Treatment of cholecystitis sports. Physical exercises in the treatment of cholecystitis. Symptoms of gallstone disease

Cholecystitis- This is an inflammation of the gallbladder. Like most inflammatory diseases, it can be acute or chronic.

It is also classified into non-calculous and calculous (that is, accompanied by the formation of stones).

Term "cholecystitis" translated from Greek means inflammation of the gallbladder.

The main purpose of the gallbladder is to deposit bile. The gallbladder is most often pear-shaped, located on the lower surface of the right lobe of the liver, projected onto the anterior abdominal wall under the right hypochondrium.

Inflammation of the gallbladder develops as a result of infection from the intestines, its transfer through the blood and stagnation of bile in the bladder. With this disease, less bile is secreted into the intestines than in a healthy person, which makes it difficult to digest and absorb fats.

Causes

Stagnation of bile due to cholelithiasis or kinks of the bile ducts.

Bacterial infections.

Pregnancy.

Physical inactivity, that is, a sedentary lifestyle.

Overeating, especially abuse of fatty, spicy and fried foods.

Excessive consumption of alcoholic beverages.

The most common cause of cholecystitis is the presence of gallstones, which block the flow of bile from the gallbladder. This leads to acute cholecystitis, which causes the gallbladder to become irritated and inflamed. Other causes of cholecystitis include previous infection or trauma, for example after a car accident. Acute cholecystitis also occurs in people with severe illnesses such as diabetes. In this case, stones are not the cause of cholecystitis; rather, it is a complication of other diseases. Inflammation of the gallbladder largely depends on nutrition, on the lack of foods containing plant fibers in the diet - vegetables, fruits, wholemeal bread, when the diet contains an excess of animal fats, various sweets, a sedentary lifestyle, and lack of physical activity as well. promotes stagnation of bile and the development of the inflammatory process in them.

Exacerbation of cholecystitis occurs when bile stagnates in the bile ducts. Therefore, you need to increase physical activity, move more, but avoid sudden movements so as not to provoke an attack of hepatic colic.

The direct impetus for an outbreak of the inflammatory process in the gallbladder is often overeating, especially the consumption of very fatty and spicy foods, drinking alcoholic beverages, an acute inflammatory process in another organ (tonsillitis, pneumonia, adnexitis, etc.).

Chronic cholecystitis can occur after acute cholecystitis, but more often it develops independently and gradually, against the background of cholelithiasis, gastritis with secretory insufficiency, chronic pancreatitis and other diseases of the digestive system, obesity.

Chronic cholecystitis occurs when inflammation of the gallbladder occurs over a long period of time, causing the walls of the gallbladder to thicken.

This disease is common and is more common in women.

Pathogenic bacterial flora (Escherichia coli, streptococci, staphylococci, etc.), in more rare cases - anaerobic infection, worms and fungi, hepatitis viruses can cause cholecystitis.

The main factor in the occurrence of the disease is stagnation of bile in the gallbladder, which can be caused by gallstones, compression and kinks of the bile ducts, dyskinesia of the gallbladder and biliary tract, disruption of their tone and motor function under the influence of various emotional stress, endocrine and nervous disorders.

Stagnation of bile in the gallbladder is also facilitated by prolapse of internal organs, pregnancy, sedentary lifestyle, rare meals, etc.

The direct impetus for an outbreak of the inflammatory process in the gallbladder is often overeating, eating very fatty and spicy foods, drinking alcoholic beverages, an acute inflammatory process in the body (sore throat, pneumonia, adnexitis, and so on).

Chronic cholecystitis can occur after acute cholecystitis, but more often it develops independently and gradually against the background of cholelithiasis, gastritis, chronic pancreatitis and other diseases of the digestive tract, as well as obesity.

Symptoms

Noncalculous cholecystitis, that is, cholecystitis without stones, is characterized by a dull pain in the right hypochondrium, which usually occurs some time after eating. As well as bloating, belching of air, unpleasant taste in the mouth, abnormal bowel movements and nausea.

In addition to all the above symptoms, calculous cholecystitis is characterized by colic, that is, attacks of acute pain.

Most often, the first signs of cholecystitis are pain in the right hypochondrium (upper right part of the abdomen), which can sometimes radiate to the back or right shoulder blade. The person may also feel nausea and vomiting and tenderness in the right side of the abdomen. There is also an increase in temperature, pain that intensifies with a deep breath, or lasts more than 6 hours, especially after eating.

Inflammation of the gallbladder is registered in almost 10% of the world's population, and women are 3-4 times more likely to suffer from cholecystitis. The possibility of developing cholecystitis is influenced by age and body weight: the older a person is and the more he weighs, the higher the risk of the occurrence and development of chronic cholecystitis.

Cholecystitis is characterized by a dull, aching pain in the right hypochondrium that is constant or occurs 1-3 hours after eating a large and especially fatty and fried meal. The pain can radiate to the area of ​​the right shoulder and neck, right shoulder blade. However, sharp pain reminiscent of biliary colic may also occur periodically.

A feeling of bitterness and a metallic taste appears in the mouth, belching of air occurs, nausea, which is accompanied by flatulence and impaired bowel movements (often alternating constipation and diarrhea). The person becomes irritable and suffers from insomnia.

Jaundice is not typical for cholecystitis.

Diagnostics

The disease is diagnosed using ultrasound or computed tomography. To diagnose acalculous cholecystitis, duodenal intubation and bacteriological examination of bile can be used (this is what often helps to identify the causative agent of cholecystitis).

Upon examination, the doctor notes that the patient has an enlarged liver. In most cases, the gallbladder cannot be palpated, since it is usually wrinkled due to a chronic scar-sclerosing process.

Bacteriological examination of bile allows you to determine the causative agent of cholecystitis.

During cholecystography, a change in the shape of the gallbladder is noted, sometimes stones are found in it: the inflammatory process is the impetus for their formation.

Signs of chronic cholecystitis are also determined by echography - in the form of thickening of the walls of the bladder, its deformation.

Course of the disease

In most cases, it is long-term and is characterized by alternating periods of remission and exacerbations. Exacerbations often occur as a result of violations in the diet, after drinking alcoholic beverages, or heavy physical work. The process can be triggered by an acute intestinal infection or general hypothermia of the body.

Treatment

Treatment for cholecystitis depends on the symptoms of the disease and the person's general health. In some cases, people who develop gallstones may not need treatment. With a mild form of cholecystitis, sometimes it is enough to have a gentle regime of the digestive system, a course of antibiotics and painkillers.

In other cases, especially with chronic cholecystitis, the gallbladder is removed surgically. Removing the gallbladder usually does not impair digestion.

In case of exacerbation of chronic cholecystitis, patients are hospitalized in a surgical or therapeutic hospital.

In this case, bed rest, dietary nutrition (diet No. 5a), antibiotics and sulfonamide drugs are prescribed.

To eliminate biliary dyskinesia, pain, and improve the outflow of bile, antispasmodic and choleretic agents are prescribed.

During the period of subsidence of the inflammatory process, thermal physiotherapeutic procedures are performed on the area of ​​the right hypochondrium.

Among medicinal herbs, decoctions of immortelle flowers (0.5 cups 2-3 times a day before meals), corn silk (1-3 tablespoons 3 times a day) or a liquid extract of these herbs are effectively used to restore the functioning of the gallbladder. (30-40 drops 3 times a day).

After returning home from the hospital, it is useful for the patient to drink choleretic tea (sold at the pharmacy): 1 tbsp. Brew a spoonful of tea with 2 cups of boiling water, take the strained infusion 0.5 cup 3 times a day 30 minutes before meals.

Treatment with mineral water (“Essentuki” No. 4 and No. 17, “Slavyanovskaya”, “Smirnovskaya”, “Mirgorodskaya”, “Naftusya”, etc.), as well as magnesium sulfate (1 tablespoon of 25% solution 2) is useful. times a day) or Carlsbad salt (1 teaspoon per glass of warm water 3 times a day).

If conservative treatment is not successful, which often happens when there are large stones in the gallbladder, as well as with frequent exacerbations of cholecystitis, surgical intervention is performed - usually cholecystectomy (surgery to remove the gallbladder).

Calculous cholecystitis

Cholecystitis is an inflammation of the gallbladder. If there are also stones in the bladder, then they speak of calculous, stone cholecystitis.

Causes

Inflammation is most often caused by bacterial infection and bile stagnation.

Infectious agents can enter the gallbladder in three ways: from the duodenum, through the blood and through the lymph.

Also, cholecystitis can occur with acute pancreatitis, when pancreatic enzymes enter the lumen of the gallbladder.

Hereditary predisposition, poor nutrition, allergies, metabolic disorders in the body and disruptions in the blood supply to the gallbladder are important.

Symptoms

With calculous cholecystitis, the patient experiences a feeling of heaviness in the right hypochondrium, as well as paroxysmal or constant dull pain. There is often a bitterness in the mouth and nausea.

Treatment

The necessary drug therapy is prescribed by the attending physician. The patient must strictly follow the instructions to avoid exacerbations of the disease.

Treatment also includes constant dieting.

For calculous cholecystitis, fruit, milk, and cereal soups, boiled meat, low-fat fish, milk, fresh curdled milk, kefir, acidophilus milk, cottage cheese (up to 200 g per day), porridge, white and black stale bread, ripe fruits, berries (except sour varieties), vegetables, herbs.

For sweets, you can consume jam, honey, sugar (up to 70 g per day), for drinks - vegetable, fruit juices, weak tea with milk.

But foods rich in fats must be limited: cream, butter - up to 10 g per day, vegetable oil - up to 20-30 g per day. You can eat one egg daily.

The exception here is chronic lesions of the gallbladder, which occur with stagnation of bile.

Table salt should be consumed no more than 10 g per day.

Meals should be five times a day.

It is necessary to completely exclude from the diet lard, fatty meats, fish, fried, spicy, smoked foods, canned food, spices, legumes, mushrooms, spinach, sorrel, onions, baked goods, vinegar, ice cream, cocoa, carbonated, alcoholic drinks, chocolate, creams.

Self-help available

Among the folk remedies for cholecystitis, we can recommend the use of decoctions and infusions that have antimicrobial and astringent effects. They can be prepared from snakeweed, St. John's wort, nettle, tansy, chamomile, chicory, and rose hips. Spasms from the smooth muscles of the biliary tract are relieved (and thereby reduce pain) by immortelle, corn silk, and mint.

Of the medicinal preparations made from plants, allohol and holagol are indicated.

Large gallstones cannot be eliminated using herbal medicine.

Also, in case of chronic cholecystitis, it is advisable to carry out tubeless tubing 2-3 times a week for a month. It is best to perform this procedure in the morning.

To do this, you need to drink a glass of decoction of choleretic herbs on an empty stomach or, at worst, warm water. After half an hour, take allohol or holagol and wash it down with warm sweet tea (a glass or half a glass) or again with a herbal decoction. Then lie on your left side, and on your right side - on the liver area - put a warm heating pad. Cover yourself with a blanket and lie there for 1.5-2 hours.

After this, take a few deep breaths and squats and then you can have breakfast.

For cholecystitis, you can treat with mineral waters for 3-4 weeks several times a year.

If the acidity of the gastric juice is high, drink water 1.5 hours before meals, if the acidity is normal - half an hour before. The norm is 0.5-0.75 glasses 2-3 times a day.

Physiotherapeutic procedures are indicated for chronic cholecystitis during remission. The most effective are diathermy and inductothermy (heating the organ with high-frequency currents), UHF (magnetic field treatment), ultrasound, mud, ozokerite or paraffin applications to the gallbladder area, radon and hydrogen sulfide baths.

To prevent exacerbations, it is necessary to follow a diet, a gentle work schedule, promptly sanitize foci of infection, and also carry out preventive treatment 2-3 times a year.

Prevention of cholecystitis consists of proper nutrition and regimen, combating a sedentary lifestyle, obesity, and diseases of the abdominal organs.

Acute cholecystitis: features of clinical manifestations

The disease begins rapidly. The leading symptom is biliary colic. The pain syndrome is caused by stretching of the gallbladder, a significant increase in pressure in it, disruption of the flow of bile through the cystic duct, inflammatory swelling of the gallbladder and adjacent peritoneum.

Pain occurs in the right hypochondrium, radiating to the right shoulder, right shoulder blade, right half of the chest, sometimes to the left half of the chest, lumbar or iliac region.

Over the course of several hours, the pain intensifies, but rarely reaches pronounced intensity. Often the patient takes a forced position on the right side or on the back.

Patients' body temperature rises and chills appear. High fever and chills are more typical for purulent or phlegmonous cholecystitis. The patient is often bothered by thirst, nausea, vomiting, constipation, and flatulence. The tongue is dry and coated. The stomach is swollen and the abdominal muscles are tense. Percussion and light tapping in the liver area cause severe pain.

