Cholecystitis

A child has cholecystitis: what is it?

The onset of the disease is often erased with periodic exacerbations, the causes of which are errors in nutrition, physical exertion, psycho-emotional disorders, intercurrent diseases. In the period of exacerbation with cholecystitis in children, symptoms of intoxication increase, dyspeptic disorders increase. You this time there are frequent complaints of pain in the right hypochondrium paroxysmal or dull nature, aggravated after taking fatty foods, while running, walking. The duration of a painful attack is from several minutes to 1–2 hours. On palpation of the abdomen, pain is noted in the right hypochondrium.

Summing up, we formulate the main clinical symptoms of the disease:

Pain that is dull, persistent, aching in nature, localized in the right hypochondrium. May increase after 1-3 hours after eating (especially if the food was fatty or fried, rich), accompanied by a feeling of heaviness and fullness in the stomach. May radiate to the lumbar region, to the right shoulder, and to the neck. Sometimes the pain can be intense, piercing, and resemble biliary colic.

Dyspeptic symptoms. Characterized by bitterness or an unpleasant metallic taste in the mouth, belching with air (often with a rotten smell), nausea, flatulence, upset stool (constipation or diarrhea, sometimes - their alternation).

Insomnia often occurs, patients can be extremely irritable.

The above mentioned symptoms occur during an exacerbation of the disease or in acute cholecystitis. In the acute process, as a rule, the manifestations are more pronounced.

Diagnosis of cholecystitis in a child

Diagnosis of the disease is carried out on the basis of anamnesis, clinical and laboratory data.

In the analysis of blood in the acute course there is leukocytosis, neutrophilis, increased ESR,

in a chronic course, the inflammatory response is moderate and persistent,

in the biochemical study of blood during exacerbation of cholecystitis in a child - an increase in the content of sialic acids, fibrin, transaminases, alkaline phosphatase.

When ultrasound examination - a decrease or increase in the gallbladder, a wall thickening of more than 1 mm, violation of the contraction of the gallbladder.

In the study of bile - reduction of specific gravity (in normal proportion in portions A 1006-1007, portions B 1024-1032, portions C 1007-1010), pH shift in the acidic direction, (normal 6.2 -7.5),

microscopic examination of sediment - mucus, leukocytes, cylindrical epithelium, an increase in cholesterol crystals, calcium bilirubinate, the presence of cyanobacria or opisthorchiasis eggs.

Differential diagnosis of cholecystitis in children is carried out with duodenitis, gastritis, pancreatitis, peptic ulcer, helminthic invasion, appendicitis.

Forms of children's cholecystitis and their symptoms

In children, the non-calculous form of the disease prevails, in most cases the process extends to several parts: the neck, bladder wall, bile ducts, and often intrahepatic ducts (cholecystocholangitis).

Calculous cholecystitis has two forms of the disease: acute and chronic. Initially, stones of small size and are in the gall bladder, but over time, the stones increase and close the bile ducts.

Exacerbation of calculous cholecystitis is expressed by hepatic colic, it is easy to recognize this with the help of characteristic symptoms: sharp pain appears in the upper abdomen, which passes into the right hypochondrium, the duration of pain varies from several seconds to several days. Sometimes colic is accompanied by vomiting, nausea, bitterness in the mouth, as well as weakness of the whole body, dizziness, bloating and tension of the front wall with a sharp attack of pain.

The surrounding organs (stomach, duodenum) are involved in the inflammatory process, which supports the course of dyskinesia. In about half of children with cholecystitis, the exocrine function of the pancreas is impaired (by the type of dyspancreatism) or pancreatitis develops.

In the clinical picture of cholecystitis in children with this form, pain syndrome, intoxication syndrome (weakness, headaches, subfebrile condition) are expressed, in the case of cholecystocholangitis - dyspeptic syndrome, functional changes in the liver.

The main syndromes of calculous cholecystitis in a child:

disorders of vegetative regulation and motility,

asthenoneurotic symptoms of the disease.

Long-term current dyskinesia, causing stagnation and infection of bile, duodenobiliary reflux, leads to the development of chronic cholecystitis. A chronic inflammatory process in the gallbladder is always secondary, developing on the background of dyscholia, dyskinesia, congenital anomalies of the biliary tract or acute cholecystitis. Especially typical is the development of cholecystitis in patients with hypotonic biliary dyskinesia combined with dysbacteriosis.

How to get rid of cholecystitis child?

Treatment begins with the appointment of a diet number 5, 5a. In case of drug therapy, neurotropic drugs are used predominantly tonic (in the hypotonic form) or sedative (in the hypertonic form) actions, antispasmodic agents (in the hypertensive form). In children with cholecystitis, antispasmodics and anticholinergics are also used (for relieving pain syndrome), antibacterial drugs, choleretic agents (choleretics, cholekinetics), vitamins, herbal teas. The standard treatment for cholecystitis in children is:

antibacterial therapy (semi-synthetic penicillins, macrolides, cefolosporins),

antiparasitic drugs when detecting worms and protozoa,

choleretics and cholekinetics depending on the type of dyskinetic disorders,

drugs to improve liver function (Carsil, Essentiale, Degalon).

Drug treatment of chronic cholecystitis in children is the use of drugs to relieve pain bouts, the normalization of all functions of the nervous system and the use of choleretic drugs. Dustatalin is prescribed 2 times a day as an antispasmodic. When eliminating the infection of bile, antibacterial drugs are used. Such drugs for the treatment of chronic cholecystitis are Biseptol, Ciprofloxacin, Ampicillin, Metronidazole, Erythromycin, Furazolidone. Antibacterial therapy is prescribed for 10-14 days.

