Cholecystitis

Description:

1. Catarral cholecystitis — is characterized intensive constant pains in right hypochondrium and epigastric area with irradiation to the lumbar area, a right shoulder-blade, a shoulder girdle, the right half of a neck.

2. Phlegmonous cholecystitis has more expressed clinical symptomatology. Hurt much more intensively, than at a catarral form of an inflammation. Pains amplify at breath, cough, a body postural change. There is nausea and repeated vomiting more often, the general condition of the patient worsens, body temperature reaches febrile, tachycardia increases to 110 — 120 in a minute. The stomach is blown a little up at the expense of intestines paresis, at breath of the patient spares the right half of an abdominal wall, intestinal noise are weakened.

3. Gangrenous cholecystitis is characterized by a rapid clinical current, usually is continuation of a phlegmonous stage of an inflammation when protective forces of an organism are not able to cope with virulent microbic flora.

Cholecystitis symptoms:

Acute cholecystitis.
Catarral cholecystitis intensive constant pains in right characterize hypochondrium, epigastric area with irradiation in a right shoulder-blade, a shoulder, the right half of a neck. At the beginning of a disease of pain can have pristupoobrazny character due to the strengthened reduction of a wall of the gall bladder directed to elimination of occlusion of a neck of a bubble or vesical channel. Often there is a vomiting gastric, and then duodenal contents which is not giving to the patient relief. Body temperature increases to subfebrile figures. Moderate tachycardia till 80-90 blows in 1 min. develops, some increase in arterial pressure is sometimes observed. Language is wet, it can be laid over by a whitish plaque. The stomach participates in the act of breath, only some lag of upper parts of the right half of an abdominal wall in the act of breath is noted. At a palpation and percussion of a stomach there is a sharp morbidity in right hypochondrium, especially in the field of a projection of a gall bladder. The muscle tension of an abdominal wall is absent or is expressed slightly. Ortner, Murphy, Georgiyevsky-Myussi symptoms positive. At 20% of patients it is possible to probe the increased, moderately painful gall bladder. In blood test note a moderate leukocytosis (10-12 h109/l).

Catarral cholecystitis, as well as hepatic colic, at most of patients errors in a diet provoke. Unlike colic the attack of acute catarral cholecystitis happens more long (up to several days) and is followed by nonspecific symptoms of vospaklitelny process (a hyperthermia, a leukocytosis, increase in SOE).

Phlegmonous cholecystitis has more expressed clinical symptomatology: hurt much more intensively, than at a catarral form of an inflammation, amplify at breath, cough, a body postural change. There are nausea and repeated vomiting more often, the general condition of the patient worsens, body temperature reaches febrile figures, tachycardia increases up to 100 blows in 1 min. and more. The stomach is blown a little up at the expense of intestines paresis, at breath of the patient spares the right half of an abdominal wall, intestinal noise are weakened. At a palpation and percussion of a stomach there is a sharp morbidity in right hypochondrium, the expressed muscular protection is noted here; it is quite often possible to define inflammatory infiltrate or the increased painful gall bladder. At a research a positive symptom of Shchetkin-Blyumberg in the right upper quadrant of a stomach, Ortner, Murphy, Georgiyevsky-Myussi symptoms, a leukocytosis to 12-18 x 109/l decide on shift of a formula to the left, increase in SOE.

Distinguishing character of phlegmonous process is transition of an inflammation to a parietal peritoneum. Increase in a gall bladder is noted: its wall is thickened, crimson and cyanotic color. On the peritoneum covering it there is a fibrinous plaque, in a gleam - purulent exudate. If at a catarral form of acute cholecystitis at microscopic examination note only initial signs of an inflammation (bubble wall hypostasis, a hyperemia), then at phlegmonous cholecystitis reveal the expressed infiltration of a wall of a bubble leukocytes, treatment of fabrics purulent exudate, sometimes with formation of small abscesses in a bubble wall.

Gangrenous cholecystitis usually is continuation of a phlegmonous stage of an inflammation when natural protective mechanisms of an organism are not able to limit distribution of virulent microflora. Into the forefront symptoms of the expressed intoxication with the phenomena of local or general purulent peritonitis act that is especially expressed at perforation of a wall of a gall bladder. The gangrenous form of an inflammation is observed more often at people of advanced and senile age with reduced regenerative abilities of fabrics, decrease in reactivity of an organism and disturbance of blood supply of a wall of a gall bladder due to atherosclerotic defeat of an abdominal part of an aorta and its branches.

Upon transition of inflammatory process to a gangrenous form there can occur some reduction of pain and the seeming improvement of the general condition of the patient. It is connected with death of sensitive nerve terminations in a gall bladder. However quickly enough this period of imaginary wellbeing is replaced by the accruing intoxication and symptoms of widespread peritonitis. The condition of patients becomes heavy, they are sluggish, slowed down. Body temperature is febrile, the expressed tachycardia (to 120 blows in 1 min. and more), the breath which is speeded up and superficial develops. Language dry, a stomach is blown up at the expense of intestines paresis, its right departments do not participate in the act of breath, the peristaltics is sharply oppressed, and at widespread peritonitis is absent. The protective muscle tension of a front abdominal wall becomes more expressed, symptoms of irritation of a peritoneum come to light. Sometimes determine by Perkutorno obtusion of a sound over the right lateral channel of a stomach. In blood tests also wet a high leukocytosis with a sharp deviation to the left, increase in SOE, disturbance of electrolytic composition of blood and an acid-base state, in urine - a proteinuria, a cylindruria (signs of a destructive inflammation and heavy intoxication).

Cholecystitis reasons:

Cholecystitis is the result of formation of stones in a gall bladder. It results in stagnation of bile and infection of intestinal microflora. Periodically arising and passing inflammations lead to change of a wall of a gall bladder with development in it chronic inflammatory process (chronic calculous cholecystitis).

On a current cholecystitis can be acute and chronic.

Treatment of Cholecystitis:

All patients with acute cholecystitis have to be in a hospital under constant observation of the surgeon. In the presence of symptoms of local or widespread peritonitis the immediate surgery is shown. In other cases carry out conservative treatment. Limit meal, resolving only alkaline drink (acid gastric contents, proteins and fats stimulate release of the intestinal hormones strengthening motor activity of a gall bladder and secretory activity of a pancreas). Apply non-narcotic analgesics to reduction of pains.