Cholecystitis

　　Cholecystitis is a common disease of the gallbladder, caused by bacterial infection or chemical irritation. The main factors leading to cholecystitis include:

　　1. Low immunity leads to biliary tract infection: Biliary tract infection can cause cholecystitis.

　　2. Emotional disorders: They can lead to the obstruction of bile excretion and trigger cholecystitis.

　　3. Diet: Have a moderate diet, avoid overeating. Eat less high-fat and cholesterol-rich foods, and pay attention to food hygiene.

　　4. Intestinal parasitic diseases: For example, the penetration of worms into the bile duct can cause inflammation of the bile duct. Their remnants and eggs can become the 'core' of gallstones.

　　5. Neglecting exercise and not drinking enough water regularly.

　　Whether it is acute or chronic cholecystitis, timely treatment is necessary; otherwise, other complications may occur.

　　1. Gallbladder perforation: It often occurs within 72 hours of the onset of acute cholecystitis, is more common in patients with fewer episodes or first-time attacks, such as when the pain worsens, the gallbladder becomes significantly enlarged, there is a high fever, and the white blood cell count is significantly increased, which strongly suggests perforation.

　　2. Gallbladder fistula: The most common is the gallbladder- duodenum fistula, and less common are gallbladder- transverse colon, stomach, small intestine, and other fistulas. During the acute cholecystitis process, the gallbladder and adjacent organs may become inflamed and adherent, the gallbladder wall may become gangrenous and penetrate. This may cause vascular thrombosis and rupture of the adherent intestinal wall, leading to communication between the gallbladder and the intestinal lumen, forming a fistula.

　　3. Others: An acute emphysematous cholecystitis, subhepatic abscess, liver abscess, suppurative portal vein inflammation, gallbladder gangrene, cholangitis, ascites, and sepsis may occur when chronic cholecystitis exacerbates acutely.

　　Cholecystitis can be divided into acute cholecystitis and chronic cholecystitis.

　　1. Acute cholecystitis: Many patients develop symptoms in the middle of the night after a greasy dinner, as high-fat foods can strengthen the contraction of the gallbladder, and lying down is more likely to cause small gallstones to slide into and become lodged in the gallbladder duct. The main symptoms are persistent pain in the upper right abdomen, which may radiate to the right shoulder and back, and may be accompanied by fever, nausea, and vomiting, but chills are rare, and jaundice is mild. Abdominal examination may show fullness in the upper right abdomen, muscle tension in the gallbladder area, marked tenderness, and rebound pain.

　　2. Chronic cholecystitis: Symptoms and signs are atypical. Most cases manifest as biliary dyspepsia, aversion to greasy foods, epigastric distension, belching, and epigastric burning, which are similar to peptic ulcer disease or chronic appendicitis; sometimes, due to gallstone obstruction of the gallbladder duct, it can present as an acute attack, but when the gallstone moves and the obstruction is relieved, it improves rapidly. Physical examination may show mild tenderness or percussion pain in the gallbladder area; if there is gallbladder hydrops, a round, smooth cystic mass can often be palpated.

　　Cholecystitis is a gallbladder disease caused by infection, bile stimulation, pancreatic juice reflux into the bile duct, and disorders of bilirubin and lipoprotein metabolism. To prevent cholecystitis, it is necessary to start with the etiology.

　　1. It is necessary to engage in physical activities regularly to activate the whole body's metabolism, especially for middle-aged people who are mentally laborious and always sit at work. They should consciously do more physical labor to prevent excessive obesity, as obesity is an important predisposing factor for cholecystitis or gallstones.

　　2. Pay attention to food hygiene, avoid overeating, and moderately limit fatty foods. Because eating fatty foods can reflexively cause the gallbladder to contract, and once the contraction is too strong, it can lead to an acute attack of biliary colic.

　　3. After the autumn cool, attention should be paid to keeping warm, especially covering the quilt well when sleeping to prevent the abdomen from getting cold. Because after the abdomen gets cold, it will stimulate the vagus nerve, causing the gallbladder to contract strongly.

　　4. People who have been diagnosed with gallstones should be treated in a timely manner to avoid inflammation of the gallbladder.

　　5. When there are intestinal worms (mainly ascaris), apply vermifugal drugs in a timely manner, and use sufficient dosage to prevent insufficient medication, as ascaris are active and can easily penetrate into the bile duct, causing obstruction and leading to cholecystitis.

　　6. When inflammation occurs, apply effective antibiotics in a timely manner.

　　7. Some traditional Chinese medicine can be taken, and the effect is also good.

　　Generally, laboratory tests and imaging examinations are required to diagnose cholecystitis.

