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Diseases of zhelchevyvodyashchy ways at children

Table of contents
Diseases of zhelchevyvodyashchy ways at children
Epidemiology and structure
Nosology, classification
Dyskinesia of extrahepatic zhelchevyvodyashchy ways
Cholecystitis at children
Cholelithiasis

Terminology

Dyskinesia of zhelchevyvodyashchy ways: the disorder of coordinate motive processes of a muscular wall of a gall bladder and/or channels which is shown disturbance of removal of bile from a liver and a gall bladder in a duodenum.
Dyscrinism: disturbance of secretory function of a mucous membrane of a gall bladder.
Cholecystitis, cholangitis: inflammation of a gall bladder, bilious channels.
Cholelithiasis [a synonym — a cholelithiasis]: the illness characterizing by formation of concrements in a gall bladder or bilious channels.

Classification

A variety of kliniko-morphological forms of pathology of extrahepatic zhelchevyvodyashchy ways was the basis for numerous attempts of their association within uniform classification. The Zhelchevydelitelny device consisting of a gall bladder and channels is the system functioning as a unit. Difficult coordination between work of sphincters, channels and a tone of a gall bladder, process of a pachycholia, an exchange of vesical and hepatic bile between a gall bladder and channels, maintenance of a certain pressure in system — all this will be organized in activity of zhelchevydelitelny system [Klimov P. K., 1969]. The continuous movement of bile on extrahepatic bilious channels is what integrates function of various links of this system. Ideas of its unity are essential to understanding of clinical questions, a pathogeny of various options of diseases and tactics of their treatment.
E. Et al. (1976) offer Spagliardi the following classification of biliary pathology taking into account diskinetichesky frustration.

CLASSIFICATION OF BILIARY PATHOLOGY

  1. Functional diseases in the field of a holo-vesical funnel.
  2. Mechanical damages of a funnel:
  3. inborn:

a)                   anomalies of a bubble;
b)                   options of development of a bubble.

  1. acquired:

a)  a hyperplasia at the level of lymph nodes;
b)                   mikrokalkulez bubble.

  1. Inflammatory diseases of area of a funnel:
  2. obturatsionny,
  3. neobturatsionny.
  4. Postoperative biliary dyskinesia.
  5. Syndrome of a hypertension of a sphincter of Oddi.
  6. Syndrome of hypotonia of a sphincter of Oddi.

We give the classifications of diseases of zhelchevyvodyashchy system developed by A. V. Mazurin, A. M. Zaprudnov (1984) and us (tab. 1).

CLASSIFICATION OF DISEASES OF ZHELCHEVYVODYASHCHY SYSTEM  

  1. Dyskinesia:

a)                   hypotonia, hypokinesia;
b)                   hypertension, hyperkinesia.

  1. Dyscrinism of a gall bladder.
  2. Inflammatory diseases:
  3. cholecystitis:

a)  the kept function of a gall bladder,
b)  the disconnected (nonfunctioning) gall bladder;

  1. cholangitis;
  2. holetsistokholangit*.
  3. Postcholecystectomy syndrome.
  4. Diseases of a big duodenal nipple and general bilious channel (area of a holo-vesical funnel):
  5. functional:

a)   hypotonia;
b)   hypertension;

  1. mechanical:

a)   inborn (anomalies).
b)   acquired (a hyperplasia of lymph nodes, mikrokalkulez);

  1. inflammatory.
  2. Exchange diseases — cholelithiasis.
  3. Parasitic — an opisthorchosis, echinococcosis, helminthoses.
  4. Tumoral.

* From especially practical positions reasonablly the use of the term "holetsistokholangit" as topical diagnosis at children is very difficult, and the clinical picture of cholecystitises and cholangites is same.

Table 1
Classification of diseases of extrahepatic zhelchevyvodyashchy ways


Inborn

Acquired

functional

organic

functional

organic

Spasm of a sphincter of Oddi, other options of dyskinesia of bilious ways

Atresia of the bilious courses. Cyst of the main bilious channel.
Segmented expansion of bilious channels. Malformations of a gall bladder — doubling, diverticulums, excesses, an agenesia; an union between a bubble and the right bend of a large intestine

Dyskinesia of a gall bladder — hypotonia, a hypertension, a hyperkinesia the Syndrome gipoit hypertensions of a sphincter of Oddi, Lyutkens

Acute edema of a gall bladder
Acute not calculous cholecystitis
Chronic cholecystitis, cholangitis, holetsistokholangit
Inflammation of a big duodenal nipple, it mikrokalkulez Tumour Cholelithiasis
Postcholecystectomy
syndrome
The states proceeding with clinic of an acute abdomen: Spontaneous perforation of bilious channels Torsion of a gall bladder Traumatic damages (bleeding, rupture of bilious channels, pseudocyst of a holedokh) of the Parasitic nature: echinococcosis
alveococcosis
clonorchosis
fascioliasis
aksaridoz



 
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