Overview
A general term for diseases in which cholecystitis and gallbladder stones coexist with recurrent episodes of right upper abdominal discomfort or right upper abdominal pain gallbladder stones are the main cause of calculous cholecystitis Treatment should be individualized according to the presence or absence of symptoms, complications and so on.
Definition
Cholecystitis is divided into stone cholecystitis and nonstone cholecystitis based on the presence or absence of stones in the gallbladder [1].
Calculous cholecystitis is a common and frequent disease, which is a general term for the coexistence of cholecystitis and gallbladder stones.
Pharmacologic treatment of calculous cholecystitis is often ineffective, and the ideal treatment is cholecystectomy, and in some cases, biliary lithotripsy.
The traditional method is to use open cholecystectomy. In recent years, with the development and improvement of endoscopic technology, laparoscopic cholecystectomy has been very widely used in the treatment of cholecystitis and cholelithiasis, which has the advantages of small trauma, fast recovery and good cosmetic appearance.
Morbidity
At present, there is no authoritative data on the incidence of stone cholecystitis in China, and stone cholecystitis accounts for 90% to 95% of all cholecystitis, so it can be roughly presumed by the reports of cholecystitis [2].
In China, the prevalence of chronic cholecystitis in adults is reported to be 0.78% to 3.91%, and the prevalence of gallbladder stones is 2.3% to 6.5% [3-5].
The prevalence of gallbladder stones in women is higher than that in men, with a male-to-female ratio of 1: (1.07-1.69).
With the gradual improvement of the living standard of our people, the incidence of chronic cholecystitis and gallbladder stones has been on the rise in recent years.
Causes
Causes
Gallbladder stones
Gallbladder stones are the main cause of stone cholecystitis.
Stones can lead to repeated obstruction of the gallbladder duct and cause damage to the gallbladder mucosa, resulting in recurrent inflammatory reactions of the gallbladder wall, scar formation and gallbladder dysfunction [6].
Bacterial infection
Normal bile should be sterile, and when the gallbladder or bile ducts become embedded and obstructed with stones, then it may lead to enterogenic bacterial infections.
The pathogenic bacteria of cholecystitis mainly originate from the intestinal tract, and the causative species are basically the same as the intestinal bacteria, with gram-negative bacteria predominantly accounting for 74.4% of the total, mainly including Escherichia coli, Bacillus immobilis, and Aspergillus chimaera [7].
Others.
A low-fiber, high-energy diet can increase bile cholesterol saturation and facilitate stone formation.
Certain medications can lead to gallbladder stone formation such as ceftriaxone and birth control pills.
Rapid weight loss such as irrational weight loss methods may predispose to gallbladder stone formation.
Symptoms
Most patients have no obvious symptoms, and asymptomatic people account for about 70% of all patients [3].
With the wide application of abdominal ultrasonography, gallbladder stones are mostly found during routine health checkups, when there are neither obvious symptoms nor positive signs, but some patients may develop symptoms in the future.
Main symptoms
Upper right abdominal discomfort
Recurrent episodes of right upper abdominal discomfort or right upper abdominal pain are more common in patients, and the episodes are often associated with fatty diets and high protein diets.
Biliary colic
Biliary colic may occur in a small number of patients, often after a full or fatty diet.
It presents as persistent pain with paroxysmal increase in the right upper abdomen or epigastrium, which may radiate to the back of the right shoulder.
The colic is relieved if the embedded stone is relieved by a change in position or by antispasmodic or other medications.
Biliary dyspepsia
Patients often suffer from biliary dyspepsia, which is characterized by belching, fullness after meals, bloating and nausea.
Other symptoms
Acute attack of cholecystitis
When an acute attack occurs, it manifests with signs and symptoms corresponding to acute cholecystitis, such as chills and fever.
Complicated biliary pancreatitis
When there is a complication of biliary pancreatitis, the signs and symptoms of acute pancreatitis may appear, such as acute abdominal pain, accompanied by nausea, vomiting, fever and jaundice.
Mirizzi syndrome
Mirizzi syndrome is a series of syndromes characterized by cholangitis and obstructive jaundice due to obstruction of the common hepatic duct or common bile duct caused by stone impaction in the neck of the gallbladder or the cystic duct and/or compression or inflammation from other benign diseases.
The manifestations are similar to those of choledocholithiasis, such as recurrent abdominal pain and jaundice.
Gallstone intestinal obstruction
The symptoms of gallstone intestinal obstruction mainly include abdominal pain, abdominal distension, nausea, vomiting, and cessation of defecation and evacuation.
Combined with gallbladder cancer
In the early stage, there is usually no obvious clinical manifestations, but in the late stage, jaundice, right upper abdomen or epigastric mass may appear, and intestinal obstruction may be caused when invading the duodenum [8].
