Chronic cholecystitis

Description:

This chronic inflammatory disease of a gall bladder which is combined with functional disturbances (dyskinesia and a diskholiya).
The etiological factors leading to development of chronic cholecystitis can be divided into the main and additional.

Symptoms of Chronic cholecystitis:

Patients with chronic cholecystitis complain of dull aches in right hypochondrium, arising in 40-90 min. after food, especially plentiful and rich with fats, and also after jolty driving and a raising of weights. Quite often pains arise or amplify at long stay in a sitting position or in an inclination. Often pain is combined with dryness, bitter taste in a mouth, heartburn, nausea, an eructation air and food. At 85% of patients pain differs in monotony, only at 10-15% rare, rather low-intensive attacks of bilious colic are observed. At many patients tendency to locks owing to disturbance of a cholepoiesis and often accompanying dyskinesia of a large intestine on hypotonic-hyperkinetically type is observed.

The provided characteristics are noted at a typical painful form which is found more than in 2/3 patients with chronic acalculous cholecystitis; less than at 1/3 patients atypical forms are observed.

Long dull aches in precordial area, and also arrhythmia are characteristic of a kardialgichesky form, is more often than premature ventricular contraction type, arising after plentiful food, is frequent in a prone position. On an ECG change of final department of a gastric complex - flattening, and sometimes and inversion of a tooth of T is noted.

Ezofagalgichesky forms are characterized by the persistent heartburn which is combined with dull ache behind a breast, after plentiful food the feeling of "stake" behind a breast sometimes appears. Pain differs in duration, occasionally there are easy difficulties when passing food on a gullet (an easy non-constant dysphagy).

Intestinal forms proceed with abdominal distention, the low-intensive, accurately not localized pain on all stomach, tendency to locks.

At chronic cholecystitis existence at the patients who are laid over, scalloped (with prints of teeth) language is characteristic that is reflection of stagnation in a gall bladder.

At a stomach palpation at patients with chronic cholecystitis the following symptoms are defined.

    * Kerr's symptom - in the field of the projection of a gall bladder located at the place of crossing of the outer edge of the right direct muscle of a stomach with edge of false edges appears morbidity at a deep palpation during a breath.
    * A symptom of Grekova-Ortnera-Rashby - morbidity at effleurage by a brush edge on the right costal arch.
    * Murphy's symptom - careful, soft introduction of a hand to a zone of a gall bladder and at a deep breath the palpating hand causes sharp morbidity.
    * A symptom of Myussi - morbidity when pressing on a phrenic nerve between legs grudinnoklyuchichno - a mastoidal muscle on the right.
    * Mackenzie's symptom - a stomach skin hyperesthesia, in the right subcostal area with most expressed morbidity in a zone of a projection of a gall bladder.
    * Shoffar's symptom - when carrying out ventrodorzalny conjoined manipulation arises pain in a zone of a projection of a head of a pancreas and gall bladder (the symptom is characteristic of a holetsistopankreatit). The same symptom is described by Zakharyin.
    * Lyakhovitsky's symptom - pain arises with an insignificant pressure upon the right half of a xiphoidal shoot or at its assignment up.
    * Kharitonov's symptom - pain at a palpation to the right of an acantha of the IV chest vertebra.
    * Yonash's symptom - pain when pressing in the place of an attachment of the right trapezoid muscle in occipital area in a zone of a projection of an occipital nerve.
    * The symptom Burchinsky I - at a deep exhalation and a natuzhivaniye of a stomach in the form of "water-melon" arises morbidity in Shoffar's zone at sharp blow by trailer phalanxes of fingers of a brush of the palpated hand.
    * A symptom Burchinsky II - emergence of sharp morbidity in Shoffar's zone in position of the patient sitting at a palpation of a gall bladder from a back.

At most of patients at a palpation the liver edge on 1-2 cm acts from under a costal arch.

