Differential diagnosis of gallstones?

Most people are familiar with gallstones. Many people may have been tortured by them. In fact, gallstones are a disease caused by gallstones. Gallstones are very harmful to the human body. Once gallstones occur, the pain makes many people miserable. However, gallstones are generally easy to be confused with other diseases during the diagnosis process, which can easily lead to misdiagnosis. So how to differentiate gallstones?

Diagnosis of Gallstones

The clinical symptoms of cholelithiasis are often atypical. For cholelithiasis with a history of acute attack, it is generally not difficult to make a diagnosis based on clinical symptoms and signs; however, if there is no history of acute attack, the diagnosis mainly depends on auxiliary examinations. The key points of diagnosis are as follows:

1. Recurrent acute cholecystitis, chronic cholecystitis, gallbladder effusion or biliary colic without yellowing of the skin and mucous membranes or with mild jaundice.

2. If a patient has had repeated attacks of cholecystitis for many years without jaundice and this attack is accompanied by jaundice, gallstones with secondary common bile duct stones should be considered.

3. Ultrasound revealed gallstones, gallbladder enlargement, fluid accumulation, wall thickening or atrophy; oral cholecystography confirmed gallstones, and the accuracy of ultrasound diagnosis can reach over 95%.

4. Mirizzi syndrome: In some patients, the cystic duct and common hepatic duct run parallel for a while before merging into the common bile duct. If there are stones incarcerated in the gallbladder neck or cystic duct, the common bile duct may be partially obstructed or narrowed due to stone compression and inflammatory edema, leading to recurrent cholangitis. Patients have right upper abdominal pain, fever and jaundice. Ultrasound and laparotomy can confirm the diagnosis.

Differential Diagnosis

1. Chronic gastritis: The main symptoms are upper abdominal distension and pain, belching, loss of appetite and a history of indigestion. Fiber gastroscopy is extremely important for the diagnosis of chronic gastritis. It can reveal gastric mucosal edema and congestion. The color of the mucosa changes to yellow-white or gray-yellow, and the mucosa atrophies. Hypertrophic gastritis can be seen with enlarged mucosal folds, or nodules, erosions and superficial ulcers.

2. Peptic ulcer: There is a history of ulcer. Upper abdominal pain is related to dietary regularity, while gallstones and chronic cholecystitis often cause increased pain after eating, especially high-fat foods. Ulcer disease often occurs acutely in spring and autumn, while chronic cholecystitis caused by gallstones often occurs at night. Barium meal examination and fiber gastroscopy have obvious differential value.

3. Gastric neurosis: Although there is a long history of recurrent attacks, it has no obvious relationship with eating greasy food, but is often closely related to mood swings. There is often nervous vomiting, and vomiting occurs suddenly after eating. Generally, there is no nausea, the amount of vomiting is not much and it is not effortful. You can eat after vomiting, and it does not affect your appetite and food intake. This disease is often accompanied by systemic neurotic symptoms. Suggestion therapy can relieve the symptoms, and it is not difficult to identify.

4. Gastroptosis: This disease may cause ptosis of other organs such as the liver and kidneys. Upper abdominal discomfort worsens after meals and is relieved when lying down. Standing examination shows fullness in the middle and lower abdomen and emptiness in the upper abdomen. Sometimes a gastric shape can be seen and there may be gurgling sounds. A barium meal examination can confirm the diagnosis.

5. Renal ptosis: There are often symptoms such as poor appetite, nausea and vomiting, which are more common on the right side. However, the pain in the right upper abdomen and waist worsens when standing and walking. Colic may occur and radiate to the lower abdomen. During physical examination, palpation is performed in the supine, sitting and standing positions. If a mass in the right upper abdomen is found to be displaced due to change in body position, it is helpful for differentiation. Supine and standing renal X-rays and intravenous urography are helpful for diagnosis.

6. Persistent hepatitis and chronic hepatitis: This disease has a history of acute hepatitis, as well as symptoms such as chronic indigestion and right upper abdominal discomfort. There may be hepatomegaly and poor liver function. In chronic hepatitis, splenomegaly, spider nevi and liver palms may occur. Ultrasound examination shows that the gallbladder function is good.

7. Chronic pancreatitis: It is often a sequela of acute pancreatitis. The upper abdominal pain radiates to the left shoulder and back. Pancreatic calcification or pancreatic stones can sometimes be seen on X-ray films. Fiberoptic duodenoscopy and retrograde cholangiopancreatography are of certain value in diagnosing chronic pancreatitis.

8. Gallbladder cancer: This disease may be accompanied by gallstones. The disease has a short history and progresses rapidly. It quickly metastasizes to the hilar lymph nodes and directly invades the nearby liver tissue. Therefore, persistent jaundice and persistent right upper abdominal pain often occur. When the symptoms are obvious, most patients can feel a hard mass under the right upper abdominal rib margin. Ultrasound and CT examinations can help with diagnosis.

9. Liver cancer: If primary liver cancer presents with right upper abdominal or epigastric pain, it is usually late. At this time, an enlarged liver with nodules can often be felt. Ultrasound examination, radionuclide scanning and CT examination can respectively reveal tumor images and radioactive defects or areas of reduced density in the liver, and alpha-fetoprotein is positive.