IX Международная студенческая научная конференция Студенческий научный форум - 2017

Cholecystitis is one of the most common diseases of the digestive system, which consists of an inflammation of the gallbladder wall.

Among the many and varieous causes of acute inflammation of the gall bladder are:

• excessive increased of hydrostatic pressure in the biliary tract - hypertension;

• presence of stones in the gall bladder and / or ducts, provoking calculous cholecystitis;

• infection of the biliary tract;

• unhealthy diet and diets fail;

• stomach diseases, provoking violation of physico-chemical properties of bile;

reduced general resistance - the ability of the human body to resist external damaging factors;

• pathological vascular changes in the ways of excretion of bile due to atherosclerosis.

In the beginning there is feeling of contractions, when inflammation further increases contractions become intense and constant. The process may last for several hours at a time with vomiting. A tongua becomes furred and dry. Due to ongoing inflammation beyond the gallbladder when breathing mobility of the right abdominal wall is restricted. When this temperature at slight inflammatory process ranges from 37.5 to 38 ° C, and at a severe cholecystitis reaches 40 ° C. The patient was shivering. The number of leukocytes in the blood goes high 10-22 thousand / ml.

Ortner’s symptom and finger pressure on the gallbladder is painful, more clearly seen with a deep breath - Murphy's sign.. Under aggravating circumstances with biliary tract clogging there appears belching, nausea, jaundice, feeling of heaviness in the stomach. The signs of intoxication, growing rapidly: increased dry mouth, frequent vomiting reflex, and the state is characterized as a stupor - disorientation, lethargy, weakness. Also join the signs of the disease such as fever, fatigue, malaise, anorexia, and vomiting.

There are several basic forms of acute cholecystitis, depending on which symptoms can vary to a certain extent. At catarrhal form the clinical picture is as follows: the patient's condition is satisfactory; body temperature is kept within the normal range; there are no symptoms of intoxication; the average intensity of pain in the right upper quadrant; nausea without vomiting; flatulence.

Phlegmon type is expressed by the following phenomena: there is a high intensity of pain syndrome, patients feel weakness with a fever,dry mouth, tachycardia up to 100 beats per minute, expressed dyspeptic syndrome: abdominal distension, nausea, persistent vomiting; pain in the right hypochondrium and epigastrium.

The features of clinical manifestation of gangrenous and gangrenous-perforated acute cholecystitis varieties are following: acute intoxication, weakness, dehydration; fever; tachycardia greater than 100 beats per minute, symptoms of peritoneal irritation, soreness of abdomen. Calculous cholecystitis is most often observed in elderly and senile age. It is characterized by the rapid development of destructive changes of the gallbladder and spread to the extrahepatic biliary tract. In this form of the disease the clinical picture does not match the morphological violations. Symptomatology is weak, it is characterized by the predominance of signs of intoxication.

For the diagnosis of acute cholecystitis it is important to identify violations in the diet or stressful conditions during the survey, the presence of symptoms of biliary colic. If there is suspect of an acute inflammation of the gall bladder it is necessarily appointed to make ultrasound investigation of the abdomen. It shows an increase of organ in sizes, the presence or absence of stones in gallbladder and bile duct. At ultrasound investigation an inflammatiry gallbladder has thick double-circuit wall, more than 4 mm.

Computed tomography gives detailed picture of abdominal cavity. For a detailed study of the bile ducts ERCP is used - endoscopic retrograde cholangiopancreatography.

Biochemical blood and urine tests show signs of inflammation: leukocytosis, high erythrocyte sedimentation rate, dysproteinemia, bilirubinemia, increased activity of enzymes amylase and transaminases.

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