Physical treatment methods help to get rid of inflammation (anti-inflammatory methods), correcting vegetative dysfunctions (vegetative correcting methods), enhancing biliary excretion (choleretic methods), and normalizing biliary tract motility (cholekinetic methods). Spa treatment is also provided.

Therapy for exacerbation of chronic cholecystitis

With exacerbation of the disease Children must be hospitalized in the surgical department. The attending physician in the exacerbation of chronic cholecystitis primarily relieves spasm from the excretory duct of the gallbladder, suspends the inflammatory process and eliminates the infection. On the first day, complete starvation is prescribed using the necessary drugs and nutrient solutions intravenously. Also, during the exacerbation of chronic cholecystitis, painkillers, antispasmodics and antibiotics are prescribed. In the absence of a result of treatment, surgical intervention is prescribed.

Chronic cholecystitis, which proceeds without exacerbations, in some cases requires surgical intervention, especially when stones are found in the gallbladder. If the stones are not detected, the treatment is carried out using conservative therapy. First of all - it is a diet with the use of drugs that are prescribed by a doctor (antispasmodics, herbal remedies).

When exacerbation of chronic cholecystitis in a child should adhere to therapeutic nutrition, which will reduce inflammation in the gallbladder, prevents the stagnation of bile, and also prevents the formation of stones.

Provoking factors

Causes of cholecystitis in children are divided into two groups: microbial and parasitic. The presence in the body of chronic inflammatory foci (tonsillitis, sore throat, gastritis) provokes the occurrence of a disease of microbial etiology. The defeat of worms (lamblia, opistarchia) causes the development of cholecystitis.

To provoke cholecystitis in children can:

  • sedentary lifestyle,
  • frequent violations of the regime and errors in nutrition (rare and abundant meals),
  • the presence of a concomitant disease (dyskinesia of the GPB (biliary tract), atony of the gall bladder),
  • frequent uncontrolled use of drugs
  • developmental pathology
  • excess weight,
  • burdened heredity.

Cholecystitis in babies causes cholecystitis:

  • in zhp stagnation,
  • infections, and therefore the presence of microorganisms,
  • upon impact, wall damage,
  • reduced immunity.

Chronic cholecystitis in children occurs in two known forms: catarrhal and purulent. The catarrhal form of the disease is characterized by compaction and a significant thickening of the wall of the ZH, mucosal atrophy occurs.

Purulent cholecystitis in children affects all layers of the bladder wall, certain areas of abscesses (suppurations) appear, the walls thicken, polyps and ulcers are possible, which later become scars.

Initial signs of illness

With careful attention of parents to the child, the first characteristic signs of cholecystitis can be easily noticed. This is primarily:

  • the surface of the tongue is lined with yellow bloom,
  • mouth bitter taste,
  • bad breath,
  • when belching the smell of a rotten egg,
  • violation of bowel emptying (alternating liquid stool and constipation),
  • poor appetite, frequent refusals of food, complaints of heaviness and pain in the right hypochondrium,
  • rumbling in the tummy.

Causes of disease

A child for the development of cholecystitis distinguish two primary factors: microbial and parasitic. The inflammatory process of the body - sinusitis, tonsillitis, tonsillitis, flu, caries, pancreatitis, appendicitis, intestinal dysbiosis - contributes to the development of microbial etymology. Worm invasions affect the manifestation of the disease.

  • Reduced physical activity in children
  • Unbalanced diet (fasting and overeating),
  • Diseases of the biliary tract and gallbladder (dyskinesia and atony),
  • Long-term drug treatment without a doctor's supervision,
  • Obesity,
  • Impaired development
  • Bad heredity
  • Bubble irregularly shaped
  • Allergies to certain foods,
  • Gallbladder injury
  • Reduced immunity
  • Pregnancy,
  • The presence of chronic infections
  • Tumors,
  • Constipation.

There are 2 forms of the disease:

  • Acute cholecystitis. The main symptom is a sharp, burning pain in the right side, giving to the side of the arm, shoulder, shoulder blade. The temperature can rise to 39 degrees. The patient is sick, bile is seen in vomiting, the skin turns pale and chills appear. A suffering child does not find a place in bed due to severe pain. On palpation of the abdomen felt bloating, tension of the abdominal wall. Inflammation affects adjacent organs and tissues. This form of acute cholecystitis is complicated by liver abscess, peritonitis, cholangitis, pancreatitis. In this condition, it is necessary to urgently seek medical help and even resort to hospitalization.
  • Chronic cholecystitis. It is characterized by a latent period of flow that turns into a chronic stage with frequent remissions. Children have complaints of headaches, fatigue, sleep problems. The skin becomes pale, there are circles under the eyes. Over a long time, the temperature may increase to 37.5. Complaints of abdominal pain no. In the morning there is bitterness in the mouth. Associated with intoxication of the body.

  • Eating disorders.
  • Excessive physical exertion (at school or in sections in a child).
  • Nerve strain (exams).
  • Period of illness (acute respiratory viral infection or exacerbation of chronic diseases).

The condition is characterized by severe pain from the right hypochondrium, aggravated by sudden, rapid movements. The pain is disturbed by attacks (of different durations), remains constant, aching.

Manifestations of observed dyspepsia:

Indicates an itchy skin disease that causes a buildup of bile in the biliary tract, leading to the release of acids into the tissue.

Inflammation leads to pain in the joints, in the head, weakness in the arms and legs, profuse sweating, arrhythmias and heart palpitations.

What it is?

Inflammation of the inner wall of the gallbladder is called cholecystitis. This pathology can develop at any age. In children, cholecystitis is accompanied by the development of numerous symptoms associated with impaired digestion.

