Symptoms of acute cholecystitis

Symptoms of acute cholecystitis in children begin acutely, suddenly, often at night, severe pain in the right upper quadrant, epigastric region, less frequently in other areas of the abdomen (in preschool children). The child is extremely restless, rushes in bed, trying to find a position that alleviates the pain. There is nausea, vomiting with an admixture of bile, often multiple and not bringing relief.

Pre-school children (up to 7 years) and primary school age (8-11 years old) have abdominal pains that are diffuse or indeterminate, which creates diagnostic difficulties and provokes medical errors. In patients of adolescence (12-13 years) the pain is severe, sharp, the "dagger" character begins to localize in the right hypochondrium. Note the irradiation of such pain in the right shoulder, scapula, right half of the back and iliac region.

The appearance of the described intolerable, "dagger" pains in the abdomen is due to:

• inflammatory process in the wall of the gallbladder, in especially severe cases passing to the peritoneum;
• difficulty in churning the bile out of the bladder;
• increased intravesical pressure;
• Stressing of the gallbladder.

In physical examination, attention is drawn to the increase in body temperature to 38-39 ° C and above, often with a previous chill and sweating. Rapidly increases toxicosis. The tongue is dry, coated with a whitish-gray coating. The abdomen is swollen, especially in the right half, respiratory movements are limited. With superficial palpation of the abdomen, early local and then widespread stress such as defense musculaire (muscular protection) is determined . The liver can protrude 2-3 cm from under the edge of the rib arc on the right middle clavicle line, moderately painful. The spleen is usually not palpable, but can be determined with phlegmous and gangrenous forms of acute cholecystitis. Jaundice of the skin, hysteria of the sclera - unstable signs, usually due to a violation of the functional state of the liver in combination with cholestasis. In the blood, leukocytosis is observed from 10-12x10 ⁹ / l to 20x10 ⁹ / l and more, neutrophilia with a shift towards young forms. In the urine, the content of urobilin is increased, and proteinuria is possible.

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

Features of the course of acute cholecystitis in children

Depends on the characteristics of morphological changes in the gallbladder.

With catarrhal cholecystitis - the most frequent form of inflammation of the gallbladder in children - a painful attack lasts 2-3 days, rarely longer. The pain gradually abates under the influence of ongoing treatment or spontaneously. Despite the fact that this form of acute cholecystitis is characterized by relative benignness of the course, a transition to a phlegmous or gangrenous cholecystitis is possible. The outcome of catarrhal inflammation is a dropsy of the gallbladder (hydrops vesicae felleae), often occurring after a mild pain attack and without anamnestic data on the lesion of the biliary tract. The child does not make any complaints, only some children have dull (undefined) pains in the right upper quadrant, sometimes nausea.

The phlegmonous form of acute cholecystitis begins as a catarrhal cholecystitis, but in the future it is difficult. The intoxication quickly increases, the general condition of the child sharply worsens, the body temperature increase is remitting, there are chills. Pain in the abdomen is intense, constant, accompanied by nausea, vomiting. The tongue is dry, coated. The abdomen is swollen, with palpation is sharply painful in the right hypochondrium, in the same area the dullness of the abdominal wall is determined. In the blood - pronounced leukocytosis, neutrophilia with a significant shift to the left. There are often complications: dropsy or empyema of the gallbladder, pericholecystitis, cholangitis, pancreatitis, liver or sub-diaphragmatic abscess.

With gangrenous form of acute cholecystitis, the condition of patients suddenly deteriorates, there are "dagger" pains in the abdomen, cold profuse sweat, fright. Perhaps a collapoid state. Due to the perforation of the gallbladder, the picture of spilled gallstones develops: the cessation of gas and feces withdrawal, the stomach is swollen, the pulse is increased to 120-140 rpm, nausea, vomiting, dry tongue, sagging face, sunken eyes, icterus of the skin. With limited peritonitis, the patient's condition is not so severe. Characteristic of the general symptoms of purulent infection: fever, chills, tachycardia, leukocytosis, neutrophilia with a shift to the left.

In addition to dropsy of the gallbladder, other complications of acute cholecystitis are possible.

• The empyema of the gallbladder arises from the obstruction of the cervix or bladder duct by the accumulation of pus or concrement. A child is concerned about severe pain in the right upper quadrant. Cough, a deep sigh, a change in the patient's position in bed lead to sharp and paroxysmal (throbbing) pain in the right hypochondrium. The body temperature is high, sometimes of a hectic character with chills, puffy sweats. In the future, the pain subsides, but there remains a feeling of heaviness, pressure in the right upper quadrant, soreness in palpation. Complete recovery without appropriate treatment does not occur, after an injury, with stress, physical overstrain, errors in nutrition, attachment of acute respiratory disease may exacerbate.
• Pericholecystitis develops due to the reaction of the surrounding gall bladder organs. After resorption of the inflammatory edema, fusions with the omentum, gastric pyloric, transverse colon, etc. Remain. In patients with a "walled" gallbladder, motor-evacuator and secretory activity disorders are noted, and the delay in the bile passage promotes the formation of biliary sludge, microliths, and then concrements. Painful attacks can recur for a long time.
• Cholangitis, a serious complication of acute cholecystitis, is characterized by a progressive deterioration in the patient's condition. Body temperature is hectic, there are severe chills, headaches, weakness, anorexia, vomiting. The liver is enlarged and painful, the splenomegaly is mild. There is icterus of skin.
• The subheading or subdiaphragmatic abscess develops after the purulent contents of the gallbladder break through under the liver or diaphragm; the disease is similar in many respects to a yellow peritonitis.

[8], [9], [10], [11], [12], [13]