Cholecystitis in children

Inflammation of the gallbladder, or cholecystitis in children is more often bacterial, sometimes occurs secondary to dyskinesia biliary tract, the presence of gallstones, with parasitic infestations.

[1], [2], [3]

Causes of cholecystitis in children

The main causes of inflammatory cholepathies (cholecystitis, cholangitis):

1. non-immune causes - changes in the composition of bile, infection, parasites;
2. autoimmune processes (primary sclerosing cholangitis, biliary cirrhosis).

Non-immune cholecystitis and cholangitis downstream are divided into acute and chronic, according to etiology - to calculuses (associated with cholelithiasis) and non-calcareous. By the nature of the pathological process, acute cholecystitis is divided into catarrhal, phlegmonous and gangrenous. These forms in some patients can also be considered as a stage of the development of the disease. The leading role in the development of acute cholecystitis belongs to infection. The most frequent pathogen is E. Coli; less often the disease causes staphylococci, streptococci and enterococci. Cholecystitis occurs in autolytic lesions of the mucous membrane of the gallbladder as a result of casting pancreatic juice into its cavity. Inflammation is possible with helminthic invasions (ascariasis). It must be remembered that infected bile does not cause inflammation of the gallbladder without predisposing factors - stagnation and damage to the walls of the organ. Stagnation is promoted by organic disturbances of the outflow path of the bile (compression or kink of the neck of the gallbladder and ducts, blockage of the ducts by stone, mucus or helminths), as well as dyskinesia of the gallbladder and bile ducts under the influence of eating disorders (rhythm, quantity, food quality, overeating, fatty foods). Great is the role of psychoemotional stress, stress, hypodynamia, metabolic disorders, leading to a change in the chemical composition of bile. Inflammation of the gallbladder can occur reflexively with the disease of other organs of the gastrointestinal tract as a result of visceral-visceral interactions. Damage to the gallbladder wall is possible with irritation of its mucous membrane with bile bile with altered physicochemical qualities (lithogenic bile), with traumatization by concrements, helminths, pancreatic enzymes that flow into the common bile duct (with sphincter spasm of Oddi).

The infectious agent enters the gallbladder in three ways:

• the ascending path from the intestine is the enterogenic pathway at the hypotension of the sphincter of Oddi;
• hematogenous pathway (in the hepatic artery with oropharyngeal and nasopharyngeal lesions or from the intestine via the portal vein in violation of the barrier function of the small intestinal epithelium);
• lymphogenous pathway (with appendicitis, pneumonia).

[4], [5], [6], [7], [8]

Symptoms of cholecystitis in children

The main symptoms of cholecystitis are nonspecific:

• abdominal pain localized in the right hypochondrium, radiating to the right shoulder;
• nausea, vomiting;
• signs of cholestasis;
• signs of intoxication.

Pain syndrome occurs suddenly, often at night after taking fatty foods. Duration of the pain syndrome from several minutes (biliary colic) to many hours and days. Particularly persistent pain is caused by acerbic cholecystitis. Pain is accompanied by reflex vomiting with an admixture of bile, chills, febrile fever, tachycardia. Palpatorically, the positive symptoms of Ortner, Mussie, Murphy, and Kera are revealed. The liver is enlarged, the edge is even, painful.

How to recognize cholecystitis in a child?

Blood analysis reveals leukocytosis, neutrophilia, toxic neutrophil count, increased ESR, increased bilirubin concentration (bound fraction) and aminotransferase activity, the appearance of C-reactive protein.

Oral cholecystography is not used, as the concentration function of the gallbladder is reduced and no accumulation of contrast occurs. It is possible to use intravenous cholangiography, ultrasound. With ultrasound, the wall of the gallbladder is loose, thickened more than 3 mm due to inflammatory edema, the contour is doubled; determine additional echoes in the liver parenchyma around the gallbladder (perifocal inflammation), congestion of the bile in the bladder (a sign of cholestasis).

In the course of duodenal probing, the bile portions determine the increase in protein concentration, the appearance of leukocytes and epithelial cells, a decrease in the concentration of bile acids and bilirubin. Sowing bile reveals coccal pathogens and E. Coli.

Chronic cholecystitis is a chronic inflammation of the gallbladder. This is the outcome of the transferred acute cholecystitis. In everyday pediatric practice, the diagnosis of chronic cholecystitis is relatively rare (10-12%) due to the lack of clear and accessible diagnostic criteria. In the pathogenesis of chronic cholecystitis, the following factors play an important role: biliary tract dysfunction, concomitant pathology of digestive organs, frequent viral infections, food allergy and food intolerance, the presence of foci of chronic infection, eating disorders, metabolic disorders.

Classification

• Degree of severity: light, medium, heavy.
• Stage of the disease: exacerbation, subsiding exacerbations, persistent and unstable remission.
• Complications: complicated and uncomplicated chronic cholecystitis.
• The nature of the current: recurrent, monotonous, intermittent.

[9]

Treatment of cholecystitis in children

Treatment of cholecystitis and cholangitis in children depends on etiology. Assign antibacterial or antiparasitic therapy, with autoimmune processes - glucocorticoids. Etiotropic therapy is supplemented with detoxification, correction of water-electrolyte and metabolic disorders, desensitization, correction of biliary tract disorders (including antispasmodics), anticholestatic therapy and hepatoprotectors.

For cupping the pain syndrome M-holnoblokatory (platifillin, metocinia iodide, tramadol, belladonna preparations), myotropic spasmolytics (mebeverin) is used. When vomiting appoint metoclopramide (intramuscularly 2 ml) or domperidone (20 mg orally). In the remission phase, the kinetics of kinetics-hofitol * and hymecromone (claston) are shown. Of antibacterial drugs, given the sensitivity of the selected microorganism, preference is given to bile cephalosporins, macrolides.