What to do if you have acute cholecystitis? What to do about acute cholecystitis?

**Approach: Conservative**.

This method is only suitable for acute cholecystitis with a first episode. Patients are required to cooperate with fasting, and then infusions are given to supplement vitamins and correct the acid-base balance in the body. In order to increase the patient's ability to resist infection, it is necessary to combine drugs, and the drugs should have a good effect on gram-negative bacteria and anaerobic bacteria.

Systemic antibiotics are best used in patients with high fever or high white blood cell index, especially in older people with low immunity, or in patients with diabetes. If the patient is new to the disease and has mild symptoms of cholecystitis, a conservative approach to inflammation control is required before surgery is considered.

There are also two types of surgery, one is to remove the gallbladder, and the other is to make an artificial stoma for the gallbladder. When performing gallbladder removal surgery, the surgical skills of the surgeon are highly demanding. Because of the presence of tissue edema around the gallbladder in the acute stage, the anatomical relationship is often unclear, and improper operation can easily injure the bile duct and nearby vital organs.

When available, intraoperative cholangiogram is used to detect bile duct stones and possible bile duct malformations.

Another type of cholecystostomy, which does not require general anesthesia. Indicated for older patients. These patients are of poor constitution and often have severe cardiopulmonary disease that makes them intolerant of cholecystectomy.

Or in the acute stage, if the anatomy around the gallbladder is unclear and the operation is difficult, cholecystostomy can also be performed first.

The purpose of this surgery is to drain the gallbladder inflammation and help the patient get through the dangerous period, and after the condition is stabilized, other ** can be performed. In most cases, another cholecystectomy will be done three months after this surgery to avoid cholecystitis**.

Acute cholecystitis is a common digestive disorder that can affect people of any age. Among them, acute calculous cholecystitis is more common in women, which is three times that of men before the age of 50 and twice as common in men after the age of 50; Patients with acute acalculous cholecystitis are more likely to have severe infection or trauma, and it is more common in frail or elderly people.

Inflammation in the initial stages of acute calculous cholecystitis may be caused by direct damage to the gallbladder mucosa by stones, leading to bacterial infection in the setting of cholestasis.

The condition of acute acalculous cholecystitis is still unclear, and it is mostly a local manifestation of systemic stress response, that is, severe inflammation of the gallbladder occurs when a serious systemic disease occurs. Acute cholecystitis is mainly manifested as epigastric pain, which can radiate to the right shoulder and back, and patients often have mild to moderate fever. Acute cholecystitis is an acute inflammatory disease with typical inflammatory manifestations – redness, swelling, heat, pain, and dysfunction.

Different from other acute inflammatory lesions, because the gallbladder is deep in the abdominal cavity, local symptoms and signs will only appear when the gallbladder inflammation spreads to the peritoneum, and the systemic inflammatory manifestations are mainly fever, fatigue, and rapid heart rate.

Because acute cholecystitis has a very rapid onset and is life-threatening in severe cases, patients must seek medical attention in time when they have symptoms such as unbearable pain, restlessness, or chills and high fever, and in severe cases, hospitalization**.

When a patient presents with severe pain in the right upper quadrant, first consider seeking help from a gastroenterologist, hepatobiliary surgeon, or general surgeon. Doctors take a history and a brief physical examination to look for typical acute cholecystitis. In addition, the doctor will recommend ultrasound, CT, and magnetic resonance imaging to further confirm the diagnosis.

Acute calculous cholecystitis eventually requires surgery**, and elective surgery should be pursued in principle. Acute acalculous cholecystitis should be treated as soon as possible**. The acute phase** includes fasting, fluids, and support**, with anti-infective and analgesic treatments, nutritional support, and correction of electrolyte acid-base imbalances.

If the patient can eat, he should eat a low-fat liquid diet, mainly light, to reduce the burden on the gallbladder.