Quite rarely, only the inner wall of the gallbladder is involved in the inflammatory process. More often, inflammation also moves to the biliary tract. Such pathologies are most often found in children's practice. This feature in children is due to the anatomical proximity of all internal organs.

According to statistics, children have much more often chronic forms of this disease. Acute and purulent variants are recorded in children's practice much less frequently. In some cases, the course of the disease may be latent. In this situation, no adverse symptoms of pathology appear.

Usually, a worsening of the disease occurs when the diet is disturbed or the disease progresses.

The development of the disease lead to a variety of causal factors. Some types of bacteria can cause severe inflammation, which rather quickly leads to the spread of the inflammatory process in all biliary tract. The most common causes leading to the development of the disease are giardia and worm infection.

Secondary foci of infection also contribute to the development of inflammation in the gallbladder. Chronic tonsillitis caused by bacterial flora, with unproven treatment, can lead to the appearance of adverse cholecystitis symptoms in a child.

The effects of appendicitis, gastritis, scarlet fever or influenza can also lead to the spread of inflammation in the organs of the gastrointestinal tract.

Depending on the time of occurrence of adverse symptoms of the disease, all clinical variants of the disease are divided into acute and chronic. The first reported disease is called the acute form. This clinical option is quite often registered in children from 8 to 13 years.

Acute cholecystitis is accompanied by an increase in blood levels of lysolecithin. With the functional blockade of the gallbladder its content increases many times. This clinical condition contributes to pronounced damage to the mucous membrane of the inflamed organ. Such disorders cause the strongest aseptic inflammation in a sick child.

Over the course of acute cholecystitis in the damaged organ, the blood supply is disturbed as a result of severe biliary hypertension. Prolonged blood stasis contributes to an increase in the size of the gallbladder, which leads to the appearance of specific symptoms of the disease in a child.

The chronic form of the disease is accompanied by alternation of several periods of remission and exacerbations. This variant of the disease can be purulent and catarrhal. The appearance of pus is the most unfavorable symptom. To eliminate the symptoms of purulent cholecystitis, antibiotic medications are required, as well as more intensive treatment.

The adverse course of chronic suppurative inflammation of the inner wall of the gallbladder can lead to the appearance of various abscesses. In this clinical situation, pus formed in the primary focus can spread to neighboring internal organs.

Purulent abscesses are difficult to diagnose, and treatment is carried out only in a hospital.

The severity of adverse clinical signs may be different. Children of earlier age can suffer the exacerbation of chronic cholecystitis much harder. The increase in symptoms usually occurs within the first few hours of the onset of the acute period of the disease.

The most frequent clinical sign of this disease is the appearance of strong bitterness in the mouth. Usually this symptom increases or appears after eating fatty and fried foods. The tongue of a sick child is usually covered with a white or yellowish bloom. Toddlers complain about the lack of or loss of appetite.

Vomiting or nausea are also quite common symptoms that occur during exacerbation of cholecystitis. Children have a broken chair. Quite often, this clinical sign is manifested by persistent constipation, which occurs due to insufficient flow of bile, necessary for proper digestion.

Abdominal pain is a classic symptom that accompanies this disease. The intensity of the pain syndrome may be different.

Some babies feel only the heaviness in the right hypochondrium. The intensity of the pain syndrome increases after an error in the diet and the abuse of fatty foods. In some cases, the pain may spread from the right hypochondrium to the unilateral arm and under the scapula.

The duration of the pain syndrome may be different. On average, it ranges from 5-15 minutes to several hours. Sick kids note the relationship between the appearance of pain and the use of fatty and fried foods. The nature of the pain syndrome is usually aching, pulling.

During the acute period of the disease, the child's pain increases in the right hypochondrium. This symptom increases with pressure in this area. In some cases, the abdominal wall tension increases in the abdomen. This pathological stress occurs as a manifestation of a protective reaction to severe inflammation.

The latent form of the disease for a long time does not manifest itself. The first symptoms of the disease can develop only a few years after the onset of the disease. Constant errors in the diet only contribute to the active progression of the disease. Before the onset of pain in a baby, nausea and a feeling of heaviness in the right hypochondrium are noticeably worse.

In adolescence, a sick child also appears concomitant symptoms of liver damage. As a rule, these clinical signs appear yellowing of the skin.

In case of a pronounced violation of the outflow of bile, the child may develop persistent itching, which brings the child great anxiety and discomfort.

Diagnostics

History taking plays an important role in establishing the correct diagnosis. To clarify the degree of damage to the internal organs requires a clinical examination with mandatory palpation of the projection of the gallbladder. During such a study, the doctor may establish specific symptoms that occur when the organ is damaged.

In the period of acute illness, laboratory tests are very informative. They help doctors determine the severity of functional disorders.

When inflammation of the gallbladder in the blood increases the amount of total bilirubin. Its fractions also change.

Conducting instrumental studies in establishing the diagnosis is also necessary. To establish the diagnosis, doctors prescribe an ultrasound examination of the abdominal cavity. The thickening of the inner wall of the gallbladder and the signs of bile stasis in it indicate that the child has signs of cholecystitis.

For the treatment of the acute period of the disease, various drugs are used. The scheme of such treatment is determined by the attending physician. Both pediatricians and pediatric gastroenterologists can treat acute or chronic cholecystitis. To identify this disease in children, a mandatory medical examination is carried out, allowing sufficient control over the development of the disease.

Medical nutrition in the treatment of cholecystitis plays the most important role. In the diet of sick kids, all fatty and fried foods are limited. Polyunsaturated fatty molecules are used as fats. They are contained, as a rule, in unrefined vegetable oils, as well as red fish.

All refined fats, as well as roasting are categorically excluded.

