Clinical symptoms

Clinical symptoms of inflammatory diseases of biliary ducts can be very diverse and not always in line with pathological changes.
Acute cholecystitis. The main symptom of acute cholecystitis are a pain. Usually associate them or with the passage of a stone, or with acute inflammatory process.
The pain often begins suddenly while working at night during sleep, soon after eating, especially fat. They mostly occur in the right hypochondrium, but may have a less specific localization. Pain can be short, but sometimes they last for several hours and even days. Often they are periodic, paroxysmal character, are aching. Sometimes attack pain preceded by several days of gravity in the epigastric region, bitter taste in mouth, nausea. Pain in acute cholecystitis are usually characterized by the irradiation in the right subclavian region, in the right shoulder and sometimes in the heart area (S. I. Botkin, 1884).
The attacks of acute cholecystitis is often accompanied by vomiting, is not bringing sick of relief.
The temperature in acute cholecystitis increased to 38-39°, but not always. When flegmona cholecystitis the temperature reaches 39-40 degrees. Jaundice in acute cholecystitis is the result of increased pressure and stress of the gallbladder to the common or liver bile duct. Jaundice may occur also because of pressure on biliary tract inflammatory infiltrate surrounding liver-duodenal sheaf. Finally, inflammatory swelling of the lymph nodes around the common bile duct can cause compression of the duct, and to jaundice.
Acute inflammation of the gallbladder may be causing changes in the liver cells, which leads to jaundice. In acute cholecystitis in 40% of patients have jaundice.
Itching is marked not always.
The liver is almost always in acute cholecystitis increased, especially in introducing forms. The gallbladder is increased not always. Apparently pear shaped gallbladder characteristic of dropsy.
In acute cholecystitis is possible to observe the following symptoms: a symptom Zakharyin - pain effleurage or pressed on the area of projection of a gall bladder; symptoms Obraztsova - sharp pain in the introduction of the hand in the area of right rib when the breath of the patient; a symptom Ortner - pain effleurage with the edge of the brush on the right arc. Skin zones hyperalgesia in typical places (Zakharyin - Ged) - the area of the ninth - eleventh intercostal spaces on the right, in the right hypochondrium, under the lower right corner of the scapula; sometimes in the area of the right shoulder girdle and along the spinous processes of the VIII-IX of the thoracic vertebrae. Hyperalgesia in these areas , as well as the radiation of pain and the emergence of a typical weak points of the St George - Mussi, right between the legs muse, sterno-cleido-mastoideus. Symptom Shchetkina - Blomberg is expressed in that case, if there are peritoneal phenomenon.
Often there is a neutrophilic leucocytosis within 8 000-10 000 with a slight shift to the left.
Briefly about some forms of cholecystitis.
Catarrhal cholecystitis proceed calmly, not the muscles of the abdominal wall, abdominal pain only during deep palpation, a small temperature increase below 38o, leukocytosis to 10 000.
Phlegmonously cholecystitis. The pain is intense with the characteristic radiation in the region of the right shoulder and in the region of the heart, uncontrollable vomiting, muscle tension of the abdominal wall, leukocytosis 15 000 - 20 000, temperature 39-40 degrees.
Gangrenous cholecystitis - availability of all symptoms of acute flamanskogo cholecystitis, along with intoxication effects include increased heart rate, dry tongue.
When perforated cholecystitis on the background of acute cholecystitis occurs suddenly a sharp pain in the right hypochondrium, or a sharp pain intensity and extension of the zone. Sometimes a perforation is masked by developing the destructive cholecystitis. Develop local symptoms of peritonitis; shortening of percussion sound in the lateral part of the abdomen, the temperature rises, the pulse quickens, dry tongue, pale, haggard face.
All listed forms of acute cholecystitis can be seen as different stages of progressive inflammation in the gallbladder. Started an attack of acute cholecystitis may soon violently to go in destructive form, in connection with which quickly grow all of the above symptoms. Under favorable course of acute cholecystitis remission of symptoms occurs within 2-3 days. Nevertheless, it can happen to determine and paced around the gallbladder inflammatory infiltrate, exciting gall bladder and surrounding organs - the greater omentum, hepatic flexure transverse colon, liver-duodenal sheaf; probed painful seal. Further favorable for this stage of acute cholecystitis are resorption inflammatory infiltrate, and the patient feels well to a new attack.
However, in a less favourable cases in the center of the inflammatory infiltrate may form an abscess that is accompanied by fever, giperlakotsitos and sharp tenderness and effleurage. An abscess is formed or around the gallbladder or in the bile bladder is empiema gall bladder, resulting flamanskogo cholecystitis. With the progression of inflammatory infiltrate around the gallbladder may spread the infection in subphrenic space education subphrenic abscess. At transition of inflammation on liver can develop abscesses in the liver, purulent cholangitis. The described dynamics of inflammatory process in acute cholecystitis after three days (72 hours) is usually defined or downward process, or toward increasing it. This fact, according to some authors, determines the tactics of the surgeon when choosing between conservative or operative treatment.
Complications (dissecting cholangitis, the involvement of the lung parenchyma, development subphrenic abscess, pancreatitis) can occur during both the first and each subsequent attack, equally with Kamneva or askamnia cholecystitis.
Acute cholecystitis should be differentiated with acute appendicitis at a known location of the vermiform process, perforated duodenal ulcer, renal colic. A frequent source of errors are right-sided pneumonia and diaphragmatic pleurisy. The diagnosis is solved carefully collected by history and examination of the lungs. Of myocardial infarction should always be remembered not only for differential diagnosis, but also because of its frequent connection with diseases of the biliary tract. Significant role here belongs electrocardiography.