Text С. Acute Cholecystitis

Among inflammatory diseases of bile ducts the most frequent is cholecysti­tis or the inflammation of the gallbladder. Cholecystitis is known to occur rarely in isolated condition, inflammatory processes both in the intrahepatic and extra-hepatic ducts, sometimes with the involvement of the liver being associated with it. The main forms of cholecystitis are the following: catarrhal, purulent and gangrenous.

The patient with cholecystitis is known to complain of intense pain, it being localized in the right hypochondrium and in the umbilical area. An attack of pain is usually preceded by physical and mental overstrain, sharp physical move­ments or abnormalities in diet, fatty food and alcohol being responsible for the onset of pain. But sometimes pain is observed to appear suddenly in quite healthy persons. Pain may radiate to the right shoulder, right arm, sternum, and lumbar area, its intensity depending on the form of cholecystitis and the patient's sensi­tivity. The pain grows much worse when the patient is lying on his right side.

Dryness in the mouth, vomiting, nausea, and constipation are the character­istic clinical manifestations of the dise'ase.

During the attack of pain the face is moist with cold perspiration, the skin is pale, the tongue and lips are dry. Even a slight palpation reveals severe tender­ness, it being due to irritation of the peritoneum. Approximately in 40-50% of cases there is slight jaundice of sclerae.jThe biochemical blood analysis is known to reveal some changes, they resulting from the effect of toxic substances in the liver.

Purulent form of cholecystitis is highly dangerous to life and requires an emergency operation. An even more severe course is observed in gangrenous cholecystitis. Recovery is achieved by surgical treatment, it being followed by prolonged antibiotic therapy and chemotherapy.