A story from my life. Surgery to remove the gallbladder. What to do with kidney stones Price for buying semi-precious stones

One morning I woke up with severe back pain. I went to the clinic for help, and the gastroenterologist prescribed me mezim. But the pain did not subside, I slept standing up, but I could not lie down. As a result, I went to the emergency room and was hospitalized. Gallstones were discovered in the gall bladder. This diagnosis was a shock for me. The severe pain was due to the fact that one stone was stuck in the bile duct, and I also turned yellow. As a result, during the 14 days I spent in the hospital, my duct was freed from the stone (not a pleasant procedure) and the inflammation was relieved. But the surgeons insisted on surgery to remove the gallbladder. Hearing such a verdict from a surgeon at 25 years old is scary and terrible. Well, what to do is what it is, that is. I had to come back for the operation in 3 months, and during this time I had to follow a strict diet. Of course I didn't come. I won’t explain why I didn’t have surgery for another 6 years. It's long, and I think not everyone will be interested. Surgery to remove the gallbladder.

I've read a lot about gallstones. There are ways to dissolve gallstones with tablets, but they will not disappear completely; another way is to crush them, but this is dangerous, since small stones are more mobile than large ones and they will clog the bile duct again. After much searching and hesitation, I realized that the only way out was surgery. No matter how scary it may sound.

At that time, we moved to the small Trans-Ural town of Kurtamysh, Kurgan region. I found out that in Kurtamysh they only perform strip surgery, then I took a direction to Kurgan. It’s easy, of course, to write that I took the referral, but in reality, to take it, I have to stand in so many lines and also convince some surgeons that I need this operation. In Kurgan, I made an appointment for a planned operation on April 14th. I collected all the tests by this deadline. On April 14 at 8 o’clock in the morning I arrived at the appointed place. It was a little exciting.

Before the operation...

I was put in a ward where there were 6 people. The doctor came and said that it was not known when the operation would take place, either tomorrow or Monday. I went to bed on Thursday. It was a shock to me that I would just have to sit here all weekend. An hour later, the surgeon announced that the operation was tomorrow and this one would be a mini-access.

Mini-access consists of two punctures and one small incision (4cm). Of course, I wanted punctures without a cut, and insisted on my own. Then the doctor told me about the difference between these operations. From her story, I understood that mini-access surgery is better than punctures; with a mini-access, if bleeding starts, the surgeon will quickly stop it and you can see where to anneal the gallbladder. During laparoscopy (punctures), if bleeding starts, the doctor puts a bandage into the hole and this makes it harder to stop the bleeding. The laparoscopy operation lasts 3 hours, and the mini-access operation lasts 1 hour. You can also read about these operations on other sites; I am not a doctor, so I will not describe them in detail.

This was a short digression, let's go back to the day before the operation. In the evening I didn’t eat anything, drank magnesia, of course, as prescribed by the surgeon, and the cleansing of the intestines began.

Well, the time has come....

In the morning, panic and fear began. The operation was scheduled for 9 am. We got there at 8:45. They put me on the operating table. My whole life flashed before my eyes while I was lying on this table in consciousness. The anesthesiologist came, put on a mask and told me to take a breath, I don’t remember anything else...

I woke up from a push in the side, the anesthesiologist said that the operation lasted 1 hour. I was transferred from the operating table to a gurney and taken to the ward. I felt severe pain in my right side, I asked for a painkiller, they gave me one, the pain did not subside, they gave me more and I fell asleep. On this day, we were only allowed to lie on our backs without a pillow. This is how the first day passed. On the second day, you can turn on your side and drink 2 glasses of water. The second day it was hard to lie on my back, my entire lower back was stiff, so I tried to turn around, but it hurt. The umbrella inserted into the side was in the way. On the third day in the morning they pulled out this umbrella for me, I slowly got up and started walking. They were allowed to drink water and jelly all day. I was discharged on the 7th day after the operation.

After surgery to remove the gallbladder.

After removal of the gallbladder, you need to follow a diet for 4-6 weeks. And then you can eat everything.

What is allowed to eat after gallbladder removal?

1. Chicken breast;
2. Beef;
3. Porridges made from cereals;
4. Boiled vegetables;
5. Fruits;
6. Fermented milk products (cottage cheese, kefir, yogurt, yogurt);
7. Cookies Maria, biscuits.

What should you not eat after gallbladder removal surgery?

