(September 21, 2018 Dr. Tsang has a question and answer session)

The treatment of cholecystitis is usually not one particular medicine that provides complete relief, but rather a systematic treatment with a set of combinations to get better.

At present, the main cause of cholecystitis is gallbladder stones, except for surgery, slightly larger gallbladder stones (>3mm), can not be treated with conventional methods to make it naturally discharged. This is because the diameter of the normal gallbladder duct is usually 3-4mm.

One of the causes of cholecystitis is that the activity of gallbladder stones damages the neck of the gallbladder or gets stuck directly in the neck of the gallbladder, which makes the neck of the gallbladder edematous, and there is an obstacle to the excretion of bile, and the high concentration of bile acids is cytotoxic, which aggravates the edematous condition of the gallbladder and the inflammation of the gallbladder; and the other is that the bacteria in the intestinal tube retrograde infection of the gallbladder, which causes the gallbladder to become inflamed.

For both of these reasons, the best medication for treating cholecystitis can be a combination of the following medications.

① Anti-infection:Cephalosporin II or III are routinely used, as well as quinolones such as cefuroxime tablets, cefoperazone sulbactam, and levofloxacin, which are antibiotics that are better at killing intestinal bacteria.

② Antispasmodic:Gallbladder pain is due to the presence of an infection or the development of gallbladder spasm, which can be significantly relieved with antispasmodic medications, and can be relieved with atropine-based medications, such as scopolamine infusion tablets, rinsed scopolamine tablets, scopolamine butylbromide, and resorcinol.

(iii) Suppression of gastric acid:Gastric acid acts as a trigger to initiate bile excretion, and excess gastric acid causes gallbladder contraction, aggravating edema and pain, which can be treated with proton pump inhibitors such as omeprazole, pantoprazole, and rabeprazole.

④ In addition to medication, a light, semi-liquid diet is recommended as much as possible during the treatment period, as too much oily food will increase the burden on the gallbladder. There are always oral ursodeoxycholic acid lithotripsy articles on the Internet, this may have a role in bile pigment crystals, but the effect is very slight, taking a long time, side effects, generally not as a routine use of drugs.

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Cholecystitis is divided into acute cholecystitis and chronic cholecystitis. Nearly 90 percent of cholecystitis cases have gallbladder stones, so gallbladder stones have a direct role in triggering cholecystitis.

To say what is the best medicine for cholecystitis, Xiao Ke thinks that most of the drugs for cholecystitis are symptomatic drugs, because cholecystitis caused by bacterial infection and spasmodic contraction of the gallbladder has a certain relationship, so in the presence of epigastric pain triggered by cholecystitis and nausea and vomiting, most of the antibiotics and antispasmodic drugs used to symptomatic treatment. However, these two drugs can only temporarily inhibit and relieve the inflammation of cholecystitis, but not completely remove the cause of the disease.

Because the most important cause of cholecystitis is gallbladder stones, but the current use of drugs to remove gallbladder stones is fundamentally no drug, such as ursodeoxycholic acid and goose deoxycholic acid, although the role of stone dissolution, but for some of the more hard stones have little effect, and most of these stone dissolving drugs have more and more serious side effects, it is not recommended that patients with gallbladder stones to take.

So what is the correct response to gallbladder stones with cholecystitis?

Kirk believes that the first thing that patients with gallbladder stones and cholecystitis should do is to eradicate the cause of the disease, such as avoiding the intake of high-fat and greasy foods and alcohol. The second thing to do is to review the disease on a regular basis to determine the size of the gallbladder stones and the inflammation of the gallbladder (ultrasound). When the condition of the gallbladder is amenable to surgery, it should be treated surgically to avoid delay and aggravation of the disease.

These are the views of Xiao Ke, welcome your questions and additions, pay attention to Xiao Ke, to learn more about health knowledge.

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What is the best medicine for cholecystitis?

