Cholecystitis is an inflammation of the gallbladder wall. There are many causes of cholecystitis, but poor nutrition is clearly in the lead. This is eloquently indicated by statistics — over the past 10 years, the number of registered cases of the disease has increased significantly. And this trend is clearly visible in civilized countries, especially those where the so-called Western diet is cultivated. It sounds a little strange, because the problem of healthy eating is not a secret behind seven seals. On the contrary, it is widely covered in the media. Tens of thousands of scientific articles and publications, books, journals, scientific seminars and conferences are devoted to this topic. And what is the result? We have come to the conclusion that cholecystitis has become the most common disease of the digestive system. Let’s talk about cholecystitis – how it develops, what symptoms it manifests, and how to treat it.
How does cholecystitis develop?
Cholecystitis is an inflammation that occurs when the pressure in the gallbladder increases. In 95% of cases, the violation occurs as a result of difficulty in the outflow of bile.
The gallbladder is functionally connected to the liver and pancreas. The liver produces bile, which accumulates in the gallbladder. When food enters the duodenum from the stomach, the gallbladder contracts and pushes a portion of bile into the bile duct. Next, the duct of the digestive gland flows into it, from where the bile, along with digestive enzymes, enters the duodenum. During digestion, part of the bile acids is absorbed in the intestine and again enters the liver, where it stimulates the production of bile. Thus, bile is needed not only for high-quality digestion of food, but also for the formation of a new portion of bile.
If there is a violation of the outflow of bile, the walls of the gallbladder stretch, its volume increases. In response to excessive stretching, blood circulation is disrupted and the protection of the mucous membrane is reduced. If an infection enters the gallbladder against this background, an inflammatory process develops. Inflammation can be caused by allergies, toxic substances, and digestive enzymes that, for whatever reason, enter the gallbladder through the bile duct.
Causes of cholecystitis
So, we already know that inflammation of the gallbladder wall occurs as a result of a violation of the outflow of bile. Now let’s analyze the causes of cholecystitis:
- Genetic factors that cause a person to be born with a deformed gallbladder. This may be its curves and other violations of the anatomy.
- Gallbladder injuries, failed surgeries.
- Tumors of nearby organs.
- Pregnancy. There are cases when the fetus squeezes the gallbladder.
- Disorders of nervous regulation, which lead to the so – called dyskinesia-a violation of the tone and motility of the gallbladder.
- Infections – bacteria, viruses, and parasites.
- Metabolic disorders in diabetes mellitus and atherosclerosis.
- Blockage of the bile duct with a stone, mucus, or bile clot.
- Dyskinesia and bile duct adhesions.
- Injection of pancreatic enzymes into the bile duct.
- Diseases of the digestive system – gastritis, hepatitis, pancreatitis and others.
There is also a factor of gender and age. Most often, women over 40 years of age suffer from cholecystitis, as a change in the hormonal background affects the outflow of bile.
The risk factor for developing cholecystitis is the age over 40 years and the female sex.
Nutrition as the most common cause of cholecystitis
For sure, the role of nutrition in the development of cholecystitis is still not obvious to you. Let’s figure it out.
When we talk about poor nutrition, we mean both errors in the diet and the eating regime itself. That is, it is important not only what we eat, but also how.
Consider the food style of a modern person. Most of us are used to working hard, so such a thing as a full meal is simply not in the lexicon. There can be a lot of reasons – there is no time, no place, no appetite, and so on. As a result, in the evening we make up for energy losses with a hearty dinner. It’s no longer up to counting calories and nutrients. The main thing is to satisfy your hunger. How does the gallbladder feel? Clearly, not very well. The liver produces bile almost continuously, the gallbladder fills up, and there is nowhere to put its contents. So there is a stagnation of bile. At the same time, it becomes thicker and more viscous, and this is a direct path to the formation of stones with all the ensuing consequences.
Another example. There are among us lovers of delicious food, and it is usually harmful. We are talking about fatty and fried food, including cooked on coals (yes, many people’s favorite kebabs are also harmful). Such food provokes the production of bile. If you are completely healthy and delicious, but dangerous food is on your table only occasionally, on holidays, then nothing terrible will happen. The liver and gallbladder will withstand this blow. But if you eat so regularly, especially if you have diseases of the digestive system, then the prospects are less rosy. The gallbladder is constantly working “on wear and tear” and sooner or later we will get a diagnosis of ” cholecystitis”, do not even doubt
It is important to understand that the rheological properties of bile, that is, its viscosity depends on the balance of its components – bile acids, phospholipids, mucin, cholesterol and water. If this ratio changes, then it becomes viscous, sediment and cholesterol stones begin to appear. Viscous clots and stones can clog the bile duct and cause cholecystitis. This situation occurs when there is a violation of metabolic processes. Fat metabolism in obesity, carbohydrate and fat metabolism in diabetes, cholesterol metabolism in atherosclerosis. By and large, all these diseases are links in the same chain. Most often, patients with cholecystitis have a number of complications and a whole bunch of concomitant diseases, including excess weight.
