Positive bladder symptoms. Gallbladder symptoms. Gallbladder: brief description of diseases

Gallbladder normally not accessible to palpation. The projection of the gallbladder onto the anterior abdominal wall corresponds to the intersection of the outer edge of the right rectus abdominis muscle with the costal arch. A number of symptoms may indicate gallbladder pathology.

Kehr's symptom (Fig. 9-12) - the appearance of sharp pain at the point of the gallbladder at the height of inspiration during normal palpation of the gallbladder).

Murphy's sign (severe and sharp pain at the moment of inhalation when the doctor’s fingers are immersed in the area of projection of the gallbladder, which forces the patient to interrupt his inhalation).

Ortner's symptom (Fig. 9-13) - pain in the right hypochondrium when tapping the edge with equal force alternately along both costal arches).

Georgievsky-Mussi symptom (phrenicus symptom) is pain at the point of the superficial location of the right phrenic nerve. It is detected by applying simultaneous pressure with your fingertips in the space between the legs of both sternocleidomastoid muscles above the medial ends of the clavicles (there is a photo of the symptoms on page 275).

Palpation - projection of the pancreas.

The pancreas can be palpated very rarely, so pain points and areas on the abdominal wall are of diagnostic importance. The head of the pancreas is projected in the Chauffard-Rivet area, which has the shape of a right triangle located in the right upper quadrant of the umbilical region. One vertex of this triangle lies on the navel, one of the legs is the midline, and the hypotenuse represents the inner third of the line connecting the navel with the right costal arch and forming an angle of 45° with the midline. The caudal part of the pancreas is projected at the Mayo-Robson point, which is located on the bisector of the left upper quadrant of the abdomen, 1/3 of the distance from the edge of the costal arch (Fig. 9-8, 9-9).

Palpation - ureteral points.

The kidneys (usually the right one) can be palpated in children of the first 2 years of life (especially with low nutrition) due to relatively large sizes and low location. In older children, the kidneys are not normally palpable. Detection of kidneys during palpation in older children indicates their enlargement or displacement. Enlarged kidneys can be palpated with hydronephrosis, tumor, vicarious hypertrophy single kidney. Sometimes it is possible to detect kidney prolapse (nephroptosis), a dystopic kidney. In the absence of kidney pathology, they can be palpated in case of abnormal development of the muscles of the abdominal wall. Painful sensations on palpation of the kidneys occur with pyelonephritis, paranephritis.

Palpation of the bladder in the suprapubic region is carried out with both hands simultaneously. Before the study bladder must be emptied. The bladder, as an elastic, fluctuating formation, the upper pole of which sometimes reaches the navel, is palpable in acute and chronic urinary retention. A normally full bladder can be felt in infants.

Palpation of the spleen.

Palpation of the spleen is carried out with the patient lying on his back and on his right side. The slightly bent fingers of the right hand are placed approximately opposite the X rib, 3-4 cm below the left costal arch, parallel to it. While inhaling, the patient’s spleen (if it is enlarged) comes out from under the edge of the costal arch, encounters the palpating fingers and “slips” from them. Normally, it is not possible to palpate the spleen, since its anterior edge does not reach the edge of the costal arch by approximately 3-4 cm. The spleen can be palpated when it is enlarged (splenomegaly) by at least 1.5-2 times. When palpating the spleen, its shape, consistency, surface condition, mobility, and pain are assessed.

Palpation of lymph nodes.

Occipital lymph nodes. Place your hands flat on the occipital protuberances and feel the surface occipital bone. U healthy children are not always palpable.

Parotid lymph nodes. Feel the area of the mastoid process, the area anterior to the earlobe and the outer ear canal. In healthy children they are not palpable.

Submandibular lymph nodes. The child's head is slightly tilted down. Usually these lymph nodes are palpable well and are no larger than a pea.

The mental lymph nodes are palpated midline chin area.

The anterior cervical lymph nodes are palpated by moving the fingers along the anterior surface of the sternocleidomastoid muscle in the upper cervical triangle.

Posterior cervical lymph nodes are palpated back surface sternocleidomastoid muscle in the lower cervical triangle.

Supraclavicular lymph nodes are palpated in the supraclavicular fossa. Normally they are not accessible to palpation.

Subclavian lymph nodes are palpated in the subclavian fossae. Normally they are not accessible to palpation.

Axillary lymph nodes. The child is asked to spread his arms to the sides. The examiner inserts his fingers deep into the armpits and asks him to lower his hands down. This group of lymph nodes is usually palpable.

Thoracic lymph nodes are palpated on the anterior surface chest under the lower edge of the pectoralis major muscle. Normally they are not palpable.

Ulnar lymph nodes. The child's arm is bent in elbow joint at a right angle, palpate the groove of the biceps muscle. Not always palpable.

The inguinal lymph nodes are palpated along the inguinal ligament.

The popliteal lymph nodes are palpated in the popliteal fossa, the leg should be bent in knee joint. Normally they are not palpable.

In healthy children, no more than three groups of lymph nodes are usually palpated. Normally, the following groups of lymph nodes are not accessible to palpation:

Chin;

Supraclavicular;

Subclavian;

Thoracic;

Cubital;

If, with a slight tap on the lower part of the ribs on the right, a sharp pain is observed, then this phenomenon in medicine is called Ortner’s symptom. IN mild form it may appear when various diseases digestive organs. For example, in acute colitis, ulcerative lesions of the stomach and intestines. But such sensations are still more typical for inflammation of the gallbladder and its ducts.

Ortner's symptom manifests itself with severe pain during cholecystitis in the acute phase. It is less pronounced in the chronic form and with biliary dyskinesia.

What is cholecystitis?

The term "cholecystitis" refers to inflammation of the gallbladder. It is one of the most common diseases modern man. It is observed equally in both women and men. Favorable factors for the development of the disease:

Unhealthy eating. The predominance of fatty, spicy, smoked foods in the diet. Abuse of sweets and baked goods.
Incorrect meal schedule. Quick snacks on the go at different times. Eating in the evening and at night. Long breaks between meals.
Having bad habits. Smoking and drinking alcohol negatively affect the functioning of the gallbladder and liver. Over time, the functioning of the entire body as a whole is disrupted.
Heavy physical activity.
Stress, nervous tension.
Decreased immunity and the occurrence of various infections.

There are two types of cholecystitis:

Spicy.
Chronic.

A positive Ortner's symptom is observed in both the first and second cases. However, acute cholecystitis has more pronounced pain and is beyond doubt.

Symptoms of cholecystitis

Cholecystitis can be suspected with the following manifestations:

Ortner's sign.
Sharp pain in the right hypochondrium, which can spread to the abdomen.
Increased body temperature.
Vomiting, diarrhea.

For cholecystitis in chronic form, sluggish manifestations of the disease are more typical:

Constant aching pain under the ribs on the right, especially after eating a heavy meal.
The temperature is usually normal, but may increase slightly during exacerbation.
Sometimes there is vomiting.
Stool upset, alternating constipation and diarrhea.
General weakness.
Bitterness in the mouth, especially in the morning.
Ortner's sign is positive, but the pain is less pronounced.

