Acute cholecystitis and cholangitis in children
Introduction
Introduction to acute cholecystitis and cholangitis in children Acute cholecystitis and cholangitis (acutechole cystitis and cholangitis) are inflammatory diseases of the gallbladder and bile duct caused by bile retention and bacterial infection. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: coma peritonitis shock
Cause
Acute cholecystitis and cholangitis in children
Bile retention and bacterial infection (30%):
The main cause of acute cholecystitis and cholangitis is bile retention and bacterial infection. Bile retention is caused by bile duct obstruction. Common obstructive factors include congenital or inflammatory stenosis of biliary tract, anastomotic stenosis and parasite after biliary anastomosis. Caused by the common bile duct sphincter spasm, bacteria can also invade the gallbladder and bile duct through the lymph, intestinal or adjacent organs through the blood, the bacteria causing inflammation is mainly Escherichia coli, accounting for 70%, other staphylococcus, hemolysis Streptococcus, Proteus, etc., may also be a mixed infection.
Increased intracoronary pressure (20%):
The gallbladder is a blind bag, and the gallbladder artery is a terminal artery. In the acute phase, after the cystic duct obstruction, the secretion of the gallbladder mucosa increases, the absorption function decreases, and the internal pressure of the gallbladder gradually increases, which can compress the lymph and blood vessels of the gallbladder wall. Lymphatic blood flow reflux disorder, small arteries can be occluded by inflammation, and then cause focal ischemic lesions, gallbladder mucosa can appear erosion, ulcer and necrosis, severe cases can cause large necrosis of the gallbladder wall, acute cholecystitis or cholangitis At the beginning of the lesion, the mucosa is congested, edema, and then affects the gallbladder or bile duct wall, the wall is thickened, and there are fibrinous exudates on the surface. In severe cases of infection, the wall of the cyst has a purulent lesion, forming suppurative cholecystitis and (or) cholangitis, the younger the age, the more rapid the disease progression, due to the simultaneous cystic duct or common bile duct sphincter spasm, gallbladder or common bile duct swelling, localized ischemia and gangrene can cause perforation, biliary peritonitis, this At the time, the child may have signs of confusion, toxic shock and the like.
Blockage of the cystic duct (10%):
The internal pressure of the gallbladder continues to increase, and the edema of the cyst wall is aggravated, which can cause inflammatory occlusion of the blood vessels in the gallbladder wall, resulting in necrosis of the tissue of the cyst wall. After the necrosis of the gallbladder tissue, the gallbladder can be perforated, and the gallbladder can be perforated. Bile flow into the abdominal cavity, can cause localized or diffuse peritonitis, and chronic cystic duct obstruction can lead to water in the gallbladder. After the pigment of the bile is absorbed, it becomes white bile, and the secretion of calcium increases, and lime water-like bile can appear. Calcium deposits in the gallbladder wall can produce a "porcelain gallbladder". In adults, 50% of cases in this case develop gallbladder cancer.
Prevention
Acute cholecystitis and cholangitis prevention in children
1. Develop good eating habits: balance diet, change eating habits, low-fat diet, eat less barbecued meat, eat more food containing cellulose, pay attention to enough vitamin C, vitamin B, vitamin E .
2. Prevention and treatment of nutritional deficiency diseases: appropriate amount of protein and high vitamins, prevention and treatment of nutritional deficiency diseases, and enhance physical fitness.
3. Orange can prevent cholecystitis: Eat more fruits, especially oranges, can prevent and reduce the incidence of cholecystitis.
4. Develop good hygiene habits: Actively prevent intestinal parasites and stomach and intestinal inflammatory diseases.
Complication
Acute cholecystitis and cholangitis complications in children Complications, coma, peritonitis, shock
High fever can cause convulsions, paralysis, coma, etc.; gallbladder perforation, purulent bile flow into the abdominal cavity, can cause localized or diffuse peritonitis; at this time, children may have toxic shock; a small number of gallbladder cancer can occur.