A kid suffering from cholecystitis should eat at least 5-6 times a day in small portions. The amount of food should not exceed the age norm. Daily calories should also be strictly observed. The basis of the diet should be high-quality protein foods and cereal porridge. Food should be supplemented with fruits and vegetables that contain a sufficient amount of plant fiber.

The acute period of the disease, doctors recommend to spend in bed. Compliance with bed rest will prevent the development of dangerous complications in the future. Eliminate adverse symptoms in bacterial purulent forms of cholecystitis is possible only with the help of medicinal antibacterial drugs.

Drugs based on penicillin, chloramphenicol and other substances are used as such agents.

If the cause of exacerbation of cholecystitis is giardiasis infection, then in this case, specific drugs based on aminoquinol and furazolidone are prescribed. Age dosages of these funds are selected by the attending physician. To eliminate the adverse symptoms required course application.

Symptomatic therapy includes the appointment of choleretic drugs. They can be represented by both herbal and pharmaceutical drugs. For babies fit broths made from oats, bearberries, corn silk. A variety of physiotherapeutic procedures can fix the positive effect.

These include ozokerkernaya therapy, UHF-treatment, paraffin therapy, as well as diathermy.

For more information about cholecystitis, learn from Dr. Komarovsky, looking at the following video.

Disease classification

Cholecystitis in children can be acute or chronic. Acute cholecystitis in children often appears in the presence of stones; in medicine, this type is called catarrh.

In some cases, the acute course can be caused by a purulent inflammatory process. Chronic cholecystitis is more often diagnosed in children, which happens with and without stones.

For the chronic phase of the pathology characteristic different forms:

  1. Latent or latent, when there are no symptoms.
  2. Often recurrent - exacerbations appear more than 2 times a year.
  3. Rarely recurring - it happens up to 2 exacerbations per year.

According to the severity of the course, the following forms of cholecystitis are distinguished:

The disease itself can pass with a stagnant process when the outflow of bile is disturbed. There are situations of increased or reduced muscle tone of the gallbladder walls.

Often, inflammation from the organ itself goes to the ducts, and in medicine it is called cholecystocholangitis, and it can affect the liver tissue.

Main reasons

The development of cholecystitis in children can be provoked by a number of other diseases that pass in a chronic form.

These include the following pathologies:

  1. Tonsillitis.
  2. Sinusitis
  3. Pyelonephritis.
  4. Caries on the teeth.

The main pathogens are:

  1. E. coli.
  2. Streptococcus and Staphylococcus.
  3. Other pathogenic bacteria.
  4. Infectious infection that enters the gallbladder directly from the gastrointestinal tract.
  5. Scarlet fever.
  6. Angina.
  7. Cold diseases.
  8. Salmonellosis.

The factors provoking the inflammatory process are the following:

  1. Disrupted diet of the child and his regime. The disease often develops with long intervals between meals, which causes biliary stagnation. An unbalanced diet can cause illness if the menu contains a lot of heavy foods (fatty and fried foods) and few plant foods.
  2. Frequent overeating.
  3. Insufficient activity of the child.
  4. Congenital malformations or anomalies of the bile ducts, bladder, dyskinesia.
  5. Disorders of the endocrine system.
  6. Stress.
  7. Chronic diseases of other internal organs and systems.
  8. Food allergy.
  9. Long-term treatment with drugs, as a result of which begins toxic poisoning of the body.
  10. Nervous system disorders.
  11. Mechanical damage to the body.
  12. Weak immune system.

Chronic cholecystitis in children often appears as a result of an acute course of the disease, which was not completely cured or therapy started too late.

Main symptoms

Acute and chronic cholecystitis have different symptoms and treatment. In children with acute progression of the disease there will be severe symptoms, but this condition is rarely diagnosed.

The latent form of the disease happens much more often, the progression of the pathology is slow and imperceptible for the parents and the child himself. In this case, there will be certain periods of exacerbations, with the appearance of provoking factors.

Statistics show that a latent course appears in 15% of children. In this case, the following symptoms develop:

  1. Frequent pains in the head.
  2. Decreased appetite.
  3. The appearance of rapid fatigue.
  4. Sleep disturbance, he becomes restless.
  5. The child's body turns pale, dark circles form on the face under the eyes.
  6. In some cases, the temperature may increase to 37-38 degrees, while abdominal pain is absent.
  7. There are common symptoms of intoxication.

Exacerbations of the disease appear in the presence of certain provoking reasons, which include:

  1. Improper nutrition and its regime.
  2. Increased physical activity.
  3. Frequent or severe stressful situations.
  4. Diseases of various kinds that affect the state of the immune system.

There are some major symptoms in children that occur most often:

  1. Pain in the liver on the right in the hypochondrium. She becomes more intense while walking, running. The syndrome may have a wave-like appearance, the duration of pain reaches several hours, most often aching in nature. Feelings after a meal intensify, especially to eat fried or fat, the appearance begins within a couple of hours. Often, pain is given in the back, shoulder blade, neck.
  2. Frequent burping of air appears.
  3. There will be a bitter taste in the mouth, especially in the morning after sleep.
  4. There are bouts of nausea, less vomiting, after which the symptoms persist.
  5. Frequent flatulence and bloating.
  6. Altered and disturbed stools, alternating diarrhea and constipation.
  7. Children become irritated, can not sleep properly.
  8. The temperature increases.
  9. There is a decrease in body weight.
  10. The liver increases, jaundice may occur.

The chronic form of the disease with stones can go on for years, and during any exacerbation the characteristic signs of an acute course appear.

Calculous pathology may not differ in symptoms from stoneless cholecystitis. But this happens while the stones are in the gallbladder and are small in themselves.

