Clinical features

The patient complains of dull boring pain in the right hypochondrium which usually develops 1-3 hours after taking abundant specially fat and roasted food. The pain radiates upward to the region of the right shoulder, neck and the scapula. If cholecystitis concurs with сholelithiasis, sharp pain may arise (like in biliary colic).

Dyspeptic signs the also present: bitter and metallic taste in the mouth, eructation, nausea, abdominal flatulence, and alternation of diarrhoea with constipation. The disease is sometimes not attended by pain except that the patient feels heaviness in the epigastrium or right hypochondrium, and dyspepsia develops.

Objective examination. The temperature is often subfebrile. Surface palpation of the abdomen reveals sensitivity and sometimes tenderness in the region of gall-bladder projection. The Mussy’s, Ortner's, Murphy’s, and Vasilenko's symptoms are positive. The gall bladder is impalpable.

- Vasilenko's symptom (sharp pain in the region of the gall bladder when it is tapped over at the height of inspiration);

- Murphy’s symptom (sharp pain in the right hypochondrium when the examiner's nandifpifess the gall bladder at the height of inspiration);

- Ortner's symptom (pain during tapping over the right costal arch by the edge of the hand). If inflammation extends onto the peritoneum overlying the gall bladder;

- Shchetkin-Blumberg’s symptom is positive. In this case, in the presence of gangrenous cholecystitis (gangrene of the gall bladder) and possible perforation of the gall-bladder wall, a dangerous sign appears;

- In moderate tension of the abdominal muscles it is sometimes possible (especially in purulent cholecystitis) to palpate an enlarged and very tender gall bladder. The liver does not usually increase, but its tender edge can sometimes be palpated;

- The Mussy’s symptom (tenderness at the point of the phrenicus nerve, between the heads of the sternocleidomastoid muscle) can often be positive.

Additional methods of examination

Clinical blood analyses. The blood changes (during exacerbation) are characterized by moderate leucocytosis and mildly increased ESR.

Signs of inflammation (mucus, leucocytes, desquamated epithelium) on be found in В bile. If inflammation involves bile ducts (cholangitis), С the contains the same signs of inflammation. The vesical reflex (B bile) is sometimes impossible to obtain even by repeated probing. This indicates disordered contractility of the gall bladder which is typical of chronic cholecystitis. Bacteriological studies of В bile reveal the character of microbial flora. Polarographic study of bile can reveal signs of inflammation.

Cholecystography shows changes in the configuration of the gall bladder and the absence of its distinct contours. This indicates upset concenting capacity of the gall-bladder mucosa. After taking a stimulating cal the gall bladder contracts insufficiently.

Cholangitis

Cholangitis is caused by bacterial infection of bile ducts and occurs in patients with other biliary problems such as choledocholithiasis, biliary strictures or tumors.

Jaundice, fiver and abdominal pain are cardinal presenting features.

CALCULUS CHOLECYSTITIS (cholelitiasis)

Calculus cholecistitis (the stone of the gall bladder) is chronic disease that caused by impaired cholesterol exchange and/or bilirubin metabolism with stones formation in the gall bladder (cholelitiasis) and/or in the common bile duct (choledocholitiasis). Stones in the common bile duct occurs in 10-15% of patients with gallstones.