Cholecystolithiasis: generally, there is no colic. Large stones are not easy to cause obstruction. They can have no obvious symptoms for a long time. Sometimes they occasionally feel bloated or dull pain in the upper abdomen after dinner, and they are mostly related to eating greasy food. At ordinary times, there are often indigestion symptoms such as heartburn, belching and abdominal distension, which are easy to be misdiagnosed as “stomach disease” or “hepatitis”. Small stones are often movable and embedded in the neck of gallbladder, resulting in severe biliary colic, accompanied by nausea and vomiting; If the location of incarcerated stones changes and the obstruction is relieved, the biliary colic can be relieved.
There is no infection in the early stage of onset, so there is no chills and fever. When accompanied by infection and obstruction, the gallbladder can become suppurative, gangrene or even perforation. Most acute attacks occur after a full meal or eating greasy food. When lying flat, gallstones are easy to slide into the cystic duct and cause obstruction, so some patients can attack at night. If the patient changes at this time (such as sitting up or sleeping on his side), the stones loosen and slide back into the gallbladder, the obstruction is relieved, and the pain will be reduced or disappear.
Choledocholithiasis: stones can come from the gallbladder or intrahepatic bile duct, or from the common bile duct. Smaller gallstones can fall into the common bile duct through the cystic duct, forming secondary common bile duct lithiasis, causing obstructive jaundice and cholangitis. About 75% of patients have jaundice. The depth of jaundice varies with the degree of stone incarceration, and fluctuates. If cholelithiasis combined with infection, abdominal pain, high fever and jaundice can occur at the same time.
Intrahepatic bile duct stones: in recent years, there are fewer and fewer patients with intrahepatic bile duct stones. According to the clinical statistics of our institute, most of these stones are yellowish brown, massive or sediment like bile pigment stones, and the chemical composition of the stones is mainly calcium bilirubin. Bacterial infection, biliary Ascaris and bile duct obstruction are closely related to the occurrence of intrahepatic bile duct stones, and may also be caused by bile duct stenosis or poor bile drainage after operation.
The clinical manifestations can vary according to the different lesion sites. When the stones fall into the extrahepatic bile duct and cause biliary obstruction or acute inflammation, suppurative cholangitis such as upper abdominal colic, chills, high fever and jaundice can occur. If the stone does not fall off and enter the extrahepatic bile duct, sometimes it will be complicated with infection.
At this time, septic symptoms such as shivering and high fever can occur, and toxic shock can occur in severe cases, but the patient can not have abdominal colic and jaundice, so it is often misdiagnosed. Sometimes intrahepatic bile duct stones block the intrahepatic bile duct for a long time, resulting in liver lesions, such as liver tissue necrosis and abscess. Finally, part of the liver shrinks and loses its normal function.
Usually there are ureteral calculi, renal calculi, renal pelvis calculi, renal calyceal calculi, bladder calculi and so on.
Primary urethral calculi often grow up gradually or are located in the diverticulum, and there may be no pain symptoms in the early stage. Most of the secondary stones are suddenly embedded in the urethra, often sudden urethral pain and micturition pain. Pain can radiate to the head, or the rectum.
Stones cause incomplete obstruction of urethra, including thinning of urinary line, bifurcation and weak ejection, accompanied by frequent urination, urgency and dripping of urine. Secondary urethral calculi, due to the sudden insertion of stones into the urethra, there is a sudden interruption of urination, and a strong urine and bladder urgency *, and more acute urinary retention.
Emergency patients often have terminal hematuria or initial hematuria, or a small amount of fresh blood drops at the end of micturition. Accompanied by severe pain; Chronic patients often have mucinous or purulent secretions in the urethra. The vast majority of patients can touch induration and tenderness locally in the urethral stones. The posterior urethral stones can be touched by digital rectal examination. Multiple stones in urethral diverticulum can touch the sand stone like friction feeling of stones.
During physical examination, B-ultrasound examination found that urine examination was negative or there were a small amount of red and white blood cells. Large stones in the renal pelvis, such as cast stones, can have hematuria after strenuous exercise. Small stones, microscopic or macroscopic hematuria, obvious percussion pain in renal area. During the onset of pain, the patient has pale complexion, cold sweat, rapid and weak pulse and even decreased blood pressure, often accompanied by gastrointestinal symptoms such as nausea, vomiting and abdominal distension.
When pain and hematuria occur, sand grains or small stones can be discharged with the urine. When the stone passes through the urethra, there is urinary flow blockage and tingling in the urethra. After the stone is discharged, the urinary flow immediately recovers to be unobstructed. The patient suddenly feels relaxed and comfortable. Pyuria can occur in case of combined infection. In case of acute attack, there can be symptoms of chills, fever, low back pain, frequent urination, urgency and pain.
No special symptoms. Pain can be caused by the stimulation of bladder mucosa by stones. It can be manifested as dull pain in the lower abdomen and meeting, or obvious or severe pain. The symptoms of pain worsen after activity, and the pain can be relieved after change. Often accompanied by frequent urination, urgency and pain, the pain intensifies at the end of urination. When stones are embedded in the neck of the bladder, there will be obvious dysuria *, and there is a typical interruption of voiding, which can also cause acute urinary retention.