Gestational acute cholecystitis

　　The causes of gestational acute cholecystitis mainly include the following aspects:

　　1. Biliary stasis

　　More than 90% of biliary stasis is caused by stone impaction. Stones can cause obstruction of the gallbladder outlet, leading to poor blood supply to the gallbladder wall and ischemic necrosis. The stasis of bile can stimulate the gallbladder wall, causing chemical inflammation. Pancreatic juice reflux can cause pancreatic digestive enzymes to erode the gallbladder wall, leading to acute cholecystitis.

　　2. Bacterial infection

　　Due to bile stasis, bacteria can proliferate and enter the gallbladder through blood flow, lymph, or retrograde biliary tract, causing infection. The main source of infection is Gram-negative bacilli, with 70% being Escherichia coli, followed by Staphylococcus, Proteus, and others.

　　3. The influence of pregnancy

　　During pregnancy, the levels of estrogen and progesterone increase significantly, leading to a doubling of gallbladder capacity, delayed gallbladder emptying. In addition, the cholesterol content in bile increases, and the ratio of cholesterol to bile salts changes, resulting in increased viscosity of bile, which is prone to gallbladder inflammation.

　　The main complications of acute cholecystitis during pregnancy are as follows:

　　1. Gallbladder perforation

　　Perforation usually occurs in the gallbladder fundus or necrotic gallbladder wall at the site of stone impaction, causing cholestatic peritonitis.

　　2. Acute suppurative cholangitis

　　Biliary obstruction and infection are the basic factors for the onset of the disease. Biliary obstruction leads to bile stasis, which is conducive to the proliferation of bacteria in bile, leading to bacterial infection. After secondary bacterial infection, the mucosal congestion and edema of the biliary tract increase the pressure within the biliary tract, which further aggravates the degree of biliary obstruction.

　　3. Biliary pancreatitis

　　Proximal bile duct stones or duodenal papillary edema can cause transient obstruction of the pancreatic duct, leading to bile reflux into the pancreatic duct and triggering acute pancreatitis.

　　This disease often occurs after a heavy meal or overexertion, and is more common at night. The pain is sudden, usually in the upper right abdomen, but can also be seen in the middle of the upper abdomen or below the xiphoid process, with paroxysmal exacerbation. The pain can radiate to the right shoulder, scapular angle, or right腰部, and a few patients may radiate to the left shoulder. About 70% to 90% of patients may have nausea and vomiting; about 80% of patients may have chills and fever; about 25% of patients may have jaundice, and severe infection may lead to shock.

　　To prevent acute cholecystitis during pregnancy, the following measures should be taken:

　　1. Pay attention to diet. Light and bland foods are recommended, with less greasy and grilled foods.

　　2. Maintain smooth defecation.

　　4. Change the sedentary lifestyle, and pay attention to more physical activity in daily life.

　　3. Pregnant women should pay attention to maintaining a pleasant mood.

　　The main examination methods for pregnant women with acute cholecystitis are as follows:

　　1. Routine blood test

　　The examination shows an elevated white blood cell count with left shift of the nucleus.

　　2. Serum enzyme testing

　　Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels are slightly elevated. When there is obstruction of the common bile duct, bilirubin levels rise.

　　3. Ultrasound examination

　　Under ultrasound, gallbladder enlargement can be seen. Since most cases of acute cholecystitis are associated with gallstones, gallstone light spots and acoustic shadows can be observed. When there is biliary tract obstruction, there is dilation of the common bile duct, with a diameter greater than 0.8cm, and sometimes gallstones within the common bile duct can also be seen.

　　Pregnant women with acute cholecystitis should pay attention to the following points in diet:

　　1. Choose foods rich in high-quality protein with relatively low cholesterol content, such as fish, lean meat, dairy products, and soy products. Control the intake of animal liver, kidney, and brain foods.

　　2. Ensure the supply of fresh vegetables and fruits. Leafy vegetables can provide necessary vitamins and a certain amount of dietary fiber, and can be eaten in greater quantities.

　　3. Reduce the intake of animal fats, such as lard and animal oils, and increase the proportion of vegetable oils such as corn oil, sunflower seed oil, peanut oil, and soybean oil.

　　4. Avoid spicy foods such as chili and curry, as well as coffee and strong tea.

　　The treatment of gestational acute cholecystitis mainly includes conservative treatment and surgical treatment.

　　First, Conservative Treatment

　　1. Diet control: Severe patients should fast, and mild patients should avoid fatty diet during the acute phase of symptoms. During the remission period, high-sugar, high-protein, low-fat, and low-cholesterol diets can be provided. Adequate fluid intake should be supplemented to correct water and electrolyte imbalance.

　　2. Symptomatic treatment: Pain patients can use antispasmodic analgesics, such as atropine 0.5-1mg intramuscular injection, or pethidine (Durogesic) 50-100mg intramuscular injection. Nitroglycerin, methadone, indomethacin (消炎痛) and other drugs also have antispasmodic analgesic effects and can be appropriately selected. During the period of symptom relief, it is appropriate to take bile-promoting drugs, such as magnesium sulfate 50%, dehydrocholic acid, ursodeoxycholic acid, and hydromorphone (bile acid) to promote gallbladder emptying.

　　3. Antimicrobial therapy: Broad-spectrum antibiotics should be used for antimicrobial therapy. Cephalosporins are 4-12 times more concentrated in bile than in blood and have no adverse effects on the fetus, so they should be the first choice.

　　Second, Surgical Treatment

　　Surgical treatment is mainly suitable for patients whose symptoms gradually worsen during the treatment period, conservative treatment fails, or severe complications occur, such as obstructive jaundice, cholecystitis with abscess, perforation of gangrenous cholecystitis, and pericholecystic abscess with diffuse peritonitis. Unless the condition is critical, surgery should be chosen during the second trimester of pregnancy, when the abortion rate is about 5%, lower than in other periods of pregnancy. If the due date is approaching, it is best to wait until after delivery for surgical treatment. Postoperative treatment should include fetal protection. The main surgical methods include cholecystostomy drainage, common bile duct drainage, cholecystectomy, or local abscess drainage.