Srasibo. Whether abusing alcohol could To lead to an inflammation cholic... [Архив]

Rasulov M.I.

12.07.2004, 16:26

Cholecystitis chronic
Cholecystitis chronic - a chronic inflammation of a cholic bubble. Disease widespread, meets at women is more often.
Etiology, pathogenesis: Bacteriemic or Bacterial flora (E. coli, streptococcuses, staphilococcuses, etc.), In rare or infrequent cases - anaeroby, a helminthic invasion (ascarides) and a mycotic affection (actinomycosis), viruses of a hepatitis; there are cholecystites of the toxic and allergic nature. Penetration of microbial flora into a cholic bubble occurs or happens enterogennym, hematogenic or lymphogenous by. Contributing factor of occurrence of a cholecystitis is stagnation of bile in a cholic bubble in which can result or bring gallstones, prelums and excesses zhelchevyvodjashchih ducts, a dyskinesia of a cholic bubble and zhelchevyvodjashchih ways, disturbance of a tonus and impellent function of cholic ways under influence of various emotional stresses, endocrine and vegetative frustration, reflexes from patholologically changed organs of an alimentary system. Stagnation of bile in a cholic bubble also is promoted by a ptosis of interiors, pregnancy, an inactive way of life, rare or infrequent receptions of nutrition, etc.; Has also value or meaning;importance zabros pancreatic juice in cholic ways at their dyskinesia with its or his proteolytic action on a mucosa of cholic ducts and a cholic bubble.
Immediate jerk to flash of inflammatory process in a cholic bubble often are the hyperalimentation, especially reception very fat and a spicy food, reception of alcoholic drinks, acute inflammatory process in other organ (an angina, a pneumonia, an adnexitis, etc.).
The cholecystitis chronic can arise after acute, but develops independently and gradually, on a background of a cloelithiasis, a gastritis with a secretory failure, a chronic pancreatitis and other diseases of organs of digestion, an obesity is more often.
Signs, current. It is characteristic blunt, nojushchaja a pain in the field of the right hypochondrium of constant character or arising through 1 3 ch after reception plentiful and especially fat and zharenoj nutrition. The pain irradiates upwards, in area of the right brachium and a neck, the right scapula. There can be the sharp pain reminding a cholic colic Are frequent dispepsicheskie the phenomena: sensation of a bitter taste and metal taste in a mouth, an eructation air, a nausea, a meteorism, disturbance of a defecation (alternating a constipation and diarrhea is frequent), and also irritability, a sleeplessness. The icterus is not characteristic. At a palpation of a stomach or belly sensitivity, and sometimes and the expressed morbidity in a projection of a cholic bubble to a forward abdominal wall and easy or light;mild muscular resistance of an abdominal wall (resistance), as a rule, is defined or determined. Often signs Mjussi - georgievskogo, Ortnera are positive, Is exemplary - Murphy. The liver is a little bit increased with plotnovatym and morbid edge or territory at a palpation at complications of a chronic cholecystitis (a chronic hepatitis, a cholangitis). The cholic bubble in most cases is not palpated, as is usual he is wrinkled owing to chronic rubtsovo-sklerozirujushchego process. At exacerbations the leukocytosis, rising of an ESR and temperature reaction are observed nejtrofilnyj. At duodenal intubation often it is not possible to receive a vesical portion In bile (owing to disturbance of concentration ability of a cholic bubble and disturbance of a vesical reflex) or this portion of bile has a little bit more dark painting, than And and With, often mutna. At microscopical research in duodenal contents it is found out a plenty of slime, cells deskvamirovannogo an epithelium, "leucocytes", especially in portion In bile (to detection of "leucocytes" in bile do not give such value or meaning;importance as earlier; As a rule, they appear kernels or cores of breaking up cells of a duodenal epithelium). Bacteriological research of bile (especially repeated) allows to define or determine the originator of a cholecystitis.
At a cholecystography change of the form of a cholic bubble, often its or his image is marked or celebrated turns out indistinct owing to disturbance of concentration ability mucous, sometimes in stones itself are found out. After reception of a stimulus - holetsistokinetika (usually two egg yolks) - insufficient reduction of a cholic bubble is marked or celebrated. Attributes of a chronic cholecystitis are defined or determined and at echography (in the form of a thickening stenok a bubble, its or his deformation, etc.).