It is not always possible to palpate an enlarged, tense, sharply painful gallbladder. In elderly people, there is often a discrepancy between the clinical manifestations of acute cholecystitis and the severity of inflammatory changes in the gallbladder. Moreover, the development of gangrenous changes in the wall of the gallbladder can be clinically manifested by the so-called period of imaginary well-being - a decrease in pain due to necrosis of the receptors of the sensitive apparatus.

The catarrhal form of acute cholecystitis with timely antibiotic therapy ends in recovery.

With the phlegmonous form of acute cholecystitis, the process is more difficult. Characterized by fever with severe chills. Symptoms of intoxication quickly increase: dry mouth, thirst, nausea. Pain in the abdominal cavity reaches great intensity. The abdomen becomes bloated and symptoms of peritoneal irritation appear.

With a favorable course, the febrile state, having reached its greatest severity by the 2-4th day of the disease, persists for several days, then recovery may occur. In some cases, the disease becomes chronic.

Dangerous complications of acute cholecystitis include pancreatic necrosis, pancreatitis, gallbladder perforation, and biliary peritonitis.

The main symptoms of gallbladder perforation are sudden severe pain in the right hypochondrium, hiccups, bloating, cessation of gas discharge, disruption of the bowel movement, and hypotension.

In acute cholecystitis, adhesions may appear between the bladder and other organs - pericholecystitis with deformation of the bladder.

Cholecystitis: maintenance therapy during remission

After inpatient treatment and the acute period subsides, patients with cholecystitis are prescribed maintenance therapy.

Nutrition should contribute to stable remission of the disease and prevent the thickening of bile. It is necessary to have scales and strictly monitor the stability of body weight. Nutrition should not be excessive. Food should be taken in small portions, at least 4 times a day. It is advisable to enrich the diet with vegetables and vegetable oil. Refractory fats, cold fizzy drinks, spicy seasonings, fried foods are prohibited; large meals at night are especially undesirable.

If the feeling of heaviness in the right hypochondrium increases or heartburn occurs, a course of treatment with choleretic agents is administered 2-3 times a year for a month.

Patients with prolonged pain and dyspeptic syndromes should undergo blind duodenal intubation, that is, tubage, once every 7-10 days. For this purpose, the patient on an empty stomach drinks 1-2 glasses of a hot solution of Carlsbad salt (2 sachets) or xylitol (15 g) dissolved in water in small sips. After this, for 40-60 minutes you need to lie comfortably on your right side, placing a warm heating pad on the liver area. These same patients sometimes almost constantly have to take choleretic drugs - 5-6 drops of Cholagol after breakfast.

Drug therapy

The basis of drug treatment of chronic cholecystitis is anti-inflammatory therapy.

Antibiotics are widely used to suppress infection in the biliary tract. The choice of antibacterial drug depends on individual tolerance and the sensitivity of the bile microflora to the antibiotic.

Correction of antibacterial therapy is carried out after receiving the results, analyzing the culture of bile for microflora and determining its sensitivity to the antibiotic.

The most effective are:

• Antimicrobial drugs of the fluoroquinolone group: norfloxacin (nolicin, norbactin, girablok) - 0.4 g 2 times a day; ofloxacin (tarivid, zanocin) - 0.2 g 2 times a day; ciprofloxacin (tsiprobay, ciprolet, tsifran) - 0.5 g 2 times a day; levofloxacin (tavanic, lefoccin) - 0.5 g 2 times a day; macrolides: erythromycin - 0.25 g 4 times a day; azithromycin (sumamed, azitrox, azitral) - 0.5 g 1 time per day; clarithromycin (klatsid, clubaks, klerimed) - 0.5 g 2 times a day; roxithromycin (rulid, roxide, roxolid) - 0.1 g 2 times a day; midecamycin (macropen) - 0.4 g 2 times a day;
• Semi-synthetic tetracyclines: doxacycline (vibramycin, unidox solutab, medomycin) - 0.1 g 2 times a day; metacycline - 0.15 g 4 times a day.

You can use semi-synthetic penicillins: ampicillin - 0.5 g 4 times a day; oxacillin - 0.5 g 4 times a day; ampiox - 0.5 g 4 times a day, although they are less active.

In severe cases, the doctor prescribes cephalosporins (ketocef, cefobid, claforan, cefepime, rocephin).

It is preferable to take the antibiotic orally (through the mouth) at the usual therapeutic dose. The course of treatment is 7-8 days. It is possible to repeat the course with other antibiotics after 3-4 days.

If the bile microflora is not sensitive to antibiotics or is allergic to them, cotrimaxozole (Biseptol, Bactrim) is recommended - 2 tablets each

2 times a day, although its effectiveness is significantly lower than that of antibiotics, and the adverse effect on the liver is higher. A good effect is achieved by using nitrofuran drugs - furazolidone, furadonin, and metronidozole - 0.5 g 3 times a day for 7-10 days.

In case of severe pain syndrome, in order to reduce spasm of the Odzi sphincter, in case of hypermotor type gallbladder dysfunction, antispasmodics are indicated.

There are several groups of antispasmodics, differing in their mechanism of action.

Metacin, gastrocepin, buscopan, and platifillin are used as antispasmodics. However, when taking this group of drugs, a number of side effects may occur (dry mouth, urinary retention, visual disturbances, tachycardia, constipation). The combination of the rather low effectiveness of this group of drugs with a wide range of side effects limits the use of this group of drugs.

Direct-acting antispasmodics, such as papaverine, drotaverine (no-spa), are effective in relieving spasms. However, they are not characterized by selectivity of action and they affect all tissues where smooth muscles are present.

Mebeverine hydrochloride (duspatalin) has a much more pronounced antispastic activity, which also has a direct effect, but it has a number of advantages over other antispasmodics. It relaxes the smooth muscles of the digestive tract, does not affect the smooth muscle wall of blood vessels and does not have the systemic effects characteristic of anticholinergics. The drug has a prolonged effect and should be taken no more than 2 times a day in the form of 200 mg capsules.

Pinaveria bromide (dicetel) also belongs to antispasmodics. The main mechanism of its action is the blockade of calcium channels located in the smooth muscle cells of the intestine, bile ducts and peripheral nerve endings. Dicetel is prescribed 100 mg 3 times a day for pain.

A drug that has a selective antispasmodic effect on the sphincter of Oddi is hymecromone (odeston). This drug combines antispasmodic and choleretic properties, ensuring harmonious emptying of intra- and extrahepatic bile ducts. Odeston does not have a direct choleretic effect, but it facilitates the flow of bile into the digestive tract, thereby increasing the circulation of bile acids. The advantage of odeston is that it has virtually no effect on other smooth muscles, in particular the circulatory system and intestinal muscles. Odeston is used 200-400 mg 3 times a day 30 minutes before meals. All antispasmodics are prescribed for a course of 2-3 weeks.

In the future, they can be used if necessary or in repeated courses. For acute pain syndrome, drugs can be used once or in short courses.

In case of gallbladder dysfunction caused by hypomotor dyskinesia, prokinetics are used to increase contractile function for 10-14 days: domperidone (Motilium, Motonium, Motilac) or metoclopramide (Cerucal)

- 10 mg 3 times a day 20 minutes before meals.

The prescription of choleretic drugs requires a differentiated approach depending on the presence of inflammation and the type of dysfunction. They are indicated only after the inflammatory process has subsided. All choleretic drugs are divided into two large groups: drugs that stimulate bile formation and drugs that stimulate bile secretion.

The first includes drugs that increase the secretion of bile and stimulate the formation of bile acids (true choleretics), which are divided into:

• on drugs containing bile acids - decholin, allochol, cholenzyme;
• herbal preparations - hofitol, tanacechol, holagol, livamine (Liv 52), hepabene, hepatofalk, silymar;
• drugs that increase bile secretion due to the water component (hydrocholeretics) - mineral waters.

The second group of drugs that stimulate bile secretion include:

• cholekinetics - drugs that cause an increase in the tone of the sphincters of the biliary tract and gallbladder - magnesium sulfate, Carlsbad salt, sorbitol, xylitol, holagogum, olimethin, rovahol;
• preparations containing oil solutions - pumpkinol;
• drugs that cause relaxation of the biliary tract (cholespasmolytics)

- platifillin, no-spa, duspatalin, odeston, dicetel.

The doctor prescribes drugs from these groups to patients differentially, depending on the type of dyskinesia accompanying chronic cholecystitis.

During the period of exacerbation of chronic acalculous cholecystitis, physiotherapeutic procedures are indicated: electrophoresis with antispasmodics for hypermotor type dysfunctions and with magnesium sulfate for hypomotor dysfunction. Diathermy, inductothermia, paraffin, ozokerite, and UHF therapy are prescribed for the gallbladder area. During the period of the onset of remission, physical therapy is used to promote emptying of the gallbladder.

Acalculous cholecystitis

Acute acalculous cholecystitis occurs due to the penetration of infection into the gallbladder with reduced evacuation capacity (stagnation of bile contributes to the development of infection).

The reflux of pancreatic juice into the bile ducts and gallbladder, which damages the mucous membrane of the gallbladder, also plays an important role in the development of inflammation. Very often, acute acalculous cholecystitis is combined with inflammatory changes in the pancreas (cholecystopan-creatitis).

The symptoms of acalculous chronic cholecystitis are similar to those of chronic cholecystitis, only pain in the right hypochondrium is not so intense, although longer lasting.

In case of long-term persistent course of the disease, if conservative treatment is ineffective, cholecystectomy (removal of the gallbladder) is prescribed.

Can acalculous cholecystitis lead to cholelithiasis?

Chronic cholecystitis often develops against the background of existing cholelithiasis as a result of constant injury to the mucous membrane of the gallbladder by hard stones.

However, the widespread belief that chronic cholecystitis must necessarily be combined with cholelithiasis is incorrect. There is no such direct dependence. It can appear for many other reasons.

If, in the presence of inflammation, stones are also found in the gallbladder, they speak of calculous cholecystitis. If there is inflammation, but there are no stones - about stoneless.

However, acalculous cholecystitis often precedes stone formation. Therefore, even in the absence of symptoms, it is still necessary to treat acalculous cholecystitis in order to avoid further unpleasant consequences and exacerbations of the disease.

Pain and discomfort during exacerbations of chronic cholecystitis are caused by spasms of the gallbladder and biliary dyskinesia, so doctors, in addition to anti-inflammatory treatment, use antispasmodics to relieve discomfort.

Antispasmodics such as atropine, metacin, belladonna preparations, and antispasmodics are widely used. But you need to know that this group of drugs is contraindicated in patients with glaucoma, prostate adenoma, pregnancy, which limits their use in a significant part of patients.

Another group of antispasmodics, such as drotaverine, papaverine, bencyclane, acts on smooth muscles, providing an antispastic, and therefore analgesic, effect. However, these drugs affect all of the body's smooth muscles, including those that make up the walls of blood vessels and the urinary tract, which can cause heart palpitations, urinary incontinence, and some other undesirable effects.

In this regard, most doctors prescribe antispasmodic drugs strictly individually, giving preference to those that do not have a systemic effect and strictly selectively affect the cells of the gastrointestinal tract.

To improve the outflow of bile, as a rule, choleretic agents are prescribed - allohol, cholenzyme, a decoction of corn silk and flowers of the main choleretic herb - immortelle.

Diagnosis of acute acalculous cholecystitis

Diagnosis of acute cholecystitis is complex. The purpose of diagnostic measures is not only to establish the fact of cholecystolithiasis and

signs of inflammation of the gallbladder wall, but also the ability to choose an adequate treatment method.

The patient's severe general condition, high body temperature, severe chills, tachycardia, severe pain in the right hypochondrium, and increased ESR make it possible to suspect acute cholecystitis.

In patients over 60 years of age, the diagnosis of acute cholecystitis is often difficult due to its atypical course. General and local reactions can be mild, purulent and destructive forms are often observed, and diffuse peritonitis develops.

For an accurate diagnosis, ultrasound, biochemical blood tests and several specific examinations are performed.

Ultrasound examination may show signs of acute cholecystitis - thickening of the walls of the bladder (more than 4 mm), a “double contour” of the wall, an increase in size, a stone at the mouth of the cystic duct.

The role of ultrasound in predicting the nature of the proposed operation is extremely important. Reliable signs of the technical complexity of the planned cholecystectomy are: the absence of a free lumen in the gallbladder;

thickened or thinned bladder wall; large stationary stones; accumulation of fluid.

Diagnostics also uses dynamic ultrasound, which is a regularly performed ultrasound examination. It helps to assess whether the clinical picture of the disease is changing or remaining stable. Dynamic ultrasound allows you to timely analyze the course of the inflammatory process and carry out the necessary surgical intervention in advance.

Laparoscopy is indicated for patients with an unclear clinical diagnosis. In acute cholecystitis, laparoscopy has a high resolution and also provides significant assistance in the differential diagnosis of other inflammatory diseases of the abdominal organs and tumor lesions.

