Gastrointestinal notes -gallbladder stones

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Gastrointestinal notes -gallbladder stones

2022-06-24 06:08:24 3 ℃

Clinical manifestation

Chilerystones are mainly cholesterol stones or mixed stones mainly mainly cholesterol. It is mainly seen in thousands of adults. Women are common, especially those with maternal and taking contraceptives. The ratio of men and women is about 1: 3. However, as the age difference decreases, the ratio of men and women at the age of 50 is 1: 1.5, and the incidence of men and women among the elderly is basically equal. This may be related to the role of estrogen in gallbladder stones.

Clinical manifestation

20%-40%of patients with gallbladder can be asymptomatic for life, called asymptomatic gallbladder stones. It can also be manifested as

Biliary

or

Urgent, chronic cholecystitis

Essence Whether the symptoms are related to the size and part of the stones are related to the infection and obstruction. The main clinical manifestations of symptoms of gallbladder stones are:

1. Gastrointestinal symptoms

After eating, especially after getting greasy foods, the upper or right upper abdomen appears hidden pain and uncomfortable, full of fullness, accompanied by qi, hiccups, etc., often misdiagnosed as "stomach disease".

2.{}

It is its typical expression

, When the gallbladder contracted after a full meal, eats greasy food, or changes position when sleeping, stones are shifted and embedded in the belly or neck of the gallbladder pot, gallbladder empty bile blocked, the pressure in the gallbladder rises, the gallbladder has strong contraction, and colic occurs. Essence The pain is located on the upper abdomen or the right upper abdomen, which is paroxysmal and can radiate to the shoulder and spleen and back, accompanied by nausea and vomiting.

3. Mirizzi syndrome continues to be embedded in the neck of the cholecies and larger cholecystectomy stones, which can compress the hepatoptis stenosis or cause gallbladder bile duct fistula. The clinical manifestations are recurrent cholecystitis, cholangitis and obstructive jaundice. Mirizzi syndrome. Its incidence accounted for 0.7%-1.1%of patients with bile bag resection. Anatomy variation, especially the bileherapy tube and hepatoptis, or the low convergence position of the gallbladder tube and the general hepatic pipe is the basis of anatomical dissection of the disease.

4. Gallbladder efficient gallbladder stones for a long time or blocking the gallbladder pipe but not combined with infection. The biliary pigment in the bile was absorbed by the gallbladder mucosa and secreted mucus substances. "".

diagnosis

History:

Repeat meals and eat greasy food

The upper right upper abdominal distension, pain, and even biliary colic, mostly accompanied by radiation pain in the right shoulder and spleen.

Physical examination:

Polygonal abdominal tenderness

, Can varying degrees

Right upper abdominal muscle tension

,,

Murphy positive

, Pain in the liver area.

The diagnosis often relies on imaging examinations. The preferred ultrasound examination is 96%. CT and MRI can also display gallbladder stones, but not as routine. Patients with acute cholecystitis often have a proportion of bloody white cells with neutral granulocytes {}.

Outlets and surgical methods of gallbladder resection

Laparoscopic gallbladder resection

It is currently the first choice to treat gallbladder stones. For asymptomatic gallbladder stones, preventive gallbladder removal is generally not performed, which can be observed and followed.

Gallbladder resection certificate:

The number of stones and the diameter of stones ≥2-3cm;

Gallbladder wall calcification or porcelain gallbladder;

Accompanied by gallbladder polyps ≥1cm;

The thickening of the cholecyst wall (> 3mm) is accompanied by chronic cholecystitis.

For patients who are not suitable for laparoscopic cholecystectomy or laparoscopic cholecystectomy, patients with severe complications should be considered.

When the gallbladder is removed, the following situations should be conducted at the same time.

Preoperative medical history, clinical manifestations, or image examination prompts that the bile tube has obstruction, including obstructive jaundice, biliary tube stones, recurrent bile colic, bile tubeitis, pancreatitis;

It was confirmed that the gallbladder tube had lesions during the operation.

The diameter of the biliary tube is more than 1cm, and the gallbladder wall is significantly thickened. It is found that pancreatitis or pancreatic heads, bile duct puncture pyrophosis, bloody bile, or mud -like biliary particles;

The gallbladder stones are small and may enter the gallbladder tube through the gallbladder tube. Those with conditions should strive for biliary angiography or biliary mirror inspections during the operation to reduce unnecessary overall gangs to explore and improve the positive rate of exploration.

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