Chronic cholecystitis

thumb|250px|Chronická rekurentní cholecystitida thumb|250px|Cholecystolitiáza na ultrasonografii thumb|250px|Cholecystolitiáza

• It occurs either by gradual development or is the result of acute cholecystitis once or repeatedly,
• each attack of cholecystitis increases the risk of life-threatening complications.

Pathological finding

• Wall fibrosis with inflammatory exudation, the wall is thickened, stiffer, the mucosa is red, sometimes covered with ulcers, sometimes completely absent,
• retraction occurs with longer duration → a picture of a wrinkled gallbladder,
• in cystic obstruction → hydrops – bile discolors after absorption of bile pigments, calcium salts fall out and give the gallbladder a milky color,
• salts can also be deposited in the wall → „porcelain gallbladder“.

Etiology

• Microbial infections, chemical irritation and metabolic causes apply.

Clinical picture

• It corresponds to the difficulties arising from lithiasis,
• biliary dyspepsia – abdominal pressure, episodic local or diffuse abdominal pain, heartburn, anorexia, flatulence, nausea, steatorrhea,
• attacks of repeated biliary colic.

Diagnosis

Anamnesis

• Cholelithiasis,
• repeated attacks of biliary colic, past acute cholecystitis.
• dyspeptic problems

Physical examination

• It usually does not contribute to the diagnosis,
• in the case of an acute exacerbation, Murphy's sign may be positive.

Further examination

• Increased sedimentation and leukocytosis in gallbladder empyema,
• the basic examination is USG,
• X-ray – pathological finding on the gallbladder – loss of function, reduced concentration and evacuation ability.

Complication

• Mainly acute exacerbations, cholangitis with hepatic parenchyma, formation of biliodigestive fistulas, development of liver or subfrenic abscess, which may cause pancreatitis.

Therapy

• Conservative - pain control, anticholinergics, antispasmodics, infection prevention, adjustment of water and electrolyte balance, stomach decompression as needed, pancreatic enzyme replacement as needed, possibly. vitamins,
• causal treatment is only surgery → cholecystectomy,
• Neither baths nor antibiotics stop the process on the gallbladder.

Links

Related articles

• Acute cholecystitis
• Infectious cholangitis

External links

• Chronická cholecystitida – video na youtube.com

Použitá literatura

Kategorie:Vložené články Kategorie:Chirurgie Kategorie:Vnitřní lékařství Kategorie:Gastroenterologie Kategorie:Patologie