Acute cholecystitis refers to acute inflammation of gallbladder caused by chemical stimulation such as bile or pancreatic juice after cystic duct obstruction and bacterial and parasitic infection. It is common in middle-aged people and obese people, and the incidence rate of women is 2 ~ 3 times higher than that of men. Chronic cholecystitis is caused by long-term chronic inflammation and repeated acute attacks, which leads to gallbladder fibrosis, atrophy, hypertrophy, cystic cavity shrinkage and functional loss. 70% of them are caused by gallstones, and a few cases are caused by chronic acalculous cholecystitis, such as gallbladder dyskinesia, infection and pancreatic juice reflux. It can be delayed by repeated attacks of acute cholecystitis, or it can be chronic. The elderly are called asymptomatic cholecystitis. Most cholecystitis occurs because there are stones in the gallbladder, which block the cystic duct, make bile discharge not smooth, and then bacterial infection occurs, forming cholecystitis. In some patients, there are no stones in the gallbladder, and bacteria enter the gallbladder from the intestine or from the blood circulation, forming cholecystitis. Cholecystitis patients are prone to gallstones because of the changes of bile composition and bile concentration, with bacteria and inflammatory and necrotic substances as the core, so cholecystitis and gallstones often coexist.

Why is gallbladder easy to be inflamed?

(1) The gallbladder is an enlarged part at the end of the cystic duct, which can hold 30 ~ 60 ml of bile. Bile enters and exits the gallbladder through the cystic duct. The cystic duct is about 3 ~ 4 cm in length and 2 ~ 3 mm in diameter. There are 5 ~ 7 spiral folds in the mucosa of the cystic duct, which narrows the lumen and makes it easy for gallstones and parasites to embed in the cystic duct. After embedding, the bile in the gallbladder can't be discharged, which makes the excess bile accumulate in the gallbladder, staying for a long time and being too concentrated, which directly stimulates the gallbladder mucosa and causes inflammation.

(2) The blood vessel supplying gallbladder nutrition is the terminal artery. When the gallbladder outlet is blocked, the gallbladder mucosa continues to secrete mucus, which makes the gallbladder dilate and accumulate water, so the blood vessels on the gallbladder wall are compressed and ischemic and necrotic. When the gallbladder is ischemic, the resistance of the gallbladder decreases, and bacteria are easy to grow and reproduce, taking the opportunity to move and cause cholecystitis.

(3) Because gallbladder has the function of storing and concentrating bile, the contact time between gallbladder and bile is longer than other bile ducts, and the contact bile concentration is also higher. At this time, if there are bacteria in people's bile duct, infection will occur, and the chance of forming cholecystitis will of course increase.

What effect does surgery have on cholecystitis?

Surgical treatment of cholecystitis is one of the most common operations in abdominal surgery. Millions of patients in the world have to undergo this kind of surgery every year, but the surgical treatment is not an ideal treatment method. Some patients will have complications after surgery, and the mortality rate is still 0.5% ~ 3%. Especially those who were forced to undergo surgery because of the sudden deterioration of their condition, the mortality rate was higher. Generally speaking, the curative effect of surgery depends on the patient's age and the timing of surgery. The older you get, the later the operation time and the worse the effect. With the development of modern medicine and the improvement of surgical methods, the safety and cure rate of surgery have been greatly improved, and satisfactory results can generally be obtained after surgery. Clinically, for those who have the following conditions, surgical treatment should be selected in time.

(1) Patients with severe clinical symptoms, ineffective drug treatment, worsening condition and refractory non-surgical treatment.

(2) Gallbladder enlargement or gradual enlargement, obvious abdominal tenderness, severe abdominal muscle tension or gangrenous perforation of gallbladder, complicated with diffuse peritonitis.

(3) Patients with recurrent acute cholecystitis, definite diagnosis, aggravated abdominal signs and obvious peritoneal irritation after treatment.

(4) Laboratory examination showed that the number of white blood cells in blood increased significantly, with the total number above 20×109/L. ..

(5) Jaundice deepened, belonging to common bile duct stone obstruction.

(6) those who suffer from chills, chills, high fever and are prone to poisoning shock.

