A. Symptoms of cholecystitis
1.Acute cholecystitis
Acute onset, persistent pain in the middle and upper abdomen or right upper abdomen, increasing in paroxysms, pain may radiate to the right shoulder, mostly occurring at night, triggered by full meals and fatty meals. If stones are present and obstruct the bile duct, there may be intermittent biliary colic. Nausea and vomiting can occur, and in severe cases, bile can be vomited and can cause dehydration. When septic cystitis occurs, chills, high fever, irritability, and delirium may occur. There is obvious pressure pain in the right upper abdomen, and the enlarged and painful gallbladder can be palpated on abdominal palpation. It can develop into steamed bun cholecystitis, gallbladder pus accumulation and toxemia; if there is necrosis and perforation of gallbladder wall, diffuse peritonitis can be formed.
2.Chronic cholecystitis
The main symptoms of chronic cholecystitis and gallstones are different degrees of pain in the right upper abdomen, as well as belching, bloating, aversion to oil and other symptoms of digestive discomfort, which are aggravated by pain during acute attacks, and fever and other symptoms of infection.
Second, the gallbladder in the acute inflammation of the diet
In principle, the diet of patients with cholecystitis should be low-fat, low-cholesterol, moderate amount of protein and high vitamin diet. Low fat and low cholesterol, on the one hand, can prevent the acute attack of chronic cholecystitis caused by the large secretion of bile and the rapid contraction of the gallbladder, and at the same time can also prevent excessive cholesterol and lead to the formation of cholesterol stones based on chronic cholecystitis. A moderate amount of protein and high vitamin is to strengthen the body and promote repair, and can prevent the formation of bile pigment stones.
Excessive protein can increase the secretion of bile, which is not conducive to the elimination of inflammation, so it is more reasonable to have 50-70g per day. The gallbladder should be fasted during acute attacks so that the gallbladder can get sufficient rest to relieve pain. It can be supplemented by intravenous fluids, drinking more water and paying attention to sodium and potassium in drinks. When the condition improves, high carbohydrate fluids such as rice soup, fruit juice, fruit juice jelly, almond tea, root powder, etc. can be given. After the patient gradually adapts to the situation, he can add over-cooked porridge and flushed egg white. Gradually increase the variety of food and the amount of fat according to the condition, such as rice porridge, cereal, bread, cookies (less oil) and a small amount of crushed soft vegetables and fruits. The amount of carbohydrates and proteins should be satisfied with small and frequent meals, and fat should be appropriately limited. The absorption of fat-soluble vitamins can also be affected when fat intake is too low.
When the acute phase disappears, a change from a fat-free diet to a low-fat diet should be made. Patients with acute cholecystitis should avoid irritating or gas-producing foods, such as milk, radish, skunk cabbage, onion, etc.; forbid drinking alcohol; avoid eating foods that cause secretion of gastric and pancreatic juices, such as broth, chicken soup, milk and egg yolk.
Third, the life care after gallbladder surgery
Surgical removal of gallbladder is an effective treatment for gallbladder stones. Fasting for 12 hours before surgery and 24 hours after surgery can be done by intravenous rehydration. When intestinal peristalsis is restored and appetite is present, low-fat clear liquid diet can be eaten, and then gradually transition to low-fat semi-fluid or low-fat soft meal. The gallbladder is an organ in the human body with a certain role but not indispensable, and after surgical removal of the gallbladder, patients can obtain their own regulatory compensation after a period of adjustment and recovery, that is, through the compensatory expansion of the bile ducts to effectively maintain the normal physiological functions of the body.
As the regulation of compensatory function after gallbladder removal needs a certain period of time, the digestive function of human body should be relatively weakened at this time after all, therefore, the patients after gallbladder removal surgery.
The following issues should be noted in home care.
1, vomiting patients after surgery often occur vomiting. The main cause of vomiting is the reaction to anesthesia, and vomiting can be stopped when the anesthesia wears off. If the patient is using general anesthesia, just back from the incision is not fully awake, do not give him a pillow to sleep, to tilt the head to the side. So that the patient in case of vomiting, vomit can flow out with the mouth, not to inhale the respiratory tract caused by asphyxiation or cause bronchitis and pneumonia.
2, keep warm when it is cold to pay attention to keep warm. Before the patient returns to the ward after surgery, two hot water bags can be placed inside the quilt in advance. After the patient is sent back to the ward, to cover the bedding, pay attention not to put hot water bags close to the body, so as not to cause burns.
3, bleeding to pay attention to the patient’s blood pressure and pulse, if the blood pressure decreases and the pulse becomes faster, we should consider whether there is the possibility of internal bleeding. In addition, you can also observe the color from the cigarette drainage and “T” tube drainage to determine whether there is bleeding. If there is a small amount of bloody fluid coming from the cigarette drainage, it may be due to exudation from the traumatic surface of the stripped gallbladder, which will improve in a day or two. If there is more bleeding, it should be dealt with promptly.