As the dimensions increase and begin to move, it is possible that the ducts overlap. In this case, the child feels liver colic. Failure of outflow of biological material leads to disruption of the liver and bladder.

With the acute course of the disease, the child immediately appears severe pain on the right side under the ribs. The syndrome gives under the scapula, in the arm or shoulder.

At this time, the temperature quickly rises, the indicators will be above 38 degrees. Among the remaining symptoms of the acute form are:

  1. Frequent nausea.
  2. Vomiting with impurities of bile.
  3. Dryness in the mouth, on the tongue appears a dense bloom of yellow or white.
  4. Bitter taste.
  5. Pallor of the skin.
  6. Dizziness, general weakness.
  7. Restless behavior of the child, frequent abdominal pain.
  8. During palpation the pain becomes more intense.
  9. Bloating, increased pressure in the abdomen, which leads to the density of the walls of the abdominal cavity.

In children with acute cholecystitis, the pain can last for several days, the inflammatory process often goes to other organs and tissues, which can cause pancreatitis.

There are risks of adhesions, which complicates the treatment, increases its duration. In the purulent form of the pathology, all parts of the gallbladder are affected, an abscess begins, and tissue dies.

If the walls are broken, peritonitis occurs, which is difficult to treat, and the child will be in serious condition.

Diagnosing

The exact diagnosis is established by the doctor during the survey of the child and the parents, visual inspection of the patient and palpation.

During the survey, doctors collect the necessary information, then take a temperature measurement, determine the work of the heart, feel the walls of the abdominal cavity. In addition, the doctor will evaluate the condition of the skin and oral mucosa.

Laboratory diagnostic methods are used to accurately establish the diagnosis:

  1. A blood test shows the presence of inflammation in the body. During an acute course or during exacerbations, the number of leukocytes will be increased, during remission, the indicator returns to normal and even decreases. Biochemical analysis of blood indicates the activity of enzymes, normal bilirubin.
  2. The analysis of feces helps to determine the presence of worms and other parasites.
  3. Probing is used to analyze bile.

The instrumental methods of examination include the following techniques:

  1. Ultrasound - the main and safest method of examination of children with cholecystitis. According to the results, doctors can see the state and size of the gallbladder, the sealing of its walls and deformation. Also determined by the presence of stones, the contractile possibility of the body.
  2. Radiography with the use of contrast agents - used to diagnose a child in rare cases due to radiation. The technique helps to determine the shape and location of the inflamed organ, shows the motility and flow rate of bile.

After a comprehensive diagnosis, treatment of cholecystitis in children is prescribed, based on the main indications.

With exacerbations and acute course, the child needs rest and bed rest. If the attacks are acute and happen at home, you need to call the ambulance physicians.

Before arrival it is allowed to apply cold in the area of ​​the liver in order to reduce pain and other symptoms. It is forbidden to use thermal procedures, as inflammation will increase.

Any painkillers are prohibited, they do not allow doctors to properly assess the condition and prescribe funds for treatment. The clinical picture will be blurred.

During exacerbations, it is only allowed to give water or compotes, but not to feed the children. In acute cholecystitis, children are often hospitalized, and rapid treatment is carried out with the help of medication injections in the vein.

Therapy itself is carried out in two ways. Conservative methods and surgical treatment are used.

Surgical intervention is indicated in the presence of gallstones that close the ducts, as well as for any complications of cholecystitis.

Conservative treatment is an integrated approach:

  1. Dietary nutrition is prescribed.
  2. Medication drugs are prescribed to restore the work of the organs and the condition of the child.
  3. Used physiotherapy.
  4. Shown phytotherapy, the use of mineral waters.
  5. For rehabilitation you need a spa treatment.

The main means for conservative treatment are as follows:

  1. Antibiotics that can kill the infection, bacteria and other causative agents of cholecystitis. To do this, use drugs based on penicillins, macrolides or cephalosporins.
  2. Medications for parasites, recommended in the presence of worms, giardiasis. For therapy prescribed Vermox, furazolidone.
  3. With increased bladder tone, antispasmodic drugs are used that relieve pain. Children shows papaverine, no-shpa.
  4. To normalize the outflow of bile, choleretic drugs are prescribed; Holosas, a decoction of corn rylets, is recommended for children.
  5. Hepatoprotectors can stabilize liver function. We must take Kars, Heparsil, Essentiale.
  6. Be sure that doctors prescribe vitamins, with poor sleep and nervous disorders you need to take sedatives.

Any medication can be taken as prescribed by a doctor, in the indicated scheme and in a specific course. When symptoms begin to pass, tubing or blind sensing is performed to improve bile flow.

Among physiotherapy is recommended:

  1. UHF
  2. Mud therapy.
  3. Paraffin applications.
  4. Diathermy.

When the acute symptoms pass you need to use physical therapy and massages.

It is imperative that during the treatment it is necessary to use proper nutrition, children will need to adjust it and monitor the use of the diet.

During the first two days with the acute course of pathology, the child should be forbidden to eat, you can only use warm drinks.

It is recommended to use teas without sugar, broth hips or homemade compotes. Excessive drinking helps to normalize the bile outflow, removes signs of intoxication.

After a time, the introduction of mucous soups, which are made on water and vegetables, is allowed. Before serving the first courses, they need to grind, grind.

You can give a liquid consistency of porridge, including semolina, rice or oatmeal. Kashi allowed to breed milk, but do not put the butter.

It is allowed to eat vegetables in the form of mashed potatoes, mousses. The amount of salt is significantly reduced, and it is better to completely eliminate the additive.

To feed the child in small portions, make split meals 5 times a day. It is recommended that all products be steamed or boiled, baking and stewing is allowed.