If acute cholecystitis is left unattended, it turns into chronic form with periodic exacerbations. This disease is difficult to treat.

Diagnosis of cholecystitis

If gallbladder disease is suspected, the doctor initially examines the patient manually, without the use of various instruments. The reception begins with palpating and light tapping on the different areas belly. To diagnose such diseases in medicine, there are the following terms:

Ortner's symptom is pain when tapping the side of the hand along the costal arches on the right.
Murphy's symptom - the doctor presses lightly with his fingers on the area of the gallbladder, while the patient experiences pain when inhaling.
Mussi's symptom - pressure is applied with two fingers in the area of the collarbones; if the patient experiences pain, then this is also considered a manifestation of pathologies of the gallbladder and its ducts.

Determining the symptoms of Ortner, Murphy, Mussi is an indication for further instrumental examination. As a rule, they prescribe:

Ultrasound of organs abdominal cavity.
General and biochemical tests blood.
Analysis of urine.
Tests for oncology, if necessary;
Biopsy in some cases.

Treatment and prognosis of the disease

Therapy for cholecystitis is long and not always successful. The acute phase of the disease is treated faster, the prognosis is favorable. Typically used in treatment:

Anti-inflammatory, painkillers, antibacterial agents(antibiotics).
Preparations for restoring intestinal microflora.
Enzymes.

If on at this stage not paying attention to the acute phase of the disease, that is, there is a risk of developing chronic cholecystitis. This form is not completely curable. If the doctor's instructions are followed, patients can achieve long-term remission, even for life, but the risk of exacerbation still remains. As a rule, it all depends on the patient. In order to reduce the risk of cholecystitis, you need to control your lifestyle:

Eat right and on time.
Minimize bad habits.
Exercise.
Eliminate emotional stress and much more.

In some cases, chronic cholecystitis can provoke oncological diseases. Doctors strongly recommend closely monitoring your health and if you have any complaints, go to the hospital. Self-medication is excluded. How earlier illness diagnosed, the more favorable the prognosis.

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general information

The gallbladder is an organ that stores bile produced by the liver and enters the small intestine. Normally, it has a soft consistency and cannot be felt through the abdominal wall. The organ becomes accessible for palpation when significantly enlarged due to the accumulation of stones, purulent inflammation, dropsy, tumor lesions or atony of the walls.

In some cases, the enlargement of the bladder is not determined, but there is pain at the point of its projection (in the right hypochondrium) and resistance of the abdominal wall. In such a situation, the doctor checks for gall bladder symptoms, that is, palpates the patient’s abdomen in a special way.

Causes

The main reason for determining positive cystic symptoms is cholecystitis - inflammation of the gallbladder, which develops as a result of disruption of bile flow and reproduction pathogenic microorganisms in the lumen of the organ.

Most often, inflammation develops against the background cholelithiasis. It may also be accompanied by biliary dyskinesia and neoplasms.

Symptoms

There are more than ten symptoms indicating diseases of the bile reservoir. All of them are associated with irritation of the phrenic nerve, which innervates the organ, or the peritoneum near it. Signs are considered positive if a person experiences pain during the doctor’s manipulations. The main bladder symptoms are as follows.

Kerra. The man lies on his back. The doctor asks him to do deep breath and presses your finger on the projection area of the gallbladder.

Obraztsova-Murphy. The patient is sitting. The doctor stands behind him, presses on the projection point of the bile reservoir and asks him to inhale from his stomach.

Vasilenko. The patient exhales, and the doctor lightly taps the area of the right costal arch with his fingertips.

Ortner-Grekov(characteristic of chronic cholecystitis). The doctor lightly hits the projection point of the gallbladder several times with the edge of his palm, as a result the patient feels pain. Then the doctor repeats his actions on the left side, but no pain is felt.

Mussi-Georgievsky. The doctor simultaneously presses with his fingertips on both sides the spaces between the legs of the sternocleidomastoid muscles above the medial ends of the clavicles. The patient feels pain only on the right side, it radiates downwards.

Boas. The doctor presses on the twelfth rib on the right.

Gubergritsa-Pekarsky. The doctor palpates the lower part of the xiphoid process of the sternum (the bone to which the ribs are attached).

Other signs are Lepen, Volsky, Beckman, Jonash, Kharitonov, Shchetkin-Blumberg and so on.

Blistering symptoms children have some characteristics: than younger child, the less pronounced they are. Up to 3-5 years they may not be detected at all.

Diagnostics

In addition to collecting anamnesis and determining the listed signs, the diagnosis of gallbladder diseases includes:

clinical and biochemical blood tests;
Ultrasound of the abdominal cavity;
cholecystocholangiography (radiography biliary tract and tank).

Treatment

If positive bladder symptoms are detected for cholecystitis, treatment is carried out with antibiotics, antispasmodics, choleretic agents and a special diet. The goal of therapy is to relieve inflammatory process and improving the flow of bile.

Sometimes duodenal intubation is used - insertion into duodenum medications that stimulate the gallbladder. If therapy is ineffective, surgery is performed to remove the bladder.

If stones are detected in the bile reservoir, lithotripsy and/or special drugs that dissolve the stones are prescribed.

Forecast

Blistering symptoms associated with cholecystitis have a positive prognosis. Without adequate treatment, the bladder may rupture and peritonitis may develop.

liqmed.ru

Characteristics of the main pathologies of the gallbladder

Cholelithiasis

This is a disease of the biliary system associated with a violation of bilirubin metabolism and cholesterol, characterized by the formation of stones inside the liver, in the common bile duct and in the gallbladder. There are 5F criteria for people most susceptible to cholelithiasis:

Female – women
Fat – overweight
Fair - fair-haired
Forties – over 40 years old
Fertile - giving birth

According to the mechanism of formation, there are 3 types of stones: cholesterol, pigment bilirubin, brown and black.

Gallstone disease can occur long time is asymptomatic, but clinically manifests itself in the form of an attack of “hepatic colic”, when the stone enters the narrow bile duct.

Chronic acalculous cholecystitis

This is a long-term inflammatory process that affects inner shell bubble and not accompanied by the formation of stones. Main causes of the disease:

Biliary dyskinesia

This is a functional disease of the biliary tract associated with changes in the tone of the gallbladder or ducts, accompanied by periodic pain in the right hypochondrium and dyspeptic disorders.

This pathology usually occurs under constant stress, psycho-emotional stress, and neuroses. Depending on the change in bladder tone, hyperkinetic (or pain) and hypokinetic (dyspeptic) types of the disease are distinguished.

Acute cholangitis

This is an acute inflammatory process that affects the bile ducts. It usually occurs as a complication of chronic cholecystitis, cholelithiasis or after removal of the gallbladder. The development of infection is facilitated by stagnation of bile, compression of the ducts by tumors and stones. There are obstructive, recurrent, bacterial, and secondary sclerosing cholangitis.

Gallbladder cancer

In most cases, cancer is the result of a chronic inflammatory process in the organ. There are: adenocarcinoma, mucinous, solid and squamous cell carcinoma. Gallbladder cancer is characterized by high malignancy, early metastasis and invasion into neighboring organs.

