acute calculous cholecystitis
Introduction
Introduction to acute calculous cholecystitis The onset of acute calculous cholecystitis is due to stones blocking the cystic duct, resulting in retention of bile in the gallbladder, secondary bacterial infection and acute inflammation. Acute acalculous cholecystitis, often without obstruction of the cystic duct. The cause of most patients is unclear. Often occurs after trauma, or after some abdominal surgery unrelated to the biliary system. The common common cause of the disease is cystic duct obstruction. About 80% of patients are caused by gallstones. When the cystic duct is obstructed, the bile is concentrated. The high concentration of bile salts can damage the gallbladder mucosal epithelium and cause inflammation changes. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: jaundice
Cause
Causes of acute calculous cholecystitis
The onset of acute calculous cholecystitis is due to stones blocking the cystic duct, causing bile retention in the gallbladder, secondary bacterial infection causing acute inflammation, such as inflammation, congestion and edema in the gallbladder mucosa, called acute simple cholecystitis If the inflammation spreads to the whole layer of the gallbladder, the gallbladder is filled with pus, and the serosal surface also has purulent fibrinous exudation, it is called acute suppurative cholecystitis. The gallbladder is extremely swollen due to empyema, causing ischemia and gangrene of the gallbladder wall. Is acute gangrenous cholecystitis, necrosis of the gallbladder wall can be perforated, leading to biliary peritonitis, gallbladder perforation occurs in the gallbladder at the bottom of the gallbladder or stone incarcerated gallbladder ampulla or neck, such as gallbladder perforation to adjacent organs In the middle, such as the duodenum, colon and stomach, it can cause biliary fistula. At this time, the acute inflammation in the gallbladder can be drained through the internal fistula, the inflammation can disappear quickly, and the symptoms are relieved, such as the pus row in the gallbladder. Into the common bile duct can cause acute cholangitis, a small number of people can also develop acute pancreatitis, most of the pathogenic bacteria are Escherichia coli, Klebsiella and Streptococcus faecalis, anaerobic bacteria accounted for 10 to 15%, but When up to 45%.
Prevention
Acute calculous cholecystitis prevention
1. Pay attention to diet. The food should be light, eat less greasy and fried, and grilled food.
2. Keep the stool clear. Six sputum is used as a pass, and the liver and gallbladder are hot and humid. When the stool is secreted, the symptoms are aggravated and it is important to keep the stool unblocked.
3. To change the sedentary lifestyle, move more and exercise more.
4. To raise sex. A long-term family is not awkward, and people with a bad mood can cause or aggravate the disease, and they should be broad-minded and comfortable.
Complication
Complications of acute calculous cholecystitis Complications
(a) gallbladder empyema
(two) emphysema cholecystitis
(three) gallbladder perforation
Symptom
Acute calculous gallbladder symptoms Common symptoms Abdominal pain with nausea, vomiting, gallbladder wall fibrosis, high fever, right upper quadrant, persistent drama... Right upper quadrant, chills, nausea, sudden upper right abdominal cramps, jaundice, bilirubin calcium stones
Acute calculous cholecystitis can be diagnosed mainly by clinical manifestations and B-ultrasound examination. B-ultrasound can show the enlargement of gallbladder volume, thickening of gallbladder wall, thickness often exceeds 3mm, and can show stone shadow in 85-90% of patients. In the diagnosis of doubt, the isotope 99mTc-IDA can be used for biliary scanning and photography, the bile duct is often displayed on the contrast film, and the gallbladder is not displayed due to obstruction of the cystic duct, thus determining the diagnosis of acute cholecystitis. More than 95%, the diagnosis of acute acalculous cholecystitis is more difficult, the key to diagnosis is the clinical manifestations of acute cholecystitis after trauma or abdominal surgery, the possibility of thinking about the disease, caused by a small number of aerogens In the case of acute emphysema cholecystitis, a flat film in the gallbladder area can be found in the gallbladder wall and in the cavity.
About 85% of patients with acute cholecystitis have paroxysmal upper and lower abdomen paroxysmal colic in the early stage of the disease, and have radiation pain in the right subscapular region, often accompanied by nausea and vomiting. The fever is generally 38 to 39% °C, no In chills, 10 to 15% of patients may have mild jaundice. Physical examination shows tenderness and muscle tension in the right upper abdomen. Murphy is positive. In about 40% of patients, the right upper quadrant can be swollen and tender. Gallbladder, white blood cell count is often slightly increased, generally in the 10,000 ~ 15,000 / mm3, such as lesions develop into gallbladder gangrene, perforation, and lead to biliary peritonitis, systemic infection symptoms can be significantly aggravated, and can appear chills and fever Increased pulse rate and white blood cell count (generally over 20,000/mm3). At this time, the local signs have an enlarged range of right upper quadrant tenderness and muscle tension, and the degree is aggravated. Generally, acute cholecystitis affects liver function less, or Only mild liver damage, such as serum bilirubin and alanine aminotransferase values increased slightly, the clinical manifestations of acalculous cholecystitis and calculous cholecystitis are similar, but often not typical.
Examine
Examination of acute calculous cholecystitis
1. The total number of white blood cells > 10 × 10 9 / L nuclear left shift.
2. Abdominal X-ray film showed positive stones in the gallbladder area.
3. B-ultrasound showed that the gallbladder was enlarged, the wall thickness was >3.5mm, and there was a strong light group with sound and shadow.
4. Intravenous cholangiography does not develop the gallbladder.
5. CT or MR shows gallstones.
Diagnosis
Diagnosis and diagnosis of acute calculous cholecystitis
Need to be identified with the following diseases: acute viral hepatitis, acute alcoholic hepatitis, acute pancreatitis, right lower pneumonia, pyelonephritis, acute right heart failure, peptic ulcer complicated by acute perforation and other diseases.
