Cholecystitis

Introduction The blood vessels that supply gallbladder nutrition are terminal arteries. When the outlet of the gallbladder is blocked, the gallbladder mucosa continues to secrete mucus, causing the pressure in the gallbladder to increase, causing the gallbladder to swell and accumulate water. The blood vessels in the gallbladder wall are thus stressed and ischemic and necrotic. . When the gallbladder is ischemia, the gallbladder resistance is reduced, the bacteria are easy to grow and multiply, and the cholecystitis occurs when the machine is activated. Cholecystitis is a cholecystitis caused by bacterial infection or chemical stimulation (change of bile composition) and is a common disease of the gallbladder. In abdominal surgery, the incidence rate is second only to appendicitis. This disease is more common in middle-aged people aged 35-55 years. The incidence of females is more than that of males, especially in obese women with multiple pregnancies.

Cause

Cholecystitis caused by bacterial infection or chemical stimulation (change in bile composition). When the gallstones are incarcerated for a long time but are not infected, the bile pigment in the bile is absorbed by the gallbladder mucosa and secretes mucous substances. Pay attention to see if there is abnormal gallbladder inflammation, if there is any problem with gallstones, you should pay attention to check whether there is abnormality of the common bile duct, such as dampness and spleen dampness.

an examination

Related inspection

Intravenous cholangiography liver, gallbladder, spleen CT examination oral cholangiography cholangiography

Laboratory examination

(1) Blood routine: When acute cholecystitis occurs, the white blood cell count is slightly increased and neutrophils are increased. If the white blood cell count exceeds 20 × 109 / L, and there are nuclear left shift and toxic particles, it may be complications such as gallbladder necrosis or perforation.

(2) Duodenal drainage: In chronic cholecystitis, such as increased mucus in bile, white blood cells piled up, bacterial culture or parasite test positive, which is very helpful for diagnosis.

2. Other auxiliary inspections

(1) Acute cholecystitis:

1 Ultrasound examination: B-ultrasound found that gallbladder enlargement, wall thickness, intracavitary bile viscosity, etc. can often make a timely diagnosis.

2 Radiological examination: The positive findings of the diagnostic significance of the abdominal plain film are: gallstones in the gallbladder area; enlarged gallbladder shadows, calcified plaques in the gallbladder wall, gas and fluid level in the gallbladder cavity. Cholecystography: oral method: the gallbladder is generally not developed; intravenous injection, the diagnosis of acute cholecystitis.

3 radionuclide examination: sensitivity to the diagnosis of acute cholecystitis is 100%, specificity is 95%, also has diagnostic value.

(2) Chronic cholecystitis:

1 Ultrasound examination: If gallbladder stones, gallbladder wall thickening, reduction or deformation are found, it has diagnostic significance.

2 abdominal X-ray film: If chronic cholecystitis, gallstones, gallbladder gallbladder, gallbladder calcification spots and gallbladder milky opaque shadows can be found.

3 gallbladder angiography: can be found in gallstones, gallbladder shrinkage or deformation, gallbladder enrichment and systolic dysfunction, gallbladder development and other images of chronic cholecystitis. When the gallbladder is not developed, if it is caused by damage to liver function or abnormal liver function, it may be chronic cholecystitis.

4 cholecystokinin test: such as gallbladder contraction amplitude is less than 50%, and biliary colic, a positive reaction, expressed as chronic cholecystitis.

5 fiber laparoscopy: If the liver and swollen gallbladder are found under direct vision, it is green, greenish brown or greenish black. It is suggested that jaundice is an extrahepatic obstruction; if the gallbladder loses its smooth, translucent and azure appearance, it becomes grayish white, and there is gallbladder shrinkage and obvious adhesion, and gallbladder deformation, etc., suggesting chronic cholecystitis.

6 small laparotomy: small laparotomy is a newly proposed method for diagnosing difficult hepatobiliary diseases and jaundice in recent years. It can not only make a clear diagnosis of chronic cholecystitis, but also understand the liver performance.

Differential diagnosis

Differential diagnosis of gallbladder hydrops:

1, gallbladder empyema: due to obstruction caused by the gallbladder neck tube, the water in the gallbladder does not circulate, the water is like the stagnant water in the pool, it is easy to cause bacterial growth and reproduction and infection, thus forming gallbladder empyema. The bile becomes a stinky pus. Afterwards, the pressure in the gallbladder gradually increases, affecting the blood and lymph circulation of the gallbladder wall mucosa, and gradually causing ulceration and necrosis on the gallbladder wall mucosa. In severe cases, large necrosis and perforation may occur.

2, gallstones: is a disease of gallstones in the gallbladder, is a common disease in China, with the increase in age, the incidence rate is also higher, women have a higher incidence than men. Under normal circumstances, the gallbladder does not have stones, because there is a certain proportion of bile salts and lecithin in the normal bile to keep the cholesterol dissolved without precipitation. Gallbladder stones generally have no special signs or only mild tenderness in the right upper abdomen when there is no infection.

3, gallbladder contraction dysfunction: diagnosis of biliary tract hypotension syndrome can be found after fat meal gallbladder contraction dysfunction. The biliary hypotony syndrome, also known as Chiray syndrome, refers to a group of syndromes in which biliary tract tension is delayed, gallbladder emptying is delayed, and indigestion occurs, which can not tolerate fatty foods and has pain in the right upper quadrant. Intrinsic to the category of biliary dysfunction syndrome, also known as gallbladder retardation syndrome. Oral gallbladder angiography or B-mode ultrasound can be found in gallbladder enlargement, and gallbladder systolic dysfunction after fat meal. In addition to (cholelithiasis, biliary ascariasis, biliary infection, etc.) biliary organic disease, the intrinsic can be considered.

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