When it comes to cholecystitis, I guess no one is unfamiliar with it, it is a relatively common disease of the biliary tract. Although we have all heard of cholecystitis in one way or another, we probably don't know much about it, so today I'm going to share some knowledge about cholecystitis.

1. What are the types of cholecystitis?

There are 2 main categories, acute cholecystitis and chronic cholecystitis;

2. What are the symptoms of cholecystitis?

• Digestive symptoms:Such as nausea, vomiting, and constipation;
• Pain in the right upper abdomen:The pain can radiate to the right shoulder, scapula, and back, and is often triggered by satiety and eating fatty foods;
• A few patients develop jaundice;
• Fever;

3. What are the medications used to treat cholecystitis?

The causative organism of cholecystitis is mainly gram-negative bacteria, the most common of which is Escherichia coli, and it can be treated with antibacterial, analgesic, and cholagogic treatment, the specific drugs are as follows:

Three generations of cephalosporins:Examples include ceftriaxone, ceftazidime, and cefotaxime;

Quinolone antibiotics:Such as levofloxacin and norfloxacin;

choleretic drug:: Cholestyramine, ursodeoxycholic acid;

3. In which cases does cholecystitis require surgery?

• Acute onset is within 48 to 72 hours;
• Those who have poor results or worsening condition after conservative treatment;
• Comorbidities such as gallbladder perforation, diffuse peritonitis, acute suppurative cholangitis, and acute necrotizing pancreatitis.

Final Summary: The medications commonly used for cholecystitis are listed above and will not be repeated here.

The above is my answer to the question, purely hand-typed, it is not easy, if you feel that the writing can be rewarded with a praise, if you have any questions you can leave a message below ......

In the emergency room has seen too many cholecystitis, gallbladder stone patients, some patients are recurring attacks, every two or three months to the infusion, what greasy food do not dare to eat, eat uncomfortable, serious impact on the patient's work and life. Often patients will ask, my cholecystitis why recurring attacks, what can be a way to cure cholecystitis, there is no special drugs.

I would like to tell all cholecystitis patients that there is a "special medicine" for cholecystitis, but it is not a medicine, it is a surgery to remove the gallbladder. For cholecystitis patients who have had one episode of cholecystitis, surgery can be performed to remove the inflamed gallbladder.

Some patients may not understand why a good gallbladder has to be removed, and does removing the gallbladder have a great impact on the body?

In fact, everyone is wrong, acute cholecystitis attack, you can infusion, the use of antibiotics to treat, most patients after infusion treatment, can get better. However, most patients will recur or turn into chronic cholecystitis. Even if you eat a light diet every day and don't dabble in meat and fish, cholecystitis may recur, seriously affecting your work and life.

Both foreign and domestic clinical guidelines recommend surgical removal of the gallbladder whenever there is a history of an acute attack of cholecystitis. Laparoscopic cholecystectomy is a minimally invasive treatment that is minimally invasive, with quick recovery and only a few small surgical scars on the stomach.

The main function of the gallbladder is to store and concentrate bile, but bile is secreted by the liver, not by the gallbladder. Most patients, after gallbladder removal, will not experience any significant complications or significantly affect their lives. People should not shy away from treatment and listen more to the doctor's advice.

This question is broad and requires clarification of exactly what type of cholecystitis is being referred to in the question: acute infectious cholecystitis? Non-infectious cholecystitis? Personally, I suspect that the former is more likely, so I will answer the question about medication for acute infectious cholecystitis.

Acute infectious cholecystitis is usually a mixed infection of many bacteria, usually intestinal flora: Escherichia coli, Klebsiella, Enterobacter, etc., while anaerobic bacteria are rare in this disease, and it is only when obstruction occurs that anaerobic bacteria may be messing with it. Regarding the medication, it needs to be based on your condition, what is suitable for your condition is the best medicine, and it cannot be said that the more expensive the better or the more the better.

