acute cholecystitis in children
Introduction
Introduction to acute cholecystitis in children Acute cholecystitis is rare in children, occasionally with cholelithiasis (children are more rare). The onset is often more rapid, more than 1 day after the onset of the disease, with abdominal pain, high fever warfare 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, paralysis, coma and other symptoms, jaundice is lighter, time is short. basic knowledge The proportion of sickness: 0.9% Susceptible people: young children Mode of infection: non-infectious Complications: cholangitis toxic shock syndrome biliary peritonitis
Cause
Causes of acute cholecystitis in children
Obstruction of the cystic duct (30%):
This plays an important role in the pathogenesis of acute cholecystitis. Often caused by stones, parasites, congenital stenosis and obstruction and congenital common bile duct malformation. Due to obstruction of the cystic duct, a large amount of cholestasis is deposited in the gallbladder, and part of the water is absorbed by the wall of the capsule, causing the bile to concentrate and the concentration of bile salts to increase, stimulating the gallbladder mucosa and causing chemical inflammation of the gallbladder. More than 90% of patients with acute cholecystitis are caused by obstruction of the cystic duct or gallbladder emptying. Gallbladder stones or bile deposits in the neck of the gallbladder are an important cause of obstruction. Therefore, acute cholecystitis has calculus and non-calculus. Points. In children, calculus cholecystitis is rare, and there has been a clear upward trend in recent years. The cause of acalculous cholecystitis is unclear and may be due to a variety of factors. If the cystic duct is too long and distorted, but the cystic duct lumen is blocked by aphids, mucus, gallbladder pedicled polyps, or gallbladder emptying disorder caused by dysfunction of the biliary system, causing bile accumulation in the cystic duct or obstruction. In rural areas of China, biliary ascariasis and biliary infections are one of the important causes of disease.
Bacterial infection (28%):
Bacterial invasion is another important cause of acute cholecystitis. The main routes of bacterial invasion are: 1 from the duodenum through the common bile duct invasion, the most common aphid drilling into the bile duct, carrying bacteria into the 2; portal vein blood into the liver and gallbladder, more common in critically ill intestinal flora shift 3; lymphatic vessels into the liver and gallbladder; 4 arterial blood into the gallbladder artery to the gallbladder, rare. Choles deposition is good for bacterial growth. The pathogenic bacteria are mainly intestinal-derived bacteria, such as Escherichia coli, Proteus, Bacteroides, etc., mostly mixed infections.
Other (30%):
Acute cholecystitis may be associated with acute pancreatitis, which may be caused by abnormal pancreaticobiliary confluence leading to pancreatic enzyme reflux, which is caused by gallbladder bile activation and damage to the gallbladder mucosa. In addition, acalculous cholecystitis can occur on the basis of severe trauma, burns, major surgery, and long-term fasting and application of cholestasis such as TPN. Most of these cases have gallbladder formation during the onset of gallbladder. . It has been reported that thick bile and bile can stimulate the secretion of prostaglandins I2 and E2 from the gallbladder epithelium, which in turn mediates the inflammatory response. Immune-suppressed children can develop opportunistic microbial infections leading to acute cholecystitis, such as cytomegalovirus or Cryptosporidium infection of acquired immunodeficiency syndrome (AIDS).
Prevention
Prevention of acute cholecystitis in children
General acute cholecystitis can be self-healing by non-surgical treatment, but with peritonitis, it must be actively prepared for surgery, and 3 cases died in 66 cases. The age is 2 months and 2 cases within 1 year. All were associated with advanced children with biliary peritonitis.
Prevention:
1. Pay attention to diet, food should be light, eat less greasy and fried, grilled food.
2. Keep the stool clear, six to use, liver and gallbladder dampness, when the stool is secret, the symptoms are aggravated, it is very important to keep the stool smooth.
3. To change the sedentary lifestyle, move more and exercise more.
4. To support, long-term family is not jealous, people with a bad mood can cause or aggravate the disease, to be broad-minded and comfortable.
Complication
Pediatric acute cholecystitis complications Complications cholangitis toxic shock syndrome biliary peritonitis
Can be complicated by gallstones, cholangitis, biliary peritonitis and even toxic shock.
Symptom
Acute gallbladder inflammation in children Common symptoms Abdominal pain Abdominal muscle bloating convulsions Congestive dull pain Peritonitis Acute illness ambiguous jaundice nausea
The onset is often more rapid, more than 1 day after the onset of the disease, with abdominal pain, high fever warfare 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, paralysis, coma and other symptoms, jaundice is lighter, time is short.
Examine
Examination of acute cholecystitis in children
The physical examination is acute, the body temperature can be above 38.5 °C, the highest can reach 41 °C, the right upper abdomen has obvious tenderness and abdominal muscle tension, sometimes can reach the enlarged gallbladder, and some serious cases are treated with toxic shock as the main manifestation. After the beginning of abdominal distension, total abdominal tension and tenderness and other signs of peritonitis.
The number of white blood cells in the peripheral blood increased, and the number of neutrophils increased, and the left nucleus moved and poisoned particles.
Diagnosis
Diagnosis and diagnosis of acute cholecystitis in children
Generally, according to the history and signs of upper abdominal pain and right upper quadrant tenderness, the diagnosis is not difficult. In children with toxic shock, it is also necessary to consider the possibility of this disease. The combination of symptoms, signs and course of disease develops rapidly. If you have a mental disorder, convulsions, confusion or coma, you can make a diagnosis. If you have abdominal effusion, you can do abdominal puncture. If you take out green exudate, you can diagnose biliary peritonitis.
Cholecystitis should be differentiated from infectious hepatitis, the latter liver enlargement, white blood cell count can not increase and liver function decline, acute cholecystitis, cholangitis with peritonitis, and other causes of peritoneum such as appendicitis, pancreas Inflammation and digestive tract perforation (such as typhoid intestinal perforation) are differentiated. 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, and abdominal puncture can also help diagnosis.
