Cholecystitis
| Classification according to ICD-10 | |
|---|---|
| K81.- | Cholecystitis |
| K80.0- | Gallbladder stone with acute cholecystitis |
| K80.1 | Gallbladder stone with other cholecystitis |
| K80.4- | Bile duct stone with cholecystitis |
| ICD-10 online (WHO version 2019) | |
The cholecystitis , cholecystitis or cholecystitis refers to inflammation of the gallbladder , which in most cases (90-95%) by gallstones is caused.
causes
By far the most common cause of gallbladder inflammation are gallstones, which interfere with the drainage of the gallbladder. The gallbladder becomes overfilled (hydrops). So initially there is an inflammation without bacteria (abacterial). As the disease progresses, germs can rise from the duodenum via the bile duct or the lymphatic system and infect the gall bladder (bacterial infection). Intestinal germs such as Escherichia coli , enterococci , Proteus mirabilis and Klebsiella are among the most common types of bacteria.
Inflammation of the gallbladder can rarely arise as a result of a long period of parenteral nutrition, an accident or primarily due to problems in the vascular system, chemical-toxic causes, large meals or infections.
Age over 40, obesity and light skin are considered risk factors for developing gallstones. Women are more likely to have gallstone problems than men. In the English language, the risk factors are referred to as the 5 Fs: female (female), fertile (fertile), fat (fat, overweight), forty (around or over forty years old) and fair (blond). More "F" s are now sometimes added and then stand for fair (here: "fair-skinned"), family disposition or flatulent (flatulence, meteorism )
frequency
Gallbladder inflammation is more common after the age of 60, but it can affect all age groups and both sexes.
Symptoms
The disease begins as acute cholecystitis usually with severe pain in the right upper abdomen , often radiating to the shoulder , accompanied by nausea , dizziness, skin paleness and sweating . The appearance of a fever suggests a bacterial infection. The sick often state that they cannot consume fatty foods, coffee or wine. These foods increase the flow of bile and thus aggravate the symptoms. If the bile duct is blocked with biliary obstruction ( cholestasis ), the stool can be lightened and the urine darkened.
examination
In addition to the typical symptoms, laboratory findings and ultrasound findings are particularly important during the examination. Clinically, the Murphy sign is often groundbreaking.
In laboratory tests, the accumulation of bile is shown by the increase in the enzymes γ-glutamyltransferase ( γ-GT ) and alkaline phosphatase ( AP ). The inflammation of the gallbladder associated with the appearance of gallstones leads to an increase in C-reactive protein and blood subsidence .
With the help of an ultrasound examination, an enlarged gallbladder, swelling of the gallbladder wall and distended shape can be shown. A sure sign of inflammation is the visibility of the three layers of the gallbladder wall. In addition, the accumulation of bile can be made visible through the diameter of the bile duct . Physiologically, the duct should not exceed a diameter of 6 mm or 9 mm with the gallbladder removed. If the bile duct cannot be fully visualized, a functional examination can also be carried out. The size of the gallbladder is measured around 45 minutes after meals. If the gallbladder shrinks, it can be assumed that the duct is open.
Chronic cholecystitis can harden the wall with calcifications ( porcelain gallbladder ).
treatment
- conservative treatment
- The main therapeutic options are bed rest and medication that calm the colic (e.g. butylscopolamine as a pure spasmolytic or metamizole , which has spasmolytic and analgesic effects). Biliary colic can also be treated with nitro spray. This also expands (relaxes) the large bile duct and sphincter muscle (sphincter) to form the duodenum (duodenum). Trapped stones in the bile duct can be eliminated through the intestine.
- Painkillers containing morphine can make symptoms worse by increasing the tone of the sphincter. However, due to the severity of the pain, they are often unavoidable and can be used in practice. Active ingredients with little effect on the sphincter such as pethidine or buprenorphine should be used.
- Antibiotics are used to treat the infection in acute cholecystitis .
- surgical gallbladder removal
- As part of the cholecystectomy , the gallbladder with the stones is removed. If possible, this will be done after the inflammation has subsided, as removing an inflamed gallbladder is associated with a higher rate of complications. If the inflammation is severe or the bile duct is blocked, an immediate operation may be necessary.
- Alternatives
- If the ultrasound examination shows signs of a stone in the biliary tract (ductus cysticus or ductus common bile duct), an attempt can be made to remove it with the help of ERCP (endoscopic retrograde cholangiopancreatography).
Complications
Hydrops (enlargement due to biliary stasis when stones block the entrance of the gallbladder) and pus formation in the gallbladder, inflammation of the bile duct, accompanying pancreatitis (inflammation of the pancreas) and gallstone ileus, gallbladder rupture with peritonitis . If pathogens get into the bloodstream, sepsis can also develop. The latter are serious complications that are still often fatal today. That is why the gallbladder must always be removed when pain from gallstones occurs .
proof
- ^ Stefan Feuerbach: Gastrointestinal System. Springer, 2007, ISBN 978-3-540-68472-5 , p. 472. Restricted preview in the Google book search
- ↑ Homayun Gharavi-Nouri : Ambulance live. Urban & Fischer, 2004, ISBN 978-3-437-43530-0 , p. 87. Restricted preview in the Google book search
- ^ Karl-Heinz Reutter: Surgical Essentials: Intensive course for further training; 25 tables. Georg Thieme Verlag, 2004, ISBN 978-3-13-126345-2 , p. 245. Restricted preview in the Google book search
- ↑ a b Gerd Herold and colleagues: Internal Medicine , Cologne, 2009 pp. 534–539
- ↑ Gutt C et al. : Updated S3 guideline of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) and the German Society for General and Visceral Surgery (DGAV) for the prevention, diagnosis and treatment of gallstones. Z Gastroenterol 2018; 56: 912-966
- ^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 124 f.
- ↑ A. Hirner, K. Weise: Surgery - Cut by Cut , 1st edition, 2004, p. 543