The purpose of the study is to isolate acute cholecystitis in a number of other pathological conditions: to distinguish it from acute appendicitis, acute pancreatitis, painful manifestations of urolithiasis, pyelonephritis, liver abscess, perforated gastric and duodenal ulcers.

Treatment of acute acalculous cholecystitis

Patients with acute cholecystitis are subject to hospitalization in a surgical hospital.

The absolute indication for surgical treatment is suspicion of perforation, gangrene, or phlegmon of the bladder.

In the absence of complications, doctors often practice wait-and-see tactics under the guise of massive daily doses of broad-spectrum antibiotics, which are effective against intestinal microflora typical of biliary tract infections.

For antibacterial therapy, drugs that can penetrate well into bile are used.

Active treatment tactics are used for all destructive forms of acute cholecystitis, which occurs with signs of purulent intoxication or peritonitis. Waiting treatment tactics are preferable for this form of acute cholecystitis, when, as a result of conservative therapy, it is possible to stop the inflammatory process.

The question of choosing treatment tactics for a patient with acute cholecystitis in the clinic is decided in the first hours of hospital stay, from the moment the clinical diagnosis is made and confirmed by ultrasound or laparoscopic methods.

If the choice falls on surgical intervention, then the operation is performed at different times from the moment of hospitalization.

The preoperative period of hospital stay is used for intensive therapy, the duration of which depends on the category of severity and physical condition of the patient. In mild cases, surgical treatment is carried out in the first 6-12 hours from the moment of admission to the hospital (after preoperative preparation). If the patient’s physical condition requires more intensive and lengthy preoperative preparation - within a period of 12 to 48 hours.

In any case, it is advisable to follow a gentle diet (table No. 5).

How and how is chronic acalculous cholecystitis treated?

Treatment of chronic acalculous cholecystitis is usually carried out on an outpatient basis, in case of exacerbation and protracted course - in the therapeutic department of the hospital, in the remission phase - at a resort or in a dispensary.

Therapeutic measures are aimed at suppressing infection, reducing the inflammatory process, increasing the body's defenses, and eliminating metabolic and dyskinetic disorders.

In the acute stage, a special diet is prescribed - table No. 5.

To eliminate pain, no-spa, halidor, papaverine, and metoclopramide are used. For severe pain, use baralgin. As a rule, pain is relieved in the first 1-2 weeks from the start of treatment; usually, therapy with these drugs does not exceed 3-4 weeks.

Pain in chronic acalculous cholecystitis depends not only on pronounced dyskinetic disorders, but also on the intensity of the inflammatory process in the biliary tract.

Early use of antibacterial therapy is very effective. It is advisable to prescribe broad-spectrum antibiotics that do not undergo significant biotransformation in the liver. Prescribe erythromycin (0.25 g 6 times a day), doxycycline hydrochloride (0.05-0.1 g 2 times a day); metacycline hydrochloride (0.3 g 2-3 times a day). It is possible to use furazolidone (0.05 g 4 times a day).

Treatment with antibiotics is carried out for 8-10 days. After a 2-4 day break, it is advisable to repeat treatment with these drugs for another 7-8 days.

In the phase of subsiding exacerbation, it is recommended to place a heating pad on the area of ​​the right hypochondrium, make hot poultices from oats or flaxseed, applications of paraffin and ozokerite will be useful.

The use of choleretic drugs during an exacerbation of severe inflammatory processes in the gallbladder and bile ducts is contraindicated.

In case of a pronounced allergic component, antihistamines are used - diphenhydramine, diazolin, suprastin, tavegil, telfast, etc.

Choleretic drugs - choleretics (drugs that stimulate the formation of bile) are recommended for use during the remission phase in combination with enzyme preparations. If there is hypotension of the gallbladder, tocholeretics are prescribed with cholekinetics - drugs that enhance muscle contraction of the gallbladder and thereby promote the release of bile into the intestine.

The following choleretics are mainly prescribed: allochol, cholenzyme, decholin; a number of synthetic substances - oxafenamide, nicodine; herbal preparations - fiamine, holagon, corn silk.

Cholekinetic agents are magnesium sulfate (magnesium sulfate), Carlsbad salt, xylitol, sorbitol, mannitol, holosas.

Allochol is prescribed 1-2 tablets 3 times a day after meals, nicodin - 0.5-1 g 3-4 times a day before meals. The course of treatment with choleretic drugs is 10-30 days, depending on the effect.

Treatment tactics outside of exacerbation are determined by the nature of dyskinetic disorders. For the hypotonic type of dyskinesia, allochol is used in combination with festal, cholekinetics, and for the hypertensive type, antispasmodics (no-spa, halidor, papaverine) are used.

For dyskinesias of the gallbladder, olimetin (Rovahol) is effective - 3-5 drops per piece of sugar 30 minutes before meals 3-4 times a day. You can take Cerucal - 10 mg 3-4 times a day.

Therapeutic duodenal intubation is indicated only in the absence of gallstones.

When the inflammatory process is sluggish, agents are used that increase the body’s immunological resistance (vitamins, aloe injections, prodigiosan, etc.).

Surgical treatment is indicated:

- with a persistent course of the disease with preserved gallbladder function, but existing adhesions, deformation, pericholecystitis; - with a disabled or severely deformed gallbladder, even in the absence of sharp pain; - in the case of difficult-to-treat pancreatitis and cholangitis.

In the remission phase, treatment also involves following a diet, taking choleretic medications, and exercising.

Physical therapy plays an important role in chronic cholecystitis with insufficient emptying of the gallbladder. Morning exercises and measured walking are of greatest importance. The complex of therapeutic exercises includes exercises for the trunk muscles in a standing, sitting and lying position on the back and right side with a gradual increase in the range of movements and load on the abdominal press.

Balneological resorts with mineral waters for drinking treatment are shown: “Arzni”, “Berezovsky Mineral Waters”, “Borjomi”, “Java”, “Jermuk”, “Druskininkai”, “Essentuki”, “Izhevsk Mineral Waters”, “Pyatigorsk”, "Truskavets". Contraindications to spa treatment are acute cholecystitis or a non-functioning gallbladder, chronic cholecystitis with frequent exacerbations.

Enzymatic cholecystitis

Changes in the chemical composition of bile (discrimination) in the form of an increase in the concentration of bile salts can cause aseptic inflammation of the gallbladder.

The occurrence of cholecystitis has been proven to be the damaging effect of pancreatic juice and the negative impact of pancreatic reflux into the bile ducts of the gallbladder and the excretory ducts of the liver.

With free outflow of pancreatic juice into the duodenum, no changes in the gallbladder are detected. But when the outflow is disrupted and hypertension increases in the biliary system, when the gallbladder is stretched, a change in the normal capillary blood flow in the wall of the bladder occurs. This causes disruption of tissue metabolism, which leads to the development of enzymatic cholecystitis.

During the inflammatory process in the gallbladder, a shift in normal acidity to the acidic side occurs (bile acidosis), which contributes to the loss of cholesterol in the form of crystals and a change in the ratio of bile acids towards cholesterol (cholate-cholesterol ratio). Therefore, in the diet of patients with cholecystitis of enzymatic origin, foods that contribute to tissue acidification should be sharply limited or excluded. These are primarily flour and spicy dishes, meat, fish, brains, etc.

Features of nutrition of patients with cholecystitis

Fats stimulate bile secretion, and the majority of patients with cholecystitis do not need to limit them. However, animal fats are high in cholesterol and should be consumed in moderation.

If there is insufficient flow of bile into the intestines, fats are poorly broken down, which leads to irritation of the intestinal mucosa and the appearance of diarrhea.

It has been proven that diets with an increased amount of fat due to vegetable oil have a positive effect on the lipid complex of bile, bile formation and bile excretion.

It should also be remembered that vegetable oils (corn, sunflower, olive), due to the content of unsaturated fatty acids - arachidonic, linoleic, linolenic - improve cholesterol metabolism, participate in the synthesis of certain substances (arachidonic acid), and affect the motility of the gallbladder.

Fats increase the metabolism of fat-soluble vitamins, especially vitamin A.

Carbohydrates, especially easily digestible ones (sugar, honey, jam), which were previously not limited in order to replenish glucose reserves in the liver, are now recommended to be reduced in the diet, especially if you are overweight.

Special studies have proven that glycogen reserves decrease only with massive liver necrosis, and the inclusion of a large amount of easily digestible carbohydrates can enhance lipogenesis and thereby increase the likelihood of gallstone formation. Therefore, the consumption of flour and sweet foods should be limited.

The diet should be rich in plant fiber, which eliminates constipation, and this reflexively improves the emptying of the gallbladder. The diet should include carrots, pumpkin, watermelons, melons, grapes, wheat and rye bran.

For oxalaturia and phosphaturia, you should limit tomatoes, sorrel, spinach, and radishes.

In case of exacerbation of chronic cholecystitis in the first week, the calorie content of food is 2000 calories per day, later, when the inflammatory process subsides, the calorie content can be increased to 2500 calories.

It should be borne in mind that food poor in proteins leads to the development of fatty liver, disruption of the synthesis of many enzymes and hormones. Long-term restriction of protein intake in the menu of patients with chronic cholecystitis is not justified.

A complete vitamin composition of food is a necessary condition for diet therapy of chronic cholecystitis.

You should include in your diet foods containing lipotropic factors: oatmeal and buckwheat, cottage cheese, cheese, cod, soy products.

Reflux into the biliary tract can lead to cholecystitis

Long-term use of anticholinergics and antispasmodics leads to dysfunction of the biliary tract, the development of hypotension (relaxation) and atony (loss of efficiency) of the sphincter of Oddi, which contributes to the reflux of duodenal contents into the biliary tract, with the formation of “pharmacological” cholestasis.

The sphincter of Oddi is a muscle knot that compresses the junction of the gallbladder and the duodenum. When this pressure weakens, the “gate” constantly remains open and the infected intestinal contents enter the bile ducts and gallbladder. This is how inflammation occurs.

In case of peptic ulcer with localization of the process in the duodenal bulb, changes in the biliary tract are also often observed.

Prolonged pain indicates cholecystitis

Biliary colic occurs suddenly and quickly reaches a peak - within a few minutes. This is a constant pain, it does not go away, but it can vary in intensity. It lasts from 15 minutes to 4-5 hours.

If the pain lasts more than 4-5 hours, then this usually indicates a complication - inflammation of the gallbladder (cholecystitis). The pain is usually quite severe, but movement does not worsen the pain.

Are surgeries performed to remove the gallbladder for acalculous cholecystitis?

Hardly ever. Conservative anti-inflammatory treatment is usually prescribed. The exception is patients with persistent pain and a sharply enlarged gallbladder, as well as severe manifestations of pericholecystitis.

Nutrition

Diet and nutritional therapy should be aimed at releasing bile from the gallbladder and eliminating inflammation. You should only consume easily digestible fats: butter and vegetable oils (olive, sunflower, corn), which stimulate the secretion of bile. The diet includes foods that contain a lot of magnesium salts. They promote the secretion of bile, reduce pain, and relieve spasm of the gallbladder. There are a lot of magnesium salts in buckwheat, vegetables and fruits.

The best diet for gallbladder diseases is frequent and small meals. This is due to the fact that when we eat, a reflex contraction of the gallbladder occurs, and the bile dilutes. There is an outflow of bile. A snack is a sandwich and an apple.

The main dietary principle for acute cholecystitis (as well as for exacerbation of chronic cholecystitis) is maximum sparing of the digestive tract. In the first two days, the patient should drink exclusively liquid, and in small portions. During this period, you can take still mineral water diluted in half with regular boiled water, sweet fruit and berry juices - also in half with water, weak tea, rosehip decoction.

As pain and inflammation decrease, which usually happens after 1-2 days, you can switch to pureed food. Prescribed mucous and pureed soups made from oats, rice, semolina; porridge made from rice, oats, semolina; sweet fruit and berry jelly, mousses, jellies. The amount of food is limited so as not to put stress on the digestive organs.

Further expansion of the diet occurs due to the inclusion in the diet of pureed low-fat cottage cheese, lean pureed meat, steamed, and low-fat boiled fish. During this period, you can also include white bread crackers in your diet. You should eat in small portions 5 times a day, preferably at certain hours. You need to drink plenty of fluids (2-2.5 liters of liquid).

After 5-10 days from the onset of acute cholecystitis (or exacerbation of chronic cholecystitis), the patient switches to diet No. 5a.

This is a physiologically complete diet, with a moderate limitation of fats and table salt, mechanical and chemical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract, with the exception of foods and dishes that enhance the processes of fermentation and putrefaction in the intestines, as well as strong stimulants of bile secretion, gastric secretion, pancreas glands, substances that irritate the liver (extractives, organic acids, foods rich in essential oils, organic acids, cholesterol, purines, fried foods containing products of incomplete breakdown of fat). All dishes are prepared boiled or steamed. Individual baked dishes without a rough crust are allowed. Food is given mostly pureed, pureed soups or with finely chopped vegetables and well-cooked cereals. Diet: 5-6 times a day in small portions.

