Cholelithiasis at children – the disease which is characterized by formation of stones in a gall bladder and bile-excreting channels. It is shown by the abdominal pain syndrome and dispepsichesky frustration connected with violations of a diet, stresses and inflammatory gastrointestinal diseases. It is diagnosed anamnestichesk and on the basis of clinical symptoms, is confirmed by an ultrasonography research. The complex therapy including the non-drug methods and medicines normalizing education and release of bile is carried out. In extreme cases the laparoscopic holetsistektomiya is carried out.
Cholelithiasis at children
Cholelithiasis at children () makes about 1% of all pathologies of a gastrointestinal tract. Girls are ill approximately twice more often than boys except for cholelithiasis cases children of preschool age, in this group male patients get sick more often. In recent years incidence steadily grows, average age of patients at the same time decreases, high relevance of this pathology in pediatrics is connected with it. One more urgent problem are diagnostic difficulties. Diagnostics of a holelitiaz in an initial stage is complicated because of total absence of clinical manifestations, at the same time late diagnosis can lead to the surgery which is inevitably exerting negative impact on quality of further life of patients.
The cholelithiasis reasons at children
Cholelithiasis at children is a multifactorial disease, arises at a combination of a number of the reasons and conditions. At the same time the true reasons of prerequisites of a disease remain not up to the end studied. The inherited mutations of some genes determining phospholipidic exchange are found. Thus, in development of cholelithiasis in children certain the hereditary factor plays a role, slightly more often mutations are transferred on the maternal line. Provocative influence of anomalies of an arrangement of a gall bladder and bilious channels, in particular – existence of excesses and banners in a gall bladder is proved. The disease can be provoked by long dysbacteriosis with change of a chair, violations in a diet, excess weight of the child and a hypodynamia. Inflammatory diseases of biliarny system also lead to development of cholelithiasis in children.
In pathogenesis of a disease a key role is played by change of composition of bile and dyskinesia of bilious ways. And that, and other factor can be primary. If in a premorbida anomaly of development of biliarny system is diagnosed, stagnation of bile and, as a result, its condensation with the subsequent formation of stones is primary. The composition of bile changes not only under the influence of its delay in a gall bladder, but also owing to inflammatory changes in the next bodies (a liver, a pancreas) in combination with dysbacteriosis. Insufficient removal of cholesterol with a stake is result of the last, and, means – its excess absorption and a hypercholesterolemia. Increase in concentration of cholesterol in bile provokes .
Along with it inevitably there is an inflammatory reaction in walls of a gall bladder which cells, collapsing, lead to increase in concentration of protein in bile. Protein becomes a kernel of the formed gallstones. Thus, formation of a vicious circle as the changing composition of bile breaks kinetics of biliarny system is obvious, and initially diagnosed dyskinesia always influences concentration of bile, promoting its condensation. The separate role in pathogenesis of cholelithiasis at children belongs to stresses, to be exact – to personal features of response of the child to stressful situations and the general situation in a family.
Classification of cholelithiasis at children
Modern qualification of pathology is offered in 2002 by the Russian institute of Gastroenterology and is the general for children and adults. Allocate several stages of a disease.
The I stage – initial (prestone)
It is characterized by change of properties of bile and its condensation with formation of a so-called biliarny sladzh. represents clots of bile or microlitas and precedes actually a holelitiaz. At an initial stage cholelithiasis at children clinically is not shown in any way.
The II stage – a stage of formation of gallstones
Single or multiple concrements with various localization are formed. Stones are found in a gall bladder, the general bilious channel or in hepatic channels. Differ on structure which can be defined by means of a X-ray analysis, ultrasonography or at invasive methods of a research. The pigmentary (bilirubinovy) and mixed stones meet cholesteric. The second stage of cholelithiasis at children can clinically not be shown (a latent form) or to proceed with typical symptomatology.
The III stage – chronic recurrent kalkulezny cholecystitis
At this stage there are expressed anatomo-physiological changes in biliarny system that leads to a chronic inflammation and frequent formation of concrements. Efficiency of conservative therapy decreases.
