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Differential diagnosis
Signs and symptoms Cholecystitis usually presents as a pain in the right upper quadrant. This is known as biliary colic. This is initially intermittent, but later usually presents as a constant, severe pain. During the initial stages, the pain may be felt in an area totally separate from the site of pathology, known as referred pain. The pain is originally located in the right upper quadrant but the referred pain may occur in the right scapula region (Boas' sign). This may also present with the above mentioned pain after eating greasy or fatty foods such as pastries, pies, and fried foods. This is usually accompanied by a low-grade fever, diarrhea, vomiting, nausea and granulocytosis. The gallbladder may be tender and distended. More severe symptoms such as high fever, shock and jaundice indicate the development of complications such as abscess formation, perforation or ascending cholangitis. Another complication,gallstone ileus, occurs if the gallbladder perforates and forms a fistula with the nearby small bowel, leading to symptoms of intestinal obstruction. Chronic cholecystitis manifests with non-specific symptoms such as nausea, vague abdominal pain, belching, and diarrhea. Causes Cholecystitis is often caused by cholelithiasis (the presence of choleliths, or gallstones, in the gallbladder), with choleliths most commonly blocking the cystic duct directly. This leads toinspissation (thickening) of bile, bile stasis, and secondary infection by gut organisms, predominantly E. coli and Bacteroides species.[ citation needed ] The gallbladder's wall becomes inflamed. Extreme cases may result in necrosis and rupture. Inflammation often spreads to its outer covering, thus irritating surrounding structures such as the diaphragm and bowel. Less commonly, in debilitated and trauma patients, the gallbladder may become inflamed and infected in the absence of cholelithiasis, and is known as acute acalculous cholecystitis. This can arise in patients with anorexia nervosa, as the lack of stimulation of the gallbladder leads to an infectious process. Stones in the gallbladder may cause obstruction and the accompanying acute attack. The patient might develop a chronic, low-level inflammation which leads to a chronic cholecystitis, where the gallbladder is fibrotic and calcified. Diagnosis Cholecystitis is usually diagnosed by a history of the above symptoms, as well as examination findings: § fever (usually low grade in uncomplicated cases) § tender right upper quadrant with or without Murphy's sign § Ortner's sign — tenderness when hand taps the edge of right costal arch. § Georgievskiy — Myussi's sign (phrenic nerve sign) — pain when press between edges of sternocleidomastoid § Boas' sign — Increased sensitivity below the right scapula (also due to phrenic nerve irritation). Subsequent laboratory and imaging tests are used to confirm the diagnosis and exclude other possible causes. Ultrasound can assist in the differential.[1][2] Differential diagnosis Дата добавления: 2015-09-18 | Просмотры: 533 | Нарушение авторских прав |