Food temperature 15-60 °C. Diet 5 times a day.

It is not recommended to take: very fresh bread; puff pastry and pastry, fried pies, cakes, cream pies; meat, fish, mushroom broths; okroshka, green cabbage soup; fatty meats (lamb, pork); poultry (duck, goose); liver, kidneys, brains; smoked meats, canned food, most sausages, fried meat; fatty fish (chum salmon, sturgeon, stellate sturgeon); salted, smoked fish, caviar, canned fish. Limit cream, 6% fat milk, fermented baked milk, sour cream, full-fat cottage cheese, fatty and salty cheese. Exclude beef, lamb lard and fats, cooking oil, margarine; fried and hard-boiled eggs; sorrel, radish, radish, green onion, garlic, mushrooms, pickled vegetables, black pepper, horseradish, mustard; ice cream, chocolate, cream products; black coffee, cocoa, cold drinks. Alcohol is completely excluded.

Bread and flour products: wheat bread from first and second grade flour, rye bread from sifted and peeled flour (yesterday's baking); baked savory products with boiled meat and fish, cottage cheese, apples; dry biscuits, dry biscuits, crackers; Cereal puddings and casseroles (buckwheat, oatmeal) - steamed and baked; boiled vermicelli, dumplings, finely chopped pasta, cheesecakes; boiled pasta.

Soups: vegetables, cereals with vegetable broth, dairy with pasta, fruit; Vegetarian borscht and cabbage soup, beetroot soup. Flour and vegetables for dressing are not fried, but dried.

Meat and meat products: lean or low-fat meats - without tendons (beef, young lean lamb, pork, rabbit, veal), lean poultry - without skin (chicken, turkey) boiled, baked after boiling, in pieces or chopped, cabbage rolls, pilaf with boiled meat; milk sausages; low-fat sausage, ham.

It is impossible to completely exclude meat from the diet - it contains animal protein that is beneficial for the body, which includes essential amino acids necessary for the liver to synthesize enzymes, hormones, blood elements and to maintain immunity.

Fish: low-fat varieties (pike perch, cod, bream, perch, navaga, silver hake) in chopped form; boiled or steamed (quenelles, meatballs, soufflé).

Milk and dairy products: milk - in its natural form or in dishes (porridge, casseroles, etc.), fermented milk drinks (kefir, acidophilus, yogurt), fresh non-acidic cottage cheese - in its natural form or in casseroles, krupeniki, cheesecakes, lazy dumplings, soufflé, pudding, noodles with cottage cheese. Sour cream is used as a seasoning for dishes.

Cheeses: mild, low-fat cheeses.

Eggs: no more than one egg per day, steamed and baked egg white omelettes; if well tolerated, up to two eggs per day are allowed (soft-boiled; steamed or baked omelettes (prohibited in case of cholelithiasis).

Cereals: any dishes from various cereals, especially buckwheat and oatmeal; pilaf with dried fruits, carrots, puddings with carrots and cottage cheese; Krupeniki. Buckwheat and oatmeal are very useful, since the carbohydrates they contain are converted into fats to a lesser extent; They are rich in fiber and vitamins.

Fats: butter - in its natural form and in dishes, vegetable oils (olive, corn, sunflower).

Vegetables: various vegetables in raw, boiled and baked forms; salads from raw and cooked vegetables and fruits; side dishes, sour sauerkraut; onions after boiling, green pea puree.

Snacks: fresh vegetable salad with vegetable oil, fruit salads, vinaigrettes, squash caviar; jellied fish after boiling; soaked lean herring, stuffed fish, seafood salads (squid, seaweed, scallops, mussels), boiled fish and boiled meat, sausages - doctor's, dairy, diet; lean ham.

Spices: parsley and dill; a small amount of red ground sweet pepper, bay leaf, cinnamon, cloves, vanillin; white sauce with a little sour cream added without toasting the flour; dairy, vegetable, sweet fruit sauces. The flour is not sautéed.

Fruits: various fruits and berries (except sour ones) raw and in dishes; lemon, black currant - if well tolerated; jams, preserves from ripe and sweet berries and fruits; dried fruits, compotes, jelly, jellies, mousses.

Sweet dishes and sweets: marmalade, non-chocolate candies, marshmallows, jam, jam from sweet ripe fruits, honey. However, you should not get carried away with sweet dishes. It is recommended no more than 50-70 g of sugar per day (including sugar contained in sweets, fruits, and confectionery). For older people, this norm is 30-50 g. You can replace some of the sugar with xylitol and sorbitol. People who are prone to obesity should avoid sugar completely.

Beverages: tea, coffee with milk, fruit, berry and vegetable juices. It is recommended to constantly use vitamin decoctions and infusions of rose hips and wheat bran. Infusions and decoctions from special collections of medicinal herbs are recommended to be taken 1/2 cup 2-3 times a day 20-30 minutes before meals, the course is 2-3 months (the break between them is 2-3 weeks).

For the normal functioning of the digestive organs, natural dietary fiber is necessary, which is contained in large quantities in wheat bran, and to a lesser extent in rolled oats, nuts, vegetables, and fruits.

The use of wheat bran is a means of preventing and treating constipation, gallbladder diseases, obesity, and diabetes. In addition, wheat bran is rich in B vitamins and has the ability to neutralize and adsorb toxic substances formed during the digestion process.

Wheat bran can be consumed in its natural form (2-3 tablespoons) or cooked from it.

Preparation of wheat bran: steam 2-3 tablespoons of bran with boiling water and leave for 30 minutes. Divide into four servings and eat throughout the day, adding to soups, borscht, porridge or simply drinking milk. A decoction of bran is very useful, which can be prepared as follows: grind the bran in a coffee grinder, pour boiling water, boil for 10 minutes and leave for several hours (up to a day). Strain the broth, add sugar or xylitol, sorbitol, lemon juice. You can use honey instead of sugar.

Also recommended for this disease are a vitamin drink made from rose hips, an infusion of rose hips, tea from rose hips and black currant berries, tea from rose hips with raisins, tea from rose hips and rowan berries, and a yeast drink.

Sample diet menu No. 5A

1st breakfast: steamed curd soufflé, pureed rice porridge with milk, tea.

2nd breakfast: baked apple with sugar.

Lunch: pureed pearl barley soup with vegetarian vegetables, steamed meat cutlets with carrot puree, jelly.

Afternoon snack: rosehip decoction.

Dinner: steamed fish dumplings with mashed potatoes, semolina casserole with sweet gravy, tea.

At night: kefir.

Sample menu (second option)

On an empty stomach: rosehip decoction - 1 glass.

1st breakfast: vegetable salad - 150 g, buckwheat porridge with butter, milk sausages - 60 g, tea.

2nd breakfast: fresh cheese - 100 g, with milk - 50 g and sugar - 10 g.

Lunch: milk soup with semolina dumplings, steamed meat cutlets, boiled noodles.

Dinner: cheese pudding from low-fat fresh cheese, tea.

Before bed: 1 glass of kefir.

For the whole day: bread - 400 g, butter - 15 g, sugar - 50 g.

Diet dishes for cholecystitis are prepared mainly by steaming or boiling. Baked dishes are acceptable, but fried ones are definitely excluded, since this method of cooking produces substances that irritate the liver, the mucous membrane of the stomach and intestines.

During the period of remission, meat, for example, can only be lightly fried after boiling it.

The daily intake of table salt should not exceed 10 g. For the normal functioning of the gallbladder, it is important that animal and plant proteins in food are in optimal proportion.

Puréed food should not be eaten for a long time, but only during an exacerbation.

For chronic cholecystitis, the diet has general recommendations with acute cholecystitis:

1. Meals should be frequent (4-6 times a day), in small portions, optimally eating at the same time. The second breakfast, afternoon snack and second dinner should not be too plentiful.

2. The amount of main food components is the same as in a normal diet: protein 90-100 g, fat 80-100 g, carbohydrates 400 g, daily calorie content 2500-2900 kcal. A distinctive feature is the increase in the content of vegetable oil (olive, sunflower, corn, soybean) to 50% of all fats.

3. Including additional sources of plant fiber in the diet (apples, melon, tomatoes, etc.). It is important to note that in case of chronic cholecystitis, it is extremely undesirable to consume red currants, lingonberries, and legumes. It is useful to carry out courses of taking wheat bran for 4-6 weeks: pour over the bran with boiling water, steam, drain the liquid, add the resulting mass 1-1.5 tablespoons to dishes 3 times a day.

4. Not recommended: spicy, salty, fried foods, dishes with a high content of extractive substances (strong meat and fish broths, egg yolks, vinegar, pepper, mustard, horseradish, fried and stewed dishes); alcoholic drinks and beer; cold and carbonated drinks. Refractory and difficult to digest fats (lard, lard, fatty meats and fish) should be excluded. The combination of alcoholic beverages and fatty foods is especially dangerous.

5. Recommended: dairy, fruit, vegetable soups; lean meats (beef, rabbit, chicken, turkey) and fish (hake, cod, bream, perch, pike perch) boiled or steamed; doctor's sausage, ham, soaked herring; porridge; puddings, casseroles, cheesecakes; boiled vermicelli, noodles, various vegetables, raw, boiled, baked; salads from boiled and raw vegetables and fruits; protein omelettes. Fermented milk products, fresh cottage cheese, lazy dumplings, cottage cheese soufflé, mild cheese (Russian, Yaroslavl). From animal fats, butter is recommended.

6. As seasonings you can use parsley, dill in small quantities, fruit and berry sauces. Vegetables such as radishes, radishes, turnips, onions, garlic, as well as sorrel and spinach are generally not well tolerated and should be avoided.

7. For drinks, you can drink weak tea, fruit, vegetable, and berry juices (but not decoctions of lingonberries or red currants), and rosehip decoction. All drinks must be warm; drinking cold drinks stimulates contractions and may cause pain. Do not drink highly carbonated drinks (Cola, Fanta, Sprite, highly carbonated mineral waters).

If cholecystitis is combined with reduced secretory function of the stomach, then mineral waters should be taken 30 minutes before meals, with increased secretion - 1.5 hours before meals.

If all acute phenomena disappear after 3-4 weeks, the patient can be switched to diet No. 5: the same dishes are allowed, but unprocessed. Rub only stringy meat and vegetables very rich in fiber (cabbage, carrots, beets). Fried foods are excluded. You can serve dishes made from stewed foods, as well as baked ones (after preliminary boiling). The amount of fat in the diet is adjusted to the physiological norm, 1/3 of the fat is given in the form of vegetable oil. Vegetable oil (olive, sunflower, corn) is added to salads, vegetable and cereal side dishes. Along with white bread (200 g), small amounts of sifted rye and wholemeal flour (100 g) are allowed.

Therapeutic nutrition is combined with the prescription of antibacterial therapy, antispasmodics and bed rest.

The importance of therapeutic nutrition in the treatment of patients with liver and gallbladder damage especially increases in cases of chronic cholecystitis. Proper nutrition can provide a long-term state of remission. Violation of the diet, its qualitative and quantitative deviations can cause an exacerbation of the disease. Among the reasons that contribute to the exacerbation of chronic cholecystitis, one of the first places is occupied by the consumption of fatty and spicy foods, alcohol, cold and carbonated drinks, etc. Poor nutrition is also one of the reasons for the transition of acute cholecystitis to chronic.

The diet for patients with chronic cholecystitis outside the period of exacerbation is structured in such a way that its main components have an active effect on the biliary function and prevent bile stagnation. The prescribed diet should also have a stimulating effect on the secretory and motor functions of the intestine. If you are prone to diarrhea, your diet should be adjusted accordingly.

For patients with chronic cholecystitis, frequent split meals are recommended at the same hours, which promotes better outflow of bile. Large amounts of food disrupt the rhythm of bile secretion and cause spasm of the bile ducts. A spasm of the pylorus may occur reflexively, and the normal secretory-motor activity of the intestine is disrupted.

Hence the frequent occurrence of pain and various types of dyspepsia after a heavy meal.

The main dietary requirement for patients with chronic cholecystitis is diet No. 5. It is preferable to administer fats in the form of vegetable oils, primarily because of their good choleretic effect. For chronic cholecystitis occurring with bile stagnation syndrome, it is recommended to increase the fat content in the diet to 100-120 g at the expense of vegetable oils (1/2 of the total amount of fat). This diet option promotes the activation of bile secretion, improves the hepatic-intestinal circulation of the compounds that make up bile, increases its bactericidal properties and intestinal motor function, and promotes the removal of cholesterol from the intestines with feces.

The choleretic effect of vegetable oils may serve as a contraindication to their introduction into the diet of patients with cholelithiasis. In these cases, activation of the functional activity of the biliary system may be accompanied by an attack of biliary colic. For patients of this profile, a diet with the usual ratio of animal and vegetable fat is prescribed.

