Acute calculous cholecystitis

　　急性结石性胆囊炎是由于结石阻塞胆囊管，造成胆囊内胆汁滞留，继发细菌感染而引起的急性炎症。常见的致病因素是胆囊管梗阻，约有80％的病人是由胆囊结石引起的，当胆囊管梗阻后，胆汁浓缩，浓度高的胆汁酸盐会损害胆囊黏膜上皮，引起炎症的变化。还有部分病人是致病细菌入侵，大多通过胆道逆行而入侵胆囊。致病细菌主要是大肠杆菌，产气杆菌及绿脓杆菌等。若合并产气厌氧菌感染时，则会引起急性气肿性。一少部分的急性则是由于创伤、化学刺激所致。当严重创伤和大手术后，胆囊的收缩功能下降，胆汁淤滞、胆汁酸盐浓度增高，刺激胆囊黏膜致病，感染时，可有胰液返流入胆囊而引起急性非结石性。

　　20. What complications are easy to occur in acute calculous cholecystitis

　　19. Acute calculous cholecystitis is an acute inflammation caused by the obstruction of the cystic duct by gallstones, leading to retained bile in the gallbladder and secondary bacterial infection. Acute calculous cholecystitis usually leads to the following complications.

　　18. 1. Empyema of the gallbladder.

　　17. 2. Gaseous cholecystitis.

　　The main symptoms of acute calculous cholecystitis include right upper quadrant pain, nausea, vomiting, and fever. Acute calculous cholecystitis can cause right upper quadrant pain, which is initially very similar to biliary colic. However, the pain caused by acute calculous cholecystitis often lasts longer, and breathing and changing body position often worsen the pain. Therefore, patients often prefer to lie on their right side to alleviate abdominal pain. Some patients may have nausea and vomiting, but vomiting is usually not severe. Most patients also have fever, with body temperature usually between 38.0℃ and 38.5℃, and high fever with chills is rare. A few patients may have mild jaundice of the whites of the eyes and skin.

　　The occurrence of acute calculous cholecystitis is closely related to poor lifestyle habits. It is recommended that the following points be paid attention to in daily life to effectively reduce the occurrence of this disease.

　　10. Pay attention to diet. Foods should be light and non-greasy, with a reduction in fatty and fried, baked foods.

　　9. Maintain smooth defecation. The six bowels function by being unobstructed. In cases of damp-heat in the liver and gallbladder and constipation, symptoms may worsen, so maintaining smooth defecation is very important.

　　8. Change from a sedentary lifestyle to more movement and exercise.

　　7. Maintain a healthy lifestyle. People with long-term family discord and emotional discomfort may trigger or worsen this disease. It is important to have a broad mind and a cheerful mood.

　　Acute calculous cholecystitis is an acute inflammation caused by the obstruction of the cystic duct by gallstones, leading to retained bile in the gallbladder and secondary bacterial infection. The common examination items include the following:

　　1. Total white blood cell count greater than 10X10^9/L, left shift.

　　2. Positive gallstones are visible in the gallbladder area on abdominal X-ray.

　　3. Ultrasound examination shows enlargement of the gallbladder with wall thickness greater than 3.5mm, accompanied by bright light spots and shadowy echoes inside.

　　4, Intrahepatic bile duct造影 does not show the gallbladder.

　　5, CT or MRI shows gallbladder stones.

　　Diet is an important part of the patient's disease treatment process. A reasonable diet can help patients recover quickly, and an improper diet may worsen the condition. So, how should patients with acute calculous cholecystitis eat?

　　What foods are good for patients with calculous cholecystitis?

　　(1) Pay attention to food hygiene, do not overeat, and eat low-fat, low-cholesterol foods as the main diet in daily life;

　　(2) Prefer vegetable oils, as modern medicine believes that vegetable oils have certain choleretic effects;

　　(3) Consume more roughage foods to keep the bowels regular.

　　(4) Ensure daily water intake.

　　What foods should be avoided for calculous cholecystitis?

　　Do not eat high-fat foods such as fatty meat, fried foods, etc. Foods rich in oil such as walnuts, peanut kernels, cashews, etc. should not be taken in large quantities. Do not eat animal oil. All types of alcohol and刺激性 food or strong seasonings can lead to acute attacks of cholecystitis, so caution is advised.

　　For patients with mild acute calculous cholecystitis, non-surgical therapy can be considered first to control inflammation, and then scheduled surgery can be performed after further investigation of the condition. For severe acute suppurative or gangrenous calculous cholecystitis or cholecystostomy, surgical treatment should be carried out in a timely manner, but adequate preoperative preparation is necessary, including correcting electrolyte and acid-base imbalances, and using antibiotics, etc. Non-surgical therapy is effective for the majority (80% to 85%) of patients with early acute calculous cholecystitis. This method includes antispasmodic analgesics, the use of antibiotics, correcting electrolyte and acid-base imbalances, and systemic supportive therapy. During the period of non-surgical therapy, the changes in the condition must be closely observed, and if symptoms and signs develop, surgical treatment should be changed in a timely manner. Especially for the elderly and diabetic patients, whose conditions change rapidly, more attention should be paid. According to statistics, about 1/4 of patients with acute calculous cholecystitis will develop into cholecystic gangrene or perforation. For patients with acute non-calculous cholecystitis, due to the rapid development of the condition, non-surgical therapy is generally not used, and surgical treatment should be performed in a timely manner after adequate preoperative preparation.