cholecystitis
Introduction
Introduction to cholecystitis Cholecystitis is a cholecystitis caused by bacterial infection or chemical stimulation (change of bile composition) and is a common disease of the gallbladder. In abdominal surgery, the incidence rate is second only to appendicitis. This disease is more common in middle-aged people aged 35-55 years. The incidence of females is more than that of males, especially in obese women with multiple pregnancies. Many patients develop symptoms in the middle of the night after greasy dinner. Because of the high-fat diet, the gallbladder can strengthen the contraction, while the supine is easy to slide into the gallbladder tube. Mainly manifested as persistent pain in the upper right abdomen, paroxysmal aggravation, can be radiated to the right shoulder; often accompanied by fever, nausea and vomiting, but chills are rare, jaundice is light. Abdominal examination revealed a full right upper abdomen, abdominal muscle tension in the gallbladder area, obvious tenderness, and rebound tenderness. basic knowledge Sickness ratio: 0.1% Susceptible people: no special people Mode of infection: non-infectious Complications: liver abscess
Cause
Cause of cholecystitis
Physical and dietary factors (30%):
Low immunity causes biliary infection, and biliary infection can cause gallbladder inflammation. The daily diet should be moderate, and avoid overeating. Eat low-fat and cholesterol-rich foods and pay attention to food hygiene.
Disease, psychological factors (30%):
Emotional disorders can lead to cholecystitis caused by obstruction of bile. Intestinal parasitic diseases, such as aphids drilling into the biliary tract can cause inflammation of the biliary tract. Its debris and eggs can become the "core" of the stone.
Prevention
Cholecystitis prevention
1. Always do some physical activity to make the whole body metabolically active, especially mental work and middle-aged people who are always sitting still, and more consciously do manual labor to prevent excessive obesity, because obesity is gallbladder An important cause of inflammation or gallstones.
2, after the cool autumn should pay attention to keep warm, especially when sleeping, cover the quilt, prevent the abdomen from getting cold, because the stomach will stimulate the vagus nerve after the cold, so that the gallbladder strongly shrinks.
3, people who have been proven to have gallstones, should be treated in time to avoid gallbladder inflammation.
4, when there are intestinal insects (mainly aphids), timely application of deworming drugs, the amount should be sufficient, in order to prevent the lack of medication, aphids active and easy to drill into the biliary tract, causing obstruction, causing cholecystitis.
5. When inflammation occurs, apply effective antibiotics in time.
6, you can drink some Chinese medicine, the effect is also good.
Complication
Cholecystitis complications Complications liver abscess
Common complications
Gallbladder water, white bile, lime milk bile, porcelain-like gallbladder, gallbladder perforation, gallbladder fistula, liver abscess.
Symptom
Cholecystitis symptoms Common symptoms Astragalus right upper quadrant pain Nausea nails fan-shaped persistent fever Abdominal muscles Gallbladder wall rough Gallbladder wall thick shoulder circumference area diffuse blunt... Abdominal pain
Clinical manifestation
Acute cholecystitis
Many patients develop symptoms in the middle of the night after greasy dinner. Because of the high-fat diet, the gallbladder can strengthen the contraction, while the supine is easy to slide into the gallbladder tube. Mainly manifested as persistent pain in the upper right abdomen, paroxysmal aggravation, can be radiated to the right shoulder; often accompanied by fever, nausea and vomiting, but chills are rare, jaundice is light. Abdominal examination revealed a full right upper abdomen, abdominal muscle tension in the gallbladder area, obvious tenderness, and rebound tenderness.
2. Chronic cholecystitis
Symptoms and signs are not typical. Most manifested as biliary dyspepsia, irritated food, upper abdominal bloating, belching, stomach burning, etc., similar to ulcer disease or chronic appendicitis; sometimes due to stone obstruction of the cystic duct, can be acute, but when the stone moves, When the obstruction is lifted, it will quickly improve. Physical examination, the gallbladder area may have mild tenderness or snoring pain; if the gallbladder accumulates water, it can often lick a round, smooth cystic mass.
Examine
Cholecystitis examination
Clinical examination
I. Laboratory inspection
1. Total white blood cells and neutrophils
About 80% of patients have an increased white blood cell count, with an average of (10-15) x 109/L. The extent of the increase is related to the severity of the lesion and the presence or absence of complications. If the total number of white blood cells is above 20 × 109 / L, the presence of gallbladder necrosis or perforation should be considered.
2. Serum total bilirubin
Clinically, about 10% of patients have jaundice, but the increase in serum total bilirubin is about 25%. When combined with acute pancreatitis, blood and urine amylase levels also increased.
3. Serum aminotransferase
2. Imaging examination
B-mode ultrasound
The most diagnostic value can show gallbladder size, wall thickness, intracapsular calculus and gallbladder contraction.
2. X-ray inspection (now generally do not do this check)
Nearly 20% of acute gallstones can be visualized in plain radiographs, suppurative cholecystitis or gallbladder effusions, and can also show enlarged gallbladder or inflammatory tissue mass shadows.
3. CT and MRI examination: It is very helpful for the diagnosis and differentiation of acute calculous cholecystitis, especially for the diagnosis of bile duct stones and acute pancreatitis.
4. Intravenous cholangiography.
5. Radionuclide imaging.
Diagnosis
Diagnosis and identification of cholecystitis
Diagnostic points
1. Rapid onset, pain in the right upper quadrant, nausea, vomiting, high fever or chills.
2. Acute sputum, visible jaundice, obvious tenderness in the right upper abdomen, abdominal muscle tension, Murphy sign positive, or can touch the enlarged gallbladder.
3. The number of white blood cells and neutrophils increased, and the nucleus moved to the left or saw poisonous particles. 4. B-ultrasound is the main basis for diagnosis, which can show the degree of gallbladder enlargement, effusion, empyema, and exudative changes around the gallbladder.
