Acute cholecystitis
- Constant intense pain in the right hypochondrium, unlike colic, does not go away after a few hours
- Temperature 37.5–38.5 °C or higher, chills
- Nausea, vomiting, without relief
- Increased pain with deep inspiration and with pressure under the right costal arch
- Rapid pulse, weakness
Treatment is carried out in a hospital: antibiotics, pain relief, infusion therapy. It is considered optimal to perform laparoscopic cholecystectomy in the first days after the onset of an attack - then the operation is technically simpler and there are fewer complications than with delayed intervention.
Chronic cholecystitis
Develops with prolonged existence of stones and repeated episodes of inflammation. It manifests itself less clearly and is often disguised as “liver problems.”
- Heaviness and dull pain in the right hypochondrium after fatty and fried foods
- Bitterness in the mouth, especially in the morning
- Nausea, belching, bloating
- Intolerance to fatty foods
Если по УЗИ камней нет, а жалобы есть, диагноз «хронический холецистит» ставить не следует автоматически. Чаще речь идёт о функциональном расстройстве желчного пузыря, ГЭРБ, гастрите или синдроме раздражённого кишечника — и лечение будет другим.
Survey
- УЗИ органов брюшной полости — main метод: показывает камни, утолщение стенки пузыря, наличие жидкости вокруг него.
- Общий анализ крови — лейкоцитоз и повышение СОЭ при остром воспалении.
- Биохимия: билирубин, АЛТ, АСТ, щелочная фосфатаза, амилаза — оценка протоков и поджелудочной железы.
- МРТ-холангиография или эндоскопическое УЗИ — при подозрении на камни в общем желчном протоке.
- КТ — при неясной картине и подозрении на осложнения.
Treatment
- Acute cholecystitis: hospitalization, antibiotics, refusal to eat for a while, infusions, pain relief
- Laparoscopic cholecystectomy - preferably within the first 72 hours of the onset of the attack
- In severe condition and high operational risk - percutaneous drainage of the bladder followed by surgery
- For stones in the common bile duct - endoscopic removal (ERCP) before or after cholecystectomy
- Chronic calculous cholecystitis - planned cholecystectomy
- Antispasmodics and painkillers - symptomatically; choleretic drugs for stones are contraindicated
Желчегонные средства и «тюбажи» при наличии камней опасны: они провоцируют движение камня, закупорку протока и панкреатит.
Food
- Regular split meals 4–5 times a day - stagnation of bile is provoked by long breaks
- Don't skip breakfast
- Limit fried, smoked, very fatty, strong broths
- Adequate fiber and fluid
- Moderation in alcohol
- Gradual rather than sudden weight loss for obesity
