Chronic noncalculous cholecystitis and diabetes mellitus type 2: clinical-instrumental features of comorbide pathology

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The purpose of the work is to identify the peculiarities of clinical course and instrumental changes by chronic noncalculous cholecystitis (CNC) and diabetes mellitus type 2 (DM).Material and methods. The clinical examination was carried out in 120 persons, patients with diabetes mellitus type 2 and CNC. All patients were divided into 2 groups depending on the presence of CNC and combined pathology: group 1 — persons with DM and CNC, group 2 — persons with isolated CNC. A thorough examination was carried out using clinical, laboratory, biochemical, instrumental methods. All patients have undergone a multi-moment duodenal sensing (DS) and an ultrasound examination (ultrasound) of the abdominal cavity.Results. Pain syndrome was observed in 100% of patients in the 2nd group, and in half of patients in group 1. The probable difference in the intensity of pain was noted. The leading symptoms of dyspeptic syndrome among patients were flatulence and nausea. In patients with a combined pathology, the signs of vagotonia prevailed: emotional lability and thirst. All patients had all the echographic signs of CNC by conducting an ultrasound investigation. Murphy's positive ultrasound symptom was observed only in 87,1% of the 1st group and 100% of the patients in the 2nd group. Taking into account the data of ultrasound and BS, all examined patients revealed hypotonic-hypokinetic dyskinesia of biliary tract, which was more severe in patients with a combined pathology. Conclusions. In patients with chronic noncalculous cholecystitis and diabetes mellitus type 2, pain is present only in a half of the examined patients with its insignificant intensity, while in patients with isolated chronic noncalculous cholecystitis there was a pain syndrome of 100% with moderate intensity and appearance of pain syndrome in 1–1,5 hours after food intake. Patients in the first group were more likely to have constipation and flatulence, which is probably due to diabetic autonomic neuropathy. In the structure of asthenovegetative syndrome in patients of the 1st group, prevailing signs of vagotonia, which indicate a more significant disorders of the homeostasis in persons of this category compared with persons in the 2nd group. There were observed in the patients with chronic noncalculous cholecystitis and diabetes mellitus type 2 by instrumental research methods thickening of walls, inequality and presence of deformations, increase in size of gallbladder, decrease in the threshold of pain sensitivity in the examination of the Murphy ultrasound symptom, and the presence of hypotonic-hypokinetic dyskinesia.