Consultation
Department
Hepatobiliary surgery
If there are recurrent episodes of right upper abdominal pain, and usually have a high-fat, protein diet, or have symptoms of dyspepsia, it is recommended to consult a doctor as soon as possible.
Routine physical examination abdominal ultrasound suggestive of cholecystitis, gallbladder stones, prompt medical attention.
Gastroenterology
You may also visit the gastroenterology department if any of the above conditions occur.
Preparation for medical treatment
Preparation for consultation: registration, preparation of documents, common problems
Tips for the doctor
In order to facilitate the doctor’s examination, try not to wear high-collared clothes or necklace jewelry, and it is recommended to choose clothes that are easy to put on and take off.
If there is any weight change, it is recommended to record the time and result of weight measurement for the doctor’s reference.
Preparation Checklist for Doctor’s Visit
Symptom Checklist
Particular attention needs to be paid to the time of symptom onset, special manifestations, etc.
What are the symptoms and what are the characteristics of the attack?
Do you usually have a regular diet? Do you eat breakfast every day?
Do you like to eat greasy or light food?
How much water do you drink every day?
List of medical history
Do you suffer from any disease, such as gallbladder stones, gallbladder dysfunction?
Have you been to other hospitals and what were the results?
Have you received any medical treatment, what kind of treatment did you receive, and what were the results?
Any history of food or drug allergies?
Any special medications you usually take?
Checklist
Test results in the last six months, which can be brought to the doctor’s office
Laboratory tests: blood routine, blood biochemistry.
Imaging tests: abdominal ultrasound or CT.
Medication list
Medication used in the last 3 months, if available, bring along the box or package for medical consultation
Antibiotics: ceftriaxone sodium, levofloxacin, etc.
Anticoagulants: warfarin, enoxaparin, rivaroxaban, etc.
Contraceptives: norethindrone, medroxyprogesterone acetate, etc.
Diagnosis
Diagnosis is based on
Medical history
Presence of gallbladder stones, fatty liver, diabetes mellitus, hypertension, hyperlipidemia, chronic pancreatitis.
Obesity.
Lack of exercise in general, irregular diet, greasy diet.
Clinical manifestations
Symptoms such as abdominal distension and abdominal pain appear after a full meal or eating greasy food.
Most patients with chronic cholecystitis may not have any positive signs, and physical examination of a few patients may reveal pressure or percussion pain in the right upper abdomen.
Laboratory Tests
Blood routine: by checking the white blood cell count, neutrophil ratio, etc., it can determine whether there is a bacterial infection and assist in the diagnosis.
Imaging examination
Abdominal ultrasound
Routine abdominal ultrasound is the most common and valuable examination method for diagnosing stone cholecystitis, which can determine the size of the gallbladder, the thickening of the gallbladder wall, and whether there are stones, etc. [9-10].
Endoscopic ultrasound has a high detection rate of microscopic gallbladder stones that are not detected by routine abdominal ultrasound. Studies have reported that 52.4% of patients with biliary colic who had negative routine abdominal ultrasonography and then underwent endoscopic ultrasonography detected gallbladder stones [11].
CT examination of the abdomen
The diagnostic value of CT examination for cholecystitis is similar to that of abdominal ultrasound. It shows good thickening of the gallbladder wall, but cannot show stones that are negative on X-ray.
Multi-energy spectral CT is a new type of CT, which can provide a comprehensive diagnostic mode based on multiple quantitative analysis methods and multi-parameter imaging, and the lipid/water-based substance map and single-energy map can well display X-ray negative stones and can analyze their stone composition, which is significantly better than conventional CT [12-13].
Magnetic resonance imaging (MRI)
MRI examination is superior to CT examination in assessing gallbladder wall fibrosis, gallbladder wall ischemia, edema of pericholecystic tissues, and pericholecystic fat accumulation.
Magnetic resonance cholangiopancreatography (MRCP) is an option when abdominal ultrasound shows unclear gallbladder lesions.
Differential Diagnosis
Non-stone cholecystitis
Similarities: Both may present with abdominal pain and distension.
Differences: The main causes of noncalculous cholecystitis include infections by various pathogens (bacteria, parasites and viruses), impaired emptying of the gallbladder, and ischemia of the gallbladder, etc.; gallbladder stones are not detected on imaging.
Chronic gastritis
Similarities: both may present with abdominal pain and distension.
Differences: Chronic gastritis may present with vague pain in the epigastrium, acid reflux, belching, etc. It can be differentiated and diagnosed by gastroscopy or ultrasonography.
Gallbladder cancer
Similarity: both can present with nausea, vomiting, etc. Differences: gallbladder cancer is mostly characterized by nausea and vomiting.