However, do not think that only overeating and irregular meals are risk factors for cholecystitis. Strict diets and fasting can also trigger the disease. Everything is obvious here. A person eats little, which means that he needs little bile. As a result, the gallbladder is full, and there is nowhere to put the bile. You already know what happens next.
And a few words about alcohol. Alcoholic beverages disrupt the motility of the gallbladder, and consequently, its emptying. In addition, the toxic effect of alcohol disrupts the natural defense mechanisms of the mucous membrane, which is the trigger for the reproduction of infection.
To sum up. If you want to keep your gallbladder healthy, forget about the following habits:
- There are a lot of them
- Eat enough for the night. Lovers of a hearty dinner should still take care of a full meal.
- Skip meals. Fans of the now popular interval diet should think about health first.
- Eat a large amount of fatty animal food. Especially dangerous in this regard are pork, lamb and beef fats.
- Eat hydrogenated fats, which are found in abundance in store-bought baked goods.
- Consume a lot of sugar.
- Stick to a diet with a low amount of dietary fiber.
- Drink little water.
- Give preference to fried food.
- Abuse alcohol.
Classification of cholecystitis
There are various classifications of cholecystitis that are convenient for practitioners. We are more interested in the nature of the course of the disease (acute or chronic) and the question of the presence or absence of gallstones.
Acute and chronic cholecystitis
It is commonly believed that cholecystitis begins with an acute form, and then turns into a chronic one. Indeed, this is most often the case, especially when the bile duct is blocked. However, cases of gradual development of chronic cholecystitis without acute symptoms are not uncommon. The reason for this course may be just poor nutrition, because this is how we slowly but surely “finish off” the gallbladder.
It is worth saying that the clinic of acute cholecystitis is quite bright, with pronounced pain and other signs. You are unlikely to miss this disease. But chronic has the property of masquerading as other diseases. So, heaviness in the abdomen and constipation can be attributed to problems with the intestines, nausea – to liver diseases, and pulling pains can be confused with gastritis or pancreatitis.
Calculous and non-calculous cholecystitis
Simply put, cholecystitis with the presence of stones and stone-free cholecystitis. There is an opinion that cholecystitis necessarily leads to the formation of stones. This is not always the case. In order for stones to form in the gallbladder, it is necessary to change the composition of bile. More specifically, it should be high in cholesterol. In this case, non-calculous cholecystitis turns into cholelithiasis, which, in turn, can cause cholecystitis. Such a vicious circle.
Symptoms of cholecystitis
The symptoms of acute and chronic cholecystitis differ significantly in their intensity and nature of manifestation. Therefore, we will present them separately.
Symptoms of acute cholecystitis:
- Severe pain and muscle tension in the right hypochondrium and epigastrium (approximately in this area is the stomach). The pain in acute cholecystitis is intense. Sometimes it gives in the right shoulder blade, the right half of the neck, the back.
- Nausea and vomiting with an admixture of bile, which does not bring relief.
- Murphy’s positive symptom. If you ask the patient to lie on his back and inhale, then palpation (groping) of the right hypochondrium will be painful and lead to forced breath retention.
- Often there is a slight increase in body temperature – no higher than 38 C. This condition is usually associated with a painful attack.
- Chills, sticky sweat.
- The taste of bitterness in the mouth.
- Bloating, heartburn, and belching bitterness.
- Jaundice, darkening of urine, discoloration of feces.
- Sometimes with cholecystitis, itching of the skin is noted.
Symptoms of chronic cholecystitis:
- Heaviness or aching tolerable pain in the right hypochondrium.
- Sometimes the pain is given to the heart area.
- Constipation, unstable stool.
- Dryness and bitterness in the mouth, especially in the morning.
- Weakness, apathy, lack of appetite.
- Jaundice of the skin and sclera of the eyes
- Discolored feces and urine
The symptoms of chronic cholecystitis are less pronounced, and in the period of remission may be absent altogether. In addition, the asymptomatic course of chronic cholecystitis is not uncommon. This is also not very good, because a person may not know about his illness.
