Lymph node-biliary syndrome

　　The pathogenesis of lymph node-biliary syndrome may be the enlargement of pre-biliary lymph nodes, which persists without regression, compressing the common bile duct and causing clinical symptoms. The phenomenon of lymph node enlargement due to internal cell proliferation or tumor cell infiltration. Lymph node enlargement is very common, can occur in any age group, can be seen in a variety of diseases, both benign and malignant, so it is important to pay attention to the cause of lymph node enlargement, seek medical attention and diagnosis in time to avoid misdiagnosis or missed diagnosis.

　　Lymph node-biliary syndrome can complicate with cholecystitis or cholelithiasis.

　　1. Cholecystitis

　　Cholelithiasis is an inflammatory disease of the gallbladder caused by bacterial infection or chemical stimulation (change in bile composition), and it is a common disease of the gallbladder. In abdominal surgery, its incidence rate is second only to appendicitis. The disease is more common in middle-aged people aged 35 to 55, with more women affected than men, especially in overweight women who have had multiple pregnancies.

　　2. Cholelithiasis

　　Gallstones are a common disease worldwide, and China is no exception. The incidence rate increases with age. In the past 20 years or so, with the popularization of imaging examinations (such as B-ultrasound, CT, and MRI), the incidence rate of cholelithiasis in the general population is about 10%. According to the autopsy reports in China, the incidence rate of cholelithiasis is 7%. With the improvement of people's living conditions and nutritional status in our country, the incidence rate of cholelithiasis has been increasing year by year, especially the incidence rate of gallbladder stones has increased significantly.

　　Lymphadeno-biliary syndrome is characterized by recurrent发作 of paroxysmal pain in the upper abdomen, sometimes accompanied by nausea, vomiting, aversion to cold, fever, and jaundice; signs include marked tenderness, rebound tenderness, and muscle tension under the xiphoid process and in the upper right abdomen, positive Murphy sign, and palpable mass in the gallbladder area, resembling the manifestation of acute cholecystitis.

　　There is currently no effective preventive measure for lymphadeno-biliary syndrome. Early detection, early diagnosis, and early treatment are the key to the prevention and treatment of the disease. Once the disease occurs, active treatment should be carried out to prevent the occurrence of complications.

　　The symptoms of lymphadeno-biliary syndrome are not typical. Clinically, it is sometimes difficult to distinguish between them through physical examination and combined with the results of auxiliary examinations. B-ultrasound examination may also be difficult to distinguish, and laparotomy is needed to make a diagnosis.

　　Patients with lymphadeno-biliary syndrome should eat foods with high protein content and soft texture, such as rice gruel, lotus root starch, almond cream, steamed egg custard, salted egg yolk rice porridge, lotus seed rice porridge, thick rice gruel with egg flower, carrot rice gruel, etc. Foods with high fat, high sugar, and strong刺激性 foods are not suitable. Cold and raw foods should be avoided.

　　Optional foods include: minced chicken, fish, minced lean pork, shrimp, eggs, skimmed milk, tofu, carrots, potatoes, winter melon, zucchini, cauliflower, congee, vermicelli, small noodles, steamed cake, steamed buns, etc.

　　After the diagnosis of lymphadeno-biliary syndrome, the enlarged lymph nodes should be removed. If there is no cholecystitis or gallstone disease and other complications, there is no need to remove the gallbladder. On the basis of gangrenous cholecystitis, perforation of the gallbladder fundus or neck may occur commonly three days after onset, with an incidence rate of about 6-12%. After perforation, it can form diffuse peritonitis, subdiaphragmatic infection, internal or external biliary fistula, liver abscess, etc., but it is often wrapped by omentum and surrounding organs, forming a pericholecystic abscess, presenting with localized peritonitis signs. At this time, surgery is very difficult and cholecystostomy must be performed.