1. Fatty (pork, lamb);
2. Smoked;
3. Spicy pickled;
4. Chicken thighs, wings
5. Butter
6. Mayonnaise
7. Shortbread cookies, buns, cakes
8. Carbonated drinks

Is it possible to eat sour cream after surgery?

Yes, 2-3 tablespoons per day.

How often do you eat?

5-6 times a day in small portions.

Why should the portion be small?

When we eat food, bile is released into the body to process it. If you eat a lot of food, a lot of bile is released. If you constantly transfer it, the body will secrete a lot of bile, even when you eat just one apple. This leads to disruption of the body's digestive system.

Do you have to eat at the same time every day?

No, not necessarily.

What tinctures should be taken to cleanse the liver?

Pour 2 cups of oats into 1.5 liters of boiled water, leave for 10-12 hours (overnight), drain and refrigerate. Drink 0.5 cups 3 times a day before meals. Drink for a month, then break for 5 months and drink again for 1 month. In general, 2 times a year.

Well, that's probably all.

In conclusion, I would like to express my gratitude to the surgeon Galina Ivanovna Kolpakova. Thanks to everyone who cares for patients after surgery - these are nurses and orderlies, and special thanks to the anesthesiologist (unfortunately I don’t know his name), who encouraged me before the operation.

Surgery to remove the gallbladder.

Where to put removed gallstones?

Some say we need to bury them; others think it should be burned; still others - burn on the waning moon. Decide for yourself what to do with them.

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What is it and reasons

Stones in the bile ducts come mainly from the gallbladder (secondary formations) or - very rarely - are formed only in the bile ducts (primary stones). The type of deposits depends on where they occur. Primary deposits are usually brown, and deposits from the gallbladder can be cholesterol or mixed.

How often do stones appear in the bile ducts?

In Europe and North America, primary gallstones are rare, but the prevalence of this disease in people after cholecystocomy (removal of the gallbladder) is estimated at 5-20%. Duct stones are much more common in Asians.

Symptoms of stones in the gallbladder ducts

Symptoms of the formation of stones in the bile ducts are associated with a mechanical obstruction to the flow of bile. Small deposits can spontaneously move in the gastrointestinal tract, from where they are removed.

They are manifested by the following symptoms: attacks of colic in the bladder, yellowing of the skin and whites of the eyes (jaundice) and itching of the skin. Nausea and vomiting are also common, as are characteristic changes in stool color and dark urine associated with complete blockage of the bile duct in the bile duct.

What to do if symptoms appear?

If a person with a confirmed diagnosis of stones in the ducts or after removal of the gallbladder develops yellowness and itching of the skin and if painful colic occurs, it is necessary to consult a doctor as soon as possible.

Symptoms such as nausea, vomiting, fever, chills, worsening contact with the patient or disturbances of consciousness require consultation with a doctor. These symptoms may indicate complications: acute inflammation of the biliary tract, acute pancreatitis, perforation of the biliary tract, or inflammation of the peritoneum.

How does a doctor make a diagnosis?

The first test recommended by your doctor in case of suspected stones in the bile ducts- ultrasound of the abdominal cavity (ultrasound). This study, however, is not very effective in detecting “flowing” gallstones - it provides mainly information about the width of the bile ducts, and sometimes also about the size, number and location of deposits.

Important information about stones in the ducts is provided by a blood test, and in particular: determination of the concentration of bilirubin and the activity of liver enzymes, which are indicators of stagnation of bile in the bile ducts.

Endoscopic ultrasonography is very useful for diagnosing stones in the bile ducts, which clearly shows changes in the bile ducts. Another study that can help make a diagnosis is magnetic resonance imaging of the biliary tract. This test is safe and at the same time highly sensitive for detecting gallstones in the ducts.

This test is carried out, however, only if the results of an ultrasound of the abdominal cavity, as well as blood tests, are ambiguous and doubtful. Also in this case, the problem is the limited availability of this method in our country.

Methods for treating duct stones

If deposits are detected in the bile ducts, reverse endoscopic retrograde cholangiopancreatography is used. This study is performed using a flexible endoscope - a duoendescope, which is inserted through the patient's mouth into the esophagus, stomach and duodenum in the vicinity of the connection of the bile ducts to the digestive tract.

In the case of the presence of large deposits (with a diameter of 15 mm), the therapeutic method is lithotripsy, performed during a duoendoscopic examination. It involves breaking up and crushing the formations in the bile ducts, and then removing the remaining particles using a balloon or endoscopic basket.

