Intolerance to a fatty diet

Introduction Postcholecystectomy syndrome (PCS) is a general term for abdominal symptoms such as abdominal pain and dyspepsia in patients with a history of cholecystectomy. Half of the patients with PCS have abdominal pain or "dyspepsia" (upper abdomen or upper right abdominal fullness, belching, nausea, vomiting, constipation, intolerance of fat or diarrhea, etc.) within a few weeks after surgery, and the other half after surgery Symptoms occur within months or years. These symptoms are non-specific and vary depending on the underlying cause, but often include pain in the right upper abdomen or upper abdomen, which is more common after a meal and is sharp. Other symptoms may include heartburn, belching, vomiting, and intolerance to a fatty diet.

Cause

(1) Causes of the disease

Some people have divided PCS into two categories. The first category is the biliary-pancreatic disease with a clear diagnosis of the current diagnosis. The second category is the real PCS that is not yet clear. The cause of postoperative cholecystectomy syndrome:

1. Preoperative symptoms continue to exist

(1) Diagnostic errors or incompleteness: The criteria for gallbladder abnormalities are incorrect, gassing, irritating colon, esophageal hiatus hernia, duodenal ulcer, coronary artery disease, intercostal neuritis.

(2) recurrent gallstones.

(3) intrahepatic stones.

(4) Lesions of adjacent organs: pancreatitis, Oddi sphincter stenosis, stenotic choledochitis or cholangitis, liver disease (cirrhosis), and tumors are neglected.

2. Symptoms caused by cholecystectomy itself

(1) Failure of surgical operation: Legions of the liver or extrahepatic bile ducts were left behind, and the tumor was neglected.

(2) Operational errors: damage to the bile duct. Immediately: bleeding, biliary peritonitis, abscess, fistula; late: stenosis, residual cystic duct.

(3) postoperative adhesions.

(4) Physiological disorders: removal of functional gallbladder, Oddi sphincter dyskinesia.

3. Other

Mental factors, etc.

(two) pathogenesis

"Cholecystectomy syndrome" is limited to anatomical and physiological disorders of the extrahepatic bile duct that continue to exist or occur newly after biliary surgery. 90% to 95% of patients with cholecystitis after cholecystectomy can be cured, but the symptoms of a few patients can continue to exist or relapse, and some patients have new symptoms, which are inconsistent with the preoperative complaints. It is obvious that these conditions are not gallbladder. Caused by resection.

The vast majority of PCS is due to preoperative diagnosis errors, that is, the symptoms are not caused by biliary diseases. In some cases, the symptoms of adjacent organs (biliary, liver, pancreas, duodenum) will be the same as before surgery. Of course, postoperative symptoms are unlikely to be alleviated.

Most of the occurrence of calculi after cholecystectomy is not careful during the operation. The small stones falling from the cystic duct into the common bile duct are not found. If intraoperative angiography and intraoperative choledochoscopy can be taken, the residual stones can be significantly reduced. Incidence; another condition is the absence of stones, the formation of stones due to metabolic disorders after cholecystectomy; the other case is due to inadvertent surgery, or the inevitable complications of the surgery itself.

Most of the common bile duct stenosis was not detected due to blunt injury to the common bile duct during surgery. It was only found when PTC or ERCP occurred after symptoms appeared. Duodenal papillary sclerosing, stenosis and pancreatic duct sclerosis, stenosis and pancreatitis may occur due to the duodenum and common bile duct incision, the metal probe forcibly passes through the nipple and damages the Oddi sphincter. Injury can also cause cholesterol to deposit in the terminal bile duct mucosa and chronic inflammation.

The incidence of PCS had no significant relationship with the following factors: gallbladder function in oral gallbladder angiography; size and number of stones in the gallbladder; cholecystitis without stones. In recent years, the diagnosis of these diseases has been clarified because the diagnosis is more accurate than before.

There are a lot of PCS in the second category, and the reason is not clear at present. In recent years, studies have shown that the bile duct wall of patients with PCS is particularly sensitive to changes in pressure. As long as 1 to 2 ml of normal saline is injected into the common bile duct, the pressure of the biliary tract increases rapidly and severe pain occurs. In patients with bile reflux before cholecystectomy, reflux recurrence may be associated with pyloric sphincter dysfunction. In addition, persistent pain in PCS may be associated with psychological factors, and sometimes the possibility of intestinal adhesions or scarring of the gallbladder bed should be considered.

an examination

Related inspection

Liver, gallbladder, pancreas and spleen MRI examination of liver, gallbladder, spleen CT examination

Clinical manifestation

Half of the patients with PCS have abdominal pain or "dyspepsia" (upper abdomen or upper right abdominal fullness, belching, nausea, vomiting, constipation, intolerance of fat or diarrhea, etc.) within a few weeks after surgery, and the other half after surgery Symptoms occur within months or years. These symptoms are non-specific and vary depending on the underlying cause, but often include pain in the right upper abdomen or upper abdomen, which is more common after a meal and is sharp. Other symptoms may include heartburn, belching, vomiting, and intolerance to a fatty diet. A small number of patients may have severe cholecystitis or pancreatitis with severe pain and may be associated with fever, jaundice or vomiting. Examination of such patients often reveals a clear disease compared to those with mild or no symptoms. In addition to the obvious jaundice, physical examination often does not have special value.

Differential diagnosis

Exclusion criteria:

1. Does not meet the mental disorders caused by brain organic mental disorders, physical diseases and psychoactive substances and independent substances.

2. There may be some schizophrenic symptoms, but it does not meet the diagnostic criteria for schizophrenia. If the diagnostic criteria for symptoms of schizophrenia are met at the same time, the differential diagnosis can refer to the diagnostic criteria for schizoaffective psychosis.

Mainly identified with the following diseases:

1. Endogenous depression: including unipolar depression, bipolar disorder (both depressive and manic episodes), and depression associated with schizophrenia.

2, body-related depression: caused by a variety of physical and neurological diseases, including drugs and various harmful substances.

3, psychogenic and reactive depression: Cardiac depression as usual, only once in a lifetime. If you have a seizure twice, you should be seen as a reaction to a normal personality, or simply endogenous depression.

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