Topic 17-18.

Cholecystitis is an inflammation of the gallbladder, which in about 70% of

cases is caused by the presence of stones (stones). Cholecystitis is more common than
other diseases of the digestive tract, which can be explained by diet (predominance of
fatty and fried foods) and lifestyle.
Chronic cholecystitis.
The disease develops gradually, manifesting itself in violation of diet or other
provoking factors. Often chronic cholecystitis is preceded by biliary dyskinesia or
other pathology. For a long time, chronic cholecystitis may be asymptomatic or
accompanied by moderate aching pain (excluding periods of exacerbation, when the
pain becomes severe).
Symptoms of cholecystitis
Signs of cholecystitis occur mainly on the background of dietary disorders.
When you eat a lot of fried, fatty foods, gallbladder dysfunction first appears,
followed by inflammation of the gallbladder. Congenital pathology can also be the
cause of cholecystitis. In the presence of stones in the gallbladder, the trigger may be
excessive stress or exercise. They contribute to the strong release of bile and
blockage of gallstones.
The main signs to suspect cholecystitis are:
Paroxysmal pain in the right hypochondrium, sometimes in the arm or right
shoulder blade
Discomfort in the right hypochondrium after eating
Nausea
Vomiting (possibly with bile)
Bitterness in the mouth
Flatulence
Jaundice of the sclera and skin
Disorders of defecation
Importantly! If you experience severe pain in the right hypochondrium, which
may be accompanied by nausea, vomiting, fever, and sometimes jaundice, you should
seek help as soon as possible! Surgeons of our clinic will be able to quickly
determine the severity of the disease and prevent serious complications.
Cholangitis is a non-specific inflammation of the bile ducts due to the
penetration of various pathogens from the gallbladder, intestines, blood and
lymphatic vessels.
Bacterial flora (Escherichia coli, enterococci, streptococci, salmonella,
Pseudomonas aeruginosa, Escherichia coli, Proteus, anaerobes) is less important in
the origin of cholangitis, less often helminths.
In most cases, cholangitis accompanies cholecystitis and gallstone disease, but
can develop as a separate disease. In its occurrence, bile stasis is of great importance
due to obstruction of the common bile duct by a stone, roundworm or compression of
it or the vater nipple by a tumor of the head of the pancreas, inflammation or
cicatricial-inflammatory narrowing of the fater nipple and so on.
Clinical manifestations
The disease manifests itself-
dull pain in the liver,
pain on palpation in the right hypochondrium and tapping (percussion) in the
liver along the intercostal space,
increase in the size of the liver,
jaundice,
high fever with chills.
Blood tests show leukocytosis, increased ESR.
Gallstone disease –is a disease that occurs due to the formation of stones
(stones) in the gallbladde. Gallstones lead to the development of cholecystitis.
Gallstones happen
Cholesterol (observed in 70% of cases of gallstone disease):
pure (formed only from cholesterol crystals);
mixed (with an admixture of calcium, bile acids and their salts).
pigmented:
black (consisting of black pigment, protein and mucin);
brown (calcium-bilirubin).
Cholesterol stones are formed due to an imbalance between the content of
cholesterol and bile acids, which leads to the deposition of cholesterol and the
formation of cholesterol crystals, which increase as bile stagnation increases.
Cholesterol stones are usually found in the bile ducts.
In the first stage, the disease is asymptomatic and can last for many years. The
pathological process can be detected only by microscopic examination of bile, in the
presence of cholesterol "flakes" and crystals, low bile acid content.
In the second stage of the disease may detect already formed so-called "dumb"
gallstones during ultrasound, X-ray examination or computed tomography. The first
symptoms may appear 5-11 years after the onset of stone formation.
Sometimes such symptoms may occur
feeling of heaviness in the epigastric region;
eructation;
nausea;
constipation.
In the third stage during gallstone disease is exacerbated with the development
of chronic cholecystitis or acute cholecystitis if the stone clogs the bile duct.
In chronic calculous cholecystitis, recurrent attacks of pain are observed.
Bile (liver) colic is characteristiс pain in the right hypochondrium, pain in the
epigastric region. Pain is characterized by paroxysmal, short, intervals between
attacks are usually about an hour or more. The pain can be of different nature and
intensity: cutting / aching, strong / weak. Usually appears if the attack lasts more than
3 days;
bloating; flatulence; nausea; persistent intolerance to fatty foods.
On palpation, the bladder symptoms are positive: Murphy (when pressing on
the gallbladder and inhaling at the same time there is pain), Musse (when pressing in
the small subclavian fossa appears pain), Ortner (when tapping on the edge of the
right costal arch - pain), Kerr (pain when pressing on the projection of the gallbladder
and simultaneous inhalation).
When one or more stones block the biliary tract (acute calculous cholecystitis),
the leading symptoms are severe pain in the right half of the chest, shoulder and
shoulder blade; fever (fever); sweating.
Chronic pancreatitis is a chronic inflammation of the pancreas (chronic form
of pancreatitis), characterized by chronic pain in the mesogastric region,
malabsorption (steatorrhea, ie "fatty" stools), focal, segmental or diffuse
parenchymal, diffuse, degenerative and ducts, gradual replacement of the
parenchyma of the organ with connective tissue with the development of its exo - and
endocrine insufficiency.
Etiology
Exactly unknown. Possible causes of chronic pancreatitis are: toxic effects of
alcohol, gallstones, genetic disorders.
Symptoms
Signs of chronic pancreatitis: pain under the chest or left under the ribs, loss of
appetite, aversion to fatty foods, increased salivation, belching, nausea, vomiting,
bloating, weight loss, thirst. When more than 80% of the islets of Langerhans are
affected, diabetes develops.
Chronic pancreatitis, symptoms:
pain, the concentration of which falls on the epigastrium and upper abdomen;
burning, pressing, stabbing or piercing nature of pain;
in the chronic course of the disease, the pain can spread to the left shoulder
blade, shoulder, neck, left iliac bone;
disturbance of normal activity of the stomach, difficult and / or painful
digestion;
pain can be both prolonged and infrequent attacks;
increased excretion of fats from the body with feces;
The pancreas is palpated in the form of a dense cord;
jaundiced skin and whites of the eyes;
increased pain after a "dense" breakfast, lunch, dinner, snack or after eating
heavy foods: fried, fatty, sweet, canned, spicy, raw fruits and vegetables, cheese,
alcohol, etc .;
weight loss is abrupt, without any preconditions (diet, increase in physical
activity.