Symptoms of acute cholecystitis

Symptoms of acute cholecystitis in children begin acutely, suddenly, often at night with severe pain in the right hypochondrium, epigastric region, less often in other areas of the abdomen (in preschool children). The child is extremely restless, tossing and turning in bed, trying to find a position that alleviates the pain. Nausea and vomiting with bile occur, often multiple and not bringing relief.

In preschool (up to 7 years) and primary school children (8-11 years), abdominal pain can be diffuse or vague, which creates diagnostic difficulties and provokes medical errors. In adolescent patients (12-13 years), the pain is pronounced, sharp, "dagger-like" in nature and begins to localize in the right hypochondrium. Irradiation of such pain to the right shoulder, shoulder blade, right half of the lower back and iliac region is noted.

The occurrence of the described unbearable, “dagger-like” pain in the abdomen is caused by:

• an inflammatory process in the wall of the gallbladder, which in particularly severe cases spreads to the peritoneum;
• difficulty in the outflow of bile from the bladder;
• increased intravesical pressure;
• stretching of the gallbladder.

During physical examination, attention is paid to an increase in body temperature to 38-39 ° C and higher, often preceded by chills and sweating. Toxicosis quickly increases. The tongue is dry, coated with a whitish-gray coating. The abdomen is swollen, especially in the right half, respiratory movements are limited. During superficial palpation of the abdomen, local and then widespread tension of the defense musculaire type (muscle defense) is determined early. The liver can protrude 2-3 cm from under the edge of the costal arch along the right midclavicular line, moderately painful. The spleen is usually not palpated, but can be determined in phlegmonous and gangrenous forms of acute cholecystitis. Yellowness of the skin, hysteria of the sclera are inconstant signs, usually caused by a violation of the functional state of the liver in combination with cholestasis. In the blood, leukocytosis from 10-12x10 ⁹ /l to 20x10 ⁹ /l and more, neutrophilia with a shift towards young forms are noted. In the urine, the content of urobilin is increased, proteinuria is possible.

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Peculiarities of the course of acute cholecystitis in children

Depends on the characteristics of morphological changes in the gallbladder.

In catarrhal cholecystitis - the most common form of inflammation of the gallbladder in children - the pain attack lasts 2-3 days, rarely longer. The pain gradually subsides under the influence of the treatment or spontaneously. Despite the fact that this form of acute cholecystitis is characterized by a relatively benign course, it is possible to transition to phlegmonous or gangrenous cholecystitis. The outcome of catarrhal inflammation is dropsy of the gallbladder (hydrops vesicae felleae), which often occurs after a mild pain attack and without anamnestic data on damage to the biliary tract. The child does not present any complaints, only some children may have dull (vague) pain in the right hypochondrium, sometimes nausea.

The phlegmonous form of acute cholecystitis begins as catarrhal cholecystitis, but later it proceeds severely. Intoxication increases rapidly, the general condition of the child sharply worsens, the increase in body temperature is of a remittent nature, there are chills. The pain in the abdomen is intense, constant, accompanied by nausea and vomiting. The tongue is dry, coated. The abdomen is bloated, on palpation it is sharply painful in the right hypochondrium, in the same area a board-like tension of the abdominal wall is determined. In the blood - pronounced leukocytosis, neutrophilia with a significant shift to the left. Complications are common: dropsy or empyema of the gallbladder, pericholecystitis, cholangitis, pancreatitis, subhepatic or subdiaphragmatic abscess.

In the gangrenous form of acute cholecystitis, the patient's condition suddenly worsens, "dagger" pains in the abdomen, cold profuse sweat, and fright occur. A collapse state is possible. As a result of perforation of the gallbladder, a picture of diffuse biliary peritonitis develops: cessation of gas and feces passage, the abdomen is swollen, the pulse accelerates to 120-140 per minute, nausea, vomiting, dry tongue, sunken face, sunken eyes, yellowness of the skin. In limited peritonitis, the patient's condition is not so severe. General symptoms of purulent infection are characteristic: fever, chills, tachycardia, leukocytosis, neutrophilia with a shift to the left.

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

• Empyema of the gallbladder occurs due to obstruction of the neck or cystic duct by a collection of pus or a calculus. The child is bothered by severe pain in the right hypochondrium. Coughing, deep breathing, changing the patient's position in bed lead to sharp and paroxysmal (pulsating) pain in the right hypochondrium. The body temperature is high, sometimes hectic in nature with chills, profuse sweating. The pain subsequently subsides, but a feeling of heaviness, pressure in the right hypochondrium, and pain on palpation remain. Complete recovery does not occur without appropriate treatment; exacerbations are possible after an injury, with stress, physical overexertion, nutritional errors, or the addition of acute respiratory infections.
• Pericholecystitis develops as a result of the reaction of the organs surrounding the gallbladder. After the resorption of the inflammatory edema, adhesions with the omentum, pylorus, transverse colon, etc. remain. In patients with a "walled" gallbladder, disturbances in motor-evacuation and secretory activity are noted, and the delay in the passage of bile contributes to the formation of biliary sludge, microliths, and then stones. Pain attacks can recur over a long period of time.
• Cholangitis, a severe complication of acute cholecystitis, is characterized by a progressive deterioration of the patient's condition. The body temperature is hectic, severe chills, headaches, weakness, anorexia, and vomiting occur. The liver is enlarged and painful, splenomegaly is moderate. Yellowness of the skin occurs.
• A subhepatic or subdiaphragmatic abscess develops after the purulent contents of the gallbladder rupture under the liver or diaphragm; the disease is in many ways similar to biliary peritonitis.

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