Clinical features

Pain in the abdomen is periodic, recurrent, has dull holding apart character with localization in the right hypochondrial region and radiation to the back, right scapulae and right shoulder, aggravated during bending of body and at night-time after improper feeding, alcohol, augment physical or psychical activity.

The clinical signs of neurotic syndrome include - irritability, fatigue, perspiration, tachycardia, and headache. The clinical signs of dyspeptic syndrome include - bitterness in a mouth, nausea, vomiting and difficult defecation.

Objective examination. General patient's condition as usual satisfactory, consciousness is clear, posture is frequently active or active with restriction in cause of intensive biliar colic.

The color of the skin and visible mucosa has corporeal color (cutis colons so-matici), without eruption, moderate moisture arid elasticity, preserved turgor, may observe transient subicteria of the skin.

The results of inspection, palpation, percussion and auscultation of respiratory and cardiovascular systems are without particularities.

In superficial tentative oriental palpation of the abdomen detect moderate pain in right hypochondria. Muscular resistance, diastases recti, and fluctuation symptoms are negative.

In penetrative palpation of the abdomen identify tenderness in gall bladder point (Ker point).

Additional methods of examination

Clinical blood analysis: without pathological changes.

Clinical urine analysis: without pathological changes.

Biochemistry blood analysis: increased activity of alkaline phosphotase and aspartate aminotransferases (more than in twice during two-multiple analisis), in combination with pancreatic ferments elevation (amylasa, lipasa), hyperbilirubunemia with predominance of bound fraction.

Medicament test (morphincholeretic test Debrea or morphinneostigmin test Nardy) - provocation of typical bile colic.

Ultrasound examination of the digestive organs. With obligatory evaluation of functional gall bladder state (use of bile discharge stimulated breakfast - 29g sorbitol in 100ml water) - specific constriction of gall bladder less than 40 %, increase of choledoch diameter more than after fat food.

Endoscopy. Endoscopic visualization of the biliary tree is now the best diagnostic procedure for stones, tumors, and strictures of the bile duct and is the only reliable means of diagnosing primary sclerosing cholangitis. Furthermore, it offers the therapeutic procedures of sphincterotomy, stone withdrawal, and the insertion of stents across strictures.

In patients with dysfunctional bile tract disorders the endoscopic sign are: edema and stricture of duodenal papilla.

Study of duodenal secretion. Reduction of gall bladder reflex (amount of bladder bile increase to 100-150ml in norm 30-70ml; the bile excreted by little portions; dilation of bile discharge more than 45min).

Chronic cholecystitis

Cholecystitis is the inflammatory gallbladder. The incidence of the disease is rather high; women are mostly affected. Inflammatory response can be evoked by three factors: mechanical inflammation; chemical inflammation and bacterial inflammation. The disease can be provoked by gall stones, dyskinesia of the bile ducts, anatomical properties of the gall bladder and bile ducts, ptosis of the internal organs, pregnancy, inactive mode of life, rare meals, etc. Chronic cholecystitis may develop after acute cholecystitis but in most cases it develops gradually as an independent disease.