calculous cholecystitis
Introduction
Introduction to calculous cholecystitis Calculous cholecystitis refers to a disease in which stones occur in the gallbladder or in the gallbladder neck. Its clinical manifestation depends on the location and size of the stone, whether it causes infection, obstruction, and the location and extent of obstruction. Calculous cholecystitis is the most common lesion in the biliary system. According to the location of the place, there may be gallstones, primary or secondary common bile duct stones, extrahepatic bile duct or intrahepatic bile duct stones. basic knowledge The proportion of illness: 0.21% Susceptible people: no specific population Mode of infection: non-infectious Complications: cholecystitis
Cause
Causes of calculous cholecystitis
Obesity (20%):
Clinical and epidemiological studies have shown that obesity is an important risk factor for the incidence of cholesterol gallstones in the gallbladder, and the incidence of obese people is three times that of normal weight. The reason why obese people are more susceptible to disease is that the amount of cholesterol synthesis in the body is absolutely increased, or the relative increase in bile acids and phospholipids makes the cholesterol supersaturated.
Age (10%):
Epidemiological studies have shown that the incidence increases with age. The disease is rare in childhood and may be associated with hemolysis or congenital biliary disease. The 5-year incidence rate of 40-69 years old is 4 times that of the low-age group, and the boundary between high-incidence and low-incidence is 40 years old. Although there are some differences in reports from various countries, the peak age of onset is 40-50 years old. One age group.
Gender differences (5%):
The results of ultrasound diagnosis are about 1:2. The difference in sex ratio is mainly reflected in the incidence of cholesterol stones. There is no significant gender difference in the incidence of gallstones in the gallbladder. High levels of cholesterol in women may be associated with estrogen lowering bile flow, increasing cholesterol secretion in bile, lowering total bile acid volume and activity, and progesterone affecting gallbladder motility and causing bile stasis.
Birth (5%):
Pregnancy promotes the formation of stones and the number of pregnancies is positively correlated with morbidity. This view has been demonstrated by clinical and epidemiological studies. The causes of stones in pregnancy are:
An increase in estrogen during pregnancy changes the bile composition and increases the saturation of cholesterol in the bile.
2 The gallbladder emptying during pregnancy is slow, B-ultrasound shows that when the pregnant woman is fasting, the gallbladder volume increases, the residual volume increases after contraction, and the gallbladder contraction rate decreases.
3 changes in body weight during pregnancy and postpartum also affect bile composition, change the intestinal liver circulation of bile acids, and promote the formation of cholesterol crystals.
Regional differences (10%):
There are some differences in the incidence rates in different countries and regions. The prevalence of calculus in Western Europe, North America and Australia is high, and cholelithiasis is rare in many parts of Africa. The types of gallstones vary from country to country, with cholesterol stones in Sweden and Germany, and calcium carbonate stones in the UK.
Dietary factors (10%):
Eating habits are the main factors affecting the formation of gallstones. The incidence of refined foods and high-cholesterol foods is significantly higher. Because refined carbohydrates increase bile cholesterol saturation.
Genetic factors (5%):
The differences in the incidence of calculous cholecystitis also suggest that genetic factors are one of the pathogenesis. The incidence of gallstones is high in people with Indian genes. Studies on single-oval twins have shown that the risk of gallstones in the relatives of the patients is also high, and the incidence rate in the family of calculous cholecystitis is also advanced, so it has a genetic predisposition.
Other factors (10%):
The incidence of calculous cholecystitis is also associated with cirrhosis, diabetes, hyperlipidemia, parenteral nutrition, surgical trauma, and the use of certain drugs. For example, the incidence of cirrhosis patients is three times that of no cirrhosis, and the incidence of diabetes patients is twice that of non-diabetic patients. The causes of the formation of cholecystitis are closely related to various factors such as lipid metabolism, nucleation time, gallbladder motor function, and bacterial gene fragments.
Prevention
Calculous cholecystitis prevention
1. Universal prevention: The purpose of primary prevention is to prevent the formation of stones. Dietary changes are associated with stone formation, the type of stone induced (cholesterol stones or bile pigment stones), and stone dissolution. The occurrence of stones has both genetic and environmental factors. The former is more difficult to change, while the latter can be adjusted. Studies of risk factors for cholesterol gallstones have also confirmed this: high calorie and fat intake, increased incidence of cholelithiasis; and reduced incidence of stones due to low intake. Based on epidemiological and stone-forming mechanisms, the following preventive measures are recommended.