The issue of introducing eggs into the diet should be decided individually. Eggs are a valuable food product, have an active choleretic effect, enhance the motor function of the gallbladder, and therefore their introduction into the diet of patients with chronic cholecystitis is indicated. At the same time, the presence of these properties provokes pain in some people when consuming eggs, which forces them to limit their introduction into the diet in such cases.

Vegetables, fruits and berries have a stimulating effect on the secretion of bile and other digestive juices and help eliminate constipation. We can recommend carrots, zucchini, tomatoes, cauliflower, grapes, watermelon, strawberries, apples, prunes, etc. Biliary activity is especially enhanced with the simultaneous introduction of vegetables with vegetable oils. Therefore, it is recommended to eat salads with vegetable oil, etc. The diet should contain wheat bran in its pure form or as part of special types of bread.

For cholecystitis that occurs with diarrhea, vegetables and berries are introduced into the diet in the form of juices, preferably diluted in half with water, or in pureed form. In these cases, preference is given to juices containing tannins (blueberries, quince, pomegranates, etc.). Vegetables rich in essential oils (radish, radish, turnip, onion, garlic), as well as oxalic acid (sorrel, spinach), are poorly tolerated by patients due to their irritating effect on the mucous membrane of the digestive tract.

Cholecystitis is quite common among women, especially during pregnancy. Despite the fact that excess weight often leads to gallstones, sudden weight loss can further complicate the course of cholecystitis.

It is also known that cholecystitis is more common among lovers of a low-calorie diet with a predominance of proteins or those who prefer diets that allow them to lose weight in a short time. Prevention of cholecystitis and chronic cholecystitis consists of following a diet, playing sports, exercising, preventing obesity, and treating focal infections.

The best way to prevent the development of cholecystitis is to maintain a normal weight and eat a moderate-calorie, low-fat diet.

• In acute cases of the disease, it is necessary to adhere to the most gentle diet possible (warm drinks, soups, liquid cereals). Eat pureed food (vegetable puree, fruit puddings, mousses, steamed meat cutlets, etc.). After a few days, you can eat boiled meat or fish.
• Include foods rich in fiber (vegetables and fruits, especially sweet ones), whole grains (whole grain bread, brown rice), lean meat (chicken, turkey) or lean fish.
• Choose low-fat dairy products (low-fat cottage cheese, low-fat milk, low-fat yogurt, kefir) and avoid or reduce the consumption of dairy products such as butter, cheeses, cream, ice cream.
• Avoid fried foods and sweets such as donuts, cookies, desserts, cakes, and sodas.
• Avoid spicy and smoked foods, as well as vegetables with a lot of essential oils, such as garlic, onions, radishes, as they are irritating to the digestive system.
• Reduce consumption of coffee and alcoholic beverages. For cholecystitis, fluid intake is indicated, such as weak tea, juices, rosehip decoction, and mineral water without gases.
• Try to stick to 4-5 meals a day in small portions instead of 3 meals a day with large amounts of food. With frequent meals in small portions, fats are better absorbed, which is very important for cholecystitis.
• It is useful to carry out courses of taking wheat bran for 4-6 weeks: pour over the bran with boiling water, steam, drain the liquid, add the resulting mass 1-1.5 tablespoons to dishes 3 times a day.

Often chronic cholecystitis develops against the background of obesity. In this case, it is useful to carry out 1-2 fasting days per week, for which you can use the following diets:

1. Curd and kefir day (900 g of kefir for six doses, 300 g of cottage cheese for three doses and 50-100 g of sugar)

2. Rice-compote day (1.5 liters of compote prepared from 1.5 kg of fresh or 250 g of dry fruit is divided into six doses; rice porridge cooked in water from 50 g of rice is divided into two doses)

3. Watermelon or grape day (2 kg of ripe watermelon or grapes are divided into six doses)

4. Fruit day (1.5-2 kg of ripe apples for six doses). This diet is especially good if you are prone to constipation and putrefactive processes in the intestines.

Disease prevention

Prevention of cholecystitis is a balanced diet, prevention of obesity, and an active lifestyle.

Prevention of chronic cholecystitis consists of following a diet, playing sports, physical education, preventing obesity, and treating focal infections.

Who is at particular risk?

Those people whose bile stagnates in the gallbladder are especially predisposed to the development of cholecystitis. This happens when:

- compression and kinks of the bile ducts; — dyskinesia of the gallbladder and biliary tract; — violations of the tone and motor function of the biliary tract; — endocrine and autonomic disorders; - pathological changes in the digestive system.

Increases bile stagnation:

- fasting; - irregular eating, combined with overeating; - sedentary lifestyle; - habitual constipation; — infections (Escherichia coli, cocci and other pathogens that penetrate from the intestines or are carried through the bloodstream).

In case of chronic cholecystitis, you need to follow the rules of a healthy diet, including frequent split meals.

As for medications, it is advisable to take antispasmodics and drugs containing pancreatin - mezim-forte, pensital, creon, pancitrate. It is useful to take several courses of probiotics - enterol, bifiform, hilak-forte. A daily intake of multivitamin complexes with microelements is required.

Choleretic drugs, including those of herbal origin, are prescribed only after examination of the gallbladder and pancreas.

A bandage is not worn for cholecystitis; it is used only if there is a hernia of the anterior abdominal wall.

What changes occur in the gallbladder as a result of inflammation?

With chronic catarrhal (edematous) inflammation (cholecystitis), the walls of the gallbladder become denser. At the same time, in some areas the epithelium is absent, in others it grows with the formation of small polyps.

The muscular layer of the wall is usually hypertrophied (thickened), and the mucous membrane, on the contrary, is atrophied. The walls of the gallbladder are covered with inflammatory infiltrates, which can lead to the development of ulcers on the mucous membrane, which is then scarred by epithelial cells.

Deposits of calcium salts may occur in certain areas of the gallbladder wall.

The bladder often becomes deformed due to the appearance of adhesions with neighboring organs.

The gallbladder is an important organ of the human digestive system. Its function is to accumulate bile coming from the liver and deliver it to the duodenum to participate in the process of digesting food. Anatomically, the gallbladder is part of the liver and is located on its lower surface. Since the organ is involved in the digestion process, disruption of its functioning negatively affects both the condition of neighboring organs and the entire organism as a whole.

Rice. 1. Abdominal organs*

The most common gallbladder diseases are:

• cholecystitis;
• cholelithiasis;
• biliary dyskinesia.

Nobody has canceled the drug treatment of these diseases, however, physical therapy can serve as an excellent means of prevention and can significantly speed up the rehabilitation process for these diseases.

Therapeutic gymnastics and exercises contribute to:

• increased blood flow to the abdominal organs;
• improving the neuropsychic state of a person;
• reduction of spastic and congestive phenomena in the biliary tract;
• stimulation of the outflow of bile into the small intestine;
• development of diaphragm mobility.

Rice. 2. Means of exercise therapy and principles of physical therapy for diseases of the gallbladder

Therapeutic exercises for cholecystitis

In simple terms, cholecystitis is an inflammation of the gallbladder. It is customary to distinguish two main forms of this disease: calculous and non-calculous.

In the first case, stones form in the cavity of the gallbladder (cholelithiasis), which injure the mucous membranes and prevent the outflow of bile. Against this background, infection of the gallbladder by intestinal microflora can occur, followed by inflammation of the walls of the organ.

In the second case, the cause is usually a bacterial infection, which provokes the proliferation of connective tissue and, as a result, disrupts the outflow of bile.

Therapeutic exercise can be used for any form of cholecystitis, but not during an exacerbation. Exercise therapy is prescribed in the absence of high fever, severe pain, nausea, vomiting, and dyspeptic disorders. In the case of uncomplicated calculous cholecystitis, exercises can be performed 3-4 days after the exacerbation is relieved. In case of complicated stone cholecystitis, the prescription of physical therapy is purely individual.

When compiling and performing a set of exercises, you must adhere to the following recommendations:

• training duration is 15-30 minutes.
• During the exercises, you need to pause for 2-3 minutes.
• starting positions lying on the left side and on all fours are preferred, although other positions can be used.
• the pace of the exercises is slow, smooth; the number of repetitions of regular exercises is 4-5 times, breathing exercises are 6-8.
• the load on the abdominal muscles is limited, especially at first; It is advisable to train the abs in a lying position, without straining and sudden fluctuations in intra-abdominal pressure.
• the inclusion of breathing exercises in a complex of therapeutic exercises is mandatory.
• After training, it is advisable to lie on your left side and rest for 20-30 minutes.

You can start performing a set of exercises only after agreeing with your doctor or exercise therapy specialist.

2. Lie on your back, arms along your body, legs together. As you inhale, raise your right arm up and bend your left leg at the knee, without lifting your foot off the floor. As you exhale, we return to the starting position (4 times for each pair of arms and legs).

3. Lie on your back, hands on your waist, legs together. As you exhale, raise your shoulders and head so that you can see your toes. We return to the starting position. Let's inhale. Repeat 4 times.

4. Lie on your back, bend your legs, arms along your body. Inhale, and as you exhale, pull your knees and chin toward your chest. Wrap your arms around your legs. Return to starting position. Do it 4 times.

5. Lie on your back, arms along your body, legs together. Bend your right leg, straighten it, then do the same with the other leg. The exercise should imitate walking. Perform for 1 minute.

6. Lie on your back, legs bent, feet and knees together. Alternately tilt the closed knees in different directions (4 times). The exercise is performed after inhaling and exhaling.

7. Lie on your back, arms along your body, legs together. Bend your right leg, straighten it, return to the starting position. Do the same with the other leg (4 times each).

8. Lie on your back, rest your elbows on the floor, legs bent, feet slightly apart. After inhaling, as you exhale, lift your pelvis. Return to starting position (4 times).

9. Lie on your left side, your left leg is bent, your left hand lies on the floor, continuing the line of the body. As you inhale, raise your right arm to the side until parallel with your left arm. As you exhale, bring your right knee to your chest, pressing it to your body with your right hand. We return to the starting position. Repeat 4 times.

10. Lie on your left side, left hand under your head. As you inhale, raise your right leg and arm up, and as you exhale, pull your bent right leg toward your chest, pressing it with your hand. At the same time, we also press the chin to the chest. Return to i.p. Repeat 4 times.

11. Lie on your left side, left hand under your head. As you exhale, raise your right arm up, then move it back. As you exhale, return to IP. 4 approaches.

12. Lie on your left side, left hand under your head. As you inhale, move both legs back, and as you exhale, bring your bent legs to your chest (4 times).

13. Diaphragmatic breathing. Inhale through your nose while inflating your stomach. Exhale slowly through the mouth, while simultaneously drawing in the stomach (6 times).

14. Get on all fours. Bring your leg toward your chest, then extend it back. Return to starting position (4 times for each leg).

15. Get on all fours. As you inhale, raise your right arm to the side, then bring it forward. As you exhale, return to the starting position. Repeat 4 times for each hand.

16. Get on all fours. Straighten your legs, lifting your pelvis up. Return to starting position. Legs and arms should remain in one place. Do the exercise 4 times.

17. Sit on the floor, lean back, leaning on your slightly bent arms. Raise your legs up. Return to starting position (4 times).

18. Sit on the floor, legs apart as wide as possible, hands on your belt. We try to reach the opposite toe of the foot with our hand (4 times for each hand).

19. Sit on the floor, feet shoulder-width apart, arms to the sides. We make turns with the body (4 times in each direction).

20. Sit on a chair. Place your right hand on your chest, your left hand on your stomach. We inhale slowly without the participation of the chest, the diaphragm goes down, while the stomach protrudes. This movement is recorded by the left hand. We continue to inhale, but this time through the chest. This is fixed by the right hand. The chest rises, the shoulders turn, and the head leans back a little. We begin to exhale slowly without the participation of the chest, the diaphragm goes up, and the stomach retracts. This movement is recorded by the left hand. We continue to exhale, but this time through the chest. This is fixed by the right hand. The chest drops, the shoulders come together, the head drops to the chest. We hold our breath. Repeat the exercise 6 times.

21. Sitting on a chair. Inhale, and as you exhale, pull the bent leg toward your stomach. Return to i.p. Repeat 4 times with each leg.

22. Sit near a chair, resting your hands on the chair. Stand up without lifting your arms and legs from their starting positions. The hips should form a straight line with the body if possible. Your arms can be fully straightened. The knees remain bent. Return to starting position. Do it 4 times.

23. Stand near a chair, holding the back with a bent hand. The other hand is on the belt. Bend in the opposite direction from the chair. Return to i.p. Repeat 4 times and change sides.

24. Stand near a chair, holding the back with your hand. The other hand is on the belt. Raise your leg and move it to the side. Return to i.p. Repeat 4 times and change legs.

