Acute cholecystitis is an acute inflammation of the gallbladder. Women suffer more often than men in three to four times. Most often occurs in excessively full individuals, but cholecystitis is not an exceptional rarity in asthenic persons( asthenics).
Here we will look at how a paramedic or emergency doctor provides emergency first aid in an attack of acute abdominal pain.
CONTENTS
Symptoms of
The most common onset of the disease is similar to hepatic colic, but with the addition of symptoms of inflammation( a sudden increase in body temperature to 39-40degrees, often with chills, intoxication, neutrophilic leukocytosis).
It is usually early to limit the mobility of the abdominal wall during breathing, initially local, and then spilled muscular protection. It often extends to the entire right side of the abdomen. When palpation a wide zone of sharp soreness in the right hypochondrium is revealed.
When the parietal peritoneum is involved in the process, the Shchetkin-Blumberg symptom is determined. Sometimes, as soon as the process begins to abate and the muscle tension decreases, it is possible to probe a painful strained bubble or the surrounding infiltrate.
Patients can detect all the local symptoms of cholecystitis: an easy palm flattening of the right hypochondrium causes a sharp increase in pain during a deep inspiration, sharply painful lunging at the edge of the lower ribs, a positive frenicus-symptom.
The spread of the inflammatory process to the liver, the attachment of cholangitis, as well as the obstruction of the common bile duct with stone or pus and mucus cause the appearance of icterism, and sometimes severe jaundice.
Often acute cholecystitis is accompanied by a pancreatic lesion and the addition of pancreatitis symptoms - cholecystopancreatitis.
Perforation of the gallbladder is manifested by sudden sharp pain in the epigastric region, more often on the right. Peritonitis can also develop as a result of percolation of infected bile through the overgrowth of the vesicle wall and the fibrous membrane of the liver( glisson capsule) without compromising the integrity of the gallbladder( exudate biliary peritonitis).
Diagnosis
Acute cholecystitis often has to be differentiated from such diseases as acute appendicitis, acute pancreatitis, subdiaphragmatic abscess, kidney stone disease, peptic ulcer, etc.
Acute cholecystitis and hepatic colic can cause reflex angina.
Difficulties in differentiating acute cholecystitis from acute appendicitis occur with a high location of the appendix, when it touches the gallbladder, or when the liver is lowered, as well as with excessive gallbladder mobility.
With appendicitis muscle tension is more pronounced in the right iliac region, with cholecystitis in the right upper quadrant. For cholecystitis, the pain radiates to the right shoulder blade and shoulder.
In the elderly, even destructive cholecystitis can occur with mildly pronounced signs of irritation of the peritoneum.
Assistance: first urgent
Emergency care and hospitalization. Patients with acute cholecystitis are subject to emergency hospitalization in the surgical department.
Treatment aims to eliminate pain syndrome, reduce inflammation and general intoxication. If as a result of the conservative treatment the pain is stopped and the general condition begins to stabilize, then the treatment continues. As the survey reveals the form of cholecystitis and decide on the need for surgical treatment.
Absolute indications for emergency surgical treatment are suspicion of perforation, gangrene, gall bladder phlegmon, peritonitis on the soil of destructive cholecystitis.
Acute and chronic cholecystitis, cholangitis, dyskinesia ZHVP
Acute and chronic cholecystitis and cholangitis. Causes, treatment of cholecystitis, cholangitis and dyskinesia ZHVP.Bile cholecystitis and cholangitis.
Acute calculous cholecystitis
Acute calculous cholecystitis - lecture. Plyusnin Boris Ivanovich - doctor of medical sciences, professor. Video lectures are provided by the Department of Faculty Surgery No. 2( moshirurg.ru) of the Moscow State Medical and Dental University.
Source of : Eliseev OM(compiler).A guide to emergency and emergency care.- SPb.: Izd. Leyla LLP, 1996