CHRONIC NON-CALCULOUS CHOLECYSTITIS

Chronic cholecystitis - polietiologicheskoe a chronic inflammatory disease of the gall bladder,

accompanied by disturbances in the outflow of bile and changes in its physico-chemical and
biochemical properties.

Etiology. Aetiology of chronic cholecystitis complicated and largely connected with the state of
biliary system, the duodenum and stomach. Violation of the sphincter apparatus, duodenostasis,
swelling and spasm of the large duodenal papilla lead to hypertension in the biliary system,
disruption of the passage of bile and hypomotoric dyskinesia of the gallbladder. As in the
development of acute cholecystitis, a role played by an infectious process (usually bacterial),
promotes the formation of cholesterol crystals.

Pathogenesis. Some importance in the formation of chronic cholecystitis are allergic

factors. Bacterial toxins, chemical and medicinal effects exacerbate diskineticheskih
disorder. The role of bowel bacteria overgrowth. Simplistically pathogenesis of chronic
cholecystitis is presented in Fig. 15-3.

Violation of the passage of bile and the change in its physical and chemical properties

Influence of allergic factors

Intestinal dysbiosis

Cholestasis

Reducing the protective function of reticuloendothelial cells of liver

The reduction factors of the local protection

Chronic inflammation of the walls of the gall bladder

Fig. 15-3. Pathogenesis of chronic cholecystitis.

Clinical picture. The disease is manifested recurrent attacks of pain in the epigastrium, right
hypochondrium and around the navel, often radiating to the right scapula. During the period of
exacerbation of chronic cholecystitis clinical picture consists of several components, resulting
not only the pathology of the gall bladder, but secondary dysfunction of other internal
bodies. Thus, the inadequacy or complete cessation (anacholia) proceeds of bile into the intestine
leads to indigestion and intestinal peristalsis, changes in evacuation-motor and secretory
functions of the stomach and duodenum, reduced secretion of pancreatic enzymes, the
emergence of fermentation, and sometimes the putrefactive processes in the intestine, appearance
of dyspeptic disorders (nausea, bitter taste in the mouth, loss of appetite, bloating, constipation or
loose stool). As a result, there are signs of chronic intoxication: weakness, low-grade body
temperature, dizziness, headache. Reduces body weight, children may lag behind in physical
development. Skin and sclera may be somewhat ikte Hex due to cholestasis. Language lined,
sometimes swollen, with imprints of teeth on the edges. Palpation abdomen determine pain in the
right hypochondrium and epigastric region.

Diagnosis. During times of increased in peripheral blood were determined with neutrocytosis
moderate leukocytosis, increased erythrocyte sedimentation rate, possibly increasing the
concentration of bilirubin, alkaline phosphatase activity (as a result of cholestasis). Diagnosis is
based on history and clinical and instrumental studies. When ultrasound reveal thickening of the
wall of the gallbladder, increased its volume, in the lumen of the bladder often define a dense
secret, and after a test breakfast is not complete emptying of the gall bladder. bubble may acquire
a spherical shape.

Differential diagnosis. Acute and chronic cholecystitis differentiate with other gastroduodenal
diseases - chronic gastroduodenitis, biliary tract, hepatitis, chronic pancreatitis, etc.

Treatment of chronic cholecystitis in the exacerbation period built on the same principles as the
treatment of acute cholecystitis: bed rest, diet number 5a and number 5 with the ratio of proteins,
fats and carbohydrates 1:1:4, plenty of fruit and vegetables, split meals. Table number 5 in the 2
years is recommended and in remission. After the second year of follow up diet can be
expanded. In severe exacerbation of chronic cholecystitis shown dezintok-sikatsionnaya therapy
- the introduction of intravenous glucose, saline, gemodeza. The rest of medical therapy is the
same as for acute cholecystitis.

Prevention. With the threat of chronic cholecystitis prevention is strict adherence to diet, the use
of choleretic, choleretic, including tea, limitation of physical activity (including physical
education in school) and emotional distress.

Forecast. Relapses of the disease may lead to the development of anatomical and functional
abnormalities (eg, thickening of the wall of the gall bladder, the appearance of the wall of
stagnation, the possible formation of gallstones).