If these methods are ineffective, a surgical procedure may be required, with a system to remove deposits in the biliary tract.

Is a complete cure possible?

Complete cure is possible after removing stones from the bile ducts using one of the above methods. If there are also stones in the gallbladder, you should consider removing it, because there is a risk of stones getting from there into the bile ducts and developing the disease. In some patients, despite removal of the gallbladder, relapses of the disease occur as a result of a tendency to form stones in the bile ducts.

What should you do after finishing treatment?

There are no clear recommendations regarding behavior after surgery to remove waste from the biliary tract. Immediately after surgery, a one-day strict diet is applied., and the next day patients can take digestible food. As in the case of patients suffering from cholecystitis, a diet low in fat and high in carbohydrates is recommended. In patients with periodic urolithiasis, it is advisable to introduce treatment with ursodeoxycholic acid drugs, which “wash out” cholesterol from the stones and lead to their dissolution.

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Consequences of gallbladder removal. Postcholecystectomy syndrome

All consequences of gallbladder removal are combined into one term - postcholecystectomy syndrome. Let's talk about this in more detail. Let's give a definition.

Postcholecystectomy syndrome is a group of diseases associated directly or indirectly with surgery to remove the gallbladder, as well as diseases that progress as a result of the operation. Let's try to figure out this problem together.

So, the operation is performed, and the patient with bright thoughts awaits the cessation of the symptoms that tormented him before. However, some time after the operation, the condition worsens again: abdominal pain, upset stool, bloating, general weakness appear, nausea or vomiting may occur, and sometimes jaundice even reappears. Patients often complain of a bitter taste in the mouth after gallbladder removal. A sick person asks a doctor a logical question: “How is this possible? I came for an operation to get rid of the problems that were bothering me, the operation was performed, the gallbladder was removed, I was not happy with the consequences, the problems did not go away, I have the same story again. Why is everything like this?

All these questions are understandable and legitimate. A doctor's actions should help, not harm. However, not everything is in his power. Statistical analysis of the problems that arise after operations shows that symptoms directly related to the absence of the main function of the gallbladder in the body (bile reserve) bother only a small number of patients.

Mostly people complain about problems arising in connection with diseases of the hepatoduodenopancreatic zone, i.e. diseases of the liver, pancreas and duodenum. Therefore, the currently used term “postcholecystectomy syndrome” is harshly criticized by many clinicians as not reflecting the cause and essence of the suffering of patients. But the term has developed historically, and everyone uses it for the convenience of professional communication.

So, these days, the term “postcholecystectomy syndrome”, depending on the clinicians who use this concept, can include the following postoperative problems:

• all pathological changes that occur in the body after removal of the gallbladder;
• relapses of hepatic colic due to an incomplete operation, the so-called true postcholecystectomy syndrome. At the same time, a separate group includes complications caused by errors made during cholecystectomy and associated with damage to the bile ducts: remaining stones of the common bile and cystic ducts, post-traumatic cicatricial stricture of the common bile duct, the remaining part of the gallbladder, pathologically altered stump of the cystic duct, cystic duct stone duct, long cystic duct, scar region neuroma and foreign body granuloma;
• complaints from patients associated with diseases not recognized before surgery, arising due to incomplete examination of the patient, re-formation of stones.

Postcholecystectomy syndrome. Causes

Damage to the extrahepatic bile ducts

According to some researchers, removal of the gallbladder leads to an increase in the volume of the common bile duct. They found that with an unremoved gallbladder, the volume of the common bile duct reaches 1.5 ml, 10 days after the operation it is already 3 ml, and a year after the operation it can reach as much as 15 ml. The increase in the volume of the common bile duct is associated with the need to reserve bile in the absence of a gallbladder.

1. The appearance of disturbing symptoms can be caused by strictures of the common bile duct, which can develop as a result of trauma to the common bile duct during surgery or necessary drainage in the postoperative period. Clinical manifestations of such problems will be jaundice and recurrent inflammation of the biliary tract (cholangitis). If the lumen of the common bile duct (choledochus) is not completely obstructed, then symptoms of bile stagnation (cholestasis) will come to the fore.

2. Another reason for continued pain after surgery may be stones in the bile ducts. In this case, a distinction is made between true stone formation, when stones form again after surgery, and false stone formation, when stones in the bile ducts were not recognized during the operation and simply remained there.