Main symptoms

Symptom	Gallstone disease (attack of hepatic colic)	Chronic cholecystitis		Acute cholangitis	Gallbladder cancer
Description of pain	Acute paroxysmal pain after dietary violations; the patient is on the right side with his legs pressed to his chest, any movement only intensifies the pain.	Mostly patients are bothered by a feeling of heaviness, constant aching pain, worse after eating fatty foods, spicy food, carbonated drinks, alcohol	Hyperkinetic type: acute short-term paroxysmal pain lasting up to 20 minutes. Hypokinetic type: dull, aching, arching pain, feeling of heaviness in the right side	Acute paroxysmal unbearable pain up to a drop in blood pressure	For a long time it may not cause pain, then appear dull pain, poorly controlled by analgesics
Localization of pain	On the right side	In the right hypochondrium, sometimes in the epigastric region		On the right side
Radiation of pain			In the right shoulder, shoulder blade, collarbone, back, left half of the body	In the right shoulder, shoulder blade, collarbone, back, left half of the body	In the right shoulder, scapula, collarbone
Dyspepsia		Nausea, vomiting mixed with bile, bitterness in the mouth, bitter belching, heartburn, loss of appetite, diarrhea, flatulence may occur.	Hyperkinetic type: nausea, vomiting. Hypokinetic type: nausea, vomiting, bowel dysfunction	Repeated vomiting without relief, nausea	Rapid weight loss, food aversions, persistent nausea, occasional episodes of vomiting
Itchy skin	Characteristic		Not typical	Characteristic	Not typical
Fever, chills		An inconsistent symptom, observed in 40% of patients	Low fever	High fever up to 40º C, accompanied by chills and heavy sweats	Low fever
Signs of peritoneal irritation	Sharply expressed in the right side	Slight tension in the abdominal muscles in the right hypochondrium		Sharply expressed in the right hypochondrium	Slight abdominal muscle tension on the right side

Diagnosis of gallbladder diseases

Painful symptoms of gallbladder pathology:

Ker's point - the point of projection of the gallbladder onto the anterior wall of the abdomen - is located at the intersection of the right edge of the rectus abdominis muscle with the right costal arch;
Georgievsky-Mussi symptom – pain when compressed between the legs of the sternocleidomastoid muscle on the right (the reference point is the inner edge of the right clavicle);
Ortner-Grekov symptom – occurrence painful sensations in the right side when tapping the edge of the palm along the edge of the costal arch.

Changes in laboratory parameters in diseases of the biliary system

Index	Norm	What is he talking about?	What diseases does it indicate?
An increase in the level of total bilirubin due to unbound	The normal level of total bilirubin is 8.5-20.8 µmol/l indirect bilirubin – 1.7-17.1 µmol/l	More often indicates a violation of the outflow of bile (obstructive jaundice)	Cholelithiasis, cancer of the gallbladder, common bile duct, papilla of Vater, acute cholangitis, chronic cholecystitis, etc.
An increase in the level of total bilirubin due to bound	total bilirubin – 8.5-20.8 µmol/l direct bilirubin – 0.85-5.1 µmol/l	Indicates decreased conjugation (binding) of bilirubin	Hemolytic anemia, Minkowski-Choffard disease, Gilbert's syndrome, Crigler-Najjar syndrome
Increased levels of transaminases (AST and ALT)	AST – 0.1-0.45 mmol/l ALT – 0.1-0.68 mmol/l	Talks about the inflammatory process and destruction of liver cells	Hepatitis, cholelithiasis, chronic cholecystitis, gallbladder cancer
Increased cholesterol levels in the blood	3.3-5.5 mmol/l	Indicates increased fat metabolism	Vascular atherosclerosis, obesity, cholelithiasis, chronic cholecystitis
Reducing blood cholesterol	3.3-5.5 mmol/l	Indicates a decrease in the building function of the liver	Acute hepatitis, acute cholangitis, acute cholecystitis, liver cirrhosis, liver and gall bladder cancer
Increased alkaline phosphatase activity	0.5-1.3 mmol/h*l	Indicates stagnation of bile in the liver and bladder	Gallstone disease, chronic cholecystitis
Appearance of C-reactive protein	not detected	Speaks of an acute inflammatory process	Acute cholecystitis, cholelithiasis, acute cholangitis

Instrumental methods for diagnosing diseases of the biliary system

Diagnostic method	Cholelithiasis	Chronic cholecystitis	Biliary dyskinesia	Acute cholangitis	Gallbladder cancer
Ultrasound of the abdominal organs	Stones, gall sand, and “porcelain” gallbladder are detected		Hyperkinetic type: intense shadow bubble, its size is reduced. Hypokinetic type: enlargement and descent of the bladder	Signs of hypertension in the bile ducts, their expansion	Increasing bubble density
Fractional duodenal intubation			Hyperkinetic type: bile evacuation is accelerated, its quantity is reduced. Hypokinetic type: bladder emptying is delayed	Decrease in the amount of gallbladder bile, change biochemical composition bile, presence of bacteria	Tumor cells are found in bile
Radiography	Calcium-containing stones are detected	Thickening, deformation of the gallbladder wall, signs of inflammation	No changes	Not used	When using contrast, a filling defect with uneven contours is revealed
CT scan	Used as additional method tests to make a diagnosis				Used to detect metastases and tumor growth into neighboring organs
ECG	Performed to exclude acute infarction of the posteroinferior myocardial wall
Fibrogastrodudodenoscopy	Superficial gastritis

Principles of treatment

Diet No. 5 (see in more detail what you can eat with cholecystitis and gallstones).

food is taken 4-6 times a day in small portions
warm drink: weak tea, juices from fruits and berries diluted with water, rosehip decoction 3-6 glasses a day
porridges: semolina, oatmeal, rice
vegetable soups
lean fish and meats
dairy products: cottage cheese, sour cream, fermented baked milk, butter
vegetable fats

Cholelithiasis

bed rest
normalization of body weight
ursodeoxycholic acid preparations: ursofalk, ursosan, ursolizin, choludexan (to improve the outflow of bile)
antibacterial therapy– cephalosporins of 3-4 generations (Fortum, cefotaxime, cefazolin) or aminoglycosides (tobramycin, amikacin) or fluoroquinolones (ciprofloxacin, levofloxacin)
hepatoprotectors – for the prevention of reactive hepatitis (Essentiale, Heptral, see. full list medicines for the liver)

For frequently recurring attacks of hepatic colic, it is indicated surgery– removal of the gallbladder (cholecystectomy).

