Gallbladder Disease

Cholecystitis in children occurs most commonly in the adolescent female, but it may affect infants who are only a few weeks of age. Cholecystitis is suggested by RUQ pain, back pain, or epigastric pain, radiating to the right subscapular area, bilious vomiting, fever, RUQ tenderness, and a RUQ mass. Jaundice is present in 25-55%, usually in association with hemolytic disease.

Hydrops of the gallbladder is characterized by massive gallbladder distention in the absence of stones, infection, or congenital malformations. It usually is preceded by another systemic disease (viral syndrome), and it is often associated with dehydration (bile thickening) or lymphadenopathy (partial obstruction). The usual treatment is a cholecystectomy.

Acalculous cholecystitis accounts for about 10-30% of gallbladder disease in children. It may occur with severe illnesses, such as burns, sepsis, or trauma.

Cholelithiasis may be a concomitant of hemolytic diseases in children. Fifty percent of children with spherocytosis develop gallstones. Sickle cell anemia and Thalassemia are the next most common causes. In adolescent females cholelithiasis can be found in the absence of hemolytic disease. Risk factors include obesity and pregnancy. Pregnancy is associated with 50% of all adolescent cholelithiasis.

Ultrasonography delineates gallstones and is the study of choice to screen for gallbladder disease.

Radioisotopic scanning evaluates biliary and gallbladder function. Nonvisualization of the gallbladder with no progression of isotope indicates acute cholecystitis.
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