Cholecystitis in children

In childhood there is a close connection disease, cholecystitis with chronic tonsillitis, adenotomy, inflammation sinusal nose, dental caries, epidemic hepatitis, etc. a role in the emergence of cholecystitis also played by malnutrition of children (disorderly and forced feeding, rare meals, feeding without taking into account the age of the children), which leads to violations of secretion and the outflow of bile. The immediate cause cholecystitis is microbes: cocci, Proteus, Escherichia coli; specific conditions for the development of cholecystitis are giardiasis biliary tract, less helminthic invasion.
The most frequent complaints children, people with cholecystitis, are loss of appetite, bitter taste in the mouth, nausea, vomiting, constipation or unstable chair.
Leading cholecystitis symptom in children are abdominal pain, often in the right hypochondrium, rarely without particular localization. Pains are paroxysmal (from a few minutes to 2-3 hours.) or almost constant, aching. The second most common symptom is enlarged liver and slight pain on palpation. The area of the gallbladder, especially in the period of exacerbation, usually painful. Often over the area of the gallbladder noted the tension of the abdominal wall. May be a long subfebrile temperature. Sometimes in the blood revealed the increase in the number of leukocytes and acceleration ROHE.
Children are more frequent catarrhal-serous cholecystitis. These cholecystitis are characterized by chronic long period with periodic outbreaks. At exacerbation of chronic cholecystitis the child deteriorates and the clinical picture resembles a picture of acute cholecystitis. Children get sick for many years, and often cholecystitis adults is a continuation of the disease, which began in childhood. At cholecystitis, the formation of adhesions (pericholecystic), which are seen in intravenous holegrafii and cause long-term course of the disease and the absence of the effect of conservative therapy.
In 15% of cases cholecystitis in children is latent and is characterized by persistent low-grade fever, symptoms of intoxication, but without local symptoms and abdominal pain. Usually after 1-2 years of latent cholecystitis passes in its classical form.
Diagnosis of cholecystitis is only possible when conducting duodenal sounding and x-ray study. On the inflammation in the gallbladder indicate a significant amount of mucus, blood, flat epithelium in the duodenal contents (portion). Sometimes you can detect and Giardia.
Treatment. In the acute period of the disease is shown in bed. To suppress the infection prescribe antibiotics in the next daily dose (per 1 kg of weight), divided into 3 injections,- penicillin 50 000 - 100 000 IU, chloramphenicol 10 mg, erythromycin 20 000-50 000 UNITS within 7-10 days; for the treatment of giardiasis biliary tract - aminohinol, furazolidone. Aminohinol appointed in the next daily dose: 4 to 6 years - 0.1 g, 6-8 years - 0.15 g, 8-12 years - 0.15-0.2 g, 12-15 years - 0.25-0.3 g; daily dose given in 2 admission in 20 minutes after the Breakfast and dinner for 8 days. Furazolidone give after eating at the rate of 10 mg per 1 kg of weight per day in 3-4 reception within 8 days. In the complex treatment of cholecystitis widely used cholagogue and tyubazhi on Damyanovo (after taking prandial magnesium sulfate to lie with a heating pad on the right side 1/2 hour)and physiotherapy (mineral wax, paraffin, diathermy, UHF and others). From choleretic funds used corn silk extract from calculation 1 drop to 1 year of life at the reception. Corn silk extract diluted in hot water (table 1, l) and give 30 minutes before meals 3 times a day. Holosas give 3 times a day for 25-30 minutes before a meal 1/2 chain. L. children 1 to 10 years and 1 chain. L. 3 times a day to children II -15 years. Giardiasis holosas cannot give. Allohol give 1 / 2 tablets 3 times a day for 10 to 15 minutes after meals to children 1 to 10 years and 1 tablet older children. When conducting tubage on Damyanovo apply a 25% solution of magnesium sulfate: children 1 to 7 years to 10 ml, in 8-10 years, 15-20 ml, 11 - 15 years - 25-30 ml per reception. Tyubazhi on Damyanovo doing every day or two. Appoint a diet rich in proteins and carbohydrates restriction of fat. Exclude spicy food, spices, fried and smoked products. Children, the sick cholecystitis, should be under medical supervision.