It is believed that false (residual) stone formation is the most common, but again stones in the bile ducts can form only when there is severe stagnation of bile in them, associated with the formation of cicatricial changes in the terminal (final) part of the common bile duct. If the patency of the bile ducts is not impaired, then the risk of recurrent stone formation is extremely low.

3. The cause of pain may also be a long stump of the cystic duct. Its increase, as a rule, is a consequence of cicatricial changes in the final (terminal) part of the common bile duct. There is a violation of the outflow of bile and biliary hypertension, leading to elongation of the stump. Neuromas and stones can form at the bottom of the stump, and it can become infected.

4. A rare cause of pain is a common bile duct cyst. The most common is aneurysmal dilatation of the walls of the common bile duct; sometimes a cyst can arise from the side wall of the common bile duct in the form of a diverticulum.

5. One of the serious complications of cholecystectomy is cholangitis - inflammation of the bile ducts. Inflammation occurs due to the ascending spread of infection, which is facilitated by the phenomenon of stagnation of bile (cholestasis), due to a violation of the outflow of bile through the ducts. Most often, this problem is caused by the stenosis of the terminal part of the common bile duct, which we have already discussed, and multiple stones of the extrahepatic ducts.

Sphincter of Oddi dysfunction

The sphincter of Oddi is a smooth muscle located in the major duodenal (papilla of Vater), located on the inner surface of the descending part of the duodenum. The major duodenal papilla opens the common bile duct and the main pancreatic duct (main pancreatic duct).

Disruption of the sphincter of Oddi leads to changes in the major duodenal papilla, thereby disrupting the activity of the pancreas, resulting in cholangitis or obstructive jaundice.

Most studies confirm the fact that after removal of the gallbladder, the tone of the sphincter of Oddi temporarily increases. This is due to the sudden elimination of the reflex effect of the gallbladder on the sphincter. This is the story.

Liver diseases

It has been proven that cholecystectomy leads to a decrease in degenerative phenomena in the liver and significantly reduces the syndrome of cholestasis (stagnation of bile) in half of the operated patients 2 years after the operation. In the first six months of the postoperative period, on the contrary, there may be increased stagnation of bile in the extrahepatic bile ducts; this occurs, as we have already understood, due to increased tone of the sphincter of Oddi.

The cause of malaise in the postoperative period may be concomitant severe liver dystrophy - fatty hepatosis, which is detected in 42% of patients undergoing surgery.

Bile passage disorders

It is quite clear that the absence of a gallbladder deprives the body of a reservoir for collecting bile. In the gallbladder, bile was concentrated during the interdigestive period and released into the duodenum as food entered the stomach. After removal of the gallbladder, this physiological mechanism of bile passage is disrupted. At the same time, disturbances in the physicochemical composition of bile still persist, leading to its increased lithogenicity (ability to form stones).

The uncontrolled flow of bile into the intestine when its physicochemical properties change, disrupts the absorption and digestion of lipids, reduces the ability of the duodenal contents to lyse bacteria, and suppresses the growth and development of normal intestinal microflora. Bacterial contamination of the duodenum increases, which leads to disruption of the metabolism of bile acids, leading to damage by their breakdown products to the mucosa of the small and large intestines - this is precisely the mechanism of development of duodenitis, reflux gastritis, enteritis and colitis.

Pancreatic diseases

Gallstone disease can also lead to pancreatic diseases.

It has been statistically proven that in 60% of patients, removal of the gallbladder leads to normalization of its function. Thus, by 6 months after the operation, normal secretion of trypsin (a pancreatic enzyme) is restored, and after 2 years, blood amylase levels are normalized.

However, a long and severe course of cholelithiasis can lead to irreversible changes in the pancreas, which can no longer be corrected by removal of the affected gallbladder alone.

Postcholecystectomy syndrome. Symptoms Clinical picture.

The clinical picture is precisely determined by the causal factors that caused postcholecystectomy syndrome.

1. Patients complain of pain in the right hypochondrium and in the upper abdomen (epigastric region). The pain can radiate (give) to the back and right shoulder blade. Pain is mainly associated with increased pressure in the biliary system, which occurs when the passage of bile through the bile ducts is disrupted.

2. Jaundice may develop.

3. Itchy skin

4. Dyspeptic symptoms (digestive disorders): a feeling of bitterness in the mouth, the appearance of nausea, flatulence (bloating), unstable stools, constipation, diarrhea.

How is postcholecystectomy syndrome diagnosed?

