The first symptoms of cholecystitis - an occasion to refer to the doctor
If over time youconcerned about the bitterness in the mouth, nausea, pain and heaviness in the right upper quadrant, arising after a meal (especially after eating fatty foods, fried meat, smoked, salted, pickled products, wine or vodka), time to go to the doctor-therapist. His task - to find out what is happening to you, because the symptoms are very different, with the non-specific diseases of the gallbladder. This means that these pains may cause nausea or ulcer, pancreatitis, liver disease. And the diagnosis of gallstone disease "by eye" is difficult even for experienced medical advice.
Therefore, to confirm the diagnosis of gallstonedisease often requires additional tests. If necessary, the therapist will refer you to a doctor, a gastroenterologist, who is engaged in treatment of uncomplicated disease of the gallbladder and bile ducts. And only in the absence of the effect of the therapeutic treatment or the development of life-threatening complications it is taken for surgeons.
The main complaints of chronic cholecystitis
On the initial admission to your advantage as fully as possible to express their complaints. For example, if you are concerned about the pain, the doctor will be interested in:
- when and where it hurts
- what is the nature of pain (it is constant or cramping)
- that brings relief (maybe a hot tub, a antispasmodics)
- which exacerbates the pain (this may be a bumpy ride, fatty or fried foods)
- whether there is vomiting
- Did you notice dark urine and discolored feces
- Do yellowing of the skin or whites of the eyes are not pointed
Describe the pain after it has already passed, it is not always easy, so it is necessary to record something immediately, as soon as you feel able to do so.
Then the doctor should examine you. As you know, the gallbladder is located under the right costal arch. The doctor very carefully palpate the area, as well as other areas of the abdomen. It is important to examine the whites of the eyes to notice the early signs of jaundice. However, gallbladder disease is worsening, as a rule, a person looks quite healthy. That is why in most cases to confirm the diagnosis are assigned additional tests and examinations.
Blood tests. Your doctor may order blood tests for transaminase. This analysis refers to the functional liver samples (ie, shows how the liver). If the stone has blocked bile ducts, transaminases may be increased. Usually it has done as CBC. If elevated white blood cell count may inflammation of the gallbladder.
Abdominal ultrasound. Most of you are familiar with this procedure, which is carried out on an empty stomach. On the belly is applied a transparent gel that facilitates the penetration of the ultrasonic beam through the skin. Using a special sensor, ultrasonic beams are directed to the internal organs. The sensor is moved across the stomach, and the doctor sees the image of bodies on the screen. If the gallbladder has stones, they are clearly visible. Ultrasound gives accurate results in the diagnosis of gallstone disease in 95% of cases, which is not bad. With the help of ultrasound can also measure the size of the gallbladder and the diameter of the duct; see if there is inflammation of the gallbladder wall. Be sure to also study other abdominal organs: liver, pancreas, spleen, kidneys.
Cholecystography gallbladder. Before they began extensive use of ultrasound, often resorted to holetsistografii. If you appoint the survey, it is necessary to swallow a few pills a contrast agent, which will go into the gallbladder. After a while, do X-rays. If the gallbladder has stones, they will appear as "filling defects", ie areas not filled with contrast medium. However, if the gallbladder is struck, the contrast agent can not do it.
Scintigraphy of the gallbladder - a very precise andexpensive type of survey, which is conducted in specialized clinics. Your doctor may prescribe it, if it considers that your complaints are related to gall bladder disease, and ultrasound and cholecystography not give diagnostic results. Scintigraphy - radioisotope study, but the radiation dose is extremely small, and it is absolutely harmless. A small amount of radioisotope formulation is injected into a vein. He is captured by the liver and stored in the gall bladder. Doctor scanning method determines the extent of this accumulation. If there is no accumulation, possibly obstructed cystic duct. If the damaged mucosa of the gallbladder, it might not be visible. According to the results of scintigraphy is often solved the question of the removal of the gallbladder.
Biliary manometry gallbladder. This is even more special study, which is conducted only in specialized gastroenterology clinics. It is designed to measure the pressure at the end of the biliary tract, at the sphincter of Oddi. Sometimes this sphincter spazmiruyutsya and bile can not flow into the duodenum. When this happens, there is pain in the patient, liver function tests vary.
Retrograde cholangiopancreatography (ERCP)is assigned if the patient complains of pain in the right upper quadrant, and other studies, such as ultrasound and computed tomography, make it impossible to establish an accurate diagnosis. Research carried out on an empty stomach, in the X-ray department. A nurse will process the back of the throat spray anesthetic substance to its sensitivity decreased. In the vein introduce a special sedative to relax the patient, but he was fully conscious. The doctor then carefully introduce the catheter into the esophagus, through the stomach, and then - in the duodenum. It lead him to Vater nipple, where the duodenum was called the common bile duct. Then the catheter is gently introduced into the common bile duct through the papilla of Vater, and a slight pressure is fed through the contrast agent. Then x-rays are done and it is estimated the condition of the bile and pancreatic ducts.
Duodenal intubation. This study is often used before, and is now recognized as not sufficiently informative. The probe is introduced into the duodenum, then drugs stimulate gallbladder and bile samples taken at several different points in bile entering duodenum.
As you can see, at the disposal of an arsenal of doctorsdiagnostic studies, but in most cases, blood tests, ultrasound and sometimes further cholecystography allow a diagnosis of gallstone disease. When it is necessary to insist on hospitalization, and when you can be treated in the clinic? It is not possible to make recommendations for all occasions, so let's look at the most typical situations.