Chronic cholecystitis is a fairly common disease, every tenth American adult suffers from it, its frequency is growing, only for chronic inflammation with calculous cholecystitis stones, almost 100 thousand operations are performed annually. The statistics of cholecystitis is very approximate, taking into account only those who applied for an exacerbation of the disease, in some patients chronic cholecystitis is noted during ultrasound examination, but if the patient did not apply directly for cholecystitis, then he will not be included in the statistics.
Formally, the disease is considered a surgical pathology, since with each exacerbation, the question of the expediency of removing the gallbladder is decided. But not every patient immediately decides for an operation, therefore, he must be observed by a gastroenterologist for years. In the absence of a gastroenterologist in the polyclinic, therapists observe such patients, but with great caution, since they cover up the staff shortage, and they are not very familiar with modern approaches to diagnosis and treatment.
As a result, in most cases, a patient suffering from chronic cholecystitis is left without modern medical care, using the recommendations for the treatment of the same restless patients.
Why does inflammation develop?
For the appearance of cholecystitis, predisposing factors are necessary that will help the infectious agent to live in the gallbladder for some time and not leave it with a portion of bile. A violation of the outflow of bile from the bladder, its temporary stagnation is necessary. Often, inflammation occurs against the background of stones that interfere with the normal outflow of secretion, occasionally moving and, like a valve, blocking the neck that passes into the cystic duct. With acalculous chronic cholecystitis, which occurs much more often than acalculous acute cholecystitis one in a hundred patients, outflow is also disturbed for many reasons.
Due to heredity or functional impairment, or even for both reasons, the gallbladder may become flaccid hypotension or even hang like a wineskin. This is also facilitated by the low motor activity of the owner of the bladder, as well as his excess weight, addiction to an unbalanced diet in terms of fats with irregular meals. The body requires consistency in nutrition, if you have to eat when you have to, constantly changing the time of eating, then bile will either stagnate with a long interval between meals, then not have time to be produced in sufficient quantities with a short one.
Excess weight helps the development of cholecystitis by the fact that a person moves little, the tone of the bladder is reduced. With cholecystitis without stones, as a rule, there is no excess weight, but neglect in relation to the diet can be traced.
Facilitates the development of infection by reflux pancreatic secretion. Anatomically, the cystic duct merges with the hepatic duct, forming a common bile duct or common bile duct, into which the pancreatic duct flows shortly before entering the duodenum. With atony of the biliary tract, it is possible for the secretion of the pancreas to move against the flow of bile, especially since bile is expelled from the bladder in one or two portions only during meals. When the secretion of the pancreas is injected, containing a mixture of enzymes, damage to the mucous duct occurs, similar to a slight chemical burn, such damaged tissues are preferred by a variety of infectious flora.
Gender also plays a role, but not as pronounced as in acute cholecystitis. Recently, men in terms of the frequency of chronic cholecystitis are trying to catch up with women, in women, sex hormones contribute to the formation of stones in the bladder. A significant influence of the neuropsychic factor is noted as an additional reason for the development of inflammation in the gallbladder. In old age, a violation of the nutrition of the bladder with extensive atherosclerosis of the vessels is seriously affected.
In all cases, three most important factors work against the owner of the gallbladder: a violation of the outflow of bile with a change in its viscosity and, of course, the attachment of an infectious agent.
Chronic and acute cholecystitis
There is no generally accepted classification of either chronic or acute cholecystitis, hence some illogicality in dividing the disease according to different criteria. When it turns out that a purely morphological criterion is woven into the grading according to the severity of the course, and the severity is mixed with the options for the course of the pathological process.
Chronic cholecystitis is subdivided by the presence of stones into acalculous or non-calculous and calculous. With acalculous cholecystitis, inflammation predominantly nests at the exit site of bile in the neck and its cause is associated with the malfunctioning of the gallbladder by a lazy bladder.
By the nature of the lesion of the wall of the gallbladder, catarrhal inflammation of the mucous membrane and submucous layer, and purulent, is isolated. There is also a purulent-ulcerative form of chronic cholecystitis, which may well be considered the progression of simply purulent XX. It is not necessary that catarrhal cholecystitis will become purulent, but it is also possible in the opposite order, but only with the timely start of treatment and high sensitivity of the flora to antibiotics.
According to the variant of the course of the disease, chronic cholecystitis can be sluggish, which is not noticed by the patient, but is detected almost by accident during ultrasound. This form is sometimes called latent latent. Flare-ups are referred to as recurrent cholecystitis. There is also the so-called residual chronic calculous cholecystitis, when the patient after an exacerbation only has a memory of chronic cholecystitis, and there are no exacerbations for many years.
According to the severity, several forms are distinguished, which are fundamental only for the recurrent variant. Mild no more than two exacerbations per year, biliary colic no more than four. Biliary colic an attack of non-intense pain for no more than 6 hours, leaving after taking an antispasmodic and analgesic, without signs of general inflammation. Colic occurs when a stone migrates into the neck, followed by a large stone leaving it into the cavity of a bubble, tiny down the duct.
Criteria for establishing moderate severity: up to four exacerbations and at least six colic, and more is possible, because for a severe degree, only exacerbations of more than five during the year are fundamentally important.