Diagnosis of chronic cholecystitis
Last reviewed: 23.04.2024
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When collecting an anamnesis pay attention to heredity, transferred infectious diseases (including viral hepatitis and intestinal infections), the nature of nutrition, the presence of physical overload and stressful situations. Assess the physical development, the color of the skin, palpation determine the size of the liver, tenderness in various parts of the abdomen. Some diagnostic value has painful points (symptoms) of Kera, Murphy, Grekov-Ortner, Mussie, and others.
[Laboratory diagnostics of chronic cholecystitis in children
Clinical blood test - in the period of exacerbation of chronic cholecystitis moderate leukocytosis is possible.
Biochemical blood test - with exacerbation of chronic cholecystitis, the content of excretory enzymes (alkaline phosphatase, leucine aminopeptidase, y-glutamyltranspeptidase) increases, a moderate increase in the activity of transaminases.
Instrumental diagnostics of chronic cholecystitis in children
When duodenal probing pay attention to the time of obtaining a portion of bile. The prolonged delay of this portion forces us to assume the hypertonicity of the sphincters of Oddi and Lutkens. Bile is inoculated, but the results of the microbiological study should be evaluated taking into account the possibility of mixing the contents of the duodenum. On the lithogenicity bile is judged by the results of a physical and chemical study. During the exacerbation of chronic cholecystitis, the content of bile acids (taurocholic, glycocholic) decreases, the content of lithocholic acid, cholesterol is increased. These disorders lead to a decrease in the cholatecholesterol coefficient, a violation of the colloidal resistance of bile, the formation of cholesterol stones. The concentration of bilirubin increases, an increase in the content of C-reactive protein, glycoproteins, free amino acids is observed. Enhanced protein secretion in the gallbladder is considered as one of the factors of cholelithiasis, and an increase in the concentration of amino acids - as a result of the inflammatory process.
X-ray examination of the gallbladder (oral, intravenous cholecystography), carried out according to strict indications, allows to judge the form, position and motor-evacuation function of the organ. After receiving the food stimulus, the rate of emptying the bladder is estimated. In the case of a prolonged evacuation of the radiopaque substance, one can assume a decrease in motility or difficulty in passing the bile through the bladder duct. Cervical cholecystitis is not excluded.
Ultrasound is a priority method for diagnosing a disease. An important echographic sign of chronic cholecystitis is a 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 digestive tract: gastroduodenitis, peptic ulcer, pancreatitis, colitis, irritable bowel syndrome, chronic hepatitis, etc. It is necessary to reject right-sided nephroptosis, hydronephrosis, in girls - gynecological diseases.