Current in most cases long, is characterized by alternating of the periods of remission and an exacerbation; the last often result from disturbances of a delivery, reception of alcoholic drinks, serious physical job, connection of acute intestinal infections, a frigorism. The forecast in most cases favorable. Deterioration of the general or common status of patients and time or temporary loss of their working capacity - only for the periods an exacerbation of illness or disease. Depending on features of current allocate latent (flaccid), the most widespread - recurring or relapsing, gnojno-ulcerative forms of a chronic cholecystitis. Complications: connection of a chronic cholangitis, a hepatitis, a pancreatitis. Often inflammatory process is "jerk" to education of stones in a cholic bubble.
Chronic cholecystitis differentiate from a cloelithiasis (these two diseases often are combined), a chronic cholangitis. Major importance data holetsisto-and have cholegraphies, especially repeated for exception of gallstones, and also echography.
Treatment. At exacerbations of a chronic cholecystitis of patients hospitalize in surgical or therapeutic hospitals and treatment spend, as at an acute cholecystitis. In easy or light;mild cases probably out-patient treatment. Appoint or nominate a confinement to bed, a dietary delivery (a diet 5), with reception of nutrition of 4 6 times in day, antibiotics (Oletetrinum, erythromycin, Levomycetinum, Ampicillinum inside or glikotsiklin, Monomycinum, etc. parenteralno). Appoint or nominate also sulfanilamidnye preparations (Sulfadimezinum, sudfapiridazin, etc.). For elimination of a dyskinesia of cholic ways, spastic pains, improvements zhelcheottoka appoint or nominate spasmolytic and cholinolytic agents (a papaverine a hydrochloride, no-shpa, Atropini sulfas, Platyphyllinum hydroSodium tartratum, etc.), And at not sharp exacerbations and during stihanija the inflammatory phenomena - duodenal intubations (in 1 2 days, on a course of 8 12 procedures) either so-called blind, or tubeless, tjubazhi with Zinci sulfas of a magnesium or warm mineral water (essentuki 17, etc.). At the expressed pain of inflammatory character apply Amidopyrinum or Analginum v/m, perinephric novocainic blockade, enter Novocainum - 30 50 ml 0, 25 0, 5 % of a solution intradermally above area of the maximal morbidity or appoint or nominate an electrophoresis with Novocainum to this zone. During stihanija inflammatory process it is possible to appoint or nominate thermal physiotherapeutic procedures to area of the right hypochondrium (a diathermy, UHF, an inductothermy, etc.).
For improvement of outflow of bile from a cholic bubble both during an exacerbation, and during remissions widely appoint or nominate cholagogue agents: Allocholum (on 2 tablets 3 times a day), Cholenzymum (on 1 tablet 3 times pass), broth (10 : 250) tsvetkov an immortele sandy (on 1/2 glasses 2 3 times a day up to meal); broth or nastoj corn rylets (10 : 200 on 1 3 table spoons 3 times a day) or their liquid extract (on 30 40 drops 3 times a day); tea cholagogue (one table spoon to make 2 glasses of the boiled water, filtered nastoj to accept on 1/2 glasses 3 times a day for 30 mines up to meal); Cycvalonum, Nicodinum, etc., and also Olimetinum, rovahol, enatin (on 0, 5 1 g in capsules of 3 5 times in day) and Cholagolum (on 5 drops on Saccharum for 30 mines up to meal 3 times a day). These agents possess spasmolytic, cholagogue, nonspecific antiinflammatory or anti-inflammatory and diuretic action. At an easy or a light;a mild attack of a cholic colic Cholagolum appoint or nominate on 20 drops to reception.
Spend treatment of chronic cholecystites by mineral water (essentuki 4 and 17, slavjanovskaja, smirnovskaja, mirgorodskaja, naftusja, novo-Izhevsk, etc.), and also Zinci sulfas of a magnesium (on 1 table spoon of 25 % of a solution 2 times a day) or karlovarskoj salt (on 1 teaspoon in a glass of warm water 3 times pass). After stihanija exacerbations of a cholecystitis and for prophylaxis of the subsequent an exacerbation (it is desirable annually) it is shown sanatorno-a resort therapy (Essentuki, Zheleznovodsk, Truskavets, Morshin and other sanatoria, including local, intended for treatment of cholecystites). At unsuccessfulness of conservative treatment and frequent exacerbations spend surgical treatment of a chronic cholecystitis (usually cholecystectomia).