Chronic cholecystitis

Diet No. 5 – excluding fatty, high-calorie and cholesterol-rich foods
bed rest for 7-10 days
broad-spectrum antibacterial drugs: 3-4 generations (Fortum, cefotaxime, cefazolin) or aminoglycosides (tobramycin, amikacin) or fluoroquinolones (ciprofloxacin, levofloxacin)
myotropic antispasmodics (mebeverdine, duspatalin) – to relieve muscle spasm for colic
enzyme preparations - Creon, Pancreatin, Festal, Panzinorm, Enzistal, Penzital, Ermital, Mezim, Gastenorm, Microzim, Pangrol, etc.
antisecretory drugs: Almagel, Maalox, Omez, Controloc, rhinitis, Kvamatel

Biliary dyskinesia

elimination stressful situations, taking antidepressants and sedatives(cm. sedatives for adults)
diet No. 5
drugs that eliminate bladder muscle spasms - no-spa, papaverine, drotaverine, mebeverdine
herbal preparations: arnica, elecampane, oregano, immortelle, calamus and others
choleretic drugs – magnesium sulfate, sorbitol, holagol, allochol, digestal
physiotherapeutic procedures – inductothermy, diadynamic currents, UHF

Acute cholangitis

broad-spectrum antibiotics: semi-protected penicillins (amoxiclav), 3-4 generation cephalosporins (ceftriaxone, cefepime), fluoroquinolones (moxifloxacin, gatifloxacin)
myotropic antispasmodics (mebeverdine, duspatalin) – to relieve muscle spasms during colic
enzymes - Festal, Mezim, Creon, etc. see above.
antipyretic drugs - paracetamol, acelysin, infulgan
narcotic and non-narcotic analgesics – nalbuphine, ketanov, promedol

Gallbladder cancer

Cancer treatment depends on the extent of the tumor process. Typically, removal of the gallbladder and partial removal of the liver and adjacent lymph nodes are performed. Therapy must be combined, that is, combine both surgical treatment and chemotherapy, radiation therapy.

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Signs of gallbladder diseases.

Pain at the point of projection of the gallbladder - the point of intersection of the outer edge of the rectus abdominis muscle on the right with the costal arch (with an enlarged liver - with the edge of the liver).
Vasilenko's symptom is the appearance of pain at the point of projection of the gallbladder when tapping on the right costal arch while inhaling. Revealed on early stages diseases.
Kehr's symptom is pain on palpation during inspiration at the point of projection of the gallbladder.
Murphy's symptom - the doctor applies even pressure at the point of projection of the gallbladder and asks the patient to take a deep breath (inflate the stomach), during which pain appears. Either: With the left hand, the torso is grasped in the area of the right flank and the right hypochondrium so that the thumb is located in the point of Kera (if the body is large, you can place 2-5 fingers of the left hand on the front lower ribs of the chest on the right). The child exhales and the thumb immediately plunges deeper. After this he takes a breath. And if during inhalation there is pain in the t. Kera, then the symptom is positive.
Ortner's (Grekov) symptom - pain when tapping along the edge of the right costal arch (it is necessary to tap on both costal arches for comparison).
Mussi-Georgievsky's symptom (phrenicus symptom) is pain on palpation between the legs of the sternocleidomastoid muscle on the right. The pain radiates downwards.
Risman's symptom is tapping with the edge of the palm along the edge of the costal arch while holding inhalation.
Boas's symptom - hyperesthesia in the lumbar region on the right and pain in the area of the transverse processes of ThXI - LI on the right.
Lepen's sign - pain when bent over index finger at the point of projection of the gallbladder.

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Acute appendicitis

Kocher-Wolkovich sign- displacement of pain 2–3 hours after the onset of the disease from the epigastric region to the right iliac region.
Shchetkin–Blumberg symptom- slowly and carefully press flat fingers on the anterior abdominal wall, and after 3–5 s quickly remove the hand. This movement causes a shock to the abdominal wall, and if there is inflammation of the peritoneum, the patient experiences sharp pain.
Khedry-Razdolsky sign- upon percussion of the anterior abdominal wall, a sharp pain occurs in the right lower quadrant of the abdomen (the source of inflammation of the peritoneum).
Rovsing's symptom- the appearance of pain in the right iliac region when performing pushes in the left iliac region in the area of the descending colon. The sigmoid colon is pressed with the other hand to the posterior wall of the abdomen.
Ortner–Sitkovsky–Ott sign- turning the patient from the back to the left side causes increased pain in the right iliac region, which is associated with displacement of the cecum and vermiform appendix, tension of the inflamed peritoneum.
Barthomier's sign- when palpating the cecum with the patient positioned on the left side, pain in the right iliac region increases sharply.
Obraztsov's symptom (psoas symptom)- when palpating (pressing) the right iliac region with the patient in the supine position, the pain sharply intensifies when the patient lifts his straightened right leg.
Sattler's symptom- the patient, sitting, raises the straightened right leg. At acute appendicitis pain appears in the ileocecal area.
Donnelly's sign- the patient is in a supine position, legs pulled up to the stomach. When extending the right leg during deep palpation of the ileocecal area, increased pain is noted. Sign of retrocecal appendicitis.
Voskresensky's symptom (shirt symptom, sliding symptom)- moving your hand from the xiphoid process along the abdominal wall through the patient’s shirt, an increase in pain is observed.
Krymov's symptom- increased pain in the right iliac region when a finger is inserted into the external opening of the right inguinal canal.
Britten's sign- palpation of the ileocecal region causes retraction of the right testicle.
Larocque's symptom- in men with acute appendicitis there is a sharp reduction in m. cremaster, due to which the right, and sometimes both testicles are pulled up.
Horn's sign- when pulling the right spermatic cord the pain intensifies in the ileocecal angle.
Cope's sign- test for painful tension of the obturator internus muscle. In the supine position, the patient bends the right leg at the knee and rotates the thigh outward. In this case, pain is felt in the depths of the pelvis on the right.
Wachenheim–Raeder sign- when the process is located in the small pelvis with digital examination rectum, sharp pain appears in the ileocecal region.
Ikramov's symptom- pressure on the femoral artery leads to increased pain in the right region.
Michelson's symptom- with acute appendicitis in pregnant women, there is increased pain in the right half of the abdomen with the patient lying on the right side due to the pressure of the uterus on the inflamed focus.
Promptov's symptom- differential diagnostic sign of acute adnexitis. A symptom is considered positive when a sharp pain in the uterus appears when it is pushed upward with fingers inserted into the vagina or rectum. In acute appendicitis, the symptom is usually negative.
Zhendrinsky's symptom, used to distinguish acute appendicitis from acute adnexitis, is that with the patient in the supine position, a finger is pressed on the abdomen at the Kümmel point and, without removing the finger, the patient is asked to sit down. Increasing pain indicates acute appendicitis, decreasing pain indicates acute adnexitis.
Yaure-Rozanov symptom- there is pain when pressing with a finger in the area of the right lumbar (Petite) triangle. Sign of retrocecal appendicitis.
Gabay's symptom- when pressing with your fingers and then quickly removing them, the pain in the area of the right lumbar triangle intensifies. Sign of retrocecal appendicitis.
Aaron's symptom- characterized by pain or a feeling of stretching in the epigastric region when pressing at McBurney's point.
Krasnobaev's symptom- sharp tension in the muscles of the anterior abdominal wall during palpation.
Kushnirenko's symptom (cough symptom)- when coughing, the patient indicates the point of pain reaction.
Moscow's symptom- dilation of the pupil of the right eye indicates the presence of acute appendicitis.
McBurney's point- the border between the middle and outer third of the linea spinoumbilicalis.
Lanza point- the border between the outer and middle third of the linea bispinalis (I. biiliaca).
Kümmel point- outward to the right and 2 cm below the navel.
Point Munrow- the place of intersection of the linea spinoumbilicalis with the outer edge of the right rectus abdominis muscle.