If the cholecystitis is simple, there is no other disease, and you have not used antibiotics (cephalosporins, penicillins, erythromycin, azithromycin, levofloxacin, etc.) in the last period of time (usually 3 months), and the current attack was not obtained during hospitalization, and all the above conditions are fulfilled, you can apply amoxicillin/sulbactam, cefoxitin, ceftriaxone, ceftizoxime, and other β-lactams, or fluoroquinolones such as moxifloxacin, moxifloxacin, and levofloxacin. or fluoroquinolones such as moxifloxacin and levofloxacin.

If you also have other underlying illnesses and this time the symptoms are severe, you have also recently applied antibiotics or you have been ill during hospitalization, in this case, strong antibiotics are required to rapidly control the symptoms of the infection, the antibiotics of choice are: piperacillin/tazobactam, meropenem, imipenem. If there is a failure to pass stools and gas, metronidazole needs to be added at this point to fight the anaerobic bacteria.

Still, only the medicine that suits your condition is the best medicine, and you should never "follow the trend" of taking medicines, as it will cost you more money and delay your condition. The doctor's advice should be followed, and trust the doctor is always right!

The above is for reference only.

References:

1. ABX Guidelines for the United States

2. Australian Guidelines - Antibiotics fascicle

Drugs.com authoritative interpretation, unauthorized reproduction, plagiarism will be prosecuted

Hello, I'm medical worker Zhang, a practicing physician, can popularize health knowledge for everyone, if you want to know more, please pay attention to me!

What is the best medicine for cholecystitis?

And what is cholecystitis?

Cholecystitis is a relatively common disease with a high incidence. It can be categorized into acute and chronic types and is often present in combination with cholelithiasis. Severe pain or colic in the right upper abdomen, theMost commonly seen in acute cholecystitis due to stone or parasite impaction and obstruction of the neck of the gallbladderIn acute cholecystitis, the pain is often sudden, severe, or colicky. In non-obstructive acute cholecystitis of the bile duct, the pain in the right upper abdomen is usually not severe, mostly persistent distension, and with the progression of inflammation of the gallbladder, the pain can also be aggravated, and the pain is radiating, and the most common radiating areas are the right shoulder and the lower angle of the right scapula.

How does it cause cholecystitis?

1. Obstructive factors:It is due to the mechanical obstruction of the gallbladder duct or gallbladder neck, the gallbladder is swollen, filled with concentrated bile, in which a high concentration of bile salts have a strong inflammatory effect, the formation of early chemical inflammation, and later secondary bacterial infections, resulting in septic infections of the gallbladder, caused by stones in the majority of people.
2. Infection Factors:Systemic infections or local foci of germs through the bloodstream, lymph, biliary tract, intestinal tract, or the spread of inflammation in neighboring organs and other ways to invade, the invasion of parasites and their brought in bacteria are important causes of cholecystitis.
3. Chemical factors:Bile is retained in the gallbladder, in which a high concentration of bile salts, or pancreatic reflux into the gallbladder, with the activity of pancreatic enzymes, can stimulate the wall of the gallbladder to undergo significant inflammatory changes in some severely dehydrated, the bile bile salts in the concentration of the bile is elevated, can also cause acute cholecystitis
   

How do you medicate cholecystitis?

1. Oral anti-inflammatory medications: haloperidol, erythromycin, chloramphenicol, cleomycin, metronidazole tablets.
   
2. Choleretics: cholestyramine, cholestyramine, cholestyramine, cholecalciferol, sodium cholate, cholic acid.

Medication is only suitable for patients with cholecystitis cholelithiasis, who often experience mild symptoms of the onset of cholecystitis, such as chest tightness, indigestion, nausea, and loss of appetite, when their resistance is very poor, or when they are suffering from inner bitterness and mental anguish, or after overeating and drinking or eating a full meal

What should people with cholecystitis avoid?