If the above-described complaints appear after surgery, the doctor may prescribe the following types of studies.

1. Laboratory research

Biochemical blood test: determination of the level of bilirubin, alkaline phosphatase, gammaglutamyltransferase, AST, ALT, lipase and amylase. It is most informative to perform a biochemical blood test during a painful attack or no later than 6 hours after its end. Thus, with dysfunction of the sphincter of Oddi, there will be a twofold increase in the level of liver or pancreatic enzymes in a specified period of time.

2. Instrumental studies

Abdominal ultrasound, magnetic resonance cholangiography, endoscopic ultrasound. The “gold standard” for diagnosing postcholecystectomy syndrome is endoscopic retrograde cholangiopancreatography and sphincter of Oddi manometry.

Postcholecystectomy syndrome. Treatment.

I. Postcholecystectomy syndrome. Diet. Let's start with diet. Diet No. 5 is prescribed, the principles of which are set out in the article dietary nutrition after removal of the gallbladder.

II. Drug therapy.

What medications should I take after gallbladder removal? Let us immediately note that in order to help a sick person with postcholecystectomy syndrome, an individual selection of the drug is necessary. First, one drug is prescribed; if this drug helps, then it is very good. If not, then another medicine is selected.

The main goal of drug therapy is to achieve normal passage (movement) of bile through the common hepatic and common bile ducts and pancreatic juice through the main pancreatic duct. This condition almost completely relieves pain in postcholecystectomy syndrome.

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What medications can help you achieve this goal?

1. Prescription of antispasmodics

A. Relief from spasms and a quick analgesic effect can be obtained using nitroglycerin. Yes, exactly nitroglycerin. The medicine that helps with heart pain will also help in this case. However, long-term use of this drug is not recommended: side effects and a pronounced effect on the activity of the cardiovascular system are possible. With prolonged use of nitroglycerin, addiction to the drug is possible, then the effect of taking it will be insignificant.

2. Anticholinergic drugs (methacin, buscopan).

These medications also have an antispasmodic effect, but their effectiveness in treating sphincter of Oddi dysfunction is low. In addition, they have a lot of unpleasant side effects: dry mouth, urinary retention, increased heart rate (tachycardia), and blurred vision.

3. Myotropic antispasmodics: drotaverine (no-spa), mebeverine, bencyclane.

They relieve spasm of the sphincter of Oddi well, but there is individual sensitivity to these medications: for some they help better, and for others worse. In addition, myotropic antispasmodics are also not without side effects due to their effect on vascular tone, the urinary system, and the activity of the gastrointestinal tract.

4. Gepabene is a combination drug that has an antispasmodic effect, stimulates bile secretion and has hepatoprotective properties (protects liver cells).

III. If the above drugs do not help when using all options for their combination or the side effects from them are too significant and significantly worsen the quality of life, then in this case, surgical intervention – endoscopic papillosphincterotomy. FGDS is performed, during this procedure a papillotome is inserted into the major duodenal papilla - a special string through which a current passes, due to which bloodless tissue dissection occurs. As a result of the procedure, the large duodenal papilla is dissected, thereby normalizing the flow of bile and pancreatic juice into the duodenum, and the pain stops. Thanks to this technique, it is also possible to remove the remaining stones in the common bile duct.

IV. In order to improve the digestion of fats and eliminate enzymatic deficiency, they are prescribed enzyme preparations(Creon, pancitrate), their combination with bile acids (festal, panzinorm forte) is possible. The course of treatment with these drugs is long; it is necessary to use them for preventive purposes.

V. According to indications, in order to reduce pain, they are sometimes prescribed nonsteroidal anti-inflammatory drugs(diclofenac).

VI. Cholecystectomy can lead to disruption of the normal intestinal biocenosis, decreased growth of normal microflora and the development of pathological flora. In such a situation, it is carried out intestinal decontamination. Initially, antibacterial drugs (doxycycline, furazolidone, metronidazole, intetrix) are prescribed in short courses of 5-7 days. After which the patient takes medications containing normal strains of intestinal flora (probiotics) and agents that improve their growth (prebiotics). Probiotics include, for example, bifidumbacterin, linex, and prebiotics include hilak-forte.

VII. In order to prevent the damaging effects of bile acids on the intestinal mucosa, antacids containing aluminum - Maalox, Almagel - are prescribed.