Acute cholecystitis

Hepatic colic- sharp, unexpected, cramping pain in the right hypochondrium, occurring more often in the evening or at night. The patient is restless and tosses about in bed.
Ortner's symptom- the appearance of pain when tapping the edge of the palm on the right costal arch.
Lepene's symptom- sharp pain when tapping the right hypochondrium, especially at the height of inspiration.
Volsky's sign- pain is expressed when a light blow is struck with the edge of the palm in an oblique direction from bottom to top along the right hypochondrium.
Pekarsky's sign- sharp pain when pressing on the xiphoid process.
Georgievsky-Mussi symptom (phrenicus symptom)- pain when pressing on the phrenic nerve between the legs of the right sternocleidomastoid muscle.
Ker's symptom- determination by palpation and light percussion of pain in the area of the gallbladder during inspiration.
Jonash's symptom- increased pain sensitivity upon palpation to the right of the spinous processes of the cervical vertebrae. Associated with irritation of the endings of the occipital nerve.
Zakharyin's symptom- pain on palpation in the area of the gallbladder projection (at the point of intersection of the lateral edge of the right rectus abdominis muscle with the costal arch).
Obraztsov's symptom- sharp pain when inserting the hand into the area of the right hypochondrium when the patient inhales.
Murphy's sign- Place the left hand so that the thumb fits in the area where the gallbladder is located, and the remaining fingers of this hand are placed along the edge of the costal arch. A deep breath is impossible due to acute pain in the abdomen under the thumb.
Risman's symptom- when the patient holds his breath while inhaling, the edge of the palm is tapped in the area of the right hypochondrium, and when the gallbladder is inflamed, the patient experiences acute pain.
Boas's sign- pain that occurs when pressing with a finger on the right Th VIII–Th X vertebrae on the back.
Symptom of G. G. Karavanov(symptom of “cough impulse”) - when coughing, a sharp pain occurs in the right hypochondrium, forcing the patient to reflexively pull the body away from the examiner’s hand.
Muscle tension (French: defense musculaire) of the abdominal wall in the right hypochondrium.
Delay of the right half of the abdominal wall in upper sections in the act of breathing.
Spector's sign- displacement of the navel upward and to the right (associated with local tension in the abdominal muscles).
Rapid shallow breathing, because the patient spares the diaphragm when breathing.
Vomiting, first of gastric and then of duodenal contents, which does not bring relief to the patient.
Courvoisier's sign- a painless enlarged gallbladder is palpated against the background of the development of obstructive jaundice. A sign characteristic of a tumor-like process in the head of the pancreas, papilla of Vater.
Fedorov's symptom- with deep palpation of the gallbladder area in hot bath When significant relaxation of the muscles of the abdominal wall occurs, crepitus of stones in the bladder is determined.
Shchetkin–Blumberg symptom positive in the right hypochondrium with inflammation of the peritoneum.
Bonde–Delbe sign- expansion of aortic pulsation. Develops in acute cholecystopancreatitis.
Kera point- a point located at the intersection of the outer edge of the right rectus abdominis muscle and the costal arch, which corresponds to the projection of the gallbladder.
Charcot's triad- pain in the right hypochondrium, fever with chills, jaundice. Characteristic of purulent cholangitis.
Reynolds Pentad- pain in the right hypochondrium, fever with chills, jaundice, impaired consciousness and shock. Characteristic of cholangiogenic sepsis.
Bar's syndrome- occurs in pregnant women, accompanied by pain in the gall bladder, right iliac region, along the ureters. Fever and bacteriuria are observed.
Westphal–Bernhard syndrome- noted with primary stenosing inflammation of the papilla of Vater. Recurrent fever, biliary colic, and intermittent jaundice are observed.
Villar's syndrome- characteristic of choledocholithiasis, manifested by colic in the right hypochondrium, fever and jaundice.

Acute pancreatitis

Bliss's sign- girdling pain at the navel level.
Voskresensky's symptom- absence or weakening of pulsation abdominal aorta upon palpation of the epigastric region due to swelling of the pancreas or infiltration around it.
Mayo-Robson sign- irradiation of pain to the left costovertebral angle.
Kerte's symptom- upon palpation of the abdomen, painful resistance is noted in the form of a transverse cord in the supra-umbilical region.
Lagerlof's sign- cyanosis of the face.
Mondor's sign- the appearance of purple spots on the skin of the face and body.
Halsted's sign- appearance of cyanosis of the anterior abdominal wall and marbled skin.
Gray Turner's sign- on the lateral skin of the abdomen there is a slightly bluish color and extensive hemorrhages. Observed in pancreatic necrosis.
Grunwald's sign- petechiae or ecchymosis around the navel.
Cullen's sign (Cullen's, Joston's symptom)- a yellowish-cyanotic color is noted in the navel area.
Davis's symptom- ecchymosis on the buttock and at the level of the costal arch in the back. Observed in pancreatic necrosis.
Gobier's sign- swelling of the transverse colon and limited mobility of the left dome of the diaphragm.
Desjardins point- the place where the duct of Wirsung enters the duodenum. It is located at a distance of 6 cm from the navel along the line connecting the navel with the right armpit. When the head of the pancreas is inflamed, there is sharp pain when pressed.
Point Gubergritsa- located 5–6 cm above the navel on a line connecting it with the top of the left axillary fossa. Painful when the tail of the pancreas is affected.

Intestinal obstruction

The most important and typical symptoms of mechanical intestinal obstruction are: cramping abdominal pain, vomiting, thirst, retention of stool and gas.
"Ileus Scream"- with strangulation obstruction, pain occurs acutely, severely, patients scream painfully.
Bayer's sign- asymmetry of abdominal bloating, observed during volvulus sigmoid colon.
Valya's symptom- a loop of intestine fixed and stretched in the form of a balloon with a zone of high tympanitis above it.
Schiemann–Dans sign- retraction of the right iliac region during cecal volvulus.
Mondor's sign- with severe distension of the intestine, a characteristic rigidity of the abdominal wall is determined, which, upon palpation, resembles the consistency of an inflated ball.
Schwartz's sign- upon palpation of the anterior abdominal wall, an elastic tumor is identified in the area of swelling in the epigastric region, which resembles a soccer ball to the touch.
Symptom of I. P. Sklyarov- when the abdominal wall is slightly rocked, a splashing sound is produced.
Mathieu's symptom- with rapid percussion of the umbilical area, a splashing noise occurs.
Kivulya's symptom- when percussing a swollen area of the abdominal wall, a tympanic sound with a metallic tint is heard.
Lothuissen's sign- When auscultating the abdomen, breathing sounds and heartbeats are heard.
Symptom of the Obukhov Hospital (Grekov's symptom)- balloon-shaped expansion of the empty ampulla of the rectum and gaping of the anus.
Spasokukotsky–Wilms sign- the sound of a falling drop is determined by auscultation.
Tsege–Manteuffel sign- in case of volvulus of the sigmoid colon, no more than 0.5–1 liters of water can be administered using an enema.
Schlange's sign- upon examination, intestinal peristalsis is visible to the eye.
Symptom of “deafening silence”- due to intestinal necrosis and peritonitis, peristaltic sounds weaken and disappear.
Thévenard's sign- sharp pain when pressing on 2 transverse fingers below the navel along the midline, i.e., where the root of the mesentery passes. This symptom is especially characteristic of small intestinal volvulus.
Laugier's symptom- if the stomach is large, spherical and convex - an obstacle in the small intestines, if the stomach is large, flat, with widely stretched sides - an obstacle in the large intestines.
Bouveret's sign- if the cecum is swollen, then the place of obstruction is in colon, if the cecum is in a dormant state, then there are obstacles in the small intestines.
Delbe Triad(at inversion small intestines) - rapidly increasing abdominal effusion, bloating and non-fecaloid vomiting.