Symptom
Acute cholecystitis and cholangitis symptoms in children. Common symptoms: high fever, abdominal pain, chills, nausea, acute illness, abdominal distension, peritonitis, abdominal muscle tension, jaundice, pain
The onset is often more rapid, more than 1 day after the onset of the disease, with abdominal pain, high fever, chills as the main symptoms, occasional jaundice, upper abdominal pain is persistent or intermittent dull pain, pain or severe cramps, often accompanied by nausea, Vomiting, high fever can cause convulsions, or mental disorders, convulsions, coma and other symptoms, jaundice is lighter, time is short, physical examination is acute, body temperature can be sustained above 38.5 ° C, up to 41 ° C, obvious tenderness in the right upper abdomen And abdominal muscle tension, sometimes can reach the enlarged gallbladder, in some serious cases with toxic shock as the initial symptoms, after the treatment, abdominal distension, total abdominal tension and tenderness and other signs of peritonitis, peripheral blood leukocyte count increased, and neutral The number of white blood cells is mainly increased, the left side of the nucleus is moved and poisoned particles are present, and the children have persistent pain in the right upper abdomen, tenderness, muscle tension, can reach the enlarged gallbladder base, or accompanied by high fever, jaundice, no difficulty in diagnosis, but children Cholecystitis often lacks typical clinical manifestations, and the incidence is low, infants and young children can not accurately express the symptoms, often affect the timely diagnosis, B-mode ultrasound and preoperative cholangiography In the diagnosis, children who seek medical treatment with toxic shock should also consider the possibility of this disease. The combination of symptoms, signs and course of disease develops rapidly, accompanied by bad spirits, paralysis, confusion or coma, etc. diagnosis.
Examine
Pediatric acute cholecystitis and cholangitis examination
1. Blood examination: In the acute phase, the peripheral white blood cell count increased to more than 12×109/L, the neutrophils increased and the left nucleus moved and poisoned particles. When the inflammation is severe or peritonitis occurs, the white blood cells can be as high as 20×109/ Above L, even toxic particles appear, the inflammation is sharp, the condition deteriorates, and the white blood cell count does not increase, suggesting that the body's response ability is low.
2. Blood biochemical examination: It is normal to check liver function. When clinical jaundice occurs, serum direct bilirubin is increased, and serum alkaline phosphatase is increased in some children.
3. Abdominal puncture: If there is abdominal cavity exudate, abdominal puncture can be done. If green exudate is taken out, it can be diagnosed as biliary peritonitis.
4. B-ultrasound: B-ultrasound can identify the extent of gallbladder enlargement, the diameter of the bile duct and the presence or absence of stones, should be listed as the preferred method of examination.
5. Radionuclide scanning: 99m radionuclide scanning (99mTC-IDA) is fast, safe, reliable and accurate to 92%.
6. Retrograde cholangiopancreatography: For biliary colic with unexplained recurrent episodes, the presence or absence of pancreaticobiliary confluence should be considered, and retrograde cholangiopancreatography can be performed.
Diagnosis
Diagnosis and diagnosis of acute cholecystitis and cholangitis in children
Should pay attention to acute appendicitis, biliary ascariasis, acute pancreatitis, liver abscess and acute infectious hepatitis, acute cholecystitis, cholangitis with peritonitis, and other causes of peritonitis such as appendicitis, pancreatitis and digestive tract Perforation (such as typhoid intestinal perforation) and other identification, in addition to general medical history, physical signs and X-ray examination, ultrasound can detect the size of the gallbladder and the wall is rough and thick, abdominal puncture examination is also helpful for diagnosis.
1. Acute appendicitis: The cecal position of children is relatively high. Some appendixes extend to the right upper abdomen. When the appendicitis is high, it can express tenderness in the right upper abdomen, muscle tension, and confusion with acute cholecystitis. In addition to clinical manifestations, ultrasound examination can help For identification.
2. biliary ascariasis: often has a history of worms or worms, manifested as paroxysmal right upper quadrant pain, mild abdominal signs, and in the pain relief period, the sick child does not have any discomfort, cholecystitis manifests as persistent abdominal pain, And there are high fever, jaundice and other performances.
3. Acute pancreatitis: pediatric acute pancreatitis is rare, some children have a history of trauma or intestinal ascariasis, clinical manifestations of upper or upper abdominal persistent pain, high fever, nausea, vomiting, obvious tenderness in the pancreas, White blood cells can be as high as 20×109/L, and the increase of blood and urine amylase content is an important basis for differential diagnosis.
4. Liver abscess: high fever, pain in the liver area, painful mass in the right upper quadrant, liver enlargement and obvious tenderness, etc. Ultrasound can detect the intrahepatic fluid level; X-ray examination shows that the diaphragm is elevated and the activity is limited. In some cases, right lung or right pleural inflammatory disease may occur.
5. Acute infectious hepatitis: viral hepatitis has a history of hepatitis exposure, sick children with abdominal swelling, loss of appetite, fatigue, low fever, scleral yellow staining, right liver can touch the swollen liver under the ribs, and mild tenderness, Abnormal liver function, flat and soft abdomen, no rebound pain, white blood cell count can not increase and liver function abnormalities.
