How to determine cholecystitis

Acute cholecystitis (1) Many patients with acute cholecystitis get sick in the middle of the night after eating a greasy dinner. Because high-fat diet can strengthen the contraction of gallbladder, it is easy for small gallstones to slip into and embed in cystic duct when lying down. The main manifestations are persistent pain in the right upper abdomen and paroxysmal aggravation, which can radiate to the right shoulder and back; It is often accompanied by fever, nausea and vomiting, but chills are rare and jaundice is mild. Abdominal examination showed that the right upper abdomen was full, and the abdominal muscles in the gallbladder area were tense, tender and rebounding.

Chronic cholecystitis (II) Symptoms and signs of chronic cholecystitis are atypical. Most of them are bile dyspepsia, aversion to greasy food, flatulence in the upper abdomen, belching, heartburn and so on. , similar to ulcer or chronic appendicitis; Sometimes the cystic duct is blocked by stones, which can be acute, but when the stones move and the obstruction is relieved, it will soon get better. Physical examination shows that there may be mild tenderness or percussion pain in gallbladder area; If there is water in the gallbladder, you can often feel a round and smooth cystic mass.

Acute cholecystitis

The symptoms of acute cholecystitis mainly include pain in the right upper abdomen, nausea, vomiting and fever. Acute cholecystitis can cause pain in the right upper abdomen. The initial pain is similar to biliary colic, but the abdominal pain caused by acute cholecystitis often lasts for a long time. Breathing and changing posture often aggravate the pain, so patients prefer to lie on the right side to relieve abdominal pain. Some patients have nausea and vomiting, but vomiting is generally not severe. Most patients are accompanied by fever, the body temperature is usually between 38.0℃ and 38.5℃, and high fever and chills are rare. A few patients also have white eyes and slight yellowing of the skin. When the doctor examines the patient's abdomen, he can find that the right upper abdomen is tender and the abdominal muscles are tense. About 65,438+0/3 patients can also feel gallbladder enlargement. When testing patients' blood, it will be found that most people's white blood cell count and neutrophils have increased. B-ultrasound examination can find that the gallbladder is enlarged, the gallbladder wall is thickened, and the gallbladder neck is blocked with stones. According to the above symptoms, combined with physical examination and various auxiliary examinations, doctors can generally make a diagnosis of acute cholecystitis in time.

chronic cholecystitis

Chronic cholecystitis is the most common gallbladder disease. Patients usually have gallstones at the same time, but patients with chronic cholecystitis without stones are not uncommon in China. Chronic cholecystitis can sometimes be a sequela of acute cholecystitis, but most patients have never suffered from acute cholecystitis in the past. Due to long-term inflammation of the gallbladder, the gallbladder wall will thicken, and fibers and scars will shrink, which will lead to gallbladder atrophy, and the cystic cavity can be completely closed, leading to gallbladder dysfunction or even complete loss of function.

After suffering from chronic cholecystitis, patients mainly have the following two groups of symptoms:

① Stones temporarily blocked cystic duct, causing biliary colic attack. The pain is mostly located in the upper abdomen or the right upper abdomen and lasts for several minutes to several hours. Pain may involve the back or right scapula, and may be accompanied by nausea and vomiting.

② Abdominal distension, discomfort in the upper abdomen or right upper abdomen, heartburn, belching, acid swallowing and other dyspeptic symptoms are common, and frequent eating of fried or greasy food will aggravate these symptoms.

Therefore, some patients may not have the attack of biliary colic, but just feel some symptoms of indigestion such as epigastric discomfort, belching, acid swallowing, and often mistake themselves for "stomach trouble". Although the symptoms of these patients are in the stomach, the root of the disease is the gallbladder. Although it has been treated according to stomach diseases for a long time, it has not been cured for a long time because of the root cause of the disease.

Cholecystography and B-ultrasound hepatobiliary scanning are valuable methods for the diagnosis of chronic cholecystitis. Cholecystography can find gallstones, gallbladder contraction and deformation, and poor centralized contraction, and sometimes the gallbladder is underdeveloped.

B-ultrasound can not only find gallstones and gallbladder appearance changes, but also see signs such as rough and thickened gallbladder wall. Patients with the above symptoms should seek medical advice in time. Through the above examination, chronic cholecystitis can generally be diagnosed.

It is generally believed that small gallstones are easy to block the cystic duct and cause acute cholecystitis; However, larger stones often have no obvious abdominal cramps, but only cause chronic cholecystitis. Chronic cholecystitis refers to chronic inflammation of the gallbladder, and the most common cause of chronic inflammation is stones in the gallbladder. It can be said that almost all patients with gallstones have chronic cholecystitis. Chronic cholecystitis can be the sequela of acute cholecystitis. After the attack of acute cholecystitis, patients almost inevitably develop into chronic cholecystitis. But in fact, most acute cholecystitis is an acute attack of chronic cholecystitis, and a considerable part of chronic cholecystitis occurs unconsciously. I have no previous history of acute cholecystitis.

The clinical manifestations of chronic cholecystitis are atypical and not obvious. Usually, indigestion symptoms such as dull pain in the right upper abdomen, bloating, belching, nausea and anorexia often occur, and some patients may feel dull pain in the right scapula, right rib or right waist. It is more obvious after standing, exercise and cold bath. The patient has mild tenderness under the costal margin of the right upper abdomen, or feels uncomfortable when pressing. B-ultrasound examination showed that the gallbladder was obviously enlarged and the emptying function was impaired. Calculi can be diagnosed by oral gallbladder contrast agent.