After a while, you can expand the menu using the basic rules of the Pevzner diet table No. 5.

This diet is shown immediately when diagnosing the disease, if the exacerbation does not appear sharply. The essence of the diet lies in the ease and shaving of the digestive tract, gallbladder and liver.

At the expense of it work of the inflamed parts is restored and bile outflow improves. Be sure to remove from the diet of the child the following products:

  1. Fried and fatty dishes.
  2. Any kinds of pickles, pickled products and preserves.
  3. Prohibited rich first courses, broths.
  4. Smoked products.
  5. Spices, seasonings, sauces.
  6. Muffin.
  7. Soda.
  8. Sweets.
  9. Nuts and mushrooms.

In the diet add the following products:

  1. Boiled beef, rabbit, chicken.
  2. Boiled lean fish.
  3. Cottage cheese.
  4. Various vegetables.
  5. White eggs.
  6. Fruits are fresh and dried.
  7. Vegetable oil.

Bread should be replaced with breadcrumbs or use 2-day dried bread. The first dishes should be cooked in vegetable broths.

It is useful for children with cholecystitis to take fermented milk products of a low-fat appearance. Sweet lovers should be given marmalade, marshmallows or honey.

Provocateurs disease

Cholecystitis in a child can provoke Escherichia coli, Proteus or cocci, caught in a favorable environment. These conditions include the infection with protozoa, that is, giardiasis, helminthic invasions, and pathologies of the biliary system. The main causes of cholecystitis are divided into 2 groups:

  • parasitic,
  • microbial.

Chronic cholecystitis in children is often associated with the presence of other foci of inflammation, for example, angina or tonsillitis. In many cases, the disease is provoked by previously transferred diseases, such as gastritis, colibacillosis, duodenitis, appendicitis, influenza, scarlet fever, dysentery.

Inflammation of the gallbladder or bile ducts can be triggered by a systematic violation of diet, absorption of large amounts of fatty foods and carbohydrate-containing foods, a clear lack of vegetables and fruits in the diet.

The mechanism of manifestation of the disease. Chronic cholecystitis

Cholecystitis in a child in a chronic form may be purulent or catarrhal in nature. The catarrhal form is associated with inflammation of the mucous membranes. In this case, the gallbladder wall becomes denser and thicker, and the mucosa atrophies from the inside of the lining organ from the inside.

For purulent cholecystitis is characterized by the involvement in the process of all tissues of the wall. In the organ abscesses are formed, which become a source of regular exacerbations of chronic cholecystitis. When the disease recurs, gallbladder swelling occurs. A characteristic feature is the thickening of the mucous membranes, the appearance of polyps and ulcers.

When healing ulcers are replaced by connective tissue, scars appear. Occasionally, adhesions with closely spaced organs are formed. This process is called pereholetsistita.

An ulcer can lead to fistula formation and the development of biliary peritonitis. If cholecystitis in a child leads to clogging of the bile duct, the hydropsy of the gallbladder may develop. Chronic cholecystitis can affect the condition of the liver, diaphragm and abdominal wall. The aggravation of the process provokes an abscess in these organs. In difficult cases, external biliary fistulas may appear.

Acute cholecystitis

Acute cholecystitis in children may require surgery. However, this happens infrequently. The development of the disease is usually associated with an infection that has spread through the bloodstream or lymph flow. At an early age, the most common factor in the development of an acute process is intestinal infections and bile stasis due to constipation or flatulence.

As a result of acute cholecystitis, a high concentration of lysolecithin is created. Bile salts damage the mucous membrane of the bladder, violating the permeability of cell membranes. As children’s immune defenses are not completely formed, edema and secondary biliary hypertension develop.

Symptoms

How does cholecystitis manifest in children? Symptoms may be bright or mild. These are usually complaints of bitter taste in the mouth, a significant decrease in appetite, nausea and vomiting, constipation or diarrhea. However, the main symptom of cholecystitis is pain in the right hypochondrium. Pain can be paroxysmal and last from several minutes to several hours or permanent.

One of the main symptoms of the disease is pain and enlargement of the liver. Sometimes with palpation there is a tension in the abdominal wall above the gallbladder. Many children have a low-grade fever for a long time. If you combine the symptoms into one list, it will look like this:

  1. Pain of paroxysmal or permanent nature, localized to the right under the ribs. Strengthened a few hours after eating, accompanied by a feeling of heaviness and overflow.
  2. Dyspepsia, that is, disorder of the digestive system. Bitter or metallic taste, frequent belching, nausea, increased flatulence in the intestine, unstable stool.
  3. Low temperature for a long time, general irritability, insomnia.

Parents should understand that, despite the obvious manifestations of the disease, self-diagnosis is unacceptable. Only a doctor is able to confirm cholecystitis in children. Symptoms and treatment of this disease depend on the severity of the patient's condition. A specialist taking into account the clinical picture and on the basis of the results of analyzes selects the appropriate type of therapy.

Diagnostics

First of all, the doctor talks with the patient or his parents and collects anamnesis. Next are clinical and laboratory tests. This is a mandatory detailed blood count and biochemistry.

To confirm the diagnosis prescribed echography. This examination allows you to determine the change in the size and thickness of the walls of the gallbladder. In addition, a violation of organ contractions is detected. In addition, it is desirable to conduct duodenal intubation and ultrasound.

Additionally, a study of bile. The analysis shows a decrease in specific gravity and an increase in acidity.

Additional information about the form of the disease

It often happens that the professional speech of a doctor is not always clear to an unprepared person. For example, if the doctor tells the patient’s parents that he has a non-calculous form of cholecystitis, this means that the disease is not associated with the formation of gallstones. Simply childish form is called beskamennaya.