If the patient has severe abdominal pain and vomiting and cannot eat, intravenous fluids are needed to supplement various physiological needs and maintain water, electrolytes and acid-base balance; Symptomatic treatment is carried out for various uncomfortable symptoms, such as antiemetic, protection of gastric mucosa, and digestion aid.

If it is the first attack of acute cholecystitis, you can take antispasmodic, anti-inflammatory, and analgesic symptoms**, use some hyoscyamine and atropine to relieve pain, and choose sensitive cephalosporin antibiotics for anti-infection**.

If the effect is ideal, you can be conservative. If the attack is more urgent, or the symptoms are more severe, or even the conservative ** effect is poor, gallbladder removal surgery can be taken in the acute stage. If cholecystectomy is too difficult, or if acute cholecystitis with severe perforation and suppuration is formed, cholecystostomy surgery can also be considered, and elective cholecystectomy surgery can be performed after the condition is stabilized.

For some elderly people with poor physical fitness and status, percutaneous liver puncture can also be used.

In the case of acute cholecystitis, patients must not eat indiscriminately. This is because fasting can reduce the burden on the stomach and intestines, reduce bile secretion, reduce biliary secretion, and to a certain extent, it can effectively alleviate the uncomfortable symptoms caused by cholecystitis. When the condition is relieved slightly, the patient can eat some foods that are good for digestion.

During an acute attack of cholecystitis, patients should not take choleretic drugs at will. Choleretic drugs can aggravate common bile duct stone obstruction and affect the best effect of cholecystitis. People with acute cholecystitis can take some necessary pain relief** to relieve the pain according to their specific situation.

For patients with acute cholecystitis with severe abdominal pain, hospitals with conditions can adopt gallbladder puncture and drainage under ultrasound positioning to help patients with surgery after acute cholecystitis**.

When patients have severe symptoms such as gallbladder wall necrosis and pyometra, surgery should be selected in time**. In this case, only surgery** can bring the condition under control and not worsen again. The specific surgical method needs to be based on the actual situation.

For patients with acute cholecystitis, daily care is important. In their free time, patients can do some proper exercise to boost their own immunity. In this way, we can better fight against the disease and achieve better results.

Patients must develop a healthy lifestyle habits. Go to bed early and wake up early to ensure adequate sleep time. In addition, patients with acute cholecystitis can also take a diet**.

Diet has a certain adjuvant effect on acute cholecystitis.

If it is a patient with mild cholecystitis, you can take some anti-inflammatory choleretic tablets, which can control the patient's condition and avoid aggravation of the condition.

Initiatives are proposed. 1. Patients with cholecystitis will have many adverse symptoms, and it is necessary to choose the appropriate method, most patients use drugs, acute cholecystitis is mostly antispasmodic and analgesic drugs, and choleretic drugs can also be taken for patients with chronic cholecystitis.

2. Patients with cholecystitis can also use Chinese patent medicines**, such as taking golden gallbladder tablets, liver clearing and gallbladder oral liquid, etc., which can be effectively relieved.

Precautions. If the patient has cholecystitis, surgery is required** to prevent the condition from getting worse.

Once diagnosed with acute cholecystitis, go to the hospital and need surgery**, in principle, we should strive for elective surgery, acute cholecystitis without serious complications, after cholecystectomy, the recovery is very good, or even completely**, the key to preventing acute cholecystitis is to reduce the formation of gallstones, eat a healthy diet, exercise actively, and control weight.

Acute cholecystitis is inflammation of the gallbladder due to blockage and bacterial invasion of the cystic ducts; It is typically characterized by paroxysmal cramping in the right upper quadrant with marked tenderness and abdominal rigidity. About 95% of patients have comorbid gallstones, called calculous cholecystitis; 5% of patients do not have gallstones, which is called acalculous cholecystitis. You can use Ba-Bao-Dan lozenge, and the effect is good.

Go to the hospital, acute illness is easy to treat, but don't delay, go to the hospital quickly.