1. Fatty foods:Patients with chronic cholecystitis will experience hidden pain after overeating fat and manifestations of indigestion, such as belching, bloating, and anorexia of greasy food. Therefore, patients with this disease should be limited/restricted to between 40 and 50 grams of fat per day, and should abstain from eating fatty meats, fried eggs, lard, butter, cream, etc. It is best to eat vegetable oil.
2. Acidic foods:Acidic foods such as vinegar, prunes, hawthorn, and lemon can stimulate the secretion of cholecystokinin from the stomach and duodenum, which can cause the gallbladder to contract and induce biliary colic. Induce biliary colic.
3. Foods that are too cold or too hot:Foods or soups that are too hot, and foods that are too cold, such as ice cream, ice cold drinks, iced coffee, and foods fresh out of the refrigerator, when ingested, can cause spasms of the biliary sphincter, which can lead to insidious pain or colic in the gallbladder area.
4. Sugar:Because sugar can stimulate the pancreatic beta-cells to secrete insulin, insulin can increase cholesterol, resulting in bile cholesterol in a state of supersaturation, promoting the formation of gallstones.
5. Spicy and irritating foods:Spicy stimulating foods such as wine, tea, coffee, chili, mustard, pepper, pepper, etc. can cause increased gastric and duodenal secretions, which increases cholecystokinin, leading to bile duct and sphincter spasm, and obstruction of bile discharge and induce biliary colic.
6. High cholesterol foods:The main component of gallstones is 90% to 99% cholesterol, so limiting the cholesterol content of food can adjust the cholesterol metabolism disorder and prevent stone formation. Foods with high cholesterol content mainly include animal offal, such as pig brain, cow brain, pig waist, pig liver, duck liver, cow liver, sheep liver, pig belly, pig heart, chicken and duck offal, etc. Other foods include ark shell meat, crab roe, crab, crucian carp, salted duck eggs, egg yolks, duck egg yolks, powdered eggs, squid, shrimp, etc.
7. Gas-producing foods:Cholecystitis patients are often aggravated by flatulence, so cholecystitis patients easy to produce gas food must be avoided or eaten with caution, such foods are soybeans, soy products, fried broad beans, potatoes, sweet potatoes, celery, leeks, bamboo shoots, garlic, etc..
   

Summarize: in fact, acute cholecystitis is more recommended for surgical treatment, now cholecystitis surgery is very mature, you can laparoscopic surgery, trauma is very small, high security, the effect is obvious.

Hello, I'm medical worker Zhang, a practicing physician, can popularize health knowledge for everyone, if you want to know more, please pay attention to me!

Cholecystitis is a relatively common disease in our department; it is an acute or chronic inflammation of the gallbladder, occurring 90% of the time in the presence of gallstones, and when it occurs acutely is calledacute cholecystitisIt may also occur gradually over time, or may be detected on histologic examination after cholecystectomy by the termChronic cholecystitis; a portion occurs in the absence of gallstones (10%) and is calledNon-Stone Cholecystitis。A lot of people have talked about the treatment options for gallstone cholecystitis on this subject, and I'd like to talk more about non-cholestone cholecystitis here! Because it is very aggressive! Best medicine? It doesn't work!!!

Non-calculous cholecystitis, which we also refer to as secondary cholecystitis, accounts for about 10% of all cases of acute cholecystitis, an acute, necrotizing, and inflammatory disease of the gallbladder.As soon as the diagnosis is confirmed, it is important to be admitted to the hospital for treatment, such as果Delayed treatment can result in a mortality rate of up to 75% for noncalculous cholecystitis! And the mortality rate after treatment is about 10%!

Why is non-stone cholecystitis so dangerous?