Treatment of cholecystitis in children is carried out according to a specific scheme:

  1. Compliance with bed rest at home.
  2. Taking antibiotics as prescribed by a doctor.
  3. Receiving choleretic drugs.
  4. If necessary - taking anti-parasitic drugs.
  5. The complex of vitamins with a high content of groups B and C.
  6. Acceptance of antispasmodics to reduce pain.
  7. Prescription drugs that improve the work of the liver.

Chronic form of cholecystitis is usually treated at home, but if the process is exacerbated, it is desirable to hospitalize the baby. The first day after the exacerbation, the child is given full starvation, and in the future parents will have to monitor adherence to a strict diet. Children with cholecystitis put on dispensary registration.

Dieting

It is impossible to cure a baby without following certain rules of nutrition. Diet for cholecystitis children involves boiled or steamed food in a ground form. The doctor prescribes diet table number 5 or 5a.

In the diet should not be spicy and spicy additives, smoked meats, fatty foods and fried foods. Portions should be small, because you can not overeat the child.

Sunflower oil, cottage cheese, fish and meat in steamed or boiled form, fruits, vegetables or light salads from them must be introduced into the diet of a small patient.

Preventive measures

All parents want to see their babies healthy. So that the child does not have cholecystitis, it is important to monitor his diet, do not allow to overeat and gorge at night. You can not give the child popular snacks in the form of snacks, crackers and chips. It is advisable to adhere to regular fractional and frequent meals.

Children must lead an active lifestyle. This will help avoid not only cholecystitis, but also many other problems. Morning exercises, sports groups, tourism, playing in the fresh air - a normal pastime for a healthy child.

Try not to allow or at least identify other gastrointestinal infections and diseases, because everything is interconnected in the body.

Conduct prophylactic treatment of helminthiasis, if you assume that the child could pick up parasites in kindergarten, at school, at home, or in the common sandbox in the yard.

As prescribed by the physician, take cholagogue preparations and mineral waters. And most importantly - watch the condition of your child, because it is easy to miss the onset of the disease or its aggravation, but to treat it is quite difficult. Subsequently, the baby may even be recommended surgery.

What is Cholecystitis in children -

Cholecystitis - inflammatory gallbladder disease. Cholecystitis occurs in two forms: acute and chronic. This is one of the most common diseases in children.

The inflammatory process rarely affects the gallbladder or ducts only. The entire biliary tract system is usually affected. Therefore, children are diagnosed with angio and hepatocholecystitis, cholecystocholangitis. Acute and purulent form of the disease in children is in rare cases. The most common course of cholecystitis in a child is chronic, there are exacerbations and relapses (recurrence of symptoms). The latent course is typical for 15–18%, after 1-2 years it becomes apparent - the symptoms appear openly and clearly, according to a researcher like M. Ya. Studenikin.

What triggers / Causes of Cholecystitis in children:

Excite cholecystitis in children, cocci, E. coli, proteus. For the development of the disease it is necessary that the body had certain conditions - giardiasis of the biliary tract, worm infestation, and so on.

Causes are divided into 2 groups: parasitic and microbial. Cholecystitis is associated with chronic foci of inflammation (in frequent cases it is tonsillitis) and previously transferred diseases (gastritis, duodenitis, colibacillosis, appendicitis, sore throat, dysentery, scarlet fever, flu, etc. the amount of carbohydrate or fatty foods, with a lack of vegetables in the diet.

Symptoms of Cholecystitis in children:

Children with cholecystitis complain of a feeling of bitterness in the mouth, absence or decreased appetite, vomiting or nausea, constipation, unstable stool. The main symptom of the disease is considered abdominal pain. It is localized mainly under the ribs in the right side. In rare cases, a certain area that hurts can not be identified. Pain can be paroxysmal, with a duration of 2-3 minutes to 2-3 hours. Also, in some cases of pain, persistent, whining character.

Also, the main symptoms of cholecystitis in children include an enlarged liver and its slight soreness when pressing on this area. The gallbladder is painful, especially when the disease is exacerbated. In some cases, the tension in the abdominal wall over the gallbladder area. A child may have subfebrile temperature for a very long time.

The blood test shows an increased number of leukocytes and an accelerated ESR. With catarrhal-serous cholecystitis in children, there are occasional exacerbations, the disease lasts a long time - several years. In the period of exacerbation, the symptoms are similar to those in acute cholecystitis. In this disease, adhesions may be formed. They can be identified by the method of cholegraphy. They lengthen the course of the disease.

In the case of a latent course, which gradually turns into an open form, the child first develops non-durable abdominal pain. Then they become more frequent and long. Before the attack, he presses in the epigastric region, the child becomes nauseated, smells unpleasantly from the mouth. With the pain, the temperature rises, which may even be high.

Along with this fix an increase in the liver, sometimes significant. In older children, cystic symptoms are distinct, and in young children they are not observed. Children rarely have jaundice with cholecystitis. There is a violation of the functions of the liver: carbohydrate, protein, detoxification, etc. There are changes in the cardiovascular, respiratory, nervous and endocrine systems.

Chronic calculous cholecystitis

This case is characterized by the formation of gallstones. With this disease, women are more likely to be overweight. The accumulation of bile and the deposition of salts contribute to a poor flow of bile, which leads to an exacerbation of the disease.

The presence of stones in the bladder hinders his work, the work of the biliary tract. During exacerbation, a person has hepatic colic, sharp pain in the right hypochondrium. During an attack, the patient experiences acute pain, nausea, bitter taste in the mouth, and general weakness.

