Zánět žlučníku

14.4.2012 , Zuzana Boučková

zanet-zlucniku.jpg - kopie
zanet-zlucniku.jpg - kopie
Zánět žlučníku může vzniknout z různých příčin, ale nejčastější z nich je zaklínění žlučového kamene ve žlučových cestách, s následným rozvojem zánětu. Zánět žlučníku se projevuje ostrou bolestí pod pravým žeberním obloukem, horečkou a příznaky podráždění pobřišnice. Zánět žlučníku se léčí antibiotiky, v těžších případech chirurgickým odstraněním žlučníku.

Zánět žlučníku

Zánět je soubor reakcí organismu na jeho poškození a je základním nástrojem naší vrozené obranyschopnosti. Na jeho vzniku se podílejí jak chemické látky uvolňované v postižené tkáni, tak i buňky imunitního systému. Jeho úkolem je organismus chránit, bohužel však mnohdy vede spíše k jeho dalšímu poškozování. Zánět může být způsoben jak účinky některých agresivních látek, tak i přítomností mikroorganismů. V případě zánětu žlučníku, odborně cholecystitidy, jde o závažné onemocnění, které tvoří poměrně vysoké procento ze všech náhlých příhod břišních.

Vznik a typy zánětu žlučníku

Záněty žlučníku se dělí typicky podle dvou kritérií, a to dle přítomnosti žlučových kamenů a délky trvání choroby.

  •  Podle délky trvání onemocnění rozlišujeme akutní a chronický zánět žlučníku. Akutní zánět je takový, který vzniká náhle, prakticky z plného zdraví. Chronický zánět představuje dlouhodobou záležitost, která nemusí mít po celou dobu žádné projevy. 
  • U 90 % jedinců se zánětem žlučníku jsou zároveň přítomny i žlučové kameny, odborně cholelitiáza. Ty se mohou zaklínit ve žlučníkovém vývodu, a způsobit tak hromadění žluči uvnitř měchýře. V takové situaci do něj snadněji pronikají bakterie z dvanáctníku, které sem doputují skrze společný žlučovod. Tak vzniká infekční cholecystitida. Naopak příčinou zánětu neinfekčního jsou jedovaté látky poškozující stěnu tohoto orgánu. To se často vyskytuje u zbylých 10 % pacientů, které žlučové kameny nemají.

 

Cholelitiáza tedy patří mezi hlavní rizikové faktory pro vznik cholecystitidy jak akutní, tedy náhle vzniklé, tak i chronické, dlouhotrvající. Zánět žlučníku také častěji vzniká u pacientů s cukrovkou. Se zánětem žlučníku bez přítomnosti kamenů, se setkáváme obvykle u pacientů po závažnějších úrazech nebo po prodělané operaci.

Projevy zánětu žlučníku

Akutní zánět žlučníku se projevuje silnou neustupující bolestí vpravo pod žebry, horečkou a příznaky dráždění pobřišnice, například napětím břišní stěny. Bolest se zvyšuje při pohybu a hlubokém nádechu. Akutní obtíže trvají krátce, řádově několik dnů. V případě chronického zánětu je žlučník spíše svraštělý a v jeho stěně se často ukládá vápník. Průběh onemocnění je spíše nenápadný, příznaky jednoznačně poukazující na tuto chorobu nejsou přítomny. Obvykle si nemocní stěžují na tlaky vpravo pod žebry, nevolnosti, poruchy trávení a nesnášenlivost určitých pokrmů. 

Komplikace zánětu žlučníku

Mezi komplikace zánětu žlučníku patří perforace, tedy protržení žlučníku. V takovém případě dochází k vylití jeho obsahu do dutiny břišní se vznikem peritonitidy, zánětu pobřišnice. Zánět se ze žlučníku může šířit na pobřišnici či do jater i bez jeho protržení. Další komplikací je tvorba píštělí, tedy komunikací mezi žlučníkem a jinými orgány, například žaludkem či dvanáctníkem. 

Diagnostika zánětu žlučníku

Diagnostika žlučového zánětu vychází z pečlivé anamnézy, samotného vyšetření lékařem a zobrazovacích metod. Lékař při vyšetření zjišťuje přítomnost tzv. Murphyho příznaku. Ten spočívá v tom, že pacient cítí při nádechu ostrou bolest ve chvíli, kdy lékař zatlačí rukou vpravo pod žebry. Pokud se kámen zaklíní trvale ve vývodu žlučníku, obsah měchýře se významně zvětší a vzniká takzvaný hydrops. Při jeho výskytu je možné přes břišní stěnu nahmatat tuhý, hruškovitě zvětšený útvar. Pokud se zánět žlučníku rozšíří i do okolí orgánu, stav označujeme jako pericholecystitidu. Žlučník obvykle znázorňujeme pomocí ultrazvuku či CT, důležité je i vyšetření scintigrafické, které umožňuje zhodnotit obsah tohoto orgánu a stav jeho stěny. To je možné vpravením kontrastní látky do žlučových cest a jejím zobrazením pod rentgenovými paprsky. Pokud se žlučník nenaplní do 60 až 90 minut, pak tato skutečnost jednoznačně svědčí pro akutní cholecystitidu. Významný je také laboratorní nález, který odhalí značně zvýšené markery zánětu v krvi nemocného. 

Léčba zánětu žlučníku

Akutní záněty žlučníku vyžadují klid na lůžku, hladovění a léky na tlumení bolesti. Později pacient přechází na žlučníkovou dietu. V lehčích případech se podávají antibiotika. Pokud je stav nemocného vážnější, volí se obvykle i chirurgické odstranění žlučníku, tzv. cholecystektomie. Nebezpečí vzniku komplikací je větší u cholecystitid bez přítomnosti kamenů, a proto se u nich doporučuje provést cholecystektomii bez zbytečných odkladů. Chronický zánět žlučníku se léčí také touto metodou.

 Prevence zánětu žlučníku

V rámci prevence vzniku zánětu žlučníku je vhodné dodržovat zdravou a rovnovážnou životosprávu. Je třeba se vyvarovat nadbytečnému příjmu tuků, zvláště cholesterolu. Doporučuje se zvýšený příjem vlákniny. Ovšem ani tato opatření nemusí vzniku této choroby zamezit.

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