25. Standing, hands on your belt, feet shoulder-width apart. We bend left and right (4 times in each direction).

26. Standing, arms along the body, feet shoulder-width apart. As you inhale, lift your arms up to the sides. As you exhale, we return to IP. 4 times.

27. Walking in place with high leg lifts and intense arm movements (1 minute).

28. Diaphragmatic breathing. Inhale through your nose while inflating your stomach. Exhale slowly through the mouth, while simultaneously drawing in the stomach (6 times).

In addition to performing a daily set of exercises, patients are recommended to walk and swim. In addition, to increase the effectiveness of treatment, you can perform several exercises from the complex during the day, outside of the main workout.

Exercises for the outflow of bile (for biliary dyskinesia)

Biliary dyskinesia is a disease characterized by a disorder of the motor function of the gallbladder and its ducts. As a result, the outflow of bile is disrupted, digestive problems arise, and other diseases of the biliary system begin to develop, for example, cholelithiasis.

Physical therapy for biliary dyskinesia is aimed at:

• restoration of motor function of the gallbladder and its ducts.
• normalization of the tone of the smooth muscles of the biliary system.
• increased blood supply to the abdominal organs.

The exercise therapy used will differ for different forms of the disease.

In the hypokinetic form, the outflow of bile is slowed down. Patients, as a rule, are bothered by dull, prolonged pain in the right hypochondrium, often of a bursting nature. Sometimes dyspepsia may occur. The complex of therapeutic exercises for the hypokinetic form of biliary dyskinesia meets the following principles:

• Lesson duration 15-30 minutes.
• a variety of starting positions are used: lying on your back, on your side, on all fours, sitting and standing.
• breathing exercises are included to help reduce pain, abdominal exercises, muscle relaxation exercises, and general developmental exercises for the lower and upper extremities.
• Bending and rotating the body are not recommended, as these movements can cause nausea and belching.
• the pace and amplitude of the exercises gradually increase.

The hyperkinetic form is characterized by short-term pain that occurs after physical exertion, excitement, nervous overload, and is often accompanied by nausea, vomiting, bowel dysfunction, as well as irritability and headache. The therapeutic gymnastics complex meets the following requirements:

• Lesson duration 15-20 minutes.
• starting positions: lying on your back and on your side.
• The pace of the exercises is slow and medium.
• the load is small with a gradual increase to medium.
• Breathing exercises, swing exercises, to relax muscles are recommended.
• Abdominal exercises with weights are not recommended.

During the period of complete remission for any form of dyskinesia, physical activities such as walking, swimming, skiing, and skating are acceptable. In the hypokinetic form, outdoor games and cycling are also allowed.

The first 15 exercises from the complex for cholecystitis are perfect for maintenance therapy for biliary dyskinesia. The exercises given in the position on the left side can also be performed on the right. Lying on the right side facilitates the free movement of bile to the neck of the gallbladder and along the cystic duct.

Exercises for gallstones (for cholelithiasis)

Gallstone disease is a disease characterized by the formation of stones in the gallbladder and its ducts. In its development, the disease goes through several stages and often does not manifest itself in any way even when the stones have formed. In the absence of a clinical picture, it is possible to detect the disease only by chance, for example, with an ultrasound of neighboring organs. Of the clinical symptoms, the most characteristic is acute, sudden pain under the right rib. Most often, pain appears after eating fatty, spicy, fried foods, alcoholic beverages, and heavy work, especially in an inclined position. A person may also be bothered by nausea, vomiting, and fever.

Treatment in the early stages includes, first of all, drug therapy and physical therapy, which is prescribed by a doctor only in the remission stage. In the later stages of the disease (calculous cholecystitis), as a rule, a planned operation to remove the gallbladder is indicated. Physical therapy can also be prescribed for surgery in order to speed up the patient’s recovery and prevent postoperative complications.

When compiling and performing a set of exercises in the early stages of cholelithiasis, you must adhere to the following recommendations:

• Preferred starting positions: lying on your back and on your left side.
• The pace of the exercises is slow, the number of repetitions is 4-5 times.
• the load on the press is limited; Abdominal muscle training should take place in a lying position without sudden fluctuations in intra-abdominal pressure.
• breathing and relaxation exercises are necessary.
• Exercises involving body shaking and weights are contraindicated.

Walking and swimming are useful cyclic exercises.

An approximate list of exercises for gallstone disease is presented below.

1. Diaphragmatic breathing. Inhale through your nose while inflating your stomach. Exhale slowly through the mouth, while simultaneously drawing in the stomach (6 times).

2. Lie on your back, arms along your body, legs together. We bend our legs, sliding our feet along the floor. Return to the starting position (4 times).

3. Lie on your back, legs bent, feet and knees together. Alternately tilt the closed knees in different directions (4 times). The exercise is performed after inhaling and exhaling.

4. Lie on your back, bend your legs, arms along your body. As you inhale, raise your arms up, as you exhale, raise your head and shoulders and reach towards your knees. Return to starting position. Do it 4 times.

5. Lie on your back, arms along your body, legs together. As you inhale, raise your arms up, while exhaling, simultaneously pull your legs towards your stomach, raise your head and shoulders, grab your heels with your hands and pull them towards you. Return to i.p. (4 times)

6. Lie on your back, arms along your body, legs together. As you inhale, spread your arms to the sides, as you exhale, return to the i.p. (4 times)

Insufficient physical activity and a sedentary lifestyle are one of the reasons for stagnation of bile in the gallbladder. There is special gymnastics for the gallbladder, which can help with cholecystitis, will help activate blood circulation in the abdominal area, the outflow of bile and improve intestinal motility. It is very useful to do these exercises for the gallbladder in the morning, since at night a person does not eat and bile is not secreted.

Therapeutic gymnastics includes breathing exercises that develop diaphragmatic breathing, which is especially useful for the abdominal organs. The complex includes exercises that provide a certain load on the abs, as well as exercises performed on the right side and abdomen. It’s good if you buy a large ball for practicing, on which you can lie on your stomach and swing back and forth, thereby increasing blood circulation both in the gall bladder and in the liver. The complex includes various turns and bends of the body, which are also useful for activating the work of the gallbladder and the secretion of bile.

standing

1. Start a set of exercises for the prevention of cholecystitis by walking in place, raising your knees high and vigorously waving your arms - for half a minute.

2. Then you should do a breathing exercise using the diaphragm: put one hand on your stomach and inhale - the stomach inflates, then exhale - the stomach retracts. The hand will help control the retraction and inflation of the abdomen. Breathe like this for 1-2 minutes.

Having completed a short warm-up, we now move on to the main part of the lesson.

3. Standing still, arms down, feet shoulder-width apart. As you inhale, raise your arms up, stretch, then bend down, your arms reach towards the floor (you can bend your knees slightly if it is difficult for you to do the exercise with straight legs), touch your hands to the floor (in the future, try to put your entire palm on the floor) – exhale. Repeat the exercise 5 times.

4. The starting position is the same. Rising on your toes, raise your arms up - inhale, lower yourself onto your toes, while simultaneously returning your arms to their place through the sides - exhale. Repeat the exercise 5 times.

5. The starting position is the same, just place your hands on your belt. Do 5-10 squats, but you don’t need to squat deeply so as not to put too much strain on your knees, especially if they hurt. You need to breathe like this: as you exhale, do a squat, and return to the starting position as you inhale. You can rest your hands on the back of a chair while performing this exercise.

6. The starting position is the same, i.e. hands on the belt. Bend your torso forward and then back. Perform 5 bends in each direction. Breathing is voluntary.

7. The starting position is the same. Bend your torso left and right. Perform 5 bends in each direction. Breathing is voluntary.

8. The starting position is the same. Make circular movements with your body clockwise - 5 rotations and then counterclockwise for 5 rotations. Breathing is voluntary.

9. Stand against the back of a chair or table and holding onto them with your hand, begin to swing your legs forward and then back. Perform 5 swings with each leg, breathing randomly.

10. Starting position - legs stand slightly wider than shoulders, lower your arms along your body. Leaning forward, touch the floor with your right hand at your left foot, and your left hand goes up. Then do the same by changing the position of your hands. Breathing is voluntary.

11. Standing still, hands on your belt, feet shoulder-width apart. We will make turns of the body - start turning the body together with the head, first in one direction, and then immediately in the other direction. In this case, the hips remain in place, and you yourself seem to “twist” during these movements. Make 5 twisting movements with your torso in each direction.

12. The last exercise in a standing position is for relaxation and breathing. Spread your arms to the sides as you inhale, lower your arms forward, making a half-tilt - exhale. Repeat the exercise at least 5 times.

Lying down

13. Starting position – lie on your back, stretch your legs forward, place your arms along your body. Let's start the exercises while lying on the floor with a breathing exercise on the diaphragm: put your hands on your stomach, inhale - your stomach protrudes, then exhale, lowering your stomach. Do 5 of these breathing exercises.

14. The starting position is the same. Sliding your foot along the floor, bend your leg at the knee, and then straighten it, without lifting your heel off the floor. Do the same movement with the other leg. Repeat 5 movements with each leg. Breathing is voluntary.

15. The starting position is the same. Having bent both legs at the knees, lift them at the same time, pressing them to your stomach - exhale. In this case, the upper back and head should be raised, try to reach your knees with your head. While inhaling, return to the starting position. Repeat the exercise at least 5 times.

16. Starting position – lie on your back, bend your knees, place your arms along your body. Inhale - straighten one leg up, exhale - return to the starting position. Perform the same movement with the other leg. 5 movements with each leg.

17. The starting position is the same. Lower your legs bent at the knees, first to your right on the floor, and then to your left. Make 5 movements in each direction. Breathing is voluntary.

18. Starting position – lie on your back, stretch your legs forward, place your arms along your body. Bend your leg and pull one knee towards your chest, exhale. Then straighten your leg and straighten it up (you can keep your knee slightly bent if you find it difficult to fully straighten your leg), inhale. Do the same movement with the other leg. 5 movements with each leg.

19. Starting position is the same. Raise your straight arms and place them behind your head - inhale, lift your straight leg up and, as you exhale, reach your hands towards its toe. As you inhale, lower your leg and arms. Do the same movement with the other leg. 5 movements with each leg.

20. The starting position is the same. As you inhale, raise your straight arms up, then bend your legs and hug them with your arms, raise your head - exhale. Repeat this exercise 5 times.

21. At the very end of the exercises, lying on your back, do a “bicycle” - spinning imaginary pedals first in one direction and then in the other direction. One minute each way.

If you are not tired, then we will continue the set of exercises further - lying on your right side.

22. As always, we start with diaphragmatic breathing: place one hand under your head and the other on your stomach. Inhale - the stomach protrudes, then exhale - the stomach retracts. Repeat the breathing exercise 5 times.

23. The starting position is the same - lying on your right side, bend your legs, put one hand under your head, and lean the other in front. Straighten your leg back - inhale, bend it and pull it to your chest - exhale. When performing this exercise, at first you can slide your knee along the mat. Repeat 5 times.

24. Starting position - lie on your right side, bend your legs, place one hand under your head, and lean the other in front of you. As you inhale, raise your leg and arm, then lower it - exhale. Do the same movements, turning over on the other side, with the other leg and arm. 5 times on each side.

25. The starting position is the same. As you inhale, move your leg back, and as you exhale, return your leg forward. Do the same movement by turning over to the other side. 5 times on each side.

Now let's roll over onto our stomach and do a few exercises while lying on our stomach.

26. Again, I start abdominal exercises with diaphragmatic breathing. As you inhale, stick out your stomach. As you exhale, draw in. Do 5 breathing exercises in this position.

27. Starting position too - lying on your stomach, begin to make movements with your legs and arms as if you were swimming breaststroke. Try to keep your head, arms, shoulders and legs up. Breathing is voluntary.

28. Now place your hands under your shoulders and go to all fours, squat on your heels. Breathing is voluntary. Do 5 spring squats on your heels.

29. We continue to perform a set of exercises in a position on all fours. Take your leg back and up - inhale, as you exhale, the knee goes to the chest. Do the same movements with the other leg. 5 movements with each leg.

30. Standing on all fours, bring your legs together and squat to the side next to your heels, first on the left and then on the right. Repeat squats to the side 5 times to the left and the same number to the right alternately. Breathing is voluntary.

31. Inhale, lean on your hands and toes and straighten your legs, raising your pelvis - exhale. Repeat the exercises 5 times.

32. Finish the exercise on all fours with diaphragmatic breathing. Inhale - sticking out your stomach, exhale - pull in your stomach. Do the diaphragmatic breathing exercise 5 times.

33. The final part of the set of exercises - stand up and finish the set of exercises by walking in place, then do diaphragmatic breathing again while standing and finish with free breathing.

In addition to regularly performing this set of exercises for cholecystitis, do not forget about the need for daily walks in the fresh air; it is also useful for you to engage in swimming, dancing, i.e., everything that will strengthen the functioning of the gallbladder and promote the secretion of bile.