Features of treatment

With the exacerbation of cholecystitis, the child needs bed rest and urgent medical care. Facilitates the condition attached to the very painful places cold. A hot water bottle and other warm compresses may not be applied to inflamed areas.

Painkillers should not be given - may make diagnosis difficult.

Do not feed the child, you can give a warm drink.

Children with acute illness are admitted to hospital. Requires complete rest. If necessary, the doctor forbids taking food for 1-2 days. The patient put the dropper, give drugs.

The treatment complex includes:

  • diet,
  • medication treatment
  • phytotherapy,
  • physiotherapy,
  • Spa treatment.

For drug treatment include:

  1. Antibiotics.
  2. Antiparasitic drugs.
  3. Painkillers
  4. Hepatoprotectors.
  5. Choleretic agents.
  6. Vitamin and mineral complexes.
  7. Sedatives.

Preparations are used under the supervision of a physician.

After easing the symptoms of exacerbation, tubages, blind sensing are performed to normalize the flow of bile and prevent stagnation.

The main thing during the treatment of chronic cholecystitis adhere to a strict diet. Children's diet is divided into 4-5 parts. It is advisable to cook in a double boiler or stew. Increase the amount of fluid you drink. Add to the diet of dried fruits, carrots, melons - contribute to the work of intestinal motility, relieve constipation.

Adherence to food can help avoid future problems with the gallbladder.

During remission, the doctor prescribes diet number 5, with an exacerbation - number 5A.

It is forbidden to eat:

  • fried foods
  • fatty dishes
  • pickles, preservation and pickles,
  • rich broths,
  • soda,
  • sweet and fresh pastries,
  • sweets, sweets,
  • seasonings and spices,
  • ice cream,
  • sour fruits,
  • radish and radish
  • fatty dairy products
  • high fat cheeses.

Products recommended for use:

  • boiled meat and fish,
  • non-fat dairy products,
  • vegetable oils (olive, sea buckthorn).

Treat children with marmalade, marshmallows, caramels. Let's take a warm drink.

Well proven in the treatment of cholecystitis herbal medicine. Such treatment is not less effective, but it has no side effects. The following herbs are mentioned in folk recipes: calamus (root), marshmallow (root), dill (fruit), chamomile (flowers), fennel, peppermint (leaf).

In childhood cholecystitis often develops in a latent form. Parents must learn to recognize the first signs. It is important to closely monitor the health and well-being of the child, noting the changes. Children's age - the period of the formation of organs. This will help in time to notice and recognize the disease.

Follow the child's food. Do not overfeed it, limit in sweets, in fatty foods, which leads to a delay of bile, the development of an inflammatory process in the gallbladder.

To treat the disease is long and difficult. Self cure is impossible. A disease that is not diagnosed in time leads to the formation of gallstones, leading to surgery. Attentiveness and care, timely medical assistance will save the health of the child. In newborns, the disease is extremely rare.

Manifestation of the disease

Acute cholecystitis in children has a sudden, acute onset, often at night. The child notes unbearable pain in the right hypochondrium and epigastric region. The baby is concerned, trying to find a certain position in the bed, which reduces the feeling of pain. The child has repeated vomiting, an admixture of bile in the vomit.

Symptoms of cholecystitis in children of primary school and preschool age are blurred (uncertain), which causes difficulties in diagnosis. In adolescents, pain syndrome is pronounced. There is pain due to the difficulty of outflow of bile from the bladder. Characterized by the irradiation of pain in the right side of the lower back and its spread throughout the abdominal cavity. The tongue is dry and coated, the temperature rises to 39 degrees.

In more than 50% of patients, the onset of cholecystitis is characterized by blurred symptoms: recurrent minor exacerbations are replaced by periods of remission. Excessive physical exertion, frequent nutritional errors, and psychological disorders contribute to the development of the disease.

Chronic cholecystitis manifests itself as follows:

  • there is an increase in digestive disorders,
  • paroxysmal or dull persistent pain symptom.

Common symptoms

The disease, both acute and chronic, has the same main symptoms:

  1. Pain. Localized on the right, in the hypochondrium. It is a constant dull, aching character, less often acute. There is an increase in symptoms after eating (especially due to overeating fatty or fried). Some patients note the irradiation of pain in the right shoulder.
  2. Dyspeptic or intestinal syndrome. Cholecystitis in children is characterized by the presence of non-permanent stools: constipation or diarrhea, their alternation is less often observed. Patients complain of nausea, constant bitterness in the mouth, flatulence.
  3. Increase the boundaries of the liver.
  4. Low-grade fever (long time).
  5. Intoxication (signs of poisoning) and jaundice.
  6. Emotional disorders. Insomnia, irritability, frequent mood swings are observed in patients.

Symptoms and treatment of both the acute and chronic forms of the disease do not practically differ, it is important to identify the disease as early as possible.

Drug therapy

Treatment of the disease is carried out according to this scheme:

  1. Bed rest
  2. Antibiotics: Metronidazole, Ciprofloxacin, Furazolidone, Ampicillin.
  3. Choleretic drugs: Allohol, Holosas.
  4. Antiparasitic drugs: Aminohinol, Worm.
  5. Vitamin preparations of group B, C.
  6. Antispasmodics: Noshpa, Baralgin, Dyustatalin.
  7. Drugs that improve the function of the liver: Essentiale, Kars, Degalon.

If an exacerbation of the disease occurs, the child is hospitalized. In the hospital, spasm is immediately removed from the bile ducts, anesthetized and anti-inflammatory therapy prescribed. The first day of treatment is complete fasting, and then a strict diet. If there is no improvement after the treatment, surgery is carried out.

Watch the video: Cholecystectomy. Gallbladder Removal Surgery. Nucleus Health (February 2020).