Acute Cholecystitis Can Be Prevented By Biophilia Tracker

Acute cholecystitis is inflammation of the gallbladder caused by obstruction of the cystic duct and bacterial invasion; its typical clinical feature is paroxysmal colic in the upper right abdomen, accompanied by obvious tenderness and abdominal muscle rigidity. About 95% of patients have gallbladder stones, called calculous cholecystitis; 5% of patients do not have gallbladder stones, called acalculous cholecystitis.

Causes of acute cholecystitis

1. Bile retention:

This is a precursor and basic factor that causes acute cholecystitis, and its causes can be roughly divided into two categories:

Mechanical obstruction: It is generally believed that more than 90% of patients with acute cholecystitis have stones incarcerated in the neck of the gallbladder or the cystic duct, resulting in bile retention; some authors believe that even if no stones are found in the gallbladder during surgery or autopsy, it cannot be proved that there are no stones in the early stage of the disease. The stones are present, and the stones may have been drained into the common bile duct. In addition to stones, the connection between the cystic duct and the common bile duct can also cause obstruction and bile retention due to the small angle, the cystic duct itself is too tortuous, deformed, or abnormal blood vessels, peripheral inflammation, adhesion, penetration of roundworms, and compression of swollen lymph nodes. Functional disorders studies have confirmed that the biliary muscles and nerves are dysfunctional, and the normal emptying of the gallbladder is blocked, which can cause temporary bile retention. When the abdominal viscera is diseased, such as stomach, duodenal ulcer, chronic appendicitis or peri-nephritis, the visceral nerve is pathologically stimulated and transmitted to the cerebral cortex, causing cortical dysfunction, which reflexively leads to the cystic duct The sphincter and duodenal papillary sphincter are dysfunctional and cause spasms, resulting in bile retention in the entire biliary system. Long-term retention and concentration of bile in the gallbladder can stimulate the gallbladder mucosa and cause inflammatory lesions. In addition to bacterial infection, acute cholecystitis can be formed.

2. Bacterial infection:

About 70% of the bacteria that cause acute cholecystitis are Escherichia coli. Others include Klebsiella, Clostridium, Staphylococcus, Typhoid, Paratyphoid, Streptococcus, and pneumococcus. About 50% of patients with acute cholecystitis have positive bile bacterial culture. The path of bacterial invasion is generally through bile or lymphatic vessels, and sometimes it can also retrograde into the biliary tract through the intestinal tract or spread blood-borne. In short, there are many paths for bacteria to reach the gallbladder.

3. Other reasons:

There are a few clinical cases with neither bile retention nor bacterial infection due to other causes. Mainly seen in trauma and pancreatic juice reflux. Trauma, including surgery, burns, etc. can lead to acute cholecystitis. In trauma, pain, fever, dehydration, emotional tension, etc. can increase the viscosity of bile and slow its emptying. In addition, when the common ducts of the pancreas and bile ducts are obstructed, the trypsin in the reflux pancreatic juice is activated by bile and combines with bile acids to activate phospholipase and convert lecithin to lysolecithin, both of which act on the gallbladder wall , Causing damage.

Symptom content:

1. Sudden persistent colic in the right upper abdomen, radiating to the right subscapular area, accompanied by nausea and vomiting.

2. Chills, fever, anorexia, abdominal distension.

3. 10% of patients may have mild jaundice.

4. Have a history of similar medical conditions in the past. Fatty meal diet is easy to induce, gallbladder stones are caused by gallbladder stones, and nocturnal onset is a characteristic.

5. Tension, tenderness or rebound pain in the right upper abdominal muscle, Murphy's sign is positive, 30%-50% of patients can palpable swelling and cysts with tenderness.

The treatment content of acute cholecystitis:

For acute simple cholecystitis with mild symptoms, non-surgical treatment can be considered first to control the inflammation, and elective surgery will be performed after further investigation of the condition. For severe acute purulent or gangrenous cholecystitis or gallbladder perforation, surgical treatment should be carried out in time, but preoperative preparations must be made, including correction of water-electrolyte and acid-base balance imbalance, and the application of antibiotics. Non-surgical treatment is effective for most (about 80-85%) patients with early acute cholecystitis. This method includes antispasmodic and analgesic, application of antibiotics, correction of water-electrolyte and acid-base balance disorders, and systemic support therapy. During the non-surgical treatment period, the changes in the condition must be closely observed. If the symptoms and signs develop, surgical treatment should be promptly changed. Especially for the elderly and diabetic patients, their condition changes rapidly, and more attention should be paid. According to statistics, about 1/4 of patients with acute cholecystitis will develop gallbladder gangrene or perforation. For patients with acute acalculous cholecystitis, non-surgical treatment is generally not used due to the rapid development of the disease. Surgical treatment should be carried out in time after preparing for the operation. Regarding the application of antibiotics for acute cholecystitis, because the cystic duct has been blocked, antibiotics cannot enter the gallbladder with bile, and cannot control the infection in the gallbladder as expected. The occurrence of complications of gallbladder inflammation is not affected by antibiotics. Department of application impact. However, the application of antibiotics can reach a certain therapeutic concentration of drugs in the blood, can reduce systemic infections caused by cholecystitis, and can effectively reduce the incidence of infectious complications after surgery. For people with fever and high white blood cell count, especially for some elderly people, or patients with diabetes and long-term use of immunosuppressants who are highly susceptible to infection, the application of systemic antibiotics is still very necessary. Generally used in broad-spectrum antibiotics, such as gentamicin, chloramphenicol, cephalosporin or ampicillin, etc., and often combined. Surgical treatment: At present, there is still controversy about the timing of surgery, and it is generally believed that early surgery should be used. Early surgery is not equivalent to emergency surgery, but after a period of non-surgical treatment and preoperative preparation after admission, and the application of B-ultrasound and isotope examination to further confirm the diagnosis, the operation should be performed under the premise that the onset time does not exceed 72 hours. . Early surgery does not increase the mortality and complication rate of surgery. Delayed surgery (or late surgery) can be used for patients who are effective for non-surgical treatment, usually after 6 weeks. There are two surgical methods. One is cholecystectomy. In the acute stage, the tissue around the gallbladder is edema, and the anatomical relationship is often unclear. The operation must be careful to avoid accidentally injuring the bile duct and adjacent important tissues. When possible, intraoperative cholangiography is used to find bile duct stones and possible bile duct malformations. Another type of operation is cholecystostomy, which is mainly used in some elderly patients, who are generally in poor condition or have serious heart and lung diseases. It is estimated that the cholecystectomy can not be tolerated. Sometimes the anatomy around the gallbladder is unclear in the acute stage and the operation is caused. If the operation is difficult, cholecystostomy can also be performed first. The cholecystostomy can be performed under local anesthesia. The purpose is to use a simple method to drain the gallbladder inflammation so that the patient can pass the dangerous period. After the condition is stable, usually 3 months after the cholecystostomy, the cholecystectomy is performed again To cure the lesion. For cholecystitis complicated with acute cholangitis, in addition to cholecystectomy, the common bile duct incision and exploration and T tube drainage must be performed at the same time.

To prevent acute cholecystitis, do the following:

1. Pay attention to the diet. The food should be light, less greasy and fried and grilled food.

2. Keep the stool unblocked.

3. To change the meditation lifestyle, move around more and exercise more.

4. It is necessary to nurture sex, long-term family disharmony, and people who are in a bad mood can cause or aggravate the disease. To be broad-minded and comfortable.

5. Perform regular health checks through Biophilia Tracker to detect diseases in advance, prevent and stop acute cholecystitis before it occurs.