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Diagnosis of chronic cholecystitis
Last reviewed: 03.07.2025
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When collecting anamnesis, attention is paid to heredity, previous infectious diseases (including viral hepatitis and intestinal infections), diet, physical overload and stressful situations. Physical development, skin color are assessed, the size of the liver and pain in various parts of the abdomen are determined by palpation. Pain points (symptoms) of Ker, Murphy, Grekov-Ortner, Mussi and others have some diagnostic value.
[ Laboratory diagnostics of chronic cholecystitis in children
Clinical blood test - during an exacerbation of chronic cholecystitis, moderate leukocytosis is possible.
Biochemical blood test - during exacerbation of chronic cholecystitis, there is an increase in the content of excretory enzymes (alkaline phosphatase, leucine aminopeptidase, y-glutamyl transpeptidase), a moderate increase in the activity of transaminases.
Instrumental diagnostics of chronic cholecystitis in children
During duodenal intubation, attention is paid to the time of obtaining a portion of bile. A long delay in this portion suggests hypertonicity of the sphincters of Oddi and Lutkens. Bile is cultured, but the results of the microbiological study should be assessed taking into account the possibility of mixing in the contents of the duodenum. The lithogenicity of bile is judged by the results of a physicochemical study. During an exacerbation of chronic cholecystitis, the content of bile acids (taurocholic, glycocholic) decreases, the content of lithocholic acid and cholesterol increases. These disorders lead to a decrease in the cholatocholesterol coefficient, disruption of the colloidal stability of bile, and the formation of cholesterol stones. The concentration of bilirubin increases, an increase in the content of C-reactive protein, glycoproteins, and free amino acids is observed. Increased secretion of protein in the gallbladder bile is considered one of the factors of cholelithiasis, and an increase in the concentration of amino acids is considered a result of the inflammatory process.
X-ray examination of the gallbladder (oral, intravenous cholecystography), performed according to strict indications, allows us to judge the shape, position and motor-evacuation function of the organ. After taking a food irritant, the rate of emptying of the bladder is assessed. In the case of prolonged evacuation of the radiopaque substance, it is possible to assume a decrease in motility or difficulty in the passage of bile through the cystic duct. Cervical cholecystitis is not excluded.
Ultrasound is the priority method for diagnosing the disease. An important echographic sign of chronic cholecystitis is considered to be local or diffuse thickening of the gallbladder wall (2-3 mm or more).
Differential diagnostics
Differentiation of chronic cholecystitis in children often occurs by excluding other diseases of the gastrointestinal tract: gastroduodenitis, peptic ulcer, pancreatitis, colitis, irritable bowel syndrome, chronic hepatitis, etc. It is necessary to exclude right-sided nephroptosis, hydronephrosis, and in girls - gynecological diseases.