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Diagnosis of acute cholecystitis
Last reviewed: 03.07.2025
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Clinical diagnostics of acute cholecystitis in children is usually uninformative, since the disease develops suddenly. When examining the patient, a forced position and yellowness of the skin are determined. The area of maximum abdominal pain (right hypochondrium), the size of the liver and spleen are determined by palpation.
[ Laboratory diagnostics of acute cholecystitis in children
Clinical blood test:
- an increase in the number of leukocytes - in the catarrhal form of acute cholecystitis - 10-12x10 9 /l, in phlegmonous and gangrenous - 15-20x10 9 /l and more;
- neutrophilia with a left shift;
- ESR from 20-30 to 50-60 mm/h.
Urine analysis - increased concentration of bile pigments. Stool analysis - absence of stercobilin.
Biochemical blood test:
- increase in bilirubin content due to the direct (conjugated) fraction;
- an increase in the concentration of excretory enzymes that serve as biochemical markers of cholestasis: alkaline phosphatase (especially liver isoenzyme), y-glutamyl transpeptidase, leucine aminopeptidase, etc.;
- increased concentration of acute phase inflammation proteins: prealbumin, beta 2 -glycoprotein, C-reactive protein, etc.;
- increased transaminase activity.
Instrumental diagnostics of acute cholecystitis in children
Ultrasound allows detecting signs of acute cholecystitis: thickening of the gallbladder walls by more than 3-4 mm, "double" wall contour and increase in organ size, perivesical fluid. Dynamic examination allows judging the form of gallbladder inflammation.
During laparoscopic examination in case of catarrhal acute cholecystitis, the serous cover of the fundus and body of the gallbladder is hyperemic, the vessels are injected. The bladder is tense and enlarged. In the phlegmonous form of acute cholecystitis, the foam of the organ is sharply edematous and hyperemic, subserous hemorrhages, fibrin deposits on the gallbladder and surrounding organs are visible. A yellowish effusion is formed in the right subhepatic space and the right lateral canal. The gangrenous form of inflammation, in addition to the listed signs, is characterized by the formation of foci of necrosis on the wall of the gallbladder.
Differential diagnostics
Acute cholecystitis in children must be differentiated from diseases that occur against the background of acute and sudden abdominal pain: acute appendicitis, acute pancreatitis, peptic ulcer, right-sided pleurisy, right-sided pneumonia, right-sided renal colic.