Introduction to the symptoms and treatment of chronic cholecystitis

Common symptoms of chronic cholecystitis are indigestion, fullness, discomfort, and pain. In treatment, attention should be paid to the use of some drugs, or anthelmintic treatment, lithotripsy and antibacterial therapy can be performed.

1. Symptoms and Signs

There may be great differences between different patients, and it is often inconsistent with the actual pathological changes; most patients have concurrent gallstones and a history of biliary colic in the past. Symptoms may appear continuously after the first attack of acute cholecystitis, or they may develop insidiously with mild symptoms, or they may not be noticed until after the diagnosis is made.

1. Indigestion? Manifested as upper abdominal fullness, discomfort, and upper abdominal discomfort after eating.

2. Intolerance to fatty foods.

3. Right upper abdominal pain? Patients often feel dull pain under the right shoulder blade or in the right waist, which is sometimes similar to biliary colic.

4. Physical examination usually shows no positive signs except mild tenderness in the right upper abdomen. Occasionally, an enlarged gallbladder may be palpated, and there may also be tenderness on the right side of the 8th to 10th thoracic vertebrae.

2. Medical treatment

(1) General treatment: A low-fat diet can reduce the chance of disease.

(2) Antispasmodic and analgesic: In general, 10-30 ml of 33% magnesium sulfate can be given orally as a choleretic, or anticholine drugs such as 0.5 mg of atropine or 10 mg of scopolamine can be used alone to relieve spasm of the Oddi sphincter.

(3) Deworming treatment: If Giardia lamblia or Clonorchis sinensis is found in the duodenal drainage, deworming treatment should be carried out.

(4) Litholytic therapy: Oral administration of ursodeoxycholic acid and chenodeoxycholic acid to dissolve the stones, but the efficacy is uncertain. In recent years, retrograde pancreaticobiliary angiography has been used to place a nasobiliary duct, through which litholytic drugs can be directly injected into the bile duct and gallbladder, which can improve the efficacy of the treatment. However, the treatment course is longer and the cost is more expensive.

(5) Antimicrobial treatment: Patients with infectious cholecystitis or other types of cholecystitis complicated with bacterial infection should be given antibiotic treatment. The antibiotic application regimen is basically the same as that for acute cholecystitis.

3. Surgical treatment

?Some non-calculous chronic cholecystitis can be kept disease-free through diet control and medical treatment, but the efficacy is unreliable. For patients with stones, surgery is generally considered to be the best treatment option for chronic cholecystitis because of the high possibility of repeated acute attacks and a series of complications.

(1) For symptomatic patients, especially those with recurrent chronic cholecystitis accompanied by gallstones, surgical removal of the gallbladder is the preferred treatment option to fundamentally remove the infected lesion and prevent all complications.

(2) For patients with mild, atypical clinical symptoms or uncertain diagnosis, the efficacy of surgical cholecystectomy may be poor, so attention should be paid to the selection of indications during surgery.

(3) For patients whose general condition is poor and who are not suitable for surgery, they should first be given active medical treatment and then undergo surgical treatment after their general condition improves.