Chronic cholecystitis tends to periodically worsen. Exacerbation of chronic cholecystitis can be triggered by overeating, an abundance of fatty foods, stress or medication. Exacerbation of cholecystitis after taking alcohol is also not a rare phenomenon.
Diagnosis of cholecystitis
If acute symptoms appear, you need to urgently consult a doctor, signs of chronic cholecystitis are a reason for examination. In acute pain, you can not take any painkillers or antispasmodics yourself, as they can blur the picture and it will be more difficult for the doctor to make a correct diagnosis.
In order to make a diagnosis of “cholecystitis”, you need a comprehensive examination, which helps to exclude other diseases with similar symptoms.
- With cholecystitis, first of all, the patient is examined. Collect complaints, palpate the abdomen, check for the presence of characteristic symptoms.
- Blood tests are general and biochemical. With cholecystitis, attention is paid to such blood indicators as white blood cells and C-reactive protein (which are markers of inflammation), urea, alkaline phosphatase, ALT, AST, bilirubin, sugar.
- Ultrasound it will show echographic signs of cholecystitis — an increase in the size and thickening of the gallbladder wall, a violation of the echostructure, the presence of stones, etc.
- FGDS (esophagogastroduodenoscopy) – examination of the esophagus, stomach and duodenum.
- Duodenal probing in cholecystitis is necessary to study the composition of bile. Also, this method will help to clarify the presence of parasites or bacteria in the bile.
- Retrograde pancreatocholangiography-a combination of radiography and endoscopic method, allows you to establish the pathology of the bile ducts and pancreatic duct
- Laparoscopy-examination of the gallbladder and the surrounding space with the help of special optics through a small incision in the abdominal wall.
Treatment of cholecystitis
In acute cholecystitis, the patient is hospitalized in a hospital-a gastroenterological or therapeutic department. Chronic cholecystitis can be treated at home, under the supervision of a doctor.
Depending on the causes of acute cholecystitis and the severity of symptoms, prescribe:
- Antibiotics (ampicillin, cefazolin, etc.) or antiparasitic agents (metronidazole, ornidazole) – depending on which infection caused the development of the disease.
- Antispasmodics – to relieve the symptoms of bile colic – atropine, papaverine or drotaverine (No-shpa).
- Anti-inflammatory drugs-diclofenac, indomethacin.
- Choleretic drugs-ursodeoxycholic acid, etc.
- Antiemetic-with severe vomiting – metoclopramide.
- For nausea – domperidone.
Emergency care for cholecystitis
How to relieve pain in cholecystitis? Given the intensity of the attacks, this is the first question that worries the patient and his relatives. Despite the fact that antispasmodics have a good analgesic effect in this case, first aid for acute cholecystitis can only be provided by a qualified medical worker. The fact is that you need to make sure that there are no stones in the gallbladder. Otherwise, improper actions can lead to blockage of the bile duct. And this is a direct indication for surgical intervention. Therefore, the correct tactic for acute cholecystitis is to lay the patient down and call an ambulance.
In certain cases, cholecystitis is treated surgically-part of the gallbladder or the entire organ is removed completely. Indications for surgery are the presence of gallstones, blockage of the bile duct with a stone, tumors and polyps of the gallbladder, and other urgent conditions. According to statistics, 20% of cases of acute cholecystitis are subject to surgical treatment.
Diet for cholecystitis
Diet for cholecystitis is no less important than treatment. For cholecystitis, the Pevsner diet No. 5 is recommended, and its more modern variations. Any dietary recommendations have general principles:
- Fractional meals in small portions 5-6 times a day. The point is not to overload the gallbladder and ensure a constant outflow of bile.
- Compliance with the food regime. This issue should be approached responsibly. Eating at the same time has a positive effect on the health of the digestive system. This process becomes predictable and allows the gallbladder, liver, stomach, pancreas and other organs to work in a gentle mode.
- The consumption of a sufficient amount of liquid is 1.5-2L per day for an adult. Recommended mineral water type “Borjomi” without gas, weak green tea, compote of dried fruits, broth of rose hips.
- We exclude from the diet fatty, fried, refined carbohydrates. We prefer boiled, baked and steamed vegetables, lean meat and fish.
- The food should be well heat-treated and ground. It can be crushed mechanically (for example, with a blender) or thoroughly chewed. You should forget about snacks “on the go”.
- It is important to observe the temperature regime – the food should be slightly warm or at room temperature.
List of permitted and prohibited foods for cholecystitis:
During the period of exacerbation of cholecystitis, you need to follow the diet No. 5A, which has even more restrictions. In the first day of exacerbation of cholecystitis, fasting is recommended.
Take care of the gallbladder and be healthy!