Acute cholecystitis is the most common complication.gallstone disease. The disease is characterized by clear clinical symptoms, but in rare cases, the disease is atypical. Pain localized in the abdomen is one of the key signs of the disease.
Acute cholecystitis is due to blockage.duct of the gallbladder stones. Primary inflammation of a non-bacterial nature develops, then the infection joins. This effect is caused by prostaglandins, lysolecithin and other similar substances. The gallbladder is affected by toxic acids that act on the affected mucosa.
General intoxication is a symptom thatcharacterized by acute cholecystitis. Symptoms of the disease are rapidly increasing: there is pain of a moderate nature in the epigastric, right subcostal area, which often radiates to the scapula, right shoulder. Sometimes nausea, vomiting. In almost all cases, there is an increase in temperature to 39 ° C. , higher numbers suggest an abscess or bacteremia. Palpation shows tenderness in the right hypochondrium during inhalation (Murphy's syndrome).
Acute cholecystitis is difficult to differentiate withan attack of pain in the biliary region. For accurate diagnosis is applied observation, which is carried out within two hours. For prolonged pain, surgery is required to remove the affected organ.
In some cases, the symptom may be weakexpressed. This is observed in patients who take tranquilizers and the elderly. In some cases, the disease begins with a toxic form, which is characterized by a pronounced increase in temperature, intense abdominal pain, bacteremia, a significant increase in the content of leukocytes in the blood.
The diagnosis of acute cholecystitis can be setonly when taking into account clinical signs, as they are specific to him. However, various methods of instrumental diagnostics are used: ultrasound, hepatobiliary scanning. If an abscess is suspected, computed tomography is used.
Acute cholecystitis affects the blood picture thatalso helps in its diagnosis. In studies there is an increase in the level of leukocytes. In some patients, there is an increase in amylase concentration. This indicates the accession of pancreatitis.
Ultrasound examination allows you to geta significant amount of information about the state of the bile ducts, liver, pancreas. If you find stones, thickening of the wall or edema of the body, the diagnosis is acute cholecystitis.
At admission the patient in the hospital heldThe following measures: determination of the level of leukocytes, ultrasound. Primary treatment is based on the prescription of antibiotics that act on enterococci, gram-negative bacteria. Infusion therapy is also performed, which is designed to prevent dehydration and restore alkaline-acid balance. If vomiting is present, a nasogastric tube is inserted.
The next stage of therapy is surgical intervention, which is necessary in case of deterioration due to the low efficacy of previously used drugs.
Выбор операции при этом заболевании проводится between open or closed type cholecystectomy. In some cases, the application of cholecystostomy. Open cholecystectomy is used in the presence of severe complications in the form of an abscess, perforation, gangrene. The operation of choice is laparoscopic organ removal.
