MECHANISM OF ACUTE CALCULOUS CHOLECESTITIS ON ELDERLY HUMANS

Increased incidence of acute cholecystitis brought him to the most urgent common surgical disease after acute appendicitis. High postoperative mortality, from 2 to 12 %, does not tend to decrease. Up to 25 % of patients with acute cholecystitis are persons older than 75 years. This category of patients with high anesthetic risk and creates major share in postoperative mortality and the development of complications. The level of postoperative mortality in them is from 8 to 18% and among patients over 80 years - 40 – 50 %, and is 10 - 12 times higher than in younger patients. In the pathogenesis of acute cholecystitis in gerontology patients with essential local and systemic hemodynamic disorder of carbohydrate metabolism disorders, age-related changes in the immune response, disease duration and variable comorbidities. An important part of the pathogenesis of cystic duct obstruction is the development konkrementom bile hypertension. Age atrophy of the muscle layer of the gallbladder wall enhances this process. There is swelling of the gallbladder wall in violation of microcirculation, blood flow and foci of necrosis in the mucosa. The appearance of stones in the bladder zhovchevomu due to increased concentrations of the various phases of cholesterol in the bile, the most unstable phase is liquid crystals. The presence of concretions in the gall bladder is a trigger factor for the development of this disease - usually acute cholecystitis in 90 % of cases occur against the background of cholelithiasis. Women suffer twice as often as men age, but this difference is reduced in the elderly and old age men and women suffer equally. More than 67 % of cases in gerontology patients with acute calculous cholecystitis admission is made within 48 hours of onset. At the time of hospitalization in these patients already suffer complications of acute calculous cholecystitis: local peritonitis, paravezykalnyy infiltrate, empyema gallbladder, biliary pancreatitis and others. The destruction of the gallbladder wall is typical for the patients of elderly and 20 % of cases observed in the early days of the disease. Progression of purulent-destructive process worsens the systemic circulation, which causes increased ischemia in the wall of the gallbladder. Acute calculous cholecystitis in elderly and senile accompanied by manifestations of acute biliary pancreatitis in 63 % of cases, obstructive jaundice in 25 % cholangitis in 12 – 87 %, 70 % SIRS. Development pozamihurovyh complications in turn increases the severity of the patient worsens the disease and prognosis of surgery. Therefore, conservative therapy in gerontology patients in most cases is ineffective. The main method of screening patients with cholelithiasis is ultrasonography.