Treatment
of Cholecystitis: Comprehensive Analysis and Coping Strategies I. Introduction Cholecystitis is a common digestive system disease. Gallbladder inflammation is caused by cystic duct obstruction, bacterial infection and other factors, which brings many discomforts to patients and seriously affects their quality of life. Understanding the treatment of cholecystitis is very important to alleviate the pain of patients and promote rehabilitation. This article will introduce the treatment of cholecystitis in detail, including treatment principles, non-surgical treatment and surgical treatment. 2. The treatment principle of cholecystitis is to formulate individualized treatment plan according to the priority of the disease and the patient’s physical condition. For patients with acute cholecystitis with mild symptoms for the first time, non-surgical treatment is usually tried to relieve symptoms, control inflammation and observe the development of the disease. If the effect of non-surgical treatment is not good or the condition continues to deteriorate, surgical treatment should be considered. For patients with chronic cholecystitis, the treatment goal is not only to alleviate symptoms, but also to improve gallbladder function and quality of life. Generally, non-surgical treatment measures are taken first, such as when the effect of conservative treatment is not ideal or there are complications such as gallstones, surgical intervention is often needed. 3. Non-surgical treatment 1. Dietary adjustment • Patients with cholecystitis should strictly control their diet during the attack. Fasting and water deprivation are generally recommended to give the gallbladder a full rest and reduce bile secretion, thereby reducing the burden on the gallbladder. • After the symptoms are relieved, the diet can be gradually resumed, but the principle of low fat and high fiber should be followed. Reduce the intake of high-fat foods such as fried food, animal viscera, butter and so on, because high-fat diet can stimulate gallbladder contraction, increase the burden of gallbladder, and easily induce the recurrence of cholecystitis. Increasing the intake of vegetables, fruits, whole grains and other foods rich in dietary fiber can help promote intestinal peristalsis and reduce cholestasis. 2. Medication • Spasmolytic and analgesic drugs: When cholecystitis attacks cause pain, spasmolytic drugs such as anisodamine and atropine can be used to relieve the spasm of gallbladder smooth muscle and relieve pain symptoms. However, these drugs may have some side effects, such as dry mouth, blurred vision, etc., when using, attention should be paid to observe the patient’s reaction. • Anti-infective drugs: Because cholecystitis is often accompanied by bacterial infections, anti-infective drugs are required for treatment. Commonly used antibiotics are cephalosporins (such as cefuroxime, ceftriaxone, etc.), quinolones (such as levofloxacin, moxifloxacin, etc.). Appropriate antibiotics should be selected according to the severity of the disease and the possible pathogens of infection, and used in accordance with the prescribed dosage and course of treatment to ensure effective control of infection. • Cholagogic drugs: such as ursodeoxycholic acid, anti-inflammatory cholagogic tablets, etc. These drugs can promote bile excretion, dilute bile, prevent cholestasis, help to alleviate gallbladder inflammation and improve gallbladder function. 3. Supportive treatment • Supportive treatment is needed for patients with severe cholecystitis, especially those with fever, vomiting and other symptoms. It includes water and electrolyte supplementation to correct water and electrolyte disorders caused by vomiting and other reasons. Normal saline, glucose solution and appropriate amount of potassium, sodium and other electrolytes can be infused through intravenous infusion to maintain the stability of the patient’s internal environment. 4. Surgical treatment 1. Indications for surgery • For patients with acute cholecystitis, if the symptoms are not significantly relieved after 48-72 hours of non-surgical treatment, or even the condition is aggravated, if the risk of serious complications such as gallbladder gangrene and perforation increases, surgical treatment should be carried out in time. • Patients with chronic cholecystitis, if repeated attacks, seriously affect the quality of life, or the presence of gallstones, gallbladder polyps and other complications, and gallbladder function has been significantly impaired, usually consider surgical treatment. 2. Cholecystectomy: This is the most commonly used surgical method for the treatment of cholecystitis. Traditional cholecystectomy is performed by open surgery to remove the gallbladder directly. With the development of medical technology, laparoscopic cholecystectomy (LC) has become the mainstream. Laparoscopic cholecystectomy has the advantages of small trauma, quick recovery and light postoperative pain. Generally, patients can get out of bed 1-2 days after operation and can be discharged in about 3-5 days. However, laparoscopic surgery also has some limitations, such as for some cases of severe gallbladder inflammation and severe adhesions, it may be necessary to convert to open surgery. • Cholecystostomy: In some special cases, such as when the patient’s physical condition is too poor to tolerate cholecystectomy, or when the local condition of the gallbladder is not suitable for immediate cholecystectomy during the onset of acute cholecystitis, cholecystostomy can be performed first. The operation is to make a fistula on the gallbladder to drain the bile from the gallbladder to relieve the pressure on the gallbladder and control the inflammation. When the patient’s physical condition improves, cholecystectomy will be considered. 5. Traditional Chinese medicine also plays a certain role in the treatment of cholecystitis. 1. Traditional Chinese medicine prescriptions: Traditional Chinese medicine often uses some traditional Chinese medicine prescriptions to treat cholecystitis patients according to their different symptoms, signs and dialectical results. For example, modified Dachaihu Decoction has the effect of harmonizing Shaoyang and purging heat, and has a certain effect on cholecystitis of liver depression and qi stagnation and gallbladder fire. 2. Acupuncture and moxibustion treatment: Acupuncture at gallbladder, Yanglingquan, Zusanli and other acupoints can regulate gallbladder function, relieve pain and promote bile excretion. Acupuncture and moxibustion treatment is generally used as an adjuvant treatment, combined with other treatment methods, can better improve the patient’s condition. 6. Precautions after cholecystitis treatment 1. Diet: After surgery, patients still need to maintain the principle of low fat and high fiber in diet, and gradually increase the amount of food and food types. Avoid overeating and eat less spicy, greasy and stimulating food to prevent complications such as post-cholecystectomy syndrome. 2. Rest and activity: Adequate rest should be ensured after operation, but proper activities should also be carried out to promote gastrointestinal peristalsis and prevent complications such as intestinal adhesion. It is generally recommended to get out of bed early after surgery and gradually increase the amount of activity according to the doctor’s instructions. 3. Regular review: Patients with non-surgical treatment or surgical treatment need regular review. Through abdominal ultrasound, liver function and other examinations, we can understand the recovery of gallbladder or cholecystectomy, and whether there are other potential problems, so that we can find and deal with them in time. 7. Conclusion The treatment of cholecystitis requires comprehensive consideration of the patient’s condition, physical condition and other factors, and the formulation of individualized treatment programs. Non-surgical treatment plays an important role in the mild or early stage of the disease, while surgical treatment is the key means to solve the problem of cholecystitis in specific cases. Traditional Chinese medicine treatment can also play a certain role as an auxiliary means. At the same time, the precautions after treatment are also very important for the rehabilitation of patients and the prevention of recurrence. Only by fully understanding the treatment of cholecystitis and related precautions, can we better help patients cope with the disease and restore healthy life.