1. The appearance of acute cholecystitis disease has a lot to do with many bad habits in our lives, such as in life, our long-term irregular diet, frequent love to eat greasy food, etc., are easy to induce the emergence of acute cholecystitis disease, and we must pay attention to it in life.

2. If you find yourself suffering from acute cholecystitis in your life, it is best for us to go to a professional hospital for a comprehensive examination in time.

3. For patients with acute cholecystitis, usually we can choose the best way of medicine or the best way of surgery for this disease, and patients can choose according to their actual condition, and we must actively cooperate with the doctor.

Precautions: For patients with acute cholecystitis, we also need to do a good job in the care of the disease in the process, patients and friends must pay attention to recuperation to ensure that they have enough sleep time, and at the same time, we must keep light in terms of diet.

Acute cholecystitis is a common abdominal emergency with fever and intense right upper quadrant pain. It is generally recommended that surgery is a better choice. Many patients are caught off guard because of sudden attacks, and they will keep asking me, can I not have surgery, and use drugs to control it first?

Let's talk about the conclusion first, acute cholecystitis, without surgery and only drugs**, is easy**, easy to become more serious, and it will be more difficult to deal with it when the time comes.

10% produce more serious complications; Mortality rate of 3% within one year

In 30% of cases, within a year, the attack will recur, severe enough to require emergency department or hospitalization.

The overall average risk of surgery is 5 per 1,000 mortality, and surgery is the preferred option for most patients.

The best time to undergo surgery is generally recommended within one week of the attack.

Choosing drugs** is riskier.

The following provides the best big data research results available today. According to a database analysis of 13 million people in Ontario, Canada:

Between 2004 and 2011, about 25,000 patients presented to the emergency department for the first episode of acute cholecystitis, with no major comorbidities. About 15,000 of them underwent surgery, while another 10,000 chose not to go under surgery and were given antibiotics first**.

Studies have shown that 10% of these patients who do not have surgery have more serious complications; Mortality rate of 3% within one year20% of patients, within three months, will have another attack, severe enough to require emergency call or hospitalization; In 30% of cases, within a year, the attack will recur, severe enough to require emergency department or hospitalization.

Therefore, acute cholecystitis is a disease that is prone to become more severe, and it is not well controlled with drugs alone. The consensus in the medical community is that surgery is the best option for most patients.

Open early vs open late?

Patients often ask, will it be safer to prescribe it later, control it with drugs first, and then prescribe it when the infection and inflammation have subsided?

The study presented below is the best integrated analysis available, collecting a total of 77 case-controlled studies over the past 30 years, with a total of about 40,000 patients, of which 26,000 patients underwent early surgery and another 14,000 patients underwent delayed surgery. Early surgery, defined as surgery within one week of the onset, and delayed surgery, defined as surgery four weeks after the onset.

The results of the study showed that, in general, early surgery was safer than delayed surgery, with fewer mortality rates and lower complications.

Early versus delayed surgery.

Mortality: vs, early surgery is significantly safer.

Overall complications: vs , early surgery is significantly safer.

Laparoscopic to open surgery: vs, early surgery is significantly safer.

There are two main reasons why mainstream research supports the safety of early surgery:

Open late, wait at least four to six weeks, and during the waiting period, easy**.

Although the inflammation subsides, the fibrous tissue begins to proliferate, just like the wound begins to scar, the scar tissue will be harder, more difficult to treat, and more likely to accidentally injure the common bile duct, which is the most dangerous complication of surgery.

When acute cholecystitis occurs, you should go to the hospital immediately, according to the severity of acute cholecystitis, the methods are also different, such as only bile colic, abdominal tenderness, paroxysmal right upper quadrant pain, rebound pain is not obvious, blood test white blood cells are not high, can be intravenously injected with some anti-inflammatory or painkiller drugs. If there is no obvious effect on the above**, or the patient gradually develops aggravation of pain and fever, the occurrence of cholecystitis, bacterial infection and purulent cholecystitis should be considered, and antibiotics should be used**.