right back pain
Introduction
Introduction Right back pain is likely to be a symptom of cholecystitis, a cholecystitis caused by bacterial infection or chemical stimuli (changes in bile composition), 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. There are a few cases in the clinic that have no bile retention or bacterial infection for other reasons. Mainly seen in trauma and pancreatic reflux. Trauma, including surgery, burns, etc., can lead to acute cholecystitis.
Cause
Cause
The cause of right back pain:
1. Mechanical obstruction: It is generally believed that more than 90% of patients with acute cholecystitis have stones embedded in the gallbladder neck or cystic duct, resulting in bile retention; some authors believe that even if there is no stone in the gallbladder during surgery or autopsy, it can not be proved in the lesion. There are no stones in the early stage, and stones may have been discharged to the common bile duct. In addition to stones, the connection between the cystic duct and the common bile duct may also be due to a small angle, the cystic duct itself is too tortuous, deformed, or abnormal blood vessels, peripheral inflammation adhesions, aphid drilling, and swelling of the lymph nodes cause obstruction and biliary retention. Functional disorders studies have confirmed that biliary muscles, neurological disorders, and normal emptying of the gallbladder are blocked, causing temporary bile retention. When there are lesions in the abdominal organs, such as stomach, duodenal ulcer, chronic appendicitis or periarteritis, the visceral nerve is transmitted to the cerebral cortex by pathological stimulation, causing dysfunction of the cortex, thereby causing the cystic duct reflexively. The sphincter and duodenal papillary sphincter dysfunction causes paralysis, resulting in retention of bile throughout the biliary system. Long-term bile retention and concentration in the gallbladder can stimulate the gallbladder mucosa, causing inflammatory lesions, and bacterial infection can form acute cholecystitis.
2. Bacterial infection: About 70% of the bacteria causing acute cholecystitis are Escherichia coli, others include Klebsiella, Clostridium, Staphylococcus, Salmonella typhi, Paratyphoid, Streptococcus, and Pneumococci Wait. About 50% of patients with acute cholecystitis have positive bile culture. The path of bacterial invasion is usually through bile or lymphatic vessels, and sometimes it can be retrograde into the biliary tract or blood-borne dissemination through the intestine. In short, there are many paths for bacteria to reach the gallbladder.
3. Other causes: There are a few cases in the clinic that have no bile retention or bacterial infection for other reasons. Mainly seen in trauma and pancreatic reflux. Trauma, including surgery, burns, etc., can lead to acute cholecystitis. In the case of trauma, bile viscosity increases due to pain, fever, dehydration, emotional stress, etc., and emptying slows down. In addition, when the pancreatic and bile ducts are obstructed, trypsin in the reflux pancreatic juice is activated by bile, which binds to bile acids and also activates phospholipase to convert lecithin to lysolecithin, both of which act on the gallbladder wall. , causing damage.
Examine
an examination
Related inspection
CT examination of bone palpation
Diagnosis of right back pain:
Diagnosis: The clinical symptoms of cholecystitis are:
(1) Many patients with acute cholecystitis develop 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.
(B) chronic gallbladder inflammation symptoms, 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.
Diagnosis
Differential diagnosis
Identification of symptoms that are easily confused with right back pain:
Shoulder and back pain: There are many patients with shoulder and back pain, most of which are caused by local bone or soft tissue diseases of the shoulder. It is also possible that the tumor has metastasized to the shoulder. Therefore, after the treatment, the back pain can not shoulder pain, shoulder pain, medical back, blind massage, scraping, cupping and other treatment methods, so that patients lose the best treatment opportunity.
Back pain: The uncomfortable feeling of the back due to illness, trauma, etc.
Back pain: The range of pain in the back pain. If you only have pain in the back, consider the thoracolumbar dislocation and need to be reset. If you have a neck or only the inside of the scapula, consider neck and shoulder syndrome and loosen the muscle spasm.
Sustained pain in the lower back: Most of the persistent pain in the lower back is caused by the injury of the lower back. It is common in lumbar muscle strain, lumbar myofasciitis, lumbar disc herniation.
There is a vague numbness on the back. Discomfort: There is a vague numbness on the back. Discomfort is caused by neuralgia. Pain is one of the common symptoms of neurology. This kind of pain refers to the pain that is felt without external stimuli, also known as spontaneous pain. There are many types of spontaneous pain, and the lesions can be divided into peripheral neuropathic pain and central nervous pain.
