Acute cholecystitis is the most frequent complicationcholelithiasis. The disease is characterized by a clear clinical symptomatology, but in rare cases the disease occurs atypically. Pain localized in the abdomen is one of the key signs of the disease.
The basis of acute cholecystitis is a blockageduct gallbladder stones. Primarily develops a non-bacterial inflammation, then the infection joins. This effect is due to prostaglandins, lysolecithin and other similar substances. The gallbladder is affected by toxic acids that affect the affected mucous membrane.
General intoxication is a sign thatcharacterized by acute cholecystitis. Symptoms of the disease quickly increase: there is a moderate pain in the epigastric, right hypochondrium, which often radiates into the scapula, the right shoulder. Sometimes nausea, vomiting is added. Almost in all cases, the temperature is raised to 39 ° C. , higher figures suggest an abscess or bacteremia. When palpation, soreness is found in the right hypochondrium during inspiration (Murphy's syndrome).
Acute cholecystitis is difficult to differentiate witha bout of pain in the biliary area. An accurate observation is made, which is carried out for two hours. With prolonged pain, surgery to remove the affected organ is required.
In some cases, the symptom may be weakis expressed. 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 marked increase in temperature, intense abdominal pain, bacteremia, a significant increase in the content of leukocytes in the blood.
The diagnosis "acute cholecystitis" can be exposedOnly when considering clinical signs, because they are specific to him. However, various methods of instrumental diagnostics are used: ultrasound, hepatobiliary scanning. If you suspect an abscess, a CT scan is used.
Cholecystitis acute affects the picture of the blood thatalso helps in its diagnosis. In studies, the level of leukocytes is increasing. In some patients an increase in the concentration of amylase is noted. This indicates the accession of pancreatitis.
Ultrasound allows you to obtaina significant amount of information about the state of the bile duct, liver, pancreas. When a stone is found, thickening of the wall or swelling of the organ is diagnosed with "acute cholecystitis."
When a patient enters the hospital,the following measures: the determination of the level of leukocytes, ultrasound. Primary treatment is based on the appointment of antibiotics, which act on enterococci, gram-negative bacteria. Also, infusion therapy is used, which is designed to prevent dehydration, restore the alkaline-acid balance. If there is vomiting, a nasogastric tube is inserted.
The next stage of therapy is surgical intervention, which is necessary when the condition worsens because of the low effectiveness of previously used medicines.
The choice of surgery for this disease isbetween an open or closed type of cholecystectomy. In some cases, the application of cholecystostomy is applied. Open cholecystectomy is used in the presence of severe complications in the form of abscess, perforation, gangrene. The operation of choice is laparoscopic removal of the organ.