In childhood, there is a close relationship of cholecystitis with chronic tonsillitis, adenoids, inflammation of the paranasal sinuses, dental caries, epidemic hepatitis, etc. A poor diet of children also plays a role in the onset of cholecystitis (indiscriminate and forced feeding, rare meals, feeding without age of children), which leads to impaired secretion and outflow of bile. The direct causative agents of cholecystitis are microbes: cocci, Proteus, E. coli; certain conditions for the development of cholecystitis are created in case of lambliasis of the biliary tract, less often with helminthic invasion.
The most frequent complaints of children with cholecystitis are loss of appetite, bitter taste in the mouth, nausea, vomiting, constipation, or unstable stool.
The leading symptom of cholecystitis in children is abdominal pain, more often in the right hypochondrium, less often without a specific location. Pains are paroxysmal (from several minutes to 2-3 hours) or almost constant, aching. The second most common symptom is an enlarged liver and its slight tenderness to palpation. The area of the gallbladder, especially in the period of exacerbation, is usually painful. Quite often over tension of an abdominal wall is noted over area of a gall bladder. There may be a long subfebrile temperature. Sometimes an increase in the number of leukocytes and an acceleration of ESR are detected in the blood.
In children, catarrhal-serous cholecystitis is more common. These cholecystitis are characterized by a chronic long course with periodic exacerbations. During exacerbation of chronic cholecystitis, the child’s condition worsens and the clinical picture resembles that of acute cholecystitis. Children have been ill for many years, and often adult cholecystitis is a continuation of the disease that began in childhood. With cholecystitis, the formation of adhesions (pericholecystitis) is possible, which are detected during intravenous cholegraphy and cause a long course of the disease and lack of effect from conservative therapy.
In 15% of cases, cholecystitis in children is latent and is characterized by persistent low-grade fever, symptoms of general intoxication, but without local symptoms and abdominal pain. Usually in 1–2 years latent cholecystitis turns into its classical form.
Diagnosis of cholecystitis is possible only with duodenal intubation and cholecystography. A significant amount of mucus, leukocytes, squamous epithelium in the duodenal contents (portion B) indicates an inflammatory process in the gallbladder. Sometimes you can find and Giardia.
Treatment. In the acute period of the disease shows bed rest. To suppress the infection, antibiotics are prescribed in the following daily dose (per 1 kg of weight) divided into 3 injections — penicillin 50,000–100,000 U, levomycetin 10 mg, erythromycin 20,000–50,000 IU for 7–10 days; for the treatment of giardiasis of the biliary tract – aminoquinol, furazolidone. Aminoquinol is prescribed in the following daily dose: 4–6 years — 0.1 g, 6–8 years – 0.15 g, 8–12 years – 0.15–0.2 g, 12–15 years – 0.25— 0.3 g; The daily dose is given in 2 divided doses in 20 minutes. after breakfast and lunch for 8 days. Furazolidone is given after a meal at the rate of 10 mg per 1 kg of weight per day in 3-4 doses for 8 days. In the complex treatment of cholecystitis, choleretic drugs and Demianov tyubazhi are widely used (after taking magnesium sulfate on an empty stomach, with a heating pad on the right side for 1/2 hour), as well as physiotherapeutic procedures (ozocerite, paraffin, diathermy, UHF, etc.). From choleretic means apply extract of corn stigmas at the rate of 1 drop for 1 year of life at the reception. The extract of corn stigmas is diluted in hot water (1 table, l.) And given in 30 minutes. before meals 3 times a day. Holosas give 3 times a day for 25-30 minutes. before meals for 1/2 tsp. l children 1-10 years old and 1 tea. l 3 times a day for children II-15 years. With giardiasis, holosas cannot be given. Allohol give 1/2 tablet 3 times a day in 10 to 15 minutes. after eating for children 1-10 years old and 1 tablet for older children. When carrying out a tyubazh according to Demyanov, a 25% solution of magnesium sulfate is used: for children 1–7 years old — 10 ml, for 8–10 years old — 15–20 ml, for 11–15 years, 25–30 ml per reception. Tubazhi according to Demyanov make every day or every other day. Assign a diet rich in proteins and carbohydrates with reduced fat. Exclude hot dishes, spices, fried and smoked products. Children with cholecystitis should be under medical supervision.