4.Patients will feel pain at the incision within 2 days after the anesthesia wears off, and the pain will be significantly reduced after 2 or 3 days, and they may not feel pain under quiet rest. Incisional pain should be dealt with, especially at night, to ensure that the patient rests. The most commonly used analgesic is dulcolax, which is injected intramuscularly or subcutaneously and has a very good pain relief effect. However, dulcolax can be addictive and can inhibit breathing and cause palpitations, nausea, vomiting and other adverse reactions, so do not be overly accommodating to the patient and give pain injections as soon as it hurts, but convince the patient to hold on as long as possible.
If the patient still feels wound pain 3 to 5 days after surgery, two conditions need to be considered. One is caused by the drying and hardening of the sutures at the incision, which is mild and does not produce pain when not moving. No special treatment is needed at this time, and if necessary, the original gauze on the incision can be removed and replaced with soft new gauze will be better. The other kind is wound inflammation.
If the pain is heavy and throbbing, and there is also an increase in body temperature and an increase in white blood cell count, inflammation of the wound should be suspected. At this point, the wound should be examined and attention should be paid to the presence of redness, swelling, and heat, and to the presence of deep pressure pain in the wound. Once the wound is inflamed, antibiotic treatment should be given and a few stitches should be removed promptly to drain the pus.
5. Urinary retention Patients often cannot urinate after surgery, causing urinary retention. Anesthesia reaction, incisional pain and patient’s unaccustomed to urinating in bed are the main reasons for urinary retention. When dealing with this, the patient should first be stabilized because anxiety and nervousness will aggravate the spasm of the bladder and urethral sphincter, making urination difficult. Hot compresses on the lower abdomen, painkillers to relieve incision pain, or tranylcypromine injections can often induce the patient to urinate on his own, or assist the patient to sit on the edge of the bed or stand up to urinate. If the above measures are still ineffective, catheterization can be performed under strict sterilization.
6.The peristalsis of the intestine is often weakened or even stopped after abdominal surgery. Therefore, it is often necessary to insert a gastric tube and use a gastrointestinal pressure reducer to pump gastric juice to reduce abdominal distension. Patients with only gallbladder removal can have the gastric tube removed at the end of surgery or a few hours later because the surgery is less disruptive to the intestines. In more complicated surgeries, especially after anastomosis of the bile duct and intestine, the gastric tube should be removed only when intestinal peristalsis is restored (usually after anal venting). Until the gastrointestinal function is restored, no diet is allowed and fluids are needed to maintain nutrition. After anal discharge, you can start to drink light fluids, such as rice soup, lotus root powder, fruit juice, chicken soup, cream of wheat, egg soup and so on.
After 1 to 2 days, change to semi-liquid diet, such as chicken porridge, minced meat porridge, wontons, rotten noodles, etc. After 1 week, you can eat normal diet. Within two weeks after surgery, it is advisable to eat a liquid diet with high carbohydrate and low fat. After surgery, patients should eat less and more meals, and the diet should be nutritious, less greasy, with appropriate taste and easy to digest. Patients should be encouraged to eat, only when nutrition is added in can the condition recover faster and better. To resume a normal diet, it is advisable to maintain a dietary structure of low fat, low cholesterol and high protein. Avoid eating brain, liver, kidney, fish and fried food, and more importantly, avoid eating fatty meat and drinking alcohol to avoid affecting liver function or causing bile duct stones.
7, encourage coughing after surgery because of wound pain, the patient often dare not cough, so phlegm is not easy to cough up, and the accumulation will cause complications such as pulmonary atelectasis and pneumonia. You should often help the patient to turn over and sit up, and encourage coughing and sputum discharge. When the patient coughs, he can press the abdominal wall on both sides of the wound with his hands, which can reduce the vibration of the wound caused by coughing, reduce the pain caused by coughing, and facilitate the discharge of sputum.
8, activity and get up after surgery patients should early activity, strive to get up in a short period of time casual activities. Early activity has many benefits, which can increase lung capacity, reduce pulmonary complications, improve systemic blood circulation, reduce thrombosis due to venous stasis in the lower limbs, and also facilitate the recovery of bowel and bladder function and reduce the occurrence of abdominal distention and urinary retention.
Getting up and moving at an early stage should gradually increase the amount of activity according to the patient’s tolerance level. After surgery, certain activities can generally be started in bed, such as deep breathing, toe and ankle extension and flexion activities, alternating exercises of lower limb muscle relaxation and contraction, intermittent turning activities, etc. From the 2nd to 3rd day after surgery, you can try to leave the bed for activities. First sit on the edge of the bed, then stand next to the bed, then walk slightly or sit on the chair for a moment.