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  4. the treatment of cholecystitis in the elderly, what to do with cholecystitis in the elderly, medication for cholecystitis in the elderly

the treatment of cholecystitis in the elderly, what to do with cholecystitis in the elderly, medication for cholecystitis in the elderly

the treatment of cholecystitis in the elderly, what to do with cholecystitis in the elderly, medication for cholecystitis in the elderly

Knowledge of diagnosis and treatment of cholecystitis in the elderly

Treatment department: Hepatobiliary Surgery Geriatrics Treatment cost: about (2000-8000 yuan) in the city's top three hospitals Treatment methods: drug treatment, surgical treatment General treatment of cholecystitis in the elderly

One, treatment

1. General treatment

(1) Actively prevent and treat bacterial infections and complications, pay attention to dietary hygiene, prevent the occurrence of biliary parasitic diseases, and actively treat intestinal ascariasis.

(2) Be restrained in daily life, pay attention to the combination of work and rest, suitable for cold and temperature, maintain optimism and have smooth bowel movements.

(3) Always keep the left side lying in the clinic, which is conducive to bile excretion.

(4) If the disease has stones, or frequently attacks, consider hand treatment.

(5) Low-fat meals should be used to reduce bile secretion and reduce the burden on the gallbladder.

2. Medication

(1) Acute cholecystitis:

① Antispasmodic and analgesic: 0.5mg intramuscular injection of atropine, 0.6mg sublingual nitroglycerin, pethidine (meperidine), etc. can be used to relieve Oddi sphincter spasm and pain.

②Antibacterial treatment: Antibiotics are used to prevent bacteremia and purulent complications. Ampicillin (aminobenzyl penicillin), clindamycin (clindamycin) and aminoglycoside are usually used in combination, or the first For second-generation cephalosporins such as cefmandole (ceftidol) or cefuroxime, the replacement of antibiotics should be based on blood culture, bile culture during surgery, bacterial culture of the gallbladder wall, and the results of drug sensitivity tests.

③Cholestatic drugs: 50% magnesium sulfate 10ml, 3 times/d, orally (not for those with diarrhea), dehydrocholic acid tablets 0.25g, 3 times/d, orally, cholic acid tablets 0.2g, 3 times/d, oral.

(2) Chronic cholecystitis

① Choleretic drugs: 50% magnesium cubanamate, dehydrocholic acid tablets, etc. can be taken orally.

② Deworming therapy: Deworming for the cause.

③ Litholysis therapy: If it is caused by cholesterol stones, chenodeoxycholic acid can be used to dissolve the stones. According to the literature, the effective rate of litholysis can reach about 60%. The dose is 500-700mg per day. The course of treatment is 6 months to 2 years. After the end, a maintenance dose (250 mg per day) is still required to prevent recurrence. Side effects: diarrhea and a slight increase in serum transaminases.

(3) Rational use of proprietary Chinese medicines:

① Jindan tablets: Function: anti-inflammatory and choleretic, used for acute and chronic cholecystitis, usage: 5 tablets, 3 times/d.

②Qinggan Lidan Oral Liquid: Function: clearing liver and gallbladder damp-heat, attending to appetite, hypochondriac pain, fatigue, yellow urine, greasy fur, pulse string, liver stagnation and qi stagnation, liver and gallbladder damp-heat unclear symptoms, 20ml each time, 3 times/d.

3. Acupuncture therapy

(1) Acupuncture therapy.

(2) Ear acupuncture therapy.

4. Surgical treatment

Cholecystectomy is the fundamental treatment for acute cholecystitis. The indications for surgery are: ①Gall bladder gangrene and perforation, complicated by diffuse peritonitis; ②Acute cholecystitis with repeated acute attacks, and the diagnosis is clear; ③After active medical treatment, the condition continues to develop and Those who worsen; ④ Those who have no contraindications to surgery and can tolerate surgery.

Chronic cholecystitis accompanied by gallstones; once the diagnosis is established, cholecystectomy is a reasonable and fundamental treatment. If the patient has serious diseases such as heart, liver, lung, or the general condition cannot tolerate surgery, medical treatment can be given.