Difference: Gallbladder cancer is mostly painless enlargement of gallbladder, which can be differentiated by ultrasound examination.
Treatment
Aim of treatment: eliminating the cause of disease, relieving symptoms, preventing recurrence and preventing complications.
Treatment principle: individualized treatment should be carried out according to whether there are symptoms and complications.
General treatment
The development of stone cholecystitis is related to diet and obesity.
Regular, low-fat, low-calorie diets are recommended, and a regular diet that is quantitative and timed is advocated [14].
Medication
Lithotripsy
Asymptomatic patients with stone cholecystitis may not be treated, while symptomatic patients who are not suitable for surgery and have cholesterol stones assessed by abdominal ultrasonography as having normal gallbladder function and negative X-rays may be considered for oral litholytic therapy [15].
Commonly used drugs include ursodeoxycholic acid (UDCA). Oral UDCA has a good litholytic effect in patients with X-ray-negative cholesterol stones who have normal gallbladder function.
It is recommended that UDCA should be taken continuously for more than 6 months. Please follow your doctor’s instructions for specific dosage.
Relief of symptoms of biliary dyspepsia
In patients with symptoms of biliary dyspepsia, supplementation with digestive enzyme drugs that promote bile synthesis and secretion, such as compound azinmitic enteric-coated tablets, is appropriate, but should not be applied if there is stone obstruction.
Other digestive enzyme drugs such as mitomycetin pancreatic enzyme tablets can also be applied, except for stone obstruction, combined with choleretic drugs such as fennel trisulfide to promote bile secretion.
Relief of biliary colic symptoms
During the acute attack of biliary colic, fasting and effective analgesic treatment should be given.
Foreign therapeutic drugs are preferred to diclofenac, indomethacin and pethidine [17-20].
Antispasmodics are still more commonly used in domestic clinics, including atropine, scopolamine (654-2) and resorcinol.
Anti-infective therapy
Stone cholecystitis usually does not require antibiotics, but can be treated empirically with antimicrobials if an acute attack occurs.
Escherichia coli, Klebsiella and Enterococcus are the main pathogens of cholecystitis, and antimicrobials that are effective against these pathogens, such as cephalosporins, quinolones and metronidazole need to be selected.
Surgery
Indications for surgery
For recurrent biliary colic and gallbladder nonfunction with acute attacks.
Commonly used surgical procedures
Traditional open cholecystectomy and laparoscopic cholecystectomy, the latter of which has now become an important treatment for stone cholecystitis.
Laparoscopic cholecystectomy has the advantages of less trauma and faster postoperative recovery, but it is not suitable for those who suffer from heart disease and poor cardiopulmonary function.
If during laparoscopic cholecystectomy, it is found that the gallbladder is heavily inflamed, densely adherent to the surrounding tissues, or anatomically unclear, it may be converted to open surgery to ensure safety.
Laparoscopic or endoscopic biliary lithotripsy may be an option for some patients.
Questions you may be concerned about
Does it help to take anti-inflammatory cholecystitis tablets for stone cholecystitis?
Stone-forming cholecystitis is generally helped by taking anti-inflammatory choleretic tablets.
The main function of anti-inflammatory choleretic tablets is to clear away heat and dampness, which is a kind of proprietary Chinese medicine. It can be used to treat acute cholecystitis and cholangitis. Because of the individuality of each person, it is recommended to take medication under the guidance of a doctor for treatment.
Anti-inflammatory cholecystolithiasis tablets do not have the effect of dissolving stones, and can only play a therapeutic role in mild acute cholecystitis or cholecystitis acute attack.
It should be noted that anti-inflammatory cholecystolithiasis tablets contain bitter wood, can not be taken for a long time. In addition, people should stop taking the drug immediately and seek medical treatment when symptoms such as asthma and drug rash occur after taking the drug. People who are allergic to the ingredients contained in the drug, pediatrics, pregnant women and breastfeeding should also not take this drug.
What is the fastest way to cure stone cholecystitis?
There is no such thing as the fastest cure for stone cholecystitis. Stone cholecystitis is an inflammation of the gallbladder caused by stones located in the gallbladder or in the neck of the gallbladder. It can be treated with general treatment and surgery.
1. General treatment: for asymptomatic gallbladder stones as well as cholecystitis patients. Daily should be low-fat diet, at the same time should eat on time, regular diet, do not overeat.
If the patient has an acute attack of cholecystitis, it should be antispasmodic and analgesic, such as isoprinosine, pethidine and so on. At the same time anti-infection treatment, such as commonly used amoxicillin, tigecycline, etc.. As well as some proprietary Chinese medicines, such as cholagogue capsule, cholagogue tablets and so on. After the symptoms are relieved, you can elective surgery.