1 prevention of cholesterol super-saturated bile: obese people have too much cholesterol in the body, bile discharge. On the other hand, obese patients use various methods to reduce weight and consume body fat tissue, in which cholesterol is discharged into bile and also increases bile cholesterol. Therefore, avoiding obesity has positive significance.
2 increase calcium and cellulose intake: DCA increases bile cholesterol secretion, inhibits bile acid synthesis rate-limiting enzyme activity, and induces nucleation to accelerate. Ruijin Hospital of Shanghai Second Medical University analyzed more than 400 patients with gallstones and found that serum DCA content was significantly greater than normal. Foods high in calcium and cellulose can reduce DCA and prevent gallstone formation.
3 Reduce the intake of saturated fatty acids: Animal experiments have shown that the reduction of saturated fatty acids in food can not only reduce the cholesterol content of bile, but also reduce the nucleation activity of bile.
4 regular meals and increased exercise: recently in the animal model with a mixture of lipids and protein or exogenous cholecystokinin (CCK) daily stimulation of gallbladder emptying, prevention of bile stasis, significantly reduced gallstones. It is recommended to eat on time to avoid excessive interval between the two meals and reduce the blocking time of bile acid enterohepatic circulation. When the liver secretes bile acids, the cholesterol/phospholipid ratio in the bile bubbles decreases. It is recommended to add a small meal before going to sleep after three meals, shortening the fasting time of one night. Frequent emptying of the gallbladder not only promotes the circulation of bile acids, but also reduces the residence time of bile in the gallbladder. This type of diet may increase the intake of calories and pose a risk of obesity, so it is necessary to increase physical activity and promote energy expenditure.
2. Prevention of high-risk groups:
In addition to primary prevention for the general population, it is also necessary to selectively prevent some high-risk groups who are about to form stones. High-risk people with stones refer to people with risk factors for the formation of gallstones. Epidemiology points out that age, women, women, people with Indian genetics, and hyperlipidemia are all risk factors.
Complication
Calculous cholecystitis complications Complications cholecystitis
(A) gallbladder empyema.
(B) emphysema cholecystitis.
(C) perforation of the gallbladder.
Symptom
Calculous gallbladder symptoms Common symptoms Abdominal bloating persistent pain jaundice biliary colic extrahepatic bile duct stones nausea sputum gas gallbladder tenderness gallbladder volume shrinking gallbladder hydrops
symptom
1, gallstones in the gallbladder generally do not produce symptoms of biliary colic, called static stones, may have pain in the right upper abdomen, acid reflux, belching, abdominal distension and other symptoms of dyspepsia, after eating greasy food, such as accompanied by infection May have symptoms of acute cholecystitis.
2, gallbladder tube stones may have biliary colic performance, sudden right upper quadrant persistent pain, paroxysmal aggravation, release to the shoulders and back, with nausea, vomiting, etc., the main points of the consultation see acute and chronic cholecystitis.
Sign
1. There is no positive sign in the gallstones of the gallbladder. When a few stones are too large, the gallbladder can be touched.
2, gallbladder tube stones, right upper abdomen tenderness, Murphy sign positive, right upper abdomen can touch the enlarged gallbladder, there is tenderness, such as the occurrence of gallbladder perforation can have full abdominal tenderness, rebound tenderness, muscle tension and other signs of acute peritonitis, part The patient may have jaundice.
Examine
Examination of calculous cholecystitis
First, physical examination found
1. There is no positive sign in the gallstones of the gallbladder. When a few stones are too large, the gallbladder can be touched.
2, gallbladder tube stones, right upper abdomen tenderness, Murphy sign positive, right upper abdomen can touch the enlarged gallbladder, there is tenderness, such as the occurrence of gallbladder perforation can have full abdominal tenderness, rebound tenderness, muscle tension and other signs of acute peritonitis, part The patient may have jaundice.
Second, laboratory inspection
1. The total number of white blood cells > 10 × 10 9th power / L nuclear left shift,
2. Positive stones can be seen in the gallbladder area of the abdominal X-ray film.
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, the gallbladder is not developed,
5. CT or MR shows gallstones.
Diagnosis
Diagnosis and diagnosis of calculous cholecystitis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
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.
