Chronic cholecystitis

　　Chronic cholecystitis refers to chronic inflammation of the gallbladder, which is one of the most common diseases of the gallbladder. It is generally caused by incomplete cure of acute cholecystitis.

　　1. Chronic calculous cholecystitis, like acute cholecystitis, can cause recurrent acute attacks due to gallstones, that is, chronic cholecystitis and acute cholecystitis are different stages of the same disease.

　　2. Chronic non-calculous cholecystitis is found during autopsy or surgery and accounts for 2% to 10% of all gallbladder lesions.

　　3. Chronic atrophic cholecystitis with stones, also known as porcelain gallbladder, is caused by inflammatory stimulation from stones, leading to calcification of the gallbladder wall and forming calcification, which can be localized to the mucosa, muscular layer, or both, and is more common in patients over 65 years old.

　　4. Yellow granulomatous cholecystitis is rare and is caused by an inflammatory reaction of connective tissue in the gallbladder cavity due to the entry of bile lipids.

　　The treatment of chronic cholecystitis should be individualized according to the factors causing the onset and the complications, etc. Common complications include:

　　1. Cholecystopathy

　　Chronic cholecystitis is characterized by excessive secretion of mucus by the gallbladder mucosal epithelium. When gallstones block the cystic duct, the increasing mucus causes the gallbladder to slowly and painlessly expand (rapid expansion can cause pain). If there is no acute inflammation, the bile is sterile. At this time, a painless, enlarged gallbladder can be palpated in the upper right abdomen. Cholecystopathy should be differentiated from gallbladder dilation caused by the slow obstruction of the common bile duct, as the latter's dilation is not due to mucus secretion and is accompanied by jaundice, whereas cholecystopathy is not.

　　2、白胆汁

　　2. White bile

　　When the gallbladder effusion lasts for several weeks, the bile pigments are decomposed and absorbed, and the bile becomes colorless and transparent.

　　3. Milk of lime bile

　　Paste-like or milky, gelatinous calcareous deposits in the gallbladder are called milk of lime bile, which can be seen in 1.3% to 3.4% of biliary stone surgery patients, with a male-to-female ratio of 1:2.7. Since Churchman reported the first case of milk of lime bile in 1911, there has been a deep understanding of this disease.

　　4. Porcelain gallbladder

　　What are the typical symptoms of chronic cholecystitis

　　Chronic cholecystitis is the most common gallbladder disease. Patients generally have gallstones at the same time, but chronic cholecystitis without gallstones is also not uncommon in China. After suffering from chronic cholecystitis, patients mainly have the following two groups of symptoms:

　　1. Gallstones temporarily block the cystic duct, causing attacks of biliary colic. The pain is usually located in the upper abdomen or upper right abdomen, lasting for several minutes to several hours, and can radiate to the back or right scapula. Nausea and vomiting may accompany the pain.

　　2. There are often symptoms such as abdominal distension, discomfort in the upper abdomen or upper right abdomen, heartburn, belching, and acid regurgitation, which are symptoms of indigestion. Eating fried or high-fat foods often aggravates these symptoms.

　　How to prevent chronic cholecystitis

　　1. Pay attention to diet. Light and bland food is recommended, and it is best to eat less greasy and fried, roasted food.

　　2. Maintain smooth defecation. The six bowels are used for their function, and when the liver and gallbladder are damp-heat, constipation can worsen the symptoms, so maintaining smooth defecation is very important.

　　3. Change the sedentary lifestyle, walk more, and exercise more.

　　4. Maintain a positive nature. People with long-term family discord and poor mood can trigger or worsen this disease. It is important to have a broad mind and a comfortable mood.

　　The diagnosis can be made based on the medical history, clinical manifestations of chronic cholecystitis patients, and ultrasound examination. The examination includes the following:

　　1. Ultrasound examination

　　It has the highest diagnostic value and can show the size of the gallbladder, the thickness of the gallbladder wall, the stones inside the gallbladder, and the contraction of the gallbladder.

　　2. Abdominal X-ray film

　　The signs of positive gallstones, gallbladder calcification, and gallbladder distension can be displayed; cholecystography can show the signs of gallstones, gallbladder size, shape, contraction, and concentration, etc.

　　3. Oral and intravenous bile duct contrast imaging

　　In addition to showing signs of stones, gallbladder size, gallbladder calcification, and gallbladder distension, it can also observe the morphology of the common bile duct and signs such as stones, worms, and tumors in the common bile duct, which have diagnostic value for this disease.

　　Due to the many characteristics of cholecystitis symptoms, it cannot be ignored, and it is best to go to a professional hospital for standardized examination. It is advisable to eat various fresh fruits and vegetables, low-fat, low-cholesterol foods such as: mushrooms, wood ear, celery, sprouts, kelp, lotus root, fish, rabbit meat, chicken, fresh beans, etc. It is advisable to eat more dried beans and their products. It is advisable to use vegetable oil instead of animal oil. When drinking water, a little hawthorn, sea buckthorn, ginkgo, and polygala herb can be added to the water cup as tea.

　　Some non-gallstone chronic cholecystitis may maintain non-attack through dietary restriction and internal medicine treatment, but the efficacy is not reliable. Those with stones have more opportunities for acute attacks and can cause a series of serious complications, occasionally leading to gallbladder cancer. Therefore, the best treatment for this condition, whether with stones or not, is surgery, and the best surgical method is cholecystectomy, which is the only way to fundamentally remove the focus of infection and prevent all complications. However, for patients with mild symptoms or those who have never attacked for a long time, especially the elderly with other serious organic diseases, it is not advisable to undergo laparotomy at will to prevent more serious complications and consequences caused by surgery.

　　Generally speaking, for patients with chronic cholecystitis with obvious symptoms, frequent and severe attacks, especially those accompanied by gallstones, the effect of surgical resection is usually good; on the contrary, if the symptoms are mild, especially for chronic cholecystitis without stones, the efficacy of cholecystectomy may be poor, and it should be paid attention to. For elderly patients with poor physical condition, comprehensive conservative treatment can be adopted, such as limiting the intake of fat, taking bile drugs, and treating with a combination of traditional Chinese and Western medicine, which is helpful for the relief of symptoms. Clinically, there are some gallbladder diseases, such as obvious inflammatory manifestations, such as cholecystic hydrops, cholecystadenomyomatosis, cholecystocholesterolosis, cholecystoneuroma, etc., which have similar clinical manifestations to cholecystitis. When the symptoms are severe, cholecystectomy should also be performed.