Perforated ulcer of the stomach and duodenum

Dieulafoy's sign- sharp pain, reminiscent of a “dagger blow”, in the epigastric region.
Tension of the abdominal wall muscles (“belly like a board”).
Dzbanovsky–Chuguev symptom- in the middle part of the abdomen, at the location of the rectus muscles, retracted transverse stripes are visible.
Clark's sign- disappearance of dullness of percussion sound over the liver.
Spizharny's symptom- narrowing or disappearance of hepatic dullness and the appearance of high tympanitis over the liver.
De Quervain's sign- dullness in the right lateral canal and right iliac fossa as a result of the release of stomach or duodenal contents through perforations down the abdomen.
Kulenkampff's sign- rectal examination reveals pain in the pouch of Douglas caused by the accumulation of peritoneal exudate and gastric contents.
Grekov's symptom- slowing of the pulse in the first hours after perforation of a stomach or duodenal ulcer.
Yudin–Yakushev symptom- when palpating the anterior abdominal wall in the epigastric region, you can feel a push of gases penetrating through the perforation.
Bernstein's sign- when the ulcer perforates in men, the testicles are pulled towards the external openings inguinal canals and the penis to the anterior abdominal wall as a result of reflex contraction of the muscles that lift the testicle and the superficial fascia of the abdomen.
Krymov's symptom- examination of the navel with a fingertip causes pain due to irritation of the peritoneum.
De Wit Stetten's sign- bloating of the left lower quadrant of the abdomen against the background of contraction of the rest of the anterior abdominal wall.
Elecker's symptom- irradiation of pain in right shoulder blade(clavicle) with perforation of an ulcer located in the pyloroduodenal zone, to the left - with an ulcer of the vault and body of the stomach.
Vigiatso's symptom- the presence of subcutaneous emphysema in the navel area due to the spread of gas along the round ligament of the liver during perforation of an ulcer on the posterior wall of the duodenum.
Podlach's symptom- the appearance of subcutaneous emphysema in the left subclavian region indicates perforation of an ulcer of the cardiac part of the stomach.
Ratner–Vicker sign- the persistence of prolonged persistent muscle tension in the right upper quadrant of the abdomen in the general good condition of the patient is a sign of covered perforation of the ulcer.

Peptic ulcer of the stomach and duodenum, complicated by bleeding

Bergman's sign- disappearance of abdominal pain following the onset of gastrointestinal bleeding.
Bleeding syndrome- weakness, dizziness, fainting, collapse are noted. The skin turns pale and becomes covered in cold, sticky sweat.
Tachycardia develops, the pulse weakens, and blood pressure decreases.
Vomiting occurs like “coffee grounds”; with massive bleeding from a stomach ulcer, bloody vomiting (haemotemesis) occurs, which can be with clots, but without foam. When bleeding from a duodenal ulcer, black, liquid, tarry stools (melena) are noted.
There are 4 degrees of blood loss:

mild - up to 10% of the bcc (up to 500 ml; occult bleeding) - there are no signs of hemodynamic disturbances;
medium - up to 20% of the bcc (up to 1000 ml);
severe - up to 30% of the bcc (up to 2000 ml);
massive (hemorrhagic shock) - more than 30% of the bcc (more than 2000 ml).

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The gallbladder is a hollow, pear-shaped organ with a wider base and a narrow distal end that merges into the cystic bile duct. Normally, the length of this organ is 80-140 mm, and the diameter is 30-50 mm.

The gallbladder is usually divided into three parts: neck, body and fundus. This organ is located on bottom surface liver in the fossa of the same name.

The wall of the gallbladder consists of three layers - serous, muscular and mucous. The mucous layer has many longitudinal folds.

The unchanged gallbladder cannot be palpated through the abdominal wall. The projection zone of this organ is located at the point of intersection of the outer edge of the rectus abdominis muscle and the right costal arch, which is called Ker’s point. In cases where the gallbladder is enlarged, it can be palpated.

Gallbladder: functions

The gallbladder functions as a reservoir in which bile is stored. Liver cells produce bile, which accumulates in the gallbladder. When a signal arrives, bile enters the cystic duct, flowing into the common bile duct, and the latter opens into the duodenum.

In addition to the reservoir function, the organ has other purposes. Thus, mucus and acetylcholecystokinin are produced in the gallbladder, and nutrients are also reabsorbed.

per day healthy people up to one liter of bile is formed. The maximum capacity of the gallbladder is 50 ml.

Bile consists of water, bile acids, amino acids, phospholipids, cholesterol, bilirubin, proteins, mucus, some vitamins, minerals, and metabolites medicines which the patient takes.

The bile is assigned the following tasks:

neutralization of gastric juice;
activation of the enzymatic ability of intestinal and pancreatic juice;
neutralization of pathogenic microorganisms in the intestines;
improvement motor function intestinal tube;
removal of toxins and drug metabolites from the body.

Gallbladder diseases: causes and mechanism of development

All causes of diseases of this organ can be divided into groups, namely:

Gallbladder: brief description of diseases

Cholelithiasis. This disease most often affects fair-haired women who have given birth over 40 years of age, who have excess weight or are obese. Stones are cholesterol, bilirubin brown and black, which can form in all parts of the biliary system. Rarely, only the gallbladder is affected. Gallstone disease is a long-term chronic illness with periods of exacerbation and remission. IN acute period stones obstruct the cystic duct, as a result of which patients develop sharp pain with other unpleasant symptoms. This combination of symptoms is commonly called hepatic colic.
Chronic noncalculous cholecystitis. In this case, there are no stones, and inflammation of the mucous layer of the gallbladder is caused by an infectious agent, reflux intestinal juice, diseases of the pancreas (pancreatitis), liver (hepatitis) or cholestasis.
Biliary dyskinesia. This disease is characterized by the absence of organic changes in the gallbladder and ducts and occurs against the background of impaired innervation. Chronic stress, excessive physical and mental load, neurasthenia. There are two types of dyskinesia - hyperkinetic, when intestinal peristalsis is too active, but chaotic, and hypokinetic, when bladder peristalsis is weakened.
Acute cholangitis, or inflammation of the bile ducts. Almost always to this disease cause other diseases of the liver and gallbladder (cholecystitis, cholelithiasis, hepatitis, postcholecystectomy syndrome and others).
Carcinoma. Malignant tumors in the gallbladder develop against the background chronic inflammation. This type of tumor is characterized by high malignancy and the appearance of screenings in the early stages of the disease.