Cholecystitis in children is among the most common diseases. The inflammatory process is rarely localized only in the gallbladder or only in the bile ducts and passages; the entire system of the biliary tract is usually affected, so cholecystocholangitis (MS Maslov), angiopathy and hepatocholecystitis are more often observed.
Unlike adults, children rarely have acute and purulent forms of cholecystitis and cholangitis, more often there is a chronic course with relapses and exacerbations; in 15–18% of cases, a latent course is observed, which in 1–2 years turns into a clear clinical form (M. Ya. Studenikin).
According to etiology, there are two large groups: cholecystitis of parasitic and microbial origin. There is no doubt that cholecystitis is associated with chronic foci of inflammation (usually tonsillitis) and previous diseases (duodenitis, gastritis, appendicitis, colibacillosis, dysentery, angina, influenza, scarlet fever, etc.). A major role in the occurrence of cholecystitis is played by a violation of the diet, an excess of fatty and carbohydrate foods, and a lack of vegetables.
Cholecystitis in children in the initial period does not give local symptoms, but occurs as a general chronic intoxication (headache, lethargy, irritability, poor appetite, sleep disorder, emaciation and sometimes low-grade fever). Obvious disease becomes from the moment of pain in the abdomen; further, the main complaint is abdominal pain (usually in the form of painful attacks).
Attacks of pain in the abdomen, initially short-lived and rare, then become more frequent and prolonged. Pain is noted in the right hypochondrium, in the epigastric region or near the navel. The attack is preceded by a feeling of pressure in the epigastric region, nausea, bad breath. Along with pain, fever (from subfebrile to high), nausea, vomiting, shortness of breath and unpleasant sensations in the heart area are noted. In the blood – moderate leukocytosis, accelerated ESR and neutrophil shift to the left.
At the same time increases the liver, often quite significantly. When feeling the abdomen, soreness and tension of the muscles are observed in the right hypochondrium or in the entire right half of the abdomen and epigastrium. Gallbladder symptoms are distinct in older children and absent in young children. Unlike adults, cholecystitis in children is rarely accompanied by jaundice.
Liver function (protein, carbohydrate, deaminating, detoxification, pigment), secretion of the stomach, pancreas, duodenum (stasis with giardiasis), motor function of the gastrointestinal tract are impaired. Changes in the cardiovascular, respiratory, nervous and endocrine systems are noted.
Features of cholecystitis in children – the frequency of catarrhal forms, the rarity of cholelithiasis and acute suppurative cholecystitis, the benign course, the rare occurrence of jaundice, the absence of irradiation of pain during an attack, the rapid involvement of the entire hepatobiliary system in the inflammatory process.
The diagnosis of cholecystitis is made on the basis of a set of symptoms and data of duodenal intubation. The cholecystography provides great assistance (see). The differential diagnosis is carried out with chronic appendicitis, duodenitis, peptic ulcer, gastritis, helminthic invasion and mesoadenitis.
Treatment. In the period of exacerbation – bed rest, table No. 5, rich in carbohydrates, with a normal protein content and a fat limit of 10–20 g. Broad-spectrum antibiotics intramuscularly (see Art. 102); At the end of the course it is advisable to introduce antibiotics through a tube into the duodenum. Intravenous infusions of 40% glucose solution, 10-15 ml, daily or every other day. Lipocaine 0.1 g 3 times a day is recommended, Pancreatin 0.5 g 4 times a day.
Effectively tyubazh according to Demyanov with magnesium sulfate (30-40 ml of a 25% solution) for 10-14 days daily, cholagogue, with abdominal pain – belladonna (0.001 g per year of life), papaverine, promedol, vitamin therapy. Also shown is spa treatment in the resorts of Truskavets, Zheleznovodsk, Yessentuki, Lake Shira.