　　One, Laboratory tests

　　1. Total white blood cell count and neutrophils: About 80% of patients have an increased white blood cell count, averaging (10-15) × 10^9/L. The degree of increase is related to the severity of the lesion and the presence of complications. If the total white blood cell count is above 20 × 10^9/L, gallbladder necrosis or perforation should be considered.

　　2. Total serum bilirubin: About 10% of patients have jaundice, but about 25% of patients have increased total serum bilirubin. When acute pancreatitis is present, the levels of blood and urine amylase also increase.

　　3. Serum transaminases

　　Two, Imaging examinations

　　1. B-ultrasound: It has the highest diagnostic value, showing the size of the gallbladder, the thickness of the gallbladder wall, the stones inside the gallbladder, and the contraction of the gallbladder.

　　2. CT and MRI examinations: These are of great help in the diagnosis and differentiation of acute calculous cholecystitis, especially valuable for the diagnosis when there are concomitant bile duct stones or acute pancreatitis.

　　3. Intrahepatic biliary tract angiography.

　　4. Radionuclide imaging.

　　5. X-ray examination (now this examination is generally not performed): About 20% of acute gallstone disease can be visualized on X-ray films, purulent cholecystitis or cholecystic hydrops can also show shadows of enlarged gallbladders or inflammatory tissue masses.

　　The treatment of cholecystitis, in addition to the use of medication and surgery, also requires attention to nutritional therapy, especially during the stages of pain relief and postoperative health recovery.

　　1. The general goal of nutritional therapy is to alleviate or relieve the patient's pain and prevent the occurrence of stones by controlling the intake of fat. Severe patients in the acute attack phase should be fasting and can receive various nutrients intravenously; when they can eat, they should avoid fatty and刺激性 foods, and can consume high-carbohydrate liquid diets in the short term. As the condition gradually improves, low-fat semi-liquid or low-fat, low-fiber soft rice can be provided. It is recommended to eat less and more frequently, while still limiting meat and foods high in fat. For chronic cholecystitis, a diet rich in high-protein, high-carbohydrate, and moderate fat restriction should be provided, along with a rich supply of vitamins.

　　2. Sufficient heat energy is required to meet the patient's needs. If the patient is overweight, a low-calorie diet should be provided to reduce the patient's weight. The low-calorie diet should also contain less fat to meet the requirements of patients with gallbladder disease for fat restriction. Generally, the daily supply of calories is 7531.2 to 8368 joules (1800 to 2000 kcal).

　　3. For patients with chronic cholecystitis, in order to maintain health, enhance appetite, promote gallbladder contraction and facilitate gallbladder emptying, it is recommended to increase the protein proportion in the diet as much as possible. The daily protein intake should be 1-1.2 grams per kilogram of body weight, but it is necessary to avoid excessive cholesterol intake with protein.

　　4. Since fat can promote the contraction of the diseased gallbladder and cause severe pain, it should be strictly limited during the acute phase. The daily fat intake should be less than 40 grams or fasting, and can be eaten in moderation after the condition improves.

　　5. When consuming carbohydrate-rich liquid diets, the main nutrient is sugar. Sufficient carbohydrates can be provided, with 300-350 grams per day, especially during the acute phase, intravenous administration should be given.

　　6. Provide a rich variety of vitamins, especially pay attention to the supplementation of vitamin B and C.

　　7. Avoid spicy foods and alcohol.

　　Acute cholecystitis has an abrupt onset, and it is generally recommended to undergo 12-24 hours of active medical treatment, and then schedule surgery after symptoms subside.

　　1. General Treatment: Bed rest, easy-to-digest liquid diet, avoid greasy foods, severe cases may require fasting and gastrointestinal decompression, intravenous nutrition, water, and electrolyte supplementation.

　　2. Antispasmodic and Analgesic Medication: Atropine 0.5mg or 654-25mg intramuscular injection; nitroglycerin 0.3-0.6mg, sublingual administration; vitamin K3 8-16mg, intramuscular injection; Durogesic or equivalent analgesics, morphine should not be used.

　　3. Antimicrobial Therapy: Ampicillin, ciprofloxacin, metronidazole; aminoglycosides or cephalosporins can also be selected as antibiotics, and it is best to choose antibiotics based on the results of bacterial culture and drug sensitivity test.

　　4. Biliary Drainage: Oral administration of舒胆通 (Shu Dan Tong), anti-inflammatory biliary tablets, Miao Ling Biliary Syndrome formula, Pu Cao Qing Dan formula, or Qing Gan Li Danye oral liquid, can be used after the attack subsides.

　　5. Surgical Treatment: Those with necrosis, abscess, perforation, or impacted gallstones should receive timely surgical treatment, such as cholecystopexy or cholecystectomy.