What are the symptoms of gallbladder disease? Most gallbladder diseases have common symptoms.

Patients may experience the following symptoms:

pain that is localized in the right hypochondrium. Moreover, the intensity pain syndrome at various diseases different. For example, polyps are completely painless, but calculous cholecystitis or cholelithiasis cause acute severe pain.
dyspepsia, such as nausea, vomiting, bloating, diarrhea, or constipation;
bitterness in the mouth. In this case, it is necessary to carry out a thorough differential diagnosis, since this symptom may also accompany liver disease;
redness of the tongue. This symptom commonly called “raspberry tongue”;
change in urine color. Due to cholestasis, it accumulates in the urine a large number of urobilinogen, which gives it the color of dark beer;
discoloration of stool. Due to stagnation of bile, stercobilin does not enter the stool, which gives the stool a natural brown color;
jaundice. With cholestasis, bile begins to be reabsorbed into the blood, as a result of which bile acids and bilirubin are deposited in the skin and mucous membranes. The sclera and oral mucosa turn yellow first, and only then the skin.

The listed symptoms and signs are the main ones for gallbladder diseases. But depending on the nosological form and course of the disease, other symptoms may occur, such as increased body temperature, general weakness, malaise, decreased appetite, and others.

Diagnosis and treatment of gallbladder diseases is carried out by a general practitioner, gastroenterologist, surgeon or hepatologist. First of all, if symptoms of diseases of this organ appear, you need to contact a general practitioner, who, if necessary, will refer you to related specialists.

During an objective examination, the doctor must palpate the liver and gallbladder, with the help of which it is possible to determine pain points, that is, bladder symptoms, namely:

Ker's sign– pain when palpating the gallbladder while inhaling;
Georgievsky-Mussi symptom - the appearance of painful sensations when pressing on a point located between the legs of the right sternocleidomastoid muscle;
Ortner-Grekov symptom– pain is provoked by tapping the edge of the palm on the right costal arch.

But complaints, anamnesis and objective data will not be enough to make an accurate diagnosis, so patients are prescribed the following additional studies:

general blood analysis, which is used to determine blood changes characteristic of the inflammatory process in the body;
general and biochemical urine analysis allows us to identify increased level urobilinogen;
coprogram will show disturbances in digestive function;
duodenal sounding. This method is performed using a thin rubber probe, which is placed through oral cavity into the duodenum to collect portions of bile.
chemical analysis of bile used to study its composition.
bile culture suggests the etiology of the disease;
Ultrasound examination of the abdominal organs. Using this method, you can study the anatomical features of the gallbladder and identify organic changes, inflammation and the presence of stones.
biopsy, which is performed with a thin needle under ultrasound guidance. The resulting material is examined under a microscope for the presence of cancer cells.
cholangiography– this is an X-ray contrast examination of the gallbladder and bile ducts;
CT scan used mainly in gallbladder cancer to estimate the prevalence of dropouts.

Treatment of gallbladder diseases

All patients are required to be prescribed a diet, the principles of which we will discuss below.

Etiotropic treatment consists in the use of drugs that are aimed at eliminating the cause. For cholecystitis, antibacterial therapy is indicated; for stones, carcinoma or polyps of the gallbladder, surgical intervention is indicated.

Pathogenetic treatment consists of using drugs that normalize the functioning of the gallbladder. For this purpose, antispasmodic, detoxification, anti-inflammatory and enzymatic drugs can be used.

Symptomatic treatment involves the prescription of painkillers, choleretic, antipyretic and other drugs. For pain, drugs such as Ketonal, Baralgin, Drotaverine, Spazmolgon and others can be used.

Even specialists often supplement traditional therapy for gallbladder pathology with herbal medicine. We bring to your attention the recipes of the most effective means and indications for their use.

Rosehip decoction: Grind 3 tablespoons of rose hips in a mortar, pour in 300 ml of boiling water and boil over low heat for 5 minutes. Then remove from heat, allow to cool and filter through a fine sieve. The prepared decoction is taken orally, 100 ml three times a day, 10 minutes before meals. This decoction has choleretic, analgesic and anti-inflammatory effects and is an analogue of the drug "Holosas". This medicine is used for non-calculous cholecystitis, cholangitis, hepatitis, biliary dyskinesia and other diseases in which the outflow of bile is slowed down.

Beetroot decoction: Wash two medium beets, peel and cut into small pieces, then add 10 glasses of water, bring to a boil and cook over low heat for about five hours. When the beets are ready, grate them, place them in cheesecloth and squeeze out the juice, which is combined with the broth. Take this medicine 60 ml half an hour before meals three times a day. For cholecystitis, the course of treatment is from 7 to 10 days.

Herbal collection: mix 1 tablespoon of herbs such as celandine, tansy (flowers), mint (leaves), calendula (flowers), wormwood, fennel seeds, dandelion (root), corn silk, immortelle (flowers). After this, 10 grams of the resulting mixture is poured with two glasses of boiling water, covered with a lid and left for 40 minutes. The finished infusion is filtered through a fine sieve and taken orally 100 ml 3 times a day before meals. This medicine has analgesic, choleretic and anti-inflammatory effects, so it is prescribed for cholangitis and cholecystitis.

Infusion of lingonberry leaves: 10 grams of crushed lingonberry leaves are poured into 200 ml of boiling water, covered with a lid and left for 40 minutes. The finished medicine is stored in the refrigerator and taken 30-40 ml 4-5 times a day before meals. Infusion lingonberry leaves dissolves stones in the gall bladder and ducts. Olive oil has the same effect, which should be consumed in a dose of 15 ml before each meal.

Dietary nutrition for gallbladder diseases

For gallbladder diseases, diet is an essential component of treatment. All patients are assigned to table No. 5 according to Pevzner.

The diet for gallbladder pathology is as follows:

eat fractionally, that is, in small portions 5-6 times a day;
you need to drink enough fluid (at least 1.5 liters);
during remission, it is recommended to reduce the proportion of fried, spicy and smoked foods in the diet;
limit the proportion of fats in the diet, including those of plant origin;
stop drinking alcohol and smoking;
during an exacerbation, it is forbidden to consume food and water. As the symptoms subside, food is resumed (50 ml of vegetable puree soup, 100 ml of unsweetened tea or fruit juice), gradually expanding the diet;
exclude from the menu fresh bread and baked goods, as well as ice cream, sweets, sweet soda and caffeinated drinks;
the menu must be composed of pureed soups with vegetables, cereals, lean meats, cereals, vegetable purees and stews, fruits, berries, vegetable salads, low-fat fermented milk products.