Cholecystitis in children is among the most common diseases. The inflammatory process rarely is localized only in the gall bladder or only in the bile ducts and conduits, usually affected the entire system of bilious ways, so you usually watch gastric (M. S. Maslov), angio - and hepatocholecystitis.
Unlike adults, children rarely acute purulent form cholecystitis and cholangitis, more common chronic relapses and exacerbations; 15-18% of cases, there was latent, which in 1-2 years becomes obvious clinical form (M. I. Studenikin).
On the etiology there are two large groups: cholecystitis parasitic and microbial origin. The undeniable link cholecystitis with chronic inflammation (often tonsillitis) and previous diseases (duodenitis, gastritis, appendicitis, colibacillosis, dysentery, sore throat, influenza, scarlet fever and other). Large part in the development of cholecystitis play a violation of the diet, excess fat and carbohydrate food, lack of vegetables.
Cholecystitis in children in the initial period does not give local symptoms, but it is in the form of common chronic intoxication (headache, lethargy, irritability, poor appetite, sleep disturbances, weight loss, and sometimes subfebrile temperature). Explicit disease becomes of the onset of abdominal pain; in the future the main complaint is abdominal pain (often in the form of painful attacks).
The episodic pain in the abdomen, first short and rare, in the future become more frequent and become long. The pain is celebrated in the right hypochondrium, in epigastralna area or near the navel. The attack is preceded by a feeling of pressure in the epigastric region, nausea, unpleasant smell from the mouth. Simultaneously with pain observed temperature increase (from low to high), nausea, vomiting, shortness of breath and unpleasant feelings in the heart area. In the blood - moderate leukocytosis, accelerated ROHE and the shift of neutrophils to the left.
At the same time increases the liver, often quite substantially. With the feeling of stomach experience pain and muscle tension in the right hypochondrium, or in the whole right part of the stomach and epigastric pain. Gallbladder symptoms distinct from older children and do not have small children. Unlike adults, cholecystitis in children rarely accompanied by jaundice.
Violation of the liver (protein, carbohydrate, deaminated, detoxification, pigment), the secretion of stomach, pancreas, duodenum (stasis giardiasis), motor function of the gastrointestinal tract. There are changes in the cardiovascular, respiratory, nervous and endocrine systems.

Peculiarities of the course of cholecystitis in children - frequency catarrhal forms, rarity of a bile stone disease and acute purulent cholecystitis, the purity of course, the rare appearance of jaundice, no irradiation of pain during the attack, the rapid involvement in the inflammatory process all of the hepatobiliary system.
Diagnosis of cholecystitis is put on set of symptoms and data duodenal sounding. Great help, cholecystography (see). The differential diagnosis is chronic appendicitis, duodenitis, peptic ulcer, gastritis, worm infestation and Mesoamerica.
Treatment. In the period of exacerbation - bed, table №5, rich in carbohydrates, with normal protein content and limitation of fat to 10-20, broad-spectrum Antibiotics intramuscularly (see Art. 102); at the end of the course it is expedient introduction of antibiotics through a probe into the duodenum. Intravenous infusion of 40% glucose solution at 10-15 ml daily or every other day. Recommended lipokain 0.1 g 3 times a day, Pancreatin - 0.5 g 4 times a day.
Effective tubage on Damyanovo with magnesium sulfate (30-40 ml of 25% solution) within 10-14 days daily, cholagogue, pain in the abdomen - belladonna (0.001 g per year of life), papaverine, promedol, vitamin therapy. It is also shown a Spa treatment at the resorts of Truskavets, Zheleznovodsk, Essentuki, lake Shira.