Non-calculous cholecystitis is usually seen in critically ill patients who are hospitalized. The literature shows that patients after open abdominal aortic reconstruction, post-cardiac surgery and bone marrow transplantation, and post-tumor surgery are at high risk for non-calculous cholecystitis! The incidence of non-calculous cholecystitis after bone marrow transplantation is as high as 4%!Complications of noncalculous cholecystitis include emphysematous cholecystitis, gangrene, and perforation; gangrene of the gallbladder occurs in approximately 50% of patients with noncalculous cholecystitis and can lead to perforation of the gallbladder; perforation can lead to cholecystic enterocutaneous fistulae, abscess formation, or free perforation associated with diffuse peritonitis, and acute pancreatitis, perforated colon, and obstruction of the common hepatic duct can also occur in patients who have developed gangrene but have not perforated.

It can be seen that non-cholestone cholecystitis mainly occurs in some critically ill patients, their own body is weak, the body has already experienced a great blow, and non-cholestone cholecystitis every complication is able to threaten the patient's life, as if adding oil to the fire, very dangerous!

What are the treatments?

1.be hospitalized, patients diagnosed with noncalculous cholecystitis must be hospitalized and, if vital signs are unstable, monitored or admitted to the ICU;

2.cholecystectomy, indications for emergency cholecystectomy include: gallbladder necrosis, emphysematous cholecystitis, and gallbladder perforation, and patients with indications for emergency cholecystectomy can only be treated by cholecystectomy;

3.gallbladder drainageIf the patient does not have an indication for emergency cholecystectomy, or is critically ill, in poor health, or unsuitable for general anesthesia, the patient should be treated by gallbladder drainage;

4.intravenous fluid replacement, supportive treatment such as pain control; initiation of antibiotic therapy (after collection of blood culture specimens), and definitive treatment by cholecystectomy or gallbladder drainage (Flowchart 1).

5.antibiotic treatment, home antibiotics after blood cultures are done may enhance the effectiveness of definitive treatment but are not a substitute for definitive treatment because purulent material in the gallbladder needs to be removed or drained.

The above content is only a personal opinion, please forgive me if it is not appropriate! Feel rewarded can click a concern, I will write some science articles from time to time.

More than 90% of this disease has the basis of cholelithiasis, although acute cholecystitis is easier to control (generally 12-24 hours relief, 3-7 days symptoms can be eliminated), but the stone is not easy to discharge: such as the occurrence of persistent incarceration can cause the gallbladder wall of the hemorrhage, necrosis, septicemia, perforation, and even cause acute diffuse peritonitis. Antimicrobial treatment with the second and third generation of cephalosporins is safe and reliable, but should pay attention to gastrointestinal reactions and bone marrow toxicity, painkillers can be used 654-2, 10mg each time, 3 times a day. Or 10mg, intramuscular injection. If you have abdominal distension and discomfort, you can use appropriate digestive drugs, such as polypeptide tablets, 0.6-0.9 grams per time, 3 times a day (after the menu). Chinese medicine is also effective in the dialectical treatment of acute and chronic cholangitis. If necessary, surgery.

Cholecystitis is overwhelmingly caused by gallbladder stones, and as long as gallbladder stones remain, then cholecystitis is difficult to heal and prone to recurring attacks. Typical symptoms of acute cholecystitis are colicky pain in the right upper abdomen, accompanied by pressure and rebound pain, and nausea and vomiting and fever in some patients.

What is the best medicine for cholecystitis?

As mentioned above, cholecystitis requires surgical treatment for a complete solution, usually through laparoscopic removal of the gallbladder. Cholecystitis is basically caused by gallbladder stones, and gallbladder stones are different from kidney stones, which can not be treated well by extracorporeal ultrasound or lithotripsy medication, so symptomatic gallbladder stones should be surgically removed with determination.

Medications for cholecystitis are generally symptomatic, such as antibiotics to treat the associated infection, antispasmodic and analgesic medications to relieve the pain of acute cholecystitis, and cholagogic medications (e.g., ursodeoxycholic acid or anti-inflammatory cholagogic tablets) to unblock bile drainage. Because none of these medications target the cause of the disease, they only provide a temporary solution to the discomfort and ultimately require surgery.

