JSC Medical university Astana department of internal diseases No 1

CHRONIC CHOLE-CYSTITIS

Turtkarin Y. 463 GM

Differential diagnosis
6. Treatment

bile salt predominant (black).

(15 %),
-Streptococus (10%)
Mixed microflora – 30%

- hematogenic way
- lymphogenic

way
- contact way

congestion
Congenital defect of gall-bladder
Metabolic disturbance
Discoordination of neurohumoral regulation of biliary

system, stress
Allergy
↓ Immune reactivity
Alimentary disorders

severe.

III. Course of disease: recurrent, permanent.

IV. Type of

dyskinesia: hypertonic, hypotonic.

(Patients present with biliary pain, jaundice, fever and often rigors.

The septicaemia is usually due to Gram-negative organisms, is frequently severe and may be lifethreatening).

up as a result of blockade of cystic duct by

concrement or mucus. During palpation increased and unpainfully gall-bladder is marked in patients. -Empyema of gall-bladder is unliquidated in time hydropsy, that at repeated infection is transformed in a new form. Gall-bladder in such patients is palpated as a dense, moderately painful formation, however, the symptoms of irritation of peritoneum, as a rule, are absent. The high temperature of body is periodically observed. In blood high leucocytosis with the shift of formula of blood to the left is present.

biliary dyskinesia.

epigastric area with an irradiation in right supraclavicular area and

right shoulder.
-If pain syndrome has the strongly expressed character, it is called hepatic colic).

Dyspepsic syndrome.
Asthenic syndrome.
Intoxication syndrome.

Alkaline phosphatase, Proteins, Amylase, Lipids, Cholesterol, Liver tests, Sodium, Potassium,

Urea, Creatinine)
Urinanalysis, Diastase of urine
Coagulogram
Duodenal tubage and Examination of bile (chemical, bacteriological)
Examination of feces, Coprogram
ECG
Endoscopy
USD
Cholecystography

the diagnosis of chronic gallbladder disease.
In 90% to 95%

of cases of cholelithiasis, ultrasonography demonstrates the echo of the calculus and the acoustic shadow behind the calculus.

the center of the image, a stone within the gallbladder

with a triangular area of acoustic attenuation (“shadowing”) behind the gallstone

gall bladder and multiple white echoes (b) representing stones.

Bottom:

The gall bladder after cholecystectomy with multiple small stones

common bile duct (choledocholithiasis)

abscess

settles with these measures.
Subsequent cholecystectomy may then be performed

when the acute episode has resolved.
Careful selection of patients with chronic cholecystitis is important as not all patients are pain-free when the gallbladder is removed; symptoms may abate spontaneously and not recur; and there is an increasing, associated, operative mortality with advancing age.
Laparoscopic cholecystectomy has increased the acceptability of the procedure for patients and has consequently become widely available.

5.
3. Desintoxication therapy.
4. Spasmolytics, Analgetics (Spasmalgon 5 ml,

No-shpa 2% 2 ml, Papaverin 2% 2 ml, Platyphyllin 0,1% 1 ml, Baralgin 5 ml, Analgin 50% 2 ml).
5. Antibacterial therapy (Ampiox, Ofloxacin, Cephalosporines, Furasolidon)

Antibiotics such as third generation cephalosporins or amino-quinolones should be

used.
Careful attention should be paid to fluid balance, urine output and renal function.

patients with uncomplicated gallstone disease who are unwilling or unfit

for surgery.
The prerequisites for treatment are that the stones should be non-calcified, the gallbladder should be functioning and the cystic duct not obstructed.
The bile acids, chenodeoxycholic acid and ursodeoxycholic acid are available and need to be given for long periods to be successful.
They have no effect on pigment stones.

and complicated forms of noncalculous cholecystitis
Acute catarrhal cholecystitis,

conservative treatment of which was uneffective