5. Rehabilitation

(1) General activities:

Rehabilitation of chronic cholecystitis takes a long time. In addition to treatments such as drugs and surgery, daily care also has a certain effect on the recovery of the disease. First of all, a scientific arrangement should be made for the patient’s work and rest time. In the acute stage, except for the necessary treatments Should stay in bed and rest; during the symptom remission period, there should be appropriate outdoor activities, such as walking after a meal, playing Tai Chi, etc., to adapt to the recovery of mental and physical strength, while ensuring sufficient sleep and rest for the patient to consolidate the effect of rehabilitation.

(2) Diet:

Actively publicize the significance of diet for the treatment of chronic cholecystitis, and on this basis, to get rid of some bad eating habits, such as

Quit smoking, alcohol, etc., generally follow the principles of low-fat, low-cholesterol, and easy-to-digest diet in the process of rehabilitation, and avoid high-calorie, spicy, raw and cold foods. It is advisable to temporarily fast during the acute attack or biliary colic. Stimulate the gastrointestinal tract and give proper nutrition by vein.

(3) Psychotherapy:

The disease is protracted and has repeated symptoms. The patient suffers from pain for a long time and is prone to pessimism and negative emotions. Psychological care can improve the patient’s psychological mood, rejuvenate the patient, build confidence, and adjust bad lifestyles and behaviors. Positive attitude to cooperate with treatment, because patients often suffer from anxiety and fear due to lack of disease knowledge. In psychological care, patient and detailed explanations and explanations should be carried out, so that they can initially grasp the knowledge and laws of the disease and eliminate errors in the disease Views, maintain a happy and comfortable mood, so as to promote the recovery of the disease, especially before the ERCP and extracorporeal shock wave lithotripsy must be explained repeatedly to eliminate bad emotions, cooperate with the doctor to operate, and actively explain chronic cholecystitis The characteristics and common predisposing factors, such as improper diet and chronic infection, can promote the recurrence of the disease. Through these work, the self-protection ability of patients can be greatly strengthened, the number of relapses can be reduced, and the quality of life can be improved.

(4) Drug treatment:

The medication used by patients with chronic cholecystitis involves antibiotics, analgesics, choleretics and other types. There are many characteristics in the use, which are directly related to the role of drugs. For example, when using antibiotics and antispasmodic drugs, you should use liver protection at the same time. Drugs, the medication time should be extended; because of the use of atropine, pethidine and other drugs, attention should be paid to observe the occurrence of side effects.

(5) Family rehabilitation guidance:

① Maintain a good mood: Due to the long duration of chronic cholecystitis, it is easy to relapse. Only short-term hospital treatment and rehabilitation can not solve the actual problems of patients. Nursing staff should provide emotional support for the actual psychological changes of specific patients at various stages of rehabilitation. , Provide psychological guidance, so as to maintain a good mood in the long-term life and work in the future. When people are in a state of tension, anxiety, and fear, the adjustment ability of the cerebral cortex and the autonomic nervous system declines, which can directly lead to gallbladder contraction and movement disorders. The normal function of the gallbladder can only be maintained when the heart is broad and full of energy. In addition, the support of society and family should be mobilized, which not only provides patients with convenience in life, but also allows them to feel the warmth of the environment and strengthen their confidence in treating diseases.

②Correctly understand the disease: Patients with chronic cholecystitis have more psychological concerns due to long-term treatment or recurrent episodes. Some patients also compare with "cancer", which often puts a heavy burden on the patient's thoughts. Generally speaking, this disease Although it is difficult to be completely cured, the cancer rate is about 3%, so patients should increase their confidence and actively treat.

③Reasonable diet arrangement: Improper diet is an important cause of chronic cholecystitis. Therefore, a reasonable diet is the basis for the treatment of chronic cholecystitis. Patients should be guided to realize the importance of good eating habits, quit smoking and alcohol, and avoid high fat and high fat. Cholesterol, high-calorie foods, each meal is rationed, nutritionally balanced, and you must control your diet during an acute attack.

④ Regular follow-up examinations: patients with chronic cholecystitis should go to the hospital for check-ups according to the severity of their illness, report recent changes in symptoms and medications to the doctor, accept the doctor's guidance, and perform a B-ultrasound check once a year to prevent early cancer.

2. Prognosis

The case fatality rate of acute cholecystitis is 5% to 10%. Almost all occur in the elderly complicated with purulent infection and other serious diseases. Acute cholecystitis complicated with localized perforation can achieve satisfactory results through surgical treatment; concurrent dissociation Sexual perforation, the prognosis is poor, and the mortality rate is as high as 25%.


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