2. Surgery: If the stones are relatively large, such as patients with gallstones over 2cm, as well as calcification of the gallbladder wall, chronic cholecystitis, etc., prophylactic resection of the gallbladder is recommended.
The above drugs should be used according to the doctor’s prescription. When gallstones are accompanied by cholecystitis, it is recommended to improve the relevant examinations to clarify the location and size of the stones and choose the appropriate treatment plan.
How to treat stone cholecystitis 0.9?
Stone cholecystitis, gallstones 0.9cm, no symptoms without treatment. If the patient has symptoms such as pain in the right upper abdomen and vomiting, general measures to regulate, as well as medication and surgery are needed.
If stone cholecystitis, gallstones 0.9cm patients have no clinical manifestations, there is no need to take therapeutic measures, and patients can be reviewed regularly.
For patients with obvious right upper abdominal pain or nausea and vomiting need to fast in time, can be in through intravenous infusion of amino acids, glucose sodium chloride, fat milk and other nutrients.
For patients with acute calculous cholecystitis, it is necessary to follow the doctor’s action of cefixime, cefuroxime and other antibiotics, as well as antispasmodic and analgesic drugs, such as scopolamine, scopolamine and so on.
In addition, patients with recurrent gallbladder inflammation need to be treated with surgical procedures such as cholecystectomy, ultrasound-guided percutaneous hepatic cholecystocentesis and drainage, partial cholecystectomy and cholecystostomy.
It is recommended that patients need to seek timely medical treatment. Doctors will choose the appropriate way of treatment according to the patient’s condition, and patients should follow the doctor’s instructions for medication.
Prognosis
Cure
Patients with stone cholecystitis can be relieved of their symptoms after active treatment, and some can be completely cured.
If treatment is not active, the condition may recur and complications may occur.
Harmfulness
Stone cholecystitis will cause abdominal discomfort or pain, thus directly affecting the patient’s daily diet, rest and work.
If stone cholecystitis is not treated in time, it may cause septic cholecystitis, diffuse peritonitis, cholestatic pancreatitis and other conditions, which may even be life-threatening in serious cases.
Daily
Daily Management
Dietary management
Low-fat diet: Reduce the intake of animal fats such as fatty meat and animal fats. Increase the proportion of vegetable oil intake such as corn oil, sunflower oil, peanut oil and soybean oil.
High-protein diet: Choose high-quality protein foods such as eggs, fish, lean meat, milk and soy products.
Low cholesterol diet: eat less fish roe, animal liver, animal kidney, animal brain and other foods.
High-vitamin diet: eat more fresh vegetables, fruits and foods such as yogurt, hawthorn and brown rice to supplement vitamins and moderate amount of fiber.
Moderate supplementation of carbohydrates: it can reduce the stimulation of the gallbladder and help maintain liver function, but be careful not to overdo it.
Avoid eating spicy and stimulating foods such as chili, curry, mustard, garlic and stimulating condiments.
Avoid alcohol and coffee, strong tea.
Regular diet, small meals, usually should ensure a balanced diet, avoid eating too full.
Pay attention to dietary hygiene to prevent intestinal parasites and bacterial infections.
Life management
Pay attention to the combination of work and rest, appropriate temperature and cold, quit smoking, and keep a good mood.
Regular work and rest, prevent overwork, ensure sufficient sleep, avoid excessive tension, and maintain a good mood.
Exercise management
You can choose suitable exercise methods, such as swimming, jogging, etc., which can help to strengthen the body and improve the body’s resistance to diseases.
Follow-up and review
Treatment of stone cholecystitis requires regular follow-ups and some tests.
Follow the doctor’s instructions for regular follow-ups (3 to 6 months for medication, 1 month, 3 months, and 6 months after surgery, or once a year if there is no abnormality).
If symptoms do not decrease, or even increase, or if there is an emergency such as severe pain, you need to see a doctor promptly.
It is still important to bring your personal medical records and report cards, etc., to the follow-up appointment.
Ultrasound of the gallbladder and blood lipids may be done at the follow-up appointment.
Prevention
A good lifestyle can help prevent cholecystitis, and regular physical examination can detect stone cholecystitis as early as possible [21].
Try to eat less greasy food, less spicy, stimulating, cold, hard and other indigestible food.
Eat more fresh vegetables and fruits.
Eat easy-to-digest and protein-rich foods such as soy milk, tofu, and milk.
You can strengthen your body through running, fitness, swimming and other exercises.
People with heavy weight need to control their diet appropriately and do exercise to make their weight drop gradually and smoothly.
Have regular medical checkups, you can pay attention to indicators such as blood lipids and gallbladder ultrasound. Read the physical examination results and doctor’s advice carefully, and go to the hospital in time if there is any abnormality.