Symptoms of cholelithiasis

Symptoms of cholelithiasis (cholelithiasis) in childhood are not so typical as in adults, because concrements in the biliary tract do not cause an acute inflammatory process in the gallbladder, which has classical symptoms of calculous cholecystitis or cholangitis. Nevertheless, in children, several variants of the clinical picture of cholelithiasis are possible:

• latent course (asymptomatic stones);
• painful form with typical biliary colic;
• dyspeptic form;
• under the mask of other diseases.

Asymptomatic stone failure is diagnosed when concrements in the gallbladder or bile ducts are an occasional diagnostic finding in a child who does not have complaints. This clinical stage of cholelithiasis is approximately half of patients (41-48%).

Special attention deserves children who have an attack of "acute abdomen" reminiscent of the character of gallstones, accompanied by reflex vomiting, less often - icteric sclera and skin, discoloration of the stool. Jaundiceous staining of the skin and visible mucous membranes is not characteristic of children with cholelithiasis. When the occurrence of icterism, a violation of the passage of bile is suggested, and when combined with acholic feces and dark urine - mechanical jaundice. Attacks of typical gallstones are noted in 5-7% of children with cholelithiasis.

Dyspeptic form is the most frequent clinical variant of cholelithiasis in childhood. Abdominal pain and dyspeptic disorders are the main complaints that make it possible to suspect gallstones in a child. Pains are very diverse in nature, can be localized in epigastrium, pyloroduodenal zone, navel region, right hypochondrium. In pre- and pubertal children, pain is localized in the right upper quadrant.

The nature of pain depends on the size of the stones. Multiple, small, easily moving stones, especially in combination with dysfunctional disorders of the hypermotor type, provoke acute pain. Patients with single stones and a decrease in the evacuation function of the gallbladder are characterized by dull, pulling, undefined pains in the abdomen.

It should pay attention to the nature of the clinical picture, depending on the location and mobility of stones. Children are more likely to find mobile, floating stones. It is these stones that cause acute abdominal pain in an undefined localization. Children with motionless concrements are concerned with dull, aching pain in the right hypochondrium.

In children with calculi in the bottom of the gallbladder, the disease often asymptomatic with the subsequent formation of aching pain, while the localization of stones in the body and neck provokes acute pain in the abdomen, accompanied by nausea and vomiting. The described clinical symptoms of cholelithiasis are associated with the peculiarities of the innervation of the gallbladder.

As you know, the bottom of the bubble is the so-called mute (painless) zone. The area of the body is moderately painful; High pain sensitivity has a bladder neck, a vesicle and a common bile duct. The entrance of the calculus into the sensitive areas causes an attack of acute pain in the abdomen, whereas a stone in the region of the bottom of the bladder can exist asymptomatically for a long time.

Pain is preceded by the intake of fatty foods or physical activity. Early pains occur soon after the error in the diet, are paroxysmal, usually associated with a violation of the passage of bile in the duodenum due to concomitant developmental abnormalities, as well as violations of the sphincter of the gastrointestinal tract. Late pains, on the contrary, are dull, aching, due to concomitant diseases of the upper gastrointestinal tract (gastroduodenitis, peptic ulcer, etc.).

There is a connection between the nature of the pain syndrome and the features of the autonomic nervous system. Thus, in Vagotonics, the disease occurs with attacks of acute pain, whereas for children with sympathicotonia, a prolonged course of the disease with a predominance of dull, aching pain is characteristic. In addition, with an increase in the tone of the sympathetic link of the autonomic nervous system, the contractile capacity of the gallbladder is sharply reduced, which leads to congestion of the bile, disruption of the digestive processes and exacerbation of the associated diseases of the upper gastrointestinal tract. In the clinical picture symptoms of hypomotor dyskinesia of the bile ducts predominate. In children with vagotonia, provoking factors of a pain attack are various psycho-emotional overloads, stresses. The parasympathetic department of the autonomic nervous system stimulates the contraction of the musculature of the gallbladder and relaxes the sphincter of Oddi.

Thus, the clinical picture of cholelithiasis in children does not have the characteristic symptoms observed in adults with exacerbation of calculous cholecystitis. In children of preschool age, the disease resembles an attack of hypertensive dyskinesia of the biliary tract. At the older age, cholelithiasis occurs under the guise of esophagitis, chronic gastroduodenitis, peptic ulcer disease, etc.

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