Your Izest wishes you success in performing gymnastics for the gallbladder and good health. More articles on this topic:

Exercise therapy for hypotension - low blood pressure

Strengthening exercises for the heart

Therapeutic exercises for joints

A set of breathing exercises and cleansing breathing of yogis

tvoyaizuminka.ru

Exercises for cholecystitis: what loads are effective

Many people are familiar with pathology of the biliary tract, such as chronic cholecystitis, firsthand. Drug therapy alleviates the patient’s condition, but during the period of remission time should be devoted to active prevention of the disease. Thus, specially designed exercises for cholecystitis will promote the outflow of bile, improve blood circulation in the peritoneum and normalize the functioning of the gastrointestinal tract. If you practice regularly, this will help avoid seasonal exacerbations of the disease.

Is it possible to play sports with cholecystitis?

Chronic cholecystitis manifests itself against the background of biliary dyskinesia, which provokes stagnation of bile, inflammation of the bladder, and in the future a stone may even form. The disease is characterized by pain in the area of ​​the organ, radiating to the right side and under the shoulder blade. Chronic cholecystitis may appear (exacerbate) under the influence of such factors:

• bile stagnation;
• hypothermia;
• bacterial flora;
• eating fatty, spicy foods;
• inflammation of other organs (tonsillitis, pneumonia).

Another reason for stagnation of bile (with subsequent exacerbation of cholecystitis) is physical inactivity and muscle weakness associated with it, especially weakness of the abdominal muscles. Therefore, any exercise therapy complex for cholecystitis has the following goals:

• improved metabolism;
• normalization of the gastrointestinal tract;
• activation of blood circulation in the abdominal area;
• restoration of peristalsis of the gallbladder and its ducts.

Therefore, sports and physical education are mandatory components of preventing exacerbation of the disease and they are not only possible, but also necessary to do.

Permissible physical activity for cholecystitis

As already mentioned, the physical complex begins to be practiced during the period of improvement. At first, you need to practice strictly in certain initial positions (IP). Separate training is used to ensure optimal peristalsis and emptying of the bile reservoir. They are performed in a supine position, on the left, right side and on the knees.

It is believed that the position on the side is especially beneficial for the unhindered outflow of bile.

Bending and lifting the limbs and bending the body are good for removing the contents of the gallbladder and improving blood flow. Any exercise therapy session includes moderate general strengthening exercises for all muscle groups. Such group training, as a rule, lasts no more than half an hour, so as not to plunge the body into stress.

To ensure a positive emotional mood, specialists resort to exercises with equipment and game paraphernalia. In addition, gymnastics aimed at relaxing muscles is often practiced. But instructors call for limiting exercise therapy positions that provoke organ concussions, so shaking should be excluded - jumping, jerking, and sudden movements should be avoided.

A set of exercises for illness

In the first 7 days, when performing a physical complex, they focus on exercises 1, 9 and 10, and by the 14th day they add another 6, 7, 11. By the end of the month of classes, the entire complex is already performed. The frequency of repetitions of any gymnastics position is 2–3 times, with increasing fitness – 6–8 times. At first the pace is slow, and then average. It is advisable to perform this set of exercises in the morning, since due to the lack of food at night, bile is not secreted.

The first set of exercises is done lying on your back.

1. Hands are on the solar plexus, diaphragmatic breathing is practiced: inhaling, bring out the stomach, and exhaling, lower it.
2. The arms are extended along the body. Alternately bend one or the other lower limb, without lifting the heels from the floor.
3. Palms are placed at the shoulders. Inhaling, the upper limbs are directed forward, and with exhalation they are returned to the shoulders.
4. The lower limbs are in a bent position. Alternately straighten the right and left legs.
5. IP the same. Inhaling, make alternating bends to one side.
6. With an inhalation, bend one of the lower limbs and pull the knee joint towards the body. Exhaling, the leg is extended and the leg is changed.
7. IP - the upper limbs are extended behind the head. As you inhale, raise your leg and stretch your fingers towards its toe; as you exhale, lower them and change legs.
8. Inhaling, they bend their lower limbs and try to grab them with their upper limbs, raising their head.

The next exercise therapy is performed while lying on your side.

1. One hand behind the head, the other on the press. Practice diaphragmatic inhalation and exhalation.
2. The lower limbs are bent, one arm is behind the head, the other is extended up the mat. As you inhale, one of the legs is straightened, and as you exhale, it is brought to the chin.
3. As you inhale, move your right arm and leg to the side, and as you exhale, lower it.
4. Inhaling, move the left leg back, exhaling, lead the right lower limb forward.
5. The exercises are performed in a position lying on the stomach.
6. Diaphragmatic breathing: inhaling - move the stomach out, exhaling - draw in.
7. The hands are placed under the shoulders, and the elbows are pressed to the ribs. With the extension of the upper limbs, the lower limbs are flexed, gradually reaching a position of standing on all fours. Then they sit on their heels.

Exercises in the pose on all fours

1. One by one, inhaling, raise the leg, exhaling, bring the knee to the body. Next, the limbs are changed.
2. Inhaling, they bend their back in an arc, exhaling, they find themselves in IP.
3. Diaphragmatic gymnastics: protruding the abs while inhaling and pulling them up as you exhale.

Exercises in a standing pose.

1. Walk in place for 30–60 seconds.
2. Inhaling, stretch your hands up, and exhale, bend forward, trying to reach your fingers to the floor.
3. IP – upper limbs at the waist. Inhaling, lift up on your toes. Next, bend one lower limb, and walk the toe of the other along the floor until a full lunge, with which they exhale. Then they change limbs.
4. Alternately swing forward and backward with one or the other leg.
5. IP – upper limbs to the sides. Lean forward and try to touch the floor with your fingers. Then the upper limbs are replaced.
6. Slowly jog for 1–5 minutes.
7. As you inhale, spread your arms to the sides; as you exhale, lower your limbs forward with a half-tilt.

Gymnastics for pathology

As you may have already noticed, gymnastics includes breathing training that develops diaphragmatic breathing. This is a particularly beneficial load for the peritoneal organs. But you should understand: such activity entails significant changes in intra-abdominal pressure, so it is recommended only at the recovery stage. It is important to carefully monitor the absence of pain.

Here are a few exercises of such gymnastics, the load of which will be more intense.

1. IP – standing, placing the upper limbs on the hips. Next, take a leisurely, not particularly deep breath, drawing in your stomach, after which you need to quickly and forcefully exhale.
2. IP – previous. Take a sharp, intense breath, drawing in your stomach as much as possible, holding your breath for 6–8 seconds. After this time, exhale and relax the abdominal muscles.
3. IP - standing. Take a leisurely breath for 1-2 seconds, then hold the air for another 2 seconds. This exercise requires several repetitions.
4. Sit in a sitting position with your lower limbs tucked in. The back should be straight and the upper limbs should be placed on the knees. They lower their head in a relaxed manner and close their eyes. You should completely relax the muscles of the lower and upper extremities, shoulder girdle, neck and face. Next, take a leisurely medium breath, and again hold the air for 1-2 seconds.

Sports for cholecystitis

Physical activity during illness is not contraindicated; moreover, it is a certain preventive measure that protects against seasonal exacerbations of the disease. But many people wonder: is it possible to engage in professional sports with such an illness. It is worth reassuring everyone who is concerned that the disease is not a contraindication to certain sports.

You can and should play sports. So, in addition to active walking, patients with chronic cholecystitis can easily engage in swimming, rowing, and they also have access to skiing and skating.

As for other sports, you should forget about them. Especially if they involve jerking, sudden movements, turns and jumping.

Patients will also benefit from physical work around the house or in the garden, if it does not contradict the requirements for physical activity. In addition, it is very important that patients follow the regime, pay special attention to their own nutrition, excluding unwanted dishes from the menu, and then the patient’s life will not be much different from the life of completely healthy people.

prozhelch.ru

Common methods of physical rehabilitation:

• Factors contributing to the occurrence (exacerbation) of the disease:
  • Various bacterial flora.
  • Excessive consumption of fatty and spicy foods.
  • Hypothermia.
  • Inflammation of other organs (pneumonia, sore throat, etc.).
  • Stagnation of bile in the gallbladder.
  Objectives of physical education:
  1. Activation of peristalsis of the gallbladder and bile ducts.
  2. Improving blood circulation in the abdominal cavity.
  3. Normalization of stomach and intestinal function.
  4. Improvement of general metabolism.
  Indications and contraindications for physical exercise for chronic cholecystitis
• Self-massage techniques and physical exercises are recommended for acalculous chronic cholecystitis. Self-massage has a pain-relieving effect, relieves tension in the abdominal muscles, and helps empty the gallbladder. Specially selected physical exercises activate the peristalsis of the gallbladder and bile ducts, improve blood circulation in the abdominal cavity, increase the outflow of bile into the duodenum, they help normalize the function of the stomach and intestines. General metabolism and well-being improve. You can start self-massage and physical exercise with the permission of a doctor, without exacerbation of the disease - when there is no pain in the right hypochondrium, and the temperature is not elevated. If physical exercises and self-massage are performed correctly, then you will feel good, and most importantly, there will be no pain in the right hypochondrium. We recommend counting your pulse before and after exercise. If it increases by no more than 10 beats/min compared to the original, this is acceptable; if more, it is better to reduce the load. Such self-control will help to use the proposed complex more effectively. Self-massage prepares the body well for physical activity. It is better to do it in the morning or afternoon before meals. Before each use, be sure to relax the muscles being massaged. Breathing is free, without delay. Before class, it is advisable to empty your intestines and bladder. Each self-massage technique must be repeated 5-7 times and must be completed with stroking. The duration of self-massage, depending on how you feel, is 3-5 minutes.

  Self-massage of the abdomen.

  Lie on your back, with a small pillow under your head, legs bent, standing on an ottoman. Using the fingers of both hands (thumbs on top, all others below), grasp, as if with forceps, the lower edge of the chest to the right and left of the sternum. Carry out, sliding along the costal arch, straight rubbing on both sides of the sternum. Place your right hand on the right lower abdomen, and your left hand on your right hand. Stroking the stomach in circles in a clockwise direction, first superficially, and then with pressure. The circles narrow towards the navel and then widen again. Bend your right hand slightly and place your fingertips into the abdominal wall. Make rotational, kneading movements in narrowing circles, and from the navel in the same direction in expanding circles throughout the abdomen. Release the pressure above the pubis. Do not clench your fists very tightly and place them on the sides of your stomach. Making rotational movements with the phalanges of bent fingers, move them to the middle of the abdomen, and then down to the groin. Treat the entire abdomen in a similar manner.

• In the first week of classes, exercises No. 1, 9, 10 and again No. 1 are done. During the second week, No. 6, 7, 11, 13, 24, 25 are added to them, and within about a month - all the rest. The outflow of bile and activation of blood circulation in the abdominal cavity are facilitated by bending the legs, lifting them, and bending over. At first, the exercises are done with a small amplitude so as not to cause pain in the right hypochondrium. After about 3-6 weeks of training, if your health improves, perform exercises with a maximum range of motion, and diaphragmatic breathing - with active retraction of the abdomen during exhalation. The number of repetitions of each exercise is 2-3 times, and as fitness increases - 6-10 times, the pace is slow at first, then medium. Do not make sudden movements, jumps, jumps. 1. Hands on your stomach. Diaphragmatic breathing: inhale, protruding your stomach; exhale, lowering your stomach. In the first days of classes, the protrusion and lowering of the abdomen is insignificant, and only after 2-3 weeks, if classes are regular, the amplitude of these movements is maximum.

  2. Arms along the body. Bend, then straighten your right leg, without lifting your heel from the carpet, do the same with your left leg. Breathing is voluntary.

  3. Hands to shoulders. Hands forward - inhale; bend towards the shoulders - exhale. 4. Legs are bent. Inhale, straighten your left leg - exhale. Same with the right foot. 5. Legs are bent. Tilt of legs to the right, i.p. left, i.p. Breathing is voluntary. 6. Inhale, bend your left leg and pull your knee to your chest - exhale. Extend your leg - inhale. Same with the right foot. 7. Arms up (straightened behind the head). Inhale, raise your right leg, reach your hands to its toe - exhale. Lower your leg - inhale. Same with the left foot. 8. Legs straight. Hands forward - inhale. Bend your legs, clasp them with your hands and raise your head - exhale. Lying on the right (left) side. 9. Diaphragmatic breathing: right hand behind the head, left hand on the stomach; inhale - the stomach protrudes, exhale - lowers. 10. Legs bent, left hand behind head, right hand up on the carpet. Straighten your left leg back - inhale; pull to the chest - exhale. Options: A. the foot slides on the carpet. B. without touching the carpet. The same, but on the left side. 11. Raise your left leg and arm to the side - inhale; lower - exhale. Also on the left side. 12. Take your left leg back - inhale, left leg forward - exhale.

  The same lying on the left side.