Reasons of Chronic cholecystitis:

Distinguish from major factors: infection (colibacillus, cocci, sometimes other microbic factors); penetration of pathogenic flora into a gall bladder from intestines, and also a hematogenous and lymphogenous way from any center of a chronic inflammation (periodontosis, an adenoid disease, a pyelitis, appendicitis, a right-hand adnexitis, etc.); diseases of a gepatokholedokhoduodenopankreatichesky zone (chronic pancreatitis owing to insolvency or the raised tone of a sphincter of Oddi), klostridiyevy intestinal dysbacteriosis.

Accessory factors include: functional disturbances of the neuromuscular device of a gall bladder and biliary tract with the phenomena of hypotonia and an atony; psychological overstrain; hypodynamia; irregular meal and unbalanced food (the uniform reduced food with small holeretichesky effect); pankreatobiliarny reflux; hereditary factors; parasitic diseases (lambliasis, opisthorchosis, amebiasis, ascaridosis); endocrine frustration (obesity, dysmenorrheas, irregular sex life).

Treatment of Chronic cholecystitis:

And at a long persistent current it is reasonable to carry out treatment in a hospital to the periods of an aggravation. Conservative treatment has to be directed, first of all, to suppression of an infection and inflammatory process bilious ways. For this purpose appoint antibiotics, preferential a broad spectrum of activity which need to be accepted within 1-2 weeks in rather high doses. Also streptocides (sulfadimethoxine, сульфаниридазин) and Nicodinum (to 8 g a day) independently or in a combination with antibiotics can be used.

Along with antibacterial therapy widely use cholagogue drugs like choleretics (Allocholum, дехолин, Cholenzymum, Chologonum, Nicodinum, Cycvalonum, оксафенамид and a number of medicines of a plant origin: immortelle, mint, dogrose, barberry, corn stigmas other).

Are shown to Holekinetiki at the sluggish course of cholecystitises. These drugs, as well as medical duodenal sounding and tyubazh, have to be applied with the known care in the presence of gallstones. Purpose of cholagogue means is shown at the accompanying locks. At the same time some of them, for example, sorbite (xylitol), Allocholum, and also tyubazh and medical duodenal sounding can sometimes cause an aggravation of chronic coloenterites.
The outstanding place in complex treatment of chronic cholecystitis is taken by spasmolysants: atropine drugs, papaverine, Euphyllinum, nitrites, spasmolysant, amizyl, throwing, etc.
Broad application is found by also physical methods of treatment (thermal procedures on area of the right hypochondrium — a hot-water bottle, poultices, paraffin and ozokeritovy applications, etc.); a diathermy (deep warming up of fabrics currents of high frequency and big force), UVCh currents, diadynamotherapy (treatment by means of diadynamic currents), a pas electrophoresis a zone of a gall bladder with drugs of novocaine, a papaverine, magnesium sulfate, ultrasound, etc.

Some patients receive simplification at treatment in balneological resorts with drinking mineral waters (Arzni, Berezovsky mineral waters, Borjomi, Dzhermuk, Druskipiikay, Yessentuki, Zheleznovodsk, the Izhevsk mineral waters, Isti-Su, Kemeri, Myrgorod, Kvasov's Glade, Pyatigorsk, to Sairma, Truskavets, Feodosiy, Shir). Treatment can be carried out in specialized local sanatoria for patients with pathology of digestive organs.

It is possible to direct to a pas sanatorium treatment only patients without strong indications of an aggravation of an inflammation and activity of an infection, without bile outflow disturbance signs (jaundice, dropsy of a gall bladder), with rather functioning gall bladder (according to the cholecystography), without the expressed pain syndrome.
The direction of a pas resorts of patients to which surgical treatment is shown is not justified.
At sluggish disease with success bottle mineral waters can be applied. Can be useful to rather compensated patients with the slowed-down emptying of a gall bladder the dosed morning exercises and careful remedial gymnastics with load of a prelum abdominale.