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elderly Cholecystitis Treatment Guide-Elderly Cholecystitis

elderly Cholecystitis Treatment Guide-Elderly Cholecystitis
The Guidelines for the Treatment of Cholecystitis in the Elderly provide answers to the questions that elderly patients with cholecystitis often have when they go to the hospital for treatment, such as: What department is assigned to the elderly with cholecystitis? What are the precautions before the examination of cholecystitis in the elderly? What do doctors usually ask? What examinations should the elderly with cholecystitis do? How do you look at the test results of cholecystitis in the elderly? and many more. The guidelines for the treatment of cholecystitis in the elderly are designed to facilitate the treatment of elderly patients with cholecystitis and solve the doubts of the elderly patients with cholecystitis.
Typical symptoms
Abdominal tenderness, fatigue, low fever
Recommended department
Hepatobiliary Surgery, Geriatrics
Best time to visit
Nothing special, see a doctor as soon as possible
Length of visit
1 day is reserved for the first visit, and half a day is reserved for each follow-up visit
Follow-up frequency/diagnostic cycle
Outpatient treatment: follow-up visits every week until the symptoms of abdominal pain are relieved.
Preparation before seeing a doctor
No special requirements, pay attention to rest.
Frequently Asked Questions
1. Describe the reason for the visit (when did you feel uncomfortable?)
2. Is the discomfort caused by obvious factors?
3. Are there any accompanying symptoms such as lazy gallbladder and belching?
4. Have you ever been to the hospital for medical treatment, and what were the examination results?
5. How is the treatment?
6. Is there a history of drug allergy?
Key inspection items
1. Blood routine
In acute cholecystitis, the total number of white blood cells increases slightly (usually between 12,000 and 15,000/
mm3), classification of neutrophils increases. If the total number of white blood cells exceeds 20×109/L, and there is a significant left shift of nucleus and toxic particles, it may be caused by gallbladder necrosis or perforation and other complications.
2. Ultrasound
B-ultrasound finds gallbladder enlargement, wall thickness, and viscous bile in the cavity can often be diagnosed in time. It is worth mentioning that the atypical clinical manifestations of the elderly often need to be diagnosed by B-ultrasound and other imaging examinations, and B-ultrasound is simple Easy to perform, it can measure the size of the gallbladder and the thickness of the cyst wall. It is especially accurate and reliable for the detection of gallstones. It is the first choice for imaging examinations to judge acute cholecystitis, and it is also one of the indicators for observing the evolution of the disease in the elderly.
3. Radiological examination
The positive findings of the abdominal plain film with decisive significance are: ① gallbladder area calculus; ② gallbladder shadow enlargement; ③ gallbladder wall calcified plaque; ④ gas and liquid level in the gallbladder cavity (see in the case of gas producing bacterial infection), cholecystography: ① oral Method: The gallbladder is generally not visualized; ②Intravenous injection: 60% sodium diatrizoate (sodium diatrizoate) is used, the amount is calculated at 2.2ml/kg, and the same amount of 5% glucose solution is mixed, and the gallbladder is quickly intravenously dripped. Arc-shaped or circular imaging is of diagnostic significance for acute cholecystitis.
4. Radionuclide inspection
The sensitivity of radionuclide biliary scan to diagnose acute cholecystitis is 100%, the specificity is 95%, and it is also of diagnostic value. Within 90 minutes after intravenous injection of 131 tetraiodotetraoxofluorescence 99mTc, if there is no cause for radioactive substances in the gallbladder area, then It means that there is cystic duct obstruction, which can be considered as acute cholecystitis.
Diagnostic criteria
1. Acute cholecystitis (1) is mostly caused by eating greasy food. (2) Sudden continuous severe pain in the right upper abdomen accompanied by paroxysmal aggravation, which may radiate to the right scapula, often with nausea, vomiting, and fever. (3) There is tenderness in the upper right abdomen, muscle tension, Murphy's sign is positive, and aundice can be seen in a few. (4) The white blood cell and neutrophil counts increase, and the serum jaundice index and bilirubin may increase. (5) B-ultrasound shows gallbladder enlargement, thickening or roughness of the gallbladder wall, floating light spots in the cyst, and stone images when accompanied by stones. (6) X-ray examination: plain film of the abdomen in the gallbladder area may show the shadow of gallbladder enlargement. 2. Chronic cholecystitis (1) Persistent dull pain or discomfort in the right upper abdomen, or accompanied by pain in the right scapular area. (2) Symptoms of indigestion such as nausea, belching, acid reflux, abdominal distension and heartburn, which worsen after eating greasy food. (3) The course of the disease is long, and the condition has the characteristics of alternating acute attack and remission. (4) There may be mild percussive pain in the gallbladder area. (5) The mucus in the bile is increased, the white blood cells are piled up, and the bacterial culture is positive. (6) B-ultrasound shows gallbladder stones, thickening of the gallbladder wall, and shrinking or deforming of the gallbladder. (7) Gallbladder can be seen on cholecystography, gallbladder shrinkage or deformation, gallbladder contraction dysfunction, or weak gallbladder development, etc.


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