  13. Diaphragmatic breathing: inhale, protruding your stomach; exhale, drawing in your stomach. 14. Palms under shoulders (elbows pressed to ribs). Extending your arms and bending your legs, move to a standing position on your knees (“all fours”), then sit on your heels. Breathing is voluntary. Stand on your knees (“all fours”) 15. Raise your left leg - inhale; knee to chest - exhale. Same with the right foot. 16. Inhale; Standing in a bent position (resting on your palms and toes, straighten your legs, raising your pelvis) - exhale. 17. Diaphragmatic breathing: inhale, protruding your stomach; exhale, drawing in your stomach. 18. Walk for 0.5 -1 minutes, with high hip lifts. 19. I.p. – o.s. Stretch your arms up - inhale; lean forward, trying to touch the floor with your fingertips, exhale. 20. I.p. – o.s. Hands on the belt. Rise on your toes - inhale; bending your right leg, slide the toe of your left leg back along the floor until your right leg lunges - exhale. The same, but bending the left leg. 21. I.p. – o.s. Swing your left leg back and forth; breathing is voluntary. Same with the right foot. 22. I.p. – o.s. Hands to the side. Bend forward, trying to touch the floor with your right hand. Breathing is voluntary. Same thing with your left hand. 23. Run at a slow pace for 1-5 minutes. 24. Walking is normal, breathing is full; then when walking, arms up - inhale, arms down and half-squatting - exhale; swing your arms one step left - to the left, one step right - to the right. Duration 2-3 minutes. 25. I.p. – o.s. Hands to the sides - inhale; lower your arms with a half-tilt forward - exhale. In addition to self-massage and recommended exercises, those suffering from acalculous chronic cholecystitis will benefit from walking, swimming, rowing, rhythmic walking on flat terrain, skiing, and skating. Physical labor at home and in the garden that is not associated with sudden movements, jerks, or jumps is also useful.

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Gymnastics for the gallbladder for various diseases

The role of the gallbladder in our body is to store bile and release it in doses for digestive needs. Bile secretion activates the movement of food through the intestines and facilitates the absorption of fats. Up to 2 liters of bile come from the liver per day; its supply is regulated by the sphincter located at the junction of the bile duct and the intestine.

If a malfunction occurs in the bile supply system, this leads to the development of pathologies of the biliary organs and the gastrointestinal tract. One of the methods for correcting the motility of the gallbladder and its ducts is exercise therapy.

What problems does exercise therapy solve?

Ukrainian cardiac surgeon Academician Amosov spoke about the benefits of physical education for biliary dyskinesia, cholecystitis and cholelithiasis. He wrote that the success of treating these pathologies largely depends on physical activity.

Therapeutic exercises stimulate the processes of muscle metabolism, have a beneficial effect on the regulatory activity of the nervous system, and activate the movement of blood and lymph vessels. During their implementation, a greater amount of hormones and bioactive substances necessary for the harmonious functioning of organs enters the blood.

An absolute contraindication for gymnastics is the period of the acute phase of cholecystitis (fever, severe pain), and in case of cholelithiasis - signs of stone displacement.

Basic exercises

The main complex of exercise therapy for the treatment and prevention of ADHD is exercises for the abdominal muscles and techniques for developing diaphragmatic breathing. When they are performed, intra-abdominal pressure increases, this helps accelerate the release of bile and prevent its stagnation. It is best to do gymnastics in the morning, before breakfast, emptying the bladder and intestines. The number of repetitions of each exercise is 3-6 times. The room where the lesson is held should be well ventilated.

Exercises in a standing position

1. Place your hands on your hips and inhale slowly, then exhale quickly.
2. Hands down. Inhale, hold your breath for 5-8 seconds, then exhale with your abdominal muscles relaxed.

Exercises in the position on all fours

1. Move your leg forward, then return it to the starting position. Repeat, changing leg.
2. Alternately bend your lower back down and up, holding each position for a few seconds.
3. Bend your arms, lower yourself onto your stomach, then rise back up onto all fours.

Exercises in a lying position

For the free movement of bile, the best position is “lying on your left side.” It gives the greatest effect from therapeutic exercises. If you lie on your right side, the movement of bile will be hampered by gravity.

1. The left arm is straight, the leg is bent. The right limbs work like a pump: the arm rises and falls, the leg either bends, pressing against the chest, or straightens.
2. Perform the previous exercise, tilting your head while bending your leg.
3. Press both legs towards your stomach, then straighten them.

The video shows another version of exercises for the gallbladder in a lying position.

Gymnastics for cholecystitis

If the gallbladder is inflamed, physical therapy is allowed only during the period of remission. To the basic exercise therapy techniques, you should add several special exercises that help relieve spasms, reduce pain, and stabilize blood flow. They are performed lying on your back, the optimal number of repetitions is from 5 to 10.

1. Raising and lowering your arm, bend and straighten the opposite leg.
2. Keeping your hands on your waist, lift your shoulders off the floor, hold for a few seconds, then lie flat.
3. Place your left hand on your chest, your right hand on your diaphragm, breathe through your stomach, feeling the movements of the abdominal wall with your hands.

The video shows exercises for cholecystitis from Vasily Volkov, candidate of biological sciences.

Gymnastics for bending the gallbladder

With this pathology, stagnation often occurs. Physiotherapists recommend performing exercises daily, which include, in addition to basic techniques, several aimed at facilitating the process of supplying bile from the deformed organ to the intestines.

1. Lie on your stomach with your arms bent. While doing push-ups, lift your torso off the floor, hold for a few seconds, then return to a lying position.
2. Lie on your back, hands under your head. Gradually raise your legs. When the angle between your legs and the floor reaches 30 - 45°, lower your legs.
3. Lying on your stomach, stretch your arms in front of you and make rowing movements with them, try to keep your head and legs suspended.

The video shows another set of exercises to improve the functioning of the liver and gall bladder.

Gymnastics for gallstone disease

If salt conglomerates are found in the gallbladder, only light exercises can be done, since muscle tension can cause the stone to dislodge, and it will block the bile duct.

The exercises are performed lying on your back, the last two - lying on your left side. The pace of execution is slow, breathing is uniform: inhale when performing a gymnastic technique, exhale when returning to the starting position. Number of repetitions: 5-6.

1. The arms lie along the body. Bend and straighten your legs, moving your feet along the floor with sliding movements.
2. Bend your knees and tilt them in both directions.
3. Raising your torso, touch your knees with your palms, then return to the starting position.
4. Move your arms like wings - spread them to the sides and press them to your body.
5. Alternately raise opposite arms and legs up.
6. Bend at the waist, move your right leg back, then pull your knee to your chest. Return to starting position.
7. Repeat the previous exercise using both arms and legs.

Exercise therapy after gallbladder removal

In the absence of complications, gymnastics can be started 4-8 weeks after surgery, at least a year after cholecystectomy daily, then every other day. Gradually increase the number of repetitions from 2-3 to 5-6. The first 3 exercises are performed standing, the last 3 - lying on your back.

1. Place your hands on your shoulders, raise your elbows to the sides - up, then lower.
2. Raise your clasped hands above your head, then lower your arms, spreading them to the sides.
3. Keeping your feet shoulder-width apart, rotate your torso.
4. Raise your legs above the floor and spread them apart. Alternately raise your legs, slightly raised above the floor, one above the other (the “scissors” technique).
When gallbladder hurts symptoms

In women, chronic cholecystitis occurs 2-7 times more often than in men. And one more pattern. It is diagnosed mainly in those over 40 and who are overweight.

Thus, the first advice to everyone, and especially women, is not to accumulate extra pounds, but for those who are already burdened with this burden, try to gradually lose it. To do this, you need to sharply limit sweets and flour dishes, arrange a fasting day once a week: rice-compote, cottage cheese-prunes. For patients with cholecystitis who are overweight, apple-honey and berry-honey days are recommended, since honey is good for the liver. If, for example, you want to have a berry-honey day, then during the day eat a kilogram of any berries (black currants, raspberries, strawberries) and 50 grams of honey (5-6 teaspoons) in 5-6 meals.

I would like to emphasize that in the prevention of exacerbations of chronic cholecystitis, a balanced diet and adherence to the necessary diet play a leading role. You need to eat often, 5-6 times a day and little by little, because every time food enters the stomach and then into the duodenum, the gallbladder contracts and empties, releasing bile necessary for the normal digestion process. This prevents stagnation of bile in the bladder.

Food should not be too hot and not very cold. Outside of exacerbation of cholecystitis, vegetarian (vegetable and cereal) and dairy soups are allowed; main courses from lean beef, fish and chicken, boiled or steamed in pieces or in the form of quenelles, meatballs, rolls; boiled vegetables - potatoes, carrots, beets, zucchini, pumpkin and dishes made from them; occasionally (1-3 times a week) in a small amount of porridge, preferably oatmeal and buckwheat, puddings. For those who have normal body weight, products made from soft dough, yesterday's or dried bread, as well as noodles, vermicelli, pasta.

Don't forget about vegetable oil (sunflower, corn, olive). It has a choleretic effect, and therefore 30-40 grams of oil should be added daily as a seasoning to dishes.

REMEMBER what dishes are strictly contraindicated for you. These are all baked pastries, cakes and pies with cream, fried pies, belyashi, pancakes and pancakes, fried vegetables; rich meat, fish, chicken and mushroom soups, fatty meats, especially fried, pork, lamb, goose, duck, spices, all canned food, pickles and marinades (including homemade ones!), sorrel, spinach, onions, garlic.

Smoking and all alcoholic beverages, including beer, have an extremely adverse effect on the course of cholecystitis. Both nicotine and alcohol disrupt the motor function of the gallbladder, leading to stagnation of bile in it and exacerbation of the inflammatory process.

It has been noted that exacerbation of chronic cholecystitis often occurs against the background of physical or psycho-emotional stress. It even happens that any quarrel, unpleasant conversation at home or at work contributes to the occurrence of an attack of pain in the right hypochondrium in those suffering from cholecystitis. Of course, it is impossible to completely protect yourself from worries and negative emotions. However, we must try to avoid them, work systematically, without rush jobs, maintain a daily routine, be outdoors, and sleep 7-8 hours.

Don't neglect your morning exercises, walk more. This is useful for everyone, but doubly useful for those suffering from cholecystitis, since physical activity favors the emptying of the gallbladder. You can also contact a medical and physical education clinic, and the doctor will select a set of special exercises for you.

Women suffering from cholecystitis should not wear tight belts, bras and laces, and sick men should not tighten the belt on their trousers too tightly. By squeezing the gallbladder, you thereby disrupt its motor and contractile function, which contributes to the development of stagnation in it.

To avoid exacerbation of cholecystitis, do not take any medications without the knowledge of the doctor observing you, including for the treatment of any concomitant disease, for example, radiculitis or hypertension, since there are medications that can sharply worsen the course of cholecystitis and contribute to the occurrence of complications.

In consultation with your doctor, you can take multivitamins, especially B vitamins, to prevent exacerbation, since they have a choleretic effect. It is a good idea to carry out a course of treatment with mineral waters, as they stimulate the processes of bile formation and bile secretion, improve the motor activity of the gallbladder, and dilute bile. The recommended mineral waters are Arzni, Borjomi, Jermuk, Mirgorodskaya, Sairme.

Of course, it is impossible to list all the mineral waters; each region of the country has its own local waters, and the doctor prescribes those that are necessary for the treatment of cholecystitis, taking into account concomitant diseases of the digestive system.

It is recommended to drink a glass of mineral water heated to 40-45° 3 times a day 30 minutes before meals if the acidity of the gastric juice is low, 45-60 minutes before if the acidity of the gastric juice is normal, and 1.5 hours before if the acidity is high. The course of treatment is 24-30 days.

Outside of an exacerbation, the doctor may prescribe a so-called tubeless tube with mineral water. It prevents congestion in the gallbladder. Tubage is carried out once every 7-10 days as follows: in the morning on an empty stomach, lying in bed on the right side, you need to drink 1-2 glasses of heated mineral water without gas in small sips for 10-15 minutes, and then lie down with a warm heating pad for 30-40 minutes. For those patients whose contractile function of the gallbladder is weakened, to enhance the secretion of bile, the doctor usually recommends adding 1/2 teaspoon of Carlsbad or bitter salt (magnesium sulfate) to a glass of water. The doctor will tell you how many tubes need to be done.

Some patients strive at all costs to undergo a course of sanatorium-resort treatment, to go to any balneological resort. But is this really necessary? I would like to warn you: the choice of a sanatorium or a mineral spring must strictly comply with the indications, and the issue of purchasing a voucher should be decided only after consulting a doctor.

In general, patients with cholecystitis need to be in close contact with their doctor. After all, they are registered with a dispensary and are required to undergo regular examinations. This allows the doctor to timely identify changes in the course of the disease, prescribe one or another treatment, and ultimately prevent an exacerbation or complication of cholecystitis. But, unfortunately, many people do not use this opportunity...