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When he was in college, Dr. Chen's father had his gallbladder removed due to recurrent attacks of multiple gallbladder stones. Although he was completely cured of cholecystitis, a person without a gallbladder can still have an impact on his quality of life.

Like Dr. Chen's father is very typical of the sequelae is very easy to diarrhea, and often easy to hear him say, did not eat much to feel full, and even sometimes he will feel something up his esophagus, which in fact are cholecystectomy caused by the more common bile reflux gastritis.

The number of people like Dr. Chen's father who are forced to have their gallbladders removed due to cholecystitis and gallbladder stones is increasing every year, which has led to many people mistakenly believing that removal of the gallbladder is the best treatment after being diagnosed with cholecystitis!

In fact, this idea is not right! Although from a medical point of view, cholecystitis belongs to the surgical disease, but not all cholecystitis comes up is necessary to remove, there are a lot of need to choose the internal medicine conservative treatment, especially now we are more and more strong concept of medical examination, was examined and found to be suffering from cholecystitis more and more people, and most of them do not have any symptoms!

But it is this asymptomatic cholecystitis that makes many people become more and more numb, feeling fine and ignoring it, which ultimately promotes and triggers cholecystitis attacks.

In fact, there are different options for the best treatment for cholecystitis at different stages, and the medications used vary somewhat!

First of all, for asymptomatic cholecystitis, it does not mean that no treatment is needed. Because cholecystitis and gallbladder stones are diseases closely related to our personal habits, once diagnosed with cholecystitis, no matter whether there are no symptoms, must be the first time to cause us great concern, adjust the lifestyle, pay attention to diet is essential.This is mainly reflected in the following three areas:

1. Avoid overexertion and overwork, as this can affect resistance;
   
2. Do not overeat, reduce high-fat diet, especially in the company dinner, friends activities, etc., pay more attention to do not forget that they have cholecystitis, once happy to eat too much and too full to promote acute attacks of cholecystitis;
   
3. Choosing a low-fat, low-cholesterol diet and focusing on eating more fruits and vegetables can reduce the incidence of cholecystitis and gallbladder stones, and it is also helpful in preventing other digestive tract tumors.
   

Secondly.For both symptomatic and asymptomatic cholecystitis patients, some choleretic medications are needed.Among the most commonly used choleretic drugs by our doctors are azinomide, compound azinomide, etc.; of course, there are some people, who naturally do not like western medicines, can also choose some proprietary Chinese medicines, or take some herbal tonics, which is also possible.

But note: not all cholecystitis must require antibiotics.Like asymptomatic cholecystitis patients, usually do not choose antibiotic treatment, only for has developed epigastric pain, low-grade fever, etc., with obvious symptoms of infection, we recommend antibiotic treatment. At the same time, for chronic cholecystitis that has developed epigastric pain, gallbladder stones, but also to use some antispasmodic drugs first to relieve this type of pain, otherwise the patient is often painful!

Therefore, the treatment of cholecystitis is a combination of symptomatic and complication-reducing choices, not a particular drug or class of drugs that can cure it, and the best drug is a combination of interventions!

Finally, for those internal medicine conservative treatment is ineffective, symptoms recurring, or ultrasound found more gallbladder stones, and some larger, appear its gallbladder wall thickening > 4mm, and then choose drug treatment will only delay the condition, as early as possible to choose the surgical removal of the gallbladder is the key, because once the gallbladder perforation, there will be peritonitis and other more serious complications!

Therefore, the treatment of cholecystitis, there is no such thing as the best drugs, take internal medicine, or surgical treatment, must be based on the individual's clinical symptoms, physical examination, ultrasound results and other comprehensive analysis, and ultimately make a judgment, the cut, should not be cut in a timely manner to pay attention to the early intervention to avoid further development!