Cholecystitis during pregnancy clinical picture and therapy

Cholecystitis during pregnancy can be a concomitant disease or a reaction to hormonal and physiological changes in the body of the expectant mother. Pathology complicates the course of the gestational period, making it painful and dangerous for the pregnant woman and the fetus. The disease is usually chronic.

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clinical picture

Pain is the main symptom of illness. Basically, it is moderate, with exacerbation it is given to the right in:

  • lower back,
  • shoulder,
  • scapula.

A pregnant woman is haunted by heaviness in the hypochondrium after eating. Then the pain becomes associated with the activity of the child, its location in the mother’s stomach. An additional cause of acute pain is gallstone disease caused by the increased formation of bile conglomerates under the influence of bile acids, bilirubin.

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The picture is complemented by the symptoms of dyspepsia, manifested by belching, a bitter taste in the mouth, and nausea.

The temperature sometimes fluctuates during an exacerbation to subfebrile numbers. Its high rates are associated with the addition of purulent complications – empyema, cholangitis.

Symptoms of complications of the gestational process with cholestasis are manifested by salivation in 15%, dyspepsia (vomiting, nausea) – in 50% of pregnancy.

Vomiting can accompany a pregnant woman for a long time. Up to 29-30 weeks of gestation. The most serious complication in pregnant women is nephropathy.

The classic symptoms accompanying chronic cholecystitis during pregnancy are erased in one third of patients.

Etiology and mechanism of development of pathology

During pregnancy, the synthetic activity of the liver increases. In the blood of a pregnant woman, the content of cholesterol lipids increases against the background of a significant decrease in cholesterol esters. The concentration of albumin, which is responsible for the binding of bilirubin, decreases. Enzymes responsible for starting biochemical processes in the body become more active.

The steroid hormones produced by the placenta decrease their activity in pregnant women. The liver’s ability to remove toxins is impaired. Pregnancy hormone – progesterone relaxes the excretory sphincter of the gallbladder, reducing the peristalsis of the biliary tract. This leads to a violation of the outflow of bile, its stagnation.

In the stagnant bile environment, disease-causing agents begin to develop, causing inflammation. This development of cholecystitis is called hypomotor or hypokinetic. This mechanism is the main one in the second half of pregnancy. The first trimester of pregnancy is characterized by a hyperkinetic type of the disease. When more bile is produced than the biliary system is able to excrete.

Acute cholecystitis, before becoming chronic, can pass unnoticed for the patient against the background of adnexitis, food poisoning. The main pathogens sown are E. coli and staphylococci.

Factors provoking an inflammatory process in the bladder and excretory system of a pregnant woman:

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  • injuries
  • tumors,
  • dyskinesia,
  • congenital deformity,
  • allergy,
  • hypodynamia,
  • obesity,
  • smoking,
  • disharmonious nutrition,
  • concomitant diseases of the digestive tract.

Diagnostics

To make the correct diagnosis, it is necessary to carefully collect an anamnesis, finding out whether a pregnant woman has dyskinesia, cholecystitis. The exacerbation of the pathological process must be distinguished from gastrointestinal diseases, appendicitis, preterm labor, angina pectoris, adnexitis. How to treat the disease in the future depends on this. A pregnant woman should be consulted by a gastroenterologist or therapist.

By palpation, the site of the projection of pain, the zone of hyperesthesia, is established at the pregnant woman.

Laboratory indicators may not always clarify the picture. The appearance of neutrophils and leukocytes can be a reaction to pregnancy.

Duodenal intubation can be used only in the early stages. The leading instrumental research method is ultrasound.

Echographic signs of inflammation of the gallbladder in a pregnant woman are:

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  • organ size,
  • Wall thickness,
  • uniformity of the contour of the organ,
  • three-layer wall with heterogeneous content.

Therapy

After the diagnosis is made, it is important to remove the acute process so that it does not affect the fetus.

Treatment should focus on:

  • elimination of pain symptom,
  • launching peristalsis in the gallbladder and biliary tract,
  • fight against infection and inflammation,
  • restoration of the digestive system.

For the safety of the fetus, exacerbation of cholecystitis must be removed by non-drug methods.

These are central electroanalgesia, special diet, physiotherapy, acupuncture. The use of psychotherapy is helpful.

Diet

The pregnant woman should eat often and in small portions in order to regularly evacuate bile. Cooking by frying should be excluded from cooking techniques.

  • alcohol,
  • soda,
  • yolks,
  • buns,
  • pastry with cream,
  • nuts,
  • cold food.

Strengthen the peristalsis of the biliary tract:

  • grated raw carrots,
  • broths
  • dairy products,
  • protein omelets,
  • cod,
  • melons,
  • dried fruits.

In the later stages, the treatment of pregnant women with cholestasis with mineral waters is excluded. Since they need to limit fluid intake.

It is useful to use phyto – means with choleretic effect from dill seeds, corn stigmas, peppermint leaves, rose hips

Physiotherapy

Hardware treatment of cholecystitis is carried out after the relief of a painful attack.

  • the pain goes away
  • spasms are relieved,
  • improves tissue nutrition.

With a hypotonic mechanism of development of pathology, they are used:

  • impulse currents of low frequency,
  • sinusoidal modulated currents,
  • ultrasound therapy.

Medicines

Drug treatment is carried out by prescribing choleretic drugs that have a laxative effect. Drugs of choice:

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  • Cholenzym,
  • Allohol,
  • Pancreatin.

They are shown to everyone who carries a child for the prevention of bile stagnation – cholestasis.

Pronounced pain in pregnant women is relieved with Drotaverine, Papaverine. Restores adequate peristalsis of the gallbladder and eliminates vomiting Metoclopramide.

Cholestasis effectively removes tubage. Carlsbad salt and vegetable oil are used during the procedure. Drink one teaspoon of salt in a glass of water or 40 ml of vegetable oil. They lie on their right side, placing a heating pad or a bottle of warm water. They lie in this position for about an hour. After the procedure, patients need to stay at home, as it has a pronounced laxative effect.

Treatment of cholecystitis with antibiotics during pregnancy is used, as a last resort, before or after surgery. Surgical intervention is indicated only in pregnant women with a disease complicated by sepsis, deformity or atrophy of the gall organ.

Pregnant women are hospitalized with severe vomiting, with edematous and hypertensive complications associated with cholecystitis in the second and third trimesters.

Prevention

The expectant mother needs to understand that her happy situation is not a disease. But so that it is not complicated by various pathologies, including bile stagnation, you need to keep yourself in good shape. For this, in the morning – gymnastics, during the day, walks in the fresh air.

You should not follow the recommendations of grandmothers – eat for two. You need to eat often and in small portions. Eliminate fast-digesting carbohydrates, seasoned and fried foods in refined oil. All genital tract infections must be treated promptly.

For prevention purposes, pregnant women with cholestasis pathology are carried out:

  • a weekly course of treatment with choleretic, antispasmodic drugs on the 16th, 28th, 38th weeks,
  • diet therapy (diet number 5),
  • research: urine – for urobilin, bile pigments, blood for bilirubin, cholesterol.

Pregnant women are hospitalized before childbirth at 38 weeks. Cholecystitis is not an indication for caesarean section. Childbirth is carried out naturally using pain relief.

The gallbladder during pregnancy becomes inflamed, according to scientific data, in 3% of women. With adequate therapy and adherence to a diet, an active lifestyle, the disease has a favorable outcome.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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