitis) and bilious channels (cholangitis).
In a clinical picture of a holetsistokholangit allocate 3 syndromes: painful, dispepsichesky and intoksikatsionny. The patient complain of abdominal pains: in the field of the right hypochondrium, it is frequent in a nadchrevya, and sometimes poured on all stomach. Pains skhvatkoobrazny or stupid, aching, they can arise in the form of an attack in this connection children quite often come to surgical departments. Pains begin after food more often, are connected with reception of greasy, fried, spicy or cold food. They amplify at bystry walking, during run. The Dispepsichesky syndrome is expressed in a loss of appetite, nausea, sometimes vomiting, abdominal murmur, a meteorism, is more rare ponosa.
Intoxication is shown in the form of the general weakness, fatigue, sometimes a headache, subfebrile body temperature; there comes exhaustion. At many children the subikterichny shade of skin and scleras, the phenomena of hypovitaminoses are observed. Language is often edematous, with prints of teeth at the edges, is laid over by a whitish plaque. At a palpation of a stomach morbidity in right hypochondrium (area of a gall bladder) is determined, especially at a breath (Kerr's symptom), effleurage by a palm edge by a costal arch over a gall bladder also painfully. The liver is increased, supports on 2,5 — 3 cm edge of a costal arch. At a palpation of a large intestine are defined rumbling, sometimes morbidity, certain sites can be reduced spastic.
In blood a neutrocytosis, SOE it is increased. At a biochemical blood analysis define a hypergammaglobulinemia, hyper - or a hypochilesterinemia, change of coagulative test of Veltman, a thymol turbidity test of amount of serumal enzymes: zymohexases, aminotransferases (transaminase), alkaline phosphatase. In urine find urobilin.
Holetsistokholangit usually infectious nature: bacterial, virus, fungal, can be a toxic origin. Communication of an inflammation of bilious ways with appendicitis, scarlet fever, dysentery, sepsis, quinsy, an adenoid disease, adenoides, sinusitis, caries of teeth, infectious hepatitis (infectious disease), is proved by helminthosis, tubercular intoxication. From the listed diseases infectious hepatitis and the centers of persistent infection are of especially great importance.
Infestants are staphylococcus, enterococci, colibacillus, a pyocyanic stick, proteas, barmy mushrooms, and also viruses, sometimes association of a microbe and a virus, a microbe and a mushroom.
The activator gets into a gall bladder and bilious channels the next ways: in the ascending way from a duodenum through a lower part of a bilious channel, a lymphogenous way from the digestive device of a liver, a pancreas, a hematogenous way from any body or intestines on system of a portal vein. A special role in developing of a disease is played by lyambliya.
In treatment of patients holetsistokholangity food is of great importance. The patient receives food in 4 — 5 receptions. Appoint a table No. 5 on Pevznera with good culinary processing. Include products with lipotropic action in a diet: cottage cheese, ovalbumin, a cod, and also the products rich with lecithin and improving fat transport: buckwheat, carrots, salad, green peas; vegetable oil (15 — 20 g a day). Mushrooms, marinated vegetables, goose, duck, fried, smoked, cold dishes, ice cream, carbonated drinks are prohibited. At a lambliasis limit sugar, sweets, acid apples, a cranberry are shown. In the period of an exacerbation of cholecystitis appoint: a bed rest on 1 — 2 week, then semi-bed after which sick transfer to a general regime with occupations remedial gymnastics; vitamin therapy: Retinolum, group B vitamins, ascorbic acid; cholagogue means: mineral waters (borzhy, Yessentuki No. 4, No. 17, smirnovsky, etc.) in combination with dehydrocholic acid (Chologonum), tablets of Allocholum, Cholenzymum, magnesium sulfate, xylitol, sorbite, a papaverine, Nospanum. In a hospital apply тюбаж across Demyanov in 1 — 2 day, it is better with introduction of mineral water. In the period of an aggravation appoint antibiotics depending on sensitivity of microorganisms to them: erythromycin, Oletetrinum, Oxacillinum sodium salt, metacycline a hydrochloride (Rondomycinum) for 7 — 10 days; in the presence of fungal flora — nystatin, levorinum; at a lambliasis — Aminochinolum, metronidazole (Trichopolum), Furazolinum. At simultaneous damage of a stomach, pancreas, intestines enzymes are shown: абомин, Pancreatinum, Mexasum, at a hyperoxemia of a gastric juice — Vicalinum, Almagelum, at intestinal dysbacteriosis — Mexaformum, колибактерин, bifidumbacterium.