As a result, we can say that gallbladder diseases have similar symptoms, so make the correct diagnosis and prescribe effective treatment Only a specialist can.

TO specific symptoms acute cholecystitis include:

The Kera-Obraztsov-Murphy symptom is pain on palpation in the projection of the gallbladder (the point of intersection of the outer edge of the right rectus abdominis muscle with the right costal arch).

Murphy's symptom is a sharp increase in pain when pressing in the projection of the gallbladder during inspiration.

Mackenzie-Rudolsky's symptom is dilation of the pupil upon palpation at the point of the gallbladder.

Ortner's symptom - pain when tapping the front of the right costal

The Svirsky-Eisenberg symptom is pain in the projection of the gallbladder when tapping the back of the right costal arch.

Eisenberg-I symptom - in a standing position, the patient rises on his toes and then quickly falls on his heels; with a positive symptom, pain appears in the right hypochondrium due to shaking of the inflamed gallbladder.

The Lepene-Vasilenko symptom is pain when tapping the xiphoid process.

Pekarsky-Gubergritsa's symptom - pain when pressing on the base of the xiphoid process.

Shoffard's symptom is pain in the common bile duct-pancreatic area.

The Mussi-Georgievsky symptom is pain when pressing in the right supraclavicular region between the legs of the sternocleidomastoid muscle.

Boas's symptom is pain on palpation of the right paravertebral points in the area of 9-12 thoracic vertebrae.

Pain at the acromion point on the right.

Pain at the scapular point (Kharitonov’s symptom) is a zone of hypersthesia in the area of the angle of the right scapula.

Jonash's symptom is pain at the point of the occipital nerve.

Bergmann's sign is pain in the orbital point on the right.

Courvoisier's symptom - an enlargement of the gallbladder is determined by palpation of the elongated part of its bottom, which protrudes quite clearly from under the edge of the liver;

Nakoma zone hypersensitivity in the occipital region at the site of attachment of the trapezius muscle of the greater occipital nerve).

Gausmann's symptom - the appearance of pain with a short blow with the edge of the palm below the right costal arch at the height of inspiration);

Clinical symptoms of pancreatitis

I.Revealed during inspection:

Sp. Legerlofa - Severe facial cyanosis (with surgical pancreatitis).

Sp. Mondora - bluish-pale spots on the face and body (with severe pancreatitis).

Microcirculation disorders:

Sp. Halstead - acrocyanosis and chilliness of remote areas of the body.

Sp. Gray - Turner - bluish-greenish color of the flanks.

Sp. Cullen - bluish-greenish coloration around the navel.

Sp. Tuzhilina - a symptom of “red droplets” on the anterolateral parts of the abdominal wall.

Sp. Davis - petechiae on the buttocks.

Sp. Grunwald - petechiae around the navel and on the buttocks.

Sp. " "Motley belly" - foci of necrosis of the pancreas - a sign of necrosis of the pancreas.

10. Sp. Bonde - swelling in the epigastrium (acute pancreatitis or exacerbation of chronic).

P. Revealed by palpation.

Sp. Grotta - thinning of the fat fold to the left of the navel compared to the right side. For chronic pancreatitis (therapist).

Sp. Milliere-Layon - pain when seizing the fat fold on the left.

Sp. Midriaz of the left pupil upon palpation of the pancreas.

Sp. Voskresensky - absence of pulsation of the abdominal aorta (swelling of the pancreas).

Sp. Kerta - pain on palpation in the pancreas projection.

Sp. Desjardins - pain in the Shaffar area on the right.

Sp. Gubergritsa - the same, only on the left.

Sp. Fedorov - pain when pressing with a finger 1.5-2 cm below the xiphoid process in the midline.

Sp. Tuzhilina - reduction of pain upon palpation in the depths of the left hypochondrium when lying on the left side.

Sp. Ortner on the left. Tapping on the left costal arch - pain on the left.

Sp. Georgievsky-Mussi on the left - left phrenicus symptom.

Sp. Msjo-Robson :

Posterior - pain when pressing in the left costovertebral angle.

Anterior - pain at a point located in the middle of the line connecting the middle of the costal arch and the navel (pain along the pancreas).

Lower - pain when pressing (sliding) in the lower third of the left leg.

Sp. Kacha - pain when pressing on the 11th rib on the left; hyperesthesia on the back from the VII to XI ribs on the left.

Pain on palpation spinous processes Th X i-xn - Li-c.

Sp. Razdolsky -pain on percussion in the pancreas area.

Sp. Milliere-Layon - pain after eating fatty, sweet foods.

The gallbladder is an organ that stores bile produced by the liver and released into the small intestine. Normally, it has a soft consistency and cannot be felt through the abdominal wall. The organ becomes accessible for palpation when significantly enlarged due to the accumulation of stones, purulent inflammation, dropsy, tumor lesions or atony of the walls.

Causes

The main reason for determining positive cystic symptoms is cholecystitis - inflammation of the gallbladder, which develops as a result of disruption of bile flow and the proliferation of pathogenic microorganisms in the lumen of the organ.

Most often, inflammation develops against the background of gallstone disease. It may also be accompanied by biliary dyskinesia and neoplasms.

Symptoms

Kerra. The man lies on his back. The doctor asks him to take a deep breath and presses his finger on the projection area of the gallbladder.

Obraztsova-Murphy. The patient is sitting. The doctor stands behind him, presses on the projection point of the bile reservoir and asks him to inhale from his stomach.

Vasilenko. The patient exhales, and the doctor lightly taps the area of the right costal arch with his fingertips.

Boas. The doctor presses on the twelfth rib on the right.

Gubergritsa-Pekarsky. The doctor palpates the lower part of the xiphoid process of the sternum (the bone to which the ribs are attached).

Other signs are Lepen, Volsky, Beckman, Jonash, Kharitonov, Shchetkin-Blumberg and so on.

Blistering symptoms in children have some characteristics: the younger the child, the less pronounced they are. Up to 3-5 years they may not be detected at all.

Diagnostics

In addition to collecting anamnesis and determining the listed signs, the diagnosis of gallbladder diseases includes:

clinical and biochemical blood tests;
Ultrasound of the abdominal cavity;
cholecystocholangiography (x-ray of the biliary tract and reservoir).

Treatment

If positive bladder symptoms are detected for cholecystitis, treatment is carried out with antibiotics, antispasmodics, choleretic agents and a special diet. The goal of therapy is to relieve the inflammatory process and improve the flow of bile.

Sometimes duodenal intubation is used - introducing drugs into the duodenum that stimulate the functioning of the gallbladder. If therapy is ineffective, surgery is performed to remove the bladder.

If stones are detected in the bile reservoir, lithotripsy and/or special drugs that dissolve the stones are prescribed.

Forecast

Blistering symptoms associated with cholecystitis have a positive prognosis. Without adequate treatment, the bladder may rupture and peritonitis may develop.

Prevention

Measures to prevent gallbladder pathologies:

balanced diet;
physical activity;
treatment of gastrointestinal diseases.