Treatment options
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.
(2) Live a moderate life, pay attention to the combination of work and rest, appropriate cold and temperature, keep optimistic mood and smooth bowel movement.
(3) Keep the left side lying position frequently during the consultation, which is conducive to bile excretion.
(4) If there are stones in this disease, or frequent attacks, consider manual treatment. Zhao Gang, gallstone disease specialist of Shanghai Oriental Hospital
(5) Low-fat meals should be chosen to reduce bile secretion and the burden on the gallbladder.
2.Drug treatment
(1) Acute cholecystitis.
(1) antispasmodic and analgesic: Atropine 0.5mg intramuscular injection, nitroglycerin 0.6mg sublingual, pethidine (dulcolax), etc. can be used to release the spasm and pain of Oddi sphincter.
②Antibacterial therapy: 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 are used for treatment. 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 medication: 50% magnesium sulfate 10ml, 3 times/d, orally (not used in those with diarrhea). Dehydrocholic acid tablets 0.25g, 3 times/d, orally. Bile acid tablets 0.2g, 3 times / d, orally.
(2) Chronic cholecystitis
①Biliary drugs: 50% magnesium Cubate, dehydrocholic acid tablets, etc. can be taken orally.
(2) Deworming therapy: Deworming for the cause of the disease.
③Lithotripsy: if cholesterol stones are the cause, goose deoxycholic acid can be used for lithotripsy treatment. It is reported in the literature that the efficiency of lithotripsy can reach about 60%. The dose is 500-700mg per day for 6 months to 2 years. A maintenance dose (250 mg per day) is required after the course of treatment to prevent recurrence. Side effects: diarrhea and a mild increase in serum transaminases.
(3) Rational use of proprietary Chinese medicines.
①Golden Bile Tablets: Function: Anti-inflammatory and bile-supporting. Used for acute and chronic cholecystitis, usage: 5 tablets, 3 times / d.
② Clear liver and gallbladder oral liquid: function: clear liver and gallbladder damp heat. Mainly for dullness, dysesthesia, fatigue, yellow urine, greasy coating, stringy pulse, liver stagnation, liver and gallbladder damp heat is not cleared. 20ml each time, 3 times/d.
3.Acupuncture therapy
(1) Acupuncture therapy.
(2) Ear acupuncture therapy.
4.Surgical treatment Cholecystectomy is the fundamental treatment for acute cholecystitis. Surgical indications: (1) gangrene and perforation of the gallbladder, complicated by diffuse peritonitis; (2) repeated acute attacks of acute cholecystitis, the diagnosis is clear; (3) after active medical treatment, the condition continues to develop and deteriorate; (4) no contraindications to surgery, and can tolerate surgery. In 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.
5.Rehab treatment
(1) General activities: The rehabilitation of chronic cholecystitis takes a long time, in addition to drugs, surgery and other treatments, daily life care also has a role in the recovery of the disease. First of all, we should make a scientific arrangement of the patient’s work and rest time. In the acute attack period, except for the necessary treatment, the patient should rest in bed; in the symptom relief period, there should be an appropriate amount of outdoor activities, such as walking after meals, playing tai chi, etc., to adapt to the recovery of mental and physical strength, and at the same time ensure that the patient has sufficient sleep and rest to consolidate the rehabilitation treatment effect.
(2) Diet: actively promote the significance of diet to the treatment of chronic cholecystitis, and on this basis make quit some bad eating habits, such as quit smoking, quit drinking, etc. In the process of rehabilitation treatment is generally based on the principle of low-fat, low-cholesterol, easy-to-digest diet, while avoiding high-calorie, spicy and cold foods. During the acute attack or biliary colic attack period, it is advisable to fast temporarily to avoid stimulating the gastrointestinal tract and to give proper nutrition by intravenous.
(3) Psychological treatment: the disease persists, symptoms recur, and patients suffer from long-term and repeated pain, which is very easy to produce pessimism and negative emotions. Psychological care can improve the patient’s psychological mood, make him/her cheer up, build up confidence, adjust the bad lifestyle and behavior, and cooperate with the treatment with a positive attitude. Since patients often have anxiety and fear due to lack of knowledge about the disease, in psychological care, patient and detailed explanation should be given to make them grasp the knowledge and rules of the disease, eliminate the wrong view of the disease, keep their spirits happy and relaxed, so as to promote the healing of the disease, especially before ERCP and extracorporeal shock wave lithotripsy must be repeatedly explained, so that they can eliminate the bad mood and cooperate with the physician. The physician should cooperate with the operation. In addition, we should also take the initiative to explain the characteristics of chronic cholecystitis and common triggering factors, such as improper diet and chronic infection can contribute to the recurrence of the disease, etc. Through these efforts, we can greatly strengthen the patient’s self-protection ability, reduce the number of recurrences and improve the quality of life.
(4) Medication: The medication for patients with chronic cholecystitis involves several types of antibiotics, painkillers, cholagogues and so on. There are many features in the use, it is directly related to the role of drugs, such as the use of antibiotics, antispasmodic and cholagogic drugs should be used at the same time to protect the liver drugs, the duration of medication should be extended; because the use of atropine, pethidine and other drugs should be observed when the occurrence of side effects.
(5) Family rehabilitation guidance.
① Maintain a good mood: Because of the long duration of chronic cholecystitis, it is easy to relapse relying only on short-term hospital treatment and rehabilitation is far from solving the actual problems of patients. Nursing staff should provide emotional support and psychological guidance for the actual psychological changes in each stage of rehabilitation of specific patients, so that they can maintain good emotions in their long-term life and work in the future. When people are in a state of tension, anxiety and fear, the regulation ability of the cerebral cortex and autonomic nervous system decreases, which can directly lead to dysregulation of gallbladder contraction movement, and the normal function of the gallbladder can only be maintained when the mind is broad and full of spirit. In addition, social and family support should be mobilized, which not only provides patients with convenience in life, but also enables them to feel the warmth of the environment and strengthen their confidence in treating the disease.
② Correct understanding of the disease: patients with chronic cholecystitis have more psychological concerns and worries due to long-standing treatment or recurrent attacks, and some patients are also compared with “cancer”, which often makes patients carry a heavy burden of thought. Generally speaking, although this disease is difficult to be completely cured, the cancer rate is about 3%, so patients should enhance their confidence and actively treat it.
③Reasonable arrangement of diet: Improper diet is an important cause of chronic cholecystitis, so a reasonable diet is the basis for the treatment of chronic cholecystitis. Patients should be instructed to recognize the importance of good dietary habits. Quit smoking and alcohol, avoid high-fat, high-cholesterol and high-calorie foods, and have a quantitative and balanced diet at each meal, and control the diet even more during acute attacks.
Regular follow-up examinations: Patients with chronic cholecystitis should go to the hospital regularly for follow-up examinations according to the severity of their condition. Report recent changes in symptoms and medication to the physician, receive guidance from the physician, and have an annual B-ultrasound examination to prevent early cancerous changes.
Complications
Complications include toxic shock, gallbladder gangrene, gallbladder perforation, etc.
Prognosis and prevention
Prognosis
Acute cholecystitis has a mortality rate of 5% to 10%, and almost always occurs in the elderly with septic infection and other serious illnesses. Acute cholecystitis with limited perforation can be treated surgically with satisfactory results; with free perforation, the prognosis is poor and the mortality rate is as high as 25%.
Prevention
Appropriate participation in exercise, sports and recreational activities, reasonable arrangements for work, study and rest according to the condition and physical strength, to enhance physical fitness, in order to promote the recovery of chronic cholecystitis.