There are generally two surgical methods for acute cholecystitis: one is cholecystectomy; The second is cholecystostomy, which is mostly used for advanced patients. It is estimated that patients who can't tolerate cholecystectomy or have serious complications can drain pus or take stones. Generally, after 6-8 weeks, cholecystectomy can be performed after the condition is stable. If the whole body is extremely weak, cholecystostomy can also be placed for long-term drainage. When there is no stone in cholangiography, the fistula can be removed. If the diagnosis is uncertain, or patients complicated with serious diseases such as heart and lung, cholecystectomy can be performed after the diagnosis is confirmed or the general condition is improved. Clinical practice showed that 15% of the patients who received surgical treatment within 48 hours after onset had gallbladder gangrene or even perforation. If the onset is more than 72 hours, the operative mortality will increase, so once there are indications for surgery, surgical treatment should be carried out as soon as possible.

What are the family standing drugs for cholecystitis patients?

Patients with cholecystitis and gallstones often have sudden onset, especially poor resistance, or depressed mood, or overeating or satiating, and often have mild cholecystitis symptoms, such as chest tightness, indigestion, nausea, loss of appetite and so on. What should I do if I go to the hospital once? You can prepare some commonly used drugs at home, and you can take them yourself as soon as you have symptoms. For example:

Oral anti-inflammatory drugs:

① Norfloxacin: take 1 ~ 2 capsules on an empty stomach three times a day (i.e. 0. 1 ~ 0.2g).

② Erythromycin: 0.3g, 4 times a day, after meals.

③ Chloramphenicol: 0.5g, 4 times a day, after meals.

④ Clindamycin: 1 ~ 2 capsules (0.25~0.5g), four times a day.

⑤ Metronidazole (metronidazole tablets) is taken three times a day, one tablet each time (i.e. 0.2g), after meals. Pregnant women are prohibited.

⑥ Xianfeng IV Capsule: 0.25~0.5g each time, four times a day.

Cholecholagogic drugs: Tong Dan, tannin, Danyining, Danle, sodium cholate, cholic acid, etc. , should also be reserved.

At the time of onset, you can choose one of the above drugs to take. Please read the instructions before taking it to avoid taking it by mistake. If the symptoms get worse, you should go to the hospital.

Diagnosis:

Early cholecystitis: it can be seen that the right hypochondrium is often painful, accompanied by thick and thick tongue coating, red and dry, multi-string and slippery pulse, dry stool and small and red stool. This is the stagnation of gallbladder heat, qi stagnation and blood stasis, so it is advisable to clear away gallbladder heat, regulate qi and relieve pain. Prescription: Bupleurum 60g, Scutellaria baicalensis Georgi 10g, Inula 10g, Curcuma longa 6g, Almond 10g, Perillae Stalk 10g, Crataegus pinnatifida, Massa Medicata Fermentata, Malt 10g, Areca catechu 10g. During the treatment, we must pay attention to diet adjustment, reduce food intake, give priority to vegetables, avoid greasy products, and take a walk every morning to help digestion.

Acute attack: mostly transferred from chronic cholecystitis, the clinical manifestations are acute pain in the right abdomen, refusal to press, fever, aversion to cold, vomiting, nausea, thick tongue coating, irritability, red and slippery pulse, constipation for several days, and fever in urine. The treatment method is to clear away gallbladder heat and attack gallbladder, and add and subtract Dachaihu decoction: Bupleurum 6g, rhubarb 3g, and immature bitter orange 6 g.

Chronic cholecystitis patients who have not been cured for a long time still need to relieve gallbladder heat and enhance digestive function. The method of regulating liver and gallbladder along clearing heat is as follows: 6g of bamboo shavings, 6g of dried tangerine peel, 6g of Pinellia ternata, 6g of cicada slough, 6 g of almond 10g, 6 g of radish seed, 0/0g of burnt hawthorn 10g of chicken gizzard-membrane.

Those who are weak, lack of qi and blood, and have poor digestive function should use the methods of invigorating qi, tonifying middle energizer and strengthening transport to relieve pain, and ask them to insist on physical exercise to cooperate with the treatment. Prescription: 6g of Radix Aucklandiae, 2g of Fructus Amomi, 0g of Atractylodis Macrocephalae10g, 0g of Poria10g, 6g of Radix Pseudostellariae, 6g of dried tangerine peel, 6g of bamboo shavings, 0g of Radix Astragali10g, 6g of burnt malt10g, and 6g of Fructus Aurantii.