The IV stage – stages of complications
Cholelithiasis at children can be complicated by a sharp holangit, pancreatitis and an obturation of a bilious channel concrements. As a rule, complications demand the emergency surgical intervention.
Cholelithiasis symptoms at children
The main clinical displays of a disease – pain and dispepsichesky frustration. The characteristic of a pain syndrome at cholelithiasis at children can differ from that at the adult. Usually pain is localized in the field of the right podreberye, pain can be skhvatkoobrazny or aching. However children often complain of pain in a navel or in epigastralny area. The pain syndrome is provoked by violations in a diet (fried and greasy food in a diet, a lack of cellulose, big breaks between meals, etc.), sometimes physical activities and emotional pressure.
Cholelithiasis at children is shown by dispepsichesky frustration, such as heartburn, an eructation, bitterness in a mouth, and also violations of a chair (diarrhea or locks) and a meteorizm. In some cases the vegetative symptomatology in the form of the increased sweating and concern joins. The disease is always shown pristupoobrazno, at any time.
Diagnosis of cholelithiasis at children
Cholelithiasis is diagnosed for children clinically. At survey it is possible to reveal only a pain syndrome, but at the time of survey it is present not always therefore major importance gets careful collecting the anamnesis, including family. As a rule, relatives also have digestive tract diseases. Parents or the child need to describe as much as possible in detail to the pediatrician of the characteristic of belly-ache: the circumstances preceding its emergence, intensity of pain, its duration etc. The accompanying dispepsichesky frustration are diagnosed anamnestichesk.
Cholelithiasis at children is confirmed by means of ultrasonography diagnostics. The research allows to reveal anomalies of development of biliarny system and a thickening of walls of a gall bladder that demonstrates inflammatory process. For more exact definition like concrements it is possible to use a X-ray analysis. So, cholesteric stones are X-ray negative, that is in their picture it will not be visible. Biochemical blood test finds a hypercholesterolemia, also perhaps increased content of bilirubin. In clinical blood test the general signs of an inflammation come to light (, increase in SOE, etc.). The analysis the calla (koprogramma) allows to define rather precisely pathology of a liver and biliary tract, a pancreas and intestines.
Treatment of cholelithiasis at children
At development of cholelithiasis in children complex therapy is required. The diet with an exception of greasy and fried food belongs to non-drug methods. The child needs to use enough cellulose and to observe the drinking mode. Has value not only quality of food, but also the number of its receptions in a day, them has to be not less than five. As one of the factors promoting development of a disease is the hypodynamia, walks and active games in the fresh air are shown. It is desirable to avoid long stressful situations.
Medicamentous therapy of cholelithiasis at children is directed to normalization of composition of bile and motility of a gall bladder and biliary tract, is appointed only the gastroenterologist. Antikholestatik, litolitik and holeretik are for this purpose applied. Treatment is supplemented with gepatoprotektor and antioxidants. It is important to eliminate a hypercholesterolemia and in general to normalize a lipidic range of blood therefore purpose of statin is expedient. Correction of a biocenosis of intestines is carried out, physical therapy methods are used (a magnesium electrophoresis, a parafinoterapiya, etc.). In case of late diagnostics and existence of complications the laparoscopic holetsistektomiya is shown.
The forecast and prevention of cholelithiasis at children
At timely diagnostics and therapy forecast of a disease favorable. However often the disease comes to light already at the II-III stage when the risk of development of chronic inflammatory process and emergence of urgentny complications increases. Prevention of cholelithiasis at children is carried out to all patients from risk group: at the established diagnosis of dyskinesia of bilious ways, cholecystitis and in general digestive tract pathology. High degree of vigilance has to be concerning the children living in unsuccessful domestic surroundings and also in the presence the child of anomalies has development of biliarny system, revealed on the first year of life.
Secondary prevention of cholelithiasis at children is directed to improvement of motility of a gall bladder, improvement of rheological properties of bile and correction of an intestinal disbioz. The child is observed at the gastroenterologist, the physiotherapist, the psychologist.