Cholecystitis is a relatively common disease with a high incidence. According to its clinical manifestations and clinical course, it can be subdivided into two types: acute and chronic, often in combination with cholelithiasis. Acute pain or colic in the right upper abdomen is most often seen in acute cholecystitis caused by stones or parasites embedded in the obstructed gallbladder neck, and the pain is often sudden, very intense, or colic-like. In non-obstructive acute cholecystitis of the gallbladder duct, the pain in the right upper abdomen is usually not severe, but mostly persistent and distending.
Causes
Acute cholecystitis can be caused by sudden obstruction of stones in the gallbladder or by an embedded cystic duct, as well as by torsion of the cystic duct, stenosis, and obstruction by biliary roundworms or biliary tumors. In addition, during the aging process, the gallbladder wall gradually becomes hypertrophic or atrophic, and the contraction function decreases, resulting in bile stagnation, concentration and formation of bile salts; the end of the common bile duct and the sphincter of Oddi become relaxed, and retrograde infection easily occurs; systemic atherosclerosis and increased blood viscosity can aggravate gallbladder artery ischemia. After obstruction of the cystic duct or gallbladder neck, the stagnant bile in the gallbladder concentrates and forms bile acid salts, which stimulates the gallbladder mucosa and causes chemical cholecystitis (early stage); at the same time, bile retention increases the pressure in the gallbladder, and the swollen gallbladder firstly affects the venous and lymphatic reflux of the gallbladder wall, and the gallbladder becomes congested and edematous. The ischemic gallbladder is prone to secondary bacterial infection, aggravating the process of cholecystitis and eventually complicating gallbladder gangrene or perforation. In case of obstruction of the cystic duct without blood circulation disorders and bacterial infection of the gallbladder wall, gallbladder effusion develops. Recent studies have shown that phospholipase A can be released from the damaged gallbladder mucosal epithelium due to bile stasis or stone impaction, causing hydrolysis of lecithin in the bile to lysolecithin, the latter in turn causing changes in the integrity of the mucosal epithelium causing acute cholecystitis.
Treatment
1.General treatment
① Actively prevent and treat bacterial infection and complications, pay attention to dietary hygiene, prevent the occurrence of biliary parasitosis, and actively treat intestinal ascariasis.
②Live a moderate life, pay attention to the combination of work and rest, cold and temperature appropriate, keep optimistic emotions and smooth bowel movement.
③If the disease has stones or frequent attacks, surgery can be considered. ④Low fat meals should be used to reduce bile secretion and the burden on the gallbladder.
2.Drug treatment
(1) Acute cholecystitis
① antispasmodic and analgesic can use atropine intramuscular injection, nitroglycerin sublingual, pethidine (dulcolax), etc. to release the spasm of Oddi sphincter and pain.
② Antibacterial treatment antibiotics are used to prevent bacteremia and septic complications, usually in combination with ampicillin (aminobenzyl penicillin), clindamycin (clindamycin) and aminoglycosides, or second generation cephalosporins such as cefamandole (cefadroxil) or cefuroxime. The change of antibiotics should be based on blood culture, bile culture at the time of surgery and bacterial culture of the gallbladder wall, as well as the results of drug sensitivity tests.
(3) Biliary medications 50% magnesium sulfate orally (not used in those with diarrhea), dehydrocholic acid tablets orally, and bile acid tablets orally.
(2) Chronic cholecystitis
① biliary drugs can be taken orally 50% magnesium Cubate, dehydrocholic acid tablets, etc.
(2) Deworming therapy for the cause of the disease.
(3) Lithotripsy therapy, such as cholesterol stones, can be treated with goose deoxycholic acid lithotripsy. It is reported in the literature that the efficiency of lithotripsy can reach about 60%. After the course of treatment, it is still necessary to take the maintenance amount to prevent recurrence.
(3) Rational use of proprietary Chinese medicine
①Golden bile tablets: anti-inflammatory and bile-supporting. Used for acute and chronic cholecystitis.
②Clear liver and gallbladder oral liquid function: clear liver and gallbladder damp heat. Mainly for the treatment of dullness, dysesthesia, fatigue, yellow urine, greasy coating, stringy pulse, liver stagnation, liver and gallbladder damp-heat is not cleared, etc.
3.Surgical treatment
Cholecystectomy is the fundamental treatment for acute cholecystitis. Surgical indications.
(1) gangrene and perforation of gallbladder, complicated by diffuse peritonitis.
(2) Recurrent acute attacks of acute cholecystitis with a clear diagnosis.
(3) those whose condition continues to develop and deteriorate after active medical treatment
(4) Those who have no contraindication to surgery and can tolerate surgery.
Chronic cholecystitis with gallstones; once the diagnosis is established, cholecystectomy is a reasonable and fundamental treatment. If the patient has serious diseases such as heart, liver, lung or other systemic conditions that cannot tolerate surgery, medical treatment can be given.