In the presence of erosive and ulcerative lesions of the gastrointestinal tract, the use of antisecretory drugs, the most effective are proton pump inhibitors (omez, nexium, pariet).

VIII. Very often, due to digestive disorders, patients are bothered by bloating (flatulence). In such situations, the appointment helps defoamers(simethicone, combination preparations containing pancreatin and dimethicone).

IX. Dispensary observation by a doctor.

If postcholecystectomy syndrome develops, patients should be under medical supervision for 6 months. Sanatorium-resort treatment can be carried out 6 months after surgery.

SO, we realized that the consequences of removal of the gallbladder are due to the previous long course of cholelithiasis with the formation of functional and organic changes in anatomically and functionally interconnected organs (liver, pancreas, stomach, small intestine).

A certain contribution to the development of postcholecystectomy syndrome is made by technical difficulties and complications during surgery to remove the gallbladder. But we can fix everything. First, complex drug treatment is prescribed; if it does not help, then minimally invasive surgery is performed.

I invite you to watch the video Gallbladder - What you can and cannot eat after surgery. Recommendations from doctors and nutritionists will help you avoid complications and minimize all negative consequences after gall bladder surgery.

Removal of the gallbladder. Consequences. Reviews

I had surgery to remove my gallbladder using the laparoscopic method. In the first days after the operation, there was weakness, there was minor pain in the right side, where the punctures themselves were. When sneezing or coughing, the pain could intensify. But the condition quickly returned to normal. I stuck to a diet. And I advise everyone to adhere to diet No. 5 for the first year, a year and a half, and then the menu can be expanded. But always look at how you feel. Some foods still make me feel bloated, sometimes I have a bitter taste in my mouth and nausea. But as soon as I review my diet (I already know the foods that can cause this condition), the picture returns to normal. It's been 20 years. I live and enjoy life. It is also very important to think positively, to think that everything will be fine. I actively go in for sports, go to dances - in a word, I am an ordinary person, I don’t feel any consequences after the gallbladder surgery.

irinazaytseva.ru

Causes

What are the most common causes of gallstones?

1. Anatomical features of the structure of the body.
2. Biochemical changes in the composition of bile, as a result of which the amount of cholesterol increases.
3. Impaired motor function of the gallbladder. Which makes it difficult for the further movement of bile.

The first signs of the disease are the appearance of pain in the right side and a slight bitterness in the mouth. The pain in the side gets worse after every meal. Especially after eating fried, fatty, smoked foods. After this, attacks of hepatic colic begin, accompanied by nausea and vomiting. But you shouldn’t wait until it hurts a lot; after the first symptoms you need to see a doctor. He, in turn, decides where to send the patient for research.

After collecting hardware data and laboratory tests, doctors prescribe treatment. Depending on certain factors of the disease, treatment may be therapeutic or surgical. With the therapeutic method, you need to take medications. Surgical treatment requires one thing - removal of the gallbladder.

Indications for cholecystectomy

There are few clear parameters leading to the operation. In the world of medicine, the question of whether surgery is necessary is often controversial.

We can only highlight some indications for which surgery is necessary:

• The appearance of persistent jaundice.
• Detection of secondary pancreatitis.
• Acute inflammation of the gallbladder.
• Chronic enlargement of the gallbladder due to inflammatory processes.
• Violation of basic liver functions.
• Relapses of hepatic colic after therapeutic treatment.
• The presence of a severe form of cholangitis due to obstruction of the bile ducts.

Severe complications after acute cholecystitis, peritonitis, perforation of the gallbladder, etc. also lead to surgical intervention. Each organism is individual, so there are individual factors that do not fall under the main causes, but require urgent surgery.

Surgical intervention can be of two types:

1. Standard procedure.
2. Application of laparoscopic technique.

Laparoscopic method

The main indication is chronic calculous cholecystitis. It is important to know that the size and number of stones do not have much influence on the choice of method of operation.

Main indications for the laparoscopic method:

• Chronic calculous cholecystitis.
• Acute cholecystitis.
• Chronic acalculous cholecystitis.
• Gallbladder polyps.

Advantages of laparoscopy:

1. Minimal scarring on the right side.
2. In some cases, there are no visible incisions on the abdominal wall.
3. The patient's recovery period is much faster.
4. Rapid restoration of intestinal passage.
5. Unpleasant consequences occur less often after surgery.

Disadvantages of laparoscopy:

• The operation is considered difficult to perform.
• Therefore, it requires professional skills in execution.
• