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Gallstone disease: symptoms
Last reviewed: 23.04.2024
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Gallstone disease in the clinical course:
- latent form (stone-breaking);
- primary-chronic cholecystitis;
- biliary colic;
- chronic recurrent cholecystitis.
The main symptom of cholelithiasis is biliary colic (usually due to transient obstruction by the stone of the bladder duct). It is characterized by acute visceral pains with localization in the epigastric or right subcostal area, rarely pain occurs only in the left subcostal region, the precordial region or the lower half of the abdomen, which greatly complicates the diagnosis.
In 50% of patients, pain radiates to the back and right shoulder blade, interscapular area, right shoulder, rarely - to the left half of the trunk.
The duration of biliary colic is from 15 minutes to 5-6 hours. Pain longer than 5-6 hours should alert the doctor with regard to complications, especially acute cholecystitis.
Pain syndrome is accompanied by increased sweating, grimace of pain on the face and forced position - on the side with legs clamped to the abdomen. Sometimes there is nausea and vomiting.
The occurrence of pain can be preceded by the use of fatty, spicy, spicy food, alcohol, physical activity, emotional distress.
Pain is associated with overgrowth of the gallbladder wall due to an increase in intravesical pressure and a spasmodic contraction of the Oddi sphincter or bladder duct. In biliary colic, an increase in body temperature is possible, but prolonged and significant hyperthermia (above 38 ° C) in combination with symptoms of intoxication (asthenovegetative syndrome, dryness and lagging of the tongue) usually indicate the adherence of acute cholecystitis.
The detection of jaundice is usually considered a sign of obstruction of the biliary tract.
When collecting anamnesis, it is necessary to ask the patient for the episodes of abdominal pain in the past, especially as in the course of the progression of cholelithiasis the episodes of biliary colic recur, become lingering, the intensity of pain increases.
Possible and nonspecific symptoms, such as heaviness in the right hypochondrium, flatulence, dyspeptic manifestations.
Physical examination
It is possible to identify the symptom of muscular defenses, increase pain in palpation in the right hypochondrium and flicking the edge of the palm along the right rib arc, as well as the Murphy symptom (involuntary retention of breath at inspiratory height during palpation of the gallbladder due to increased pain). Accession of acute cholecystitis is characterized by the appearance of specific inflammatory symptoms from the gallbladder.
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