Cholecystitis often occurs, with rapid pulse, red tongue and dry mouth, and symptoms of yin injury and yang hyperactivity. It is appropriate to use the method of nourishing blood, softening liver and dispersing soil: angelica sinensis 10g, Paeonia lactiflora 10g, papaya 10g, raw oyster 20g, rhizoma Cyperi 10g, turmeric 6g and Eclipta prostrata 65438+.

If the yin hurts while the yang is hot, the pulse is slightly slippery, and the patient is upset, thirsty and impatient. MUBI sleeps at night, and his body is emaciated, and even has a low fever in the afternoon. Jin Lingzi 10g, Rhizoma corydalis 6g, Rhizoma Cyperi 10g, Inula 10g, Bupleurum 6g, Prunella vulgaris 10g.

What are the acupuncture treatments for cholecystitis and cholelithiasis?

Acupuncture has the functions of spasmolysis, analgesia, choledocholithiasis, depression, vomiting and so on, and can be used alone or in combination with other therapies.

(1) body acupuncture therapy

① Acupuncture

A. Acupoints: Danshu, Zhongwan, Zusanli, Zhidan and Yanglingquan. Colic plus Hegu; High fever plus meandering pool; Vomiting plus internal clearance.

B acupuncture method: select the above 2-4 acupoints, deeply prick and repeatedly acupuncture, continuously twist the needle for 3-5 minutes, and hold the needle for 30 minutes, twice a day.

② electroacupuncture

A. Acupoints: You Danshu (cathode), Zhidan, Riyue and Taichong (anode).

B. Methods: Insert the needle and connect it with the electro-acupuncture instrument. Using adjustable wave, the intensity gradually increases from weak to tolerable, 30 minutes each time, 2 ~ 3 times a day.

③ Water needle

A. Acupoints: Danshu, Zusanli, Zhongwan and Zhidan.

B. Methods: Select 1 ~ 2 acupoints and inject 2ml of Angelica sinensis solution or safflower solution into each acupoint; Or 5ml 10% glucose solution, and inject it quickly after acupuncture, 1 ~ 2 times, once a day 1 time.

Yantai Wendeng Central Hospital used body acupuncture to treat 2 19 cases of cholelithiasis, and discharged 185 cases, accounting for 84.5%. This group 185 patients * * discharged stones1cm×1block, of which the largest was 4.5cm×3.5cm and the largest transverse diameter was 3.5cm. Some patients also discharged stones with ascaris lumbricoides residue and kitchen broom seedlings as the core. Take the right side of the point, the sun, the moon and the gate. For patients with severe epigastric pain and gallbladder distension, Queque is used to treat gallbladder points through abdominal mourning. After the needle is inserted, it is electrified with an electroacupuncture instrument for 60 minutes, once a day 1 time, and twice a day for those with severe pain. At the same time, 40ml of 33% magnesium sulfate was taken orally.

(2) Ear acupuncture therapy

① Acupoints: liver, gallbladder, spleen, stomach, duodenum, Shenmen and sympathetic nerve.

② Acupuncture: Select 2-3 acupoints with obvious reaction above, re-stimulate, and keep the needle for 30 minutes, twice a day.

In recent years, people in many parts of the country have used vaccaria seed, white mustard seed or rapeseed to apply pressure to select points, and combined with high-fat diet such as pig's trotters to treat gallstones, which has a good effect of removing stones.

How to treat cholecystitis and cholelithiasis with massage therapy?

(1) Acupoint massage: Look for pain points in the back, mostly near the ninth thoracic vertebra, and at the gallbladder meridian points on both sides. Stimulate the back tenderness point for 3 ~ 5 minutes by point or press, and then stimulate the gallbladder meridian point for 3 ~ 5 minutes. Every day 1 time, 7 days is 1 time course.

(2) Push or rub the right gallbladder point, Yanglingquan, right liver, Danshu and bilateral Taichong points with one finger Zen to soothe the liver and benefit the gallbladder.

(3) Apply the palm friction method to the ribs on both sides.

(4) Acupoint therapy for biliary colic:

Diseases include cholecystitis and gallstones. Acupoint selection: Dan Shu (double). Shiatsu, subject to the patient's tolerance, lasts for 10 ~ 15 minutes each time, and the pain is aggravated as appropriate. Then massage this acupoint up and down with the soles of your feet for 30 times. In this group 100 cases, 65 cases were markedly effective (the pain was completely relieved), 30 cases were effective and 5 cases were ineffective, and the effective rate was 95%. In addition, acupuncture points (10 min) and blank control group (50 cases each) were set up, and the maximum cross section of gallbladder and common bile duct was detected by Aloka- 190 ultrasonic instrument. Results: There were 45 cases of gallbladder and 42 cases of common bile duct contraction and 2 cases of dilatation in the two groups. There was significant difference between the two groups (P < = 0.0 1.00 1).

(5) Special massage for hepatolithiasis:

Chest-expanding shaking method (the doctor moves his shoulders with his hands and knees to Danshu point, shaking it hard for 2 ~ 3 times), point-penetrating method (the doctor taps the back of one palm 1 ~ 3 times on Baihui point with his empty fist) and four-finger tapping method (according to the position of the stone, lie on your back, lie on your side, lie on your side first and then lie on your side, and tap the liver area from top to bottom for 3 ~ 5 times). Acupoint method: Acupoint back Danshu, Ganshu, Ashi and Zhiyang; Then click the conventional gate, Sun Moon, Dovetail, Middle-old, Yangxi, Zusanli, Gongsun, Taichong and Xu Qiu, and take 3-4 acupoints at a time 15-30 seconds for each acupoint according to the meridian flow injection method, so as to get the appropriate degree. Every time 15 minutes, every day 1 time, 1 time is1course of treatment. In this group of 36 cases, after 3 courses of treatment, 9 cases were cured, 2 1 case was effective and 6 cases were ineffective.

(6) Observation on the analgesic effect of massaging back acupoints on cholecystitis;

There were 45 cases in this group, including 3 cases of intrahepatic bile duct stones, 3 cases of gallbladder stones and common bile duct stones 1 case. Treatment: Massage Xinshu, Du Meridian and Shu Ge points is the main method. The patient takes a prone position, and the operator massages the acupoints with the thumb pulp or thenar, or with the palm root, once 10 ~ 20 minutes, twice a day, and the course of treatment is the fifth day 1. Some patients combine cupping in the tenderness area of the back. Results: 40 cases were effective and 5 cases were ineffective (all accompanied by intrahepatic bile duct stones, although the pain was relieved after massage, the duration was short).

(7) Four methods of cholelithiasis massage:

The first method: Stimulate the acupoints on the back of the seventh to ninth thoracic vertebrae and on both sides of the gallbladder for 2-3 minutes.

The second method: rotate the spinous process of the spine on the plane of the tenderness point of the left back for reduction.

The third method: massage along the bladder meridian on both sides of the back for about 6 minutes, then press Danshu, Ganshu and Shu Ge for 65 and 438+0 minutes, and finally press the bladder meridian on the back, with heat penetration as the degree.

The fourth method: Knead both ribs, with slight heat penetration as the degree, and then knead both ribs 1 min, with acid swelling as the degree.

References:

Excerpt from physiological health network

cardinal symptom

1, acute cholecystitis

Acute onset, persistent pain in the upper middle abdomen or right upper abdomen, paroxysmal aggravation, pain can radiate to the right shoulder, mostly at night, with full meals and high-fat meals as the inducement. If accompanied by stones and cystic duct obstruction, intermittent biliary colic may occur. Nausea and vomiting may occur, and in severe cases bile may be vomited, leading to dehydration. When suppurative cholecystitis occurs, high fever, irritability and delirium may occur. There is obvious tenderness in the right upper abdomen, and the abdomen can touch the swollen and tender gallbladder. Can develop into chronic cholecystitis, gallbladder empyema and toxemia; If the gallbladder wall appears necrotic perforation, diffuse peritonitis can be formed.

2. Chronic cholecystitis

Symptoms and signs are atypical, mostly bile dyspepsia, aversion to greasy, flatulence in the upper abdomen, belching, heartburn and so on. , similar to ulcer or chronic appendicitis; Sometimes it can be an acute attack because stones block the cystic duct, but when stones move and the obstruction is relieved, they can get better quickly.

Nutritional diet conditioning in different stages of disease

1, acute phase

Fasting should be done during acute attack, so that the gallbladder can be fully rested and the pain can be relieved. At this time, you can supplement nutrition through veins, drink plenty of water, and add sodium and potassium salts to drinks to facilitate the treatment of diseases. After the pain is relieved, you can gradually adjust your diet according to your condition. It is advisable to eat a light liquid diet or a liquid diet with low fat, low cholesterol and high carbon hydrate, such as rice soup, lotus root starch, soybean milk and other foods. After getting better, you can eat a low-fat semi-liquid diet or soft rice with low fat and little residue, such as tofu brain and soft noodles.

2. Chronic phase

Patients with chronic cholecystitis should avoid eating high-fat foods. A high-fat diet will make the gallbladder contract, cause pain and aggravate the condition. Therefore, patients with chronic cholecystitis should not eat fat, lard, fried food and oil cakes.

Patients with chronic cholecystitis should avoid eating foods with high cholesterol. Foods rich in cholesterol, such as heart, liver, brain, intestine, egg yolk, preserved eggs, roe and chocolate, are not suitable for eating.

Patients with chronic cholecystitis should avoid spicy food. Spicy condiments, such as pepper, spicy oil, spiced powder, curry powder, Chili noodles, cigarettes, wine, coffee, camellia oleifera, etc. It is also a taboo for patients with chronic cholecystitis. Because these foods have the function of stimulating gastric acid secretion, excessive gastric acid secretion can cause gallbladder contraction, sphincter spasm of biliary tract mouth, make bile discharge difficult and induce biliary colic.

Nutritional diet

Dandelion porridge

[Formula] Dandelion 40-60g (fresh consumption 60-90g) and japonica rice 50-100g.

[Production] Dandelion was washed, chopped and decocted to get juice. Add the medicinal juice to the washed japonica rice and cook it into porridge, preferably thin.

[Usage] 2 ~ 3 times a day, with 3 ~ 5 days as 1 course of treatment. Warm clothes.

【 Efficacy 】 Clearing away heat and toxic materials, invigorating the middle energizer and benefiting qi, and promoting diuresis and dampness.

Stewed mussel with corn stigma

[Formula] 50 grams of corn stigma, 200 grams of mussel meat, salt and monosodium glutamate.

[Production] Wash and drain the corn beard, wash the mussel meat, put it into a casserole, add appropriate amount of water and salt, stew until the mussel meat is cooked, and add a small amount of monosodium glutamate.

[Usage] Take it every other day 1 time, eat meat and drink soup. Can be taken with meals or alone.

【 Efficacy 】 Clearing away heat and toxic materials, nourishing liver and kidney, benefiting gallbladder and clearing heat.

maize gruel

【 Formula 】 Fresh corn stigma 30g (dry 15g).

[Making] Wash and cut off Wang Mi's beard, brew it with freshly boiled water, cover it and stew it for 10 minute, then filter to get juice, then brew it with boiling water 1 time, and combine the two juices. 30 grams of japonica rice, add appropriate amount of water, and cook until the rice grains bloom. Add the corn stigma juice to the porridge and cook for a while.

[Usage] Take it while it is hot, twice a day.

【 Efficacy 】 Regulating qi and relieving pain is suitable for qi-stagnation cholecystitis with dull pain and belching under the right hypochondrium.

Gardenia porridge

[Formula] 5 grams of gardenia kernel, 0/00 grams of japonica rice/kloc.

[Production] Gardenia seed is ground into fine powder, and japonica rice is cooked into porridge. When the porridge is cooked, you can cook it at the end of gardenia kernel.

[Usage] Take 1 dose daily, and finish it twice.

【 Efficacy 】 It is suitable for chronic cholecystitis of damp-heat type.

Huangzidi Dingzhou

[Formula] Viola yedoensis (dandelion) 30g, Viola yedoensis 30g (fresh product 60g), japonica rice 100g.

[Production] The viola yedoensis and the viola yedoensis were boiled in water, filtered to remove residues to get juice, and the rice was boiled into porridge with the juice, and white sugar was added for seasoning.

[Usage] 1 ~ twice a day, 1 week is a course of treatment.

【 Efficacy 】 It is suitable for damp-heat cholecystitis.

Carp, red bean and tangerine peel soup

[Formula] Carp 1, adzuki bean 120g, dried tangerine peel 6g, salt and monosodium glutamate.

[Production] Scrape carp to remove internal organs and wash them. Wash red beans and drain. Wash dried tangerine peel with clear water to remove dust and drain. Put the three into a pot, add appropriate amount of water and salt, cook until the fish is cooked and the beans are rotten, and add appropriate amount of monosodium glutamate.

[Usage] 65438+ 0 ~ 2 times a day, which can be taken with meals or alone.

【 Efficacy 】 Strengthen the spleen and stomach, regulate qi and detoxify.