Acute cholecystitis: symptoms

Acute cholecystitis against cholelithiasis (calculous cholecystitis).

Symptoms of acute cholecystitis are due to the severity of the pathological process, which ranges from a small inflammation to the fulminant gangrene of the gallbladder wall. Often an attack of the disease is an exacerbation of chronic cholecystitis.

People of any constitution, sex and age are ill, although women more than 40 years old who suffer from obesity are more likely to suffer.

The main symptoms of acute cholecystitis are as follows:

Pain (biliary colic) is localized in the epigastric or right subcostal area, radiates to the back below the angle of the nasal scapula, the right shoulder, less often to the left half of the trunk and may resemble an attack of angina. Pain occurs at night or early in the morning, increases to a certain intensity and persists for 30-60 minutes. The occurrence of pain can be preceded by the use of fatty, spicy, spicy food, alcohol, emotional experiences.

Characterized by excessive sweating, a grimace of pain and a motionless pose on his side with his legs pressed to his stomach. Often patients apply to the right hypochondrium a heating pad.

Pain from the dilatation of the gallbladder arises in connection with the obturation of the cystic duct and an intensified contraction of the gallbladder. The pain is localized in the depth, more centrally, is not accompanied by tension of the muscles of the abdominal wall, does not increase with superficial or deep palpation.

Pain from irritation of the peritoneum is localized superficially, strengthened by touching the skin, accompanied by hyperesthesia and muscle tension of the abdominal wall. The bottom of the gallbladder touches the diaphragmatic peritoneum, which is innervated by the diaphragmatic and six lower intercostal nerves. The irritation of the anterior branches of intercostal nerves causes pain in the right upper quadrant of the abdomen, irritation of the posterior cutaneous branch - a characteristic pain under the right scapula.

Spinal nerves innervate a small area of mesentery and gastrohepatic ligament around large bile ducts. The irritation of these nerves is perceived as a pain in the back and right upper quadrant of the abdomen, which explains the pain in the stones of the common bile duct and cholangitis.

Digestive system. For acute cholecystitis are characterized by flatulence and nausea; the addition of vomiting makes one think of concomitant choledocholithiasis.

Fever - often subfebrile, rarely reaches febrile values (with destructive forms of cholecystitis or due to complications). The hectic temperature curve, accompanied by severe sweating, severe chills, often indicates a purulent inflammation (empyema of the gallbladder, abscess). In weakened patients and the elderly, body temperature even with purulent cholecystitis may remain subfebrile, and sometimes even normal, due to reduced reactivity.

Other symptoms are a burp bitterness or a constant bitter taste in the mouth; a feeling of raspiraniya in the upper half of the abdomen, bloating, stool, nausea, vomiting bilious.

Jaundice is not typical, but it is possible with obstructed bile outflow due to congestion of mucus, epithelium, obstruction of the common bile duct by concrements or with developed cholangitis.

When collecting an anamnesis, it is necessary to carefully examine the patient on the following points:

• character, duration, localization and irradiation of pain;
• associated symptoms, such as fever, chills, nausea, vomiting;
• presence in the anamnesis of episodes of biliary colic; age of the patient (since in the elderly and senile age complications often occur);
• presence of diabetes mellitus (with this disease often develops gangrenous cholecystitis).

In the physical examination it is necessary to carry out:

• assessment of the general condition;
• examination of the skin and visible mucous membranes (especially carefully examine the sclera, conjunctiva and the bridle of the tongue) and skin for the timely detection of jaundice;
• determination of muscle tension in the anterior abdominal wall, especially in the right hypochondrium and epigastric regions;
• palpation of the right hypochondrium to identify an enlarged gallbladder with simultaneous examination of the symptoms of gallbladder inflammation (sensitivity of Murphy's positive symptom in acute cholecystitis is 92%, specificity is 48%);
• body temperature measurement.

The following signs can be found in patients with acute cholecystitis.

Symptoms of inflammation of the gallbladder, which include the following:

• Murphy's symptom is a sharp pain when pressure is applied to the area of the right hypochondrium at the height of inspiration (in another interpretation: involuntary retention of breath on inspiration due to severe soreness with pressure on the right hypochondrium);
• symptom Kera - pain when palpation of the right hypochondrium;
• Ortner's symptom is painfulness when tapping on the right rib arc;
• symptom de Moussi-Georgievsky (frenicus-symptom) - soreness when pressing a finger between the legs of the right sternocleidomastoid muscle.
• the Shchetkin-Blumberg syndrome becomes positive when the peritoneum (peritonitis) is involved in the inflammatory process.

Acute cholecystitis in the absence of cholelithiasis (acanthocephalic cholecystitis) is characterized by more frequent complications and higher lethality.

Acute cholecystitis should be assumed in patients in critical condition.

It must be remembered that in this case the clinical picture can be erased: the pain syndrome is often absent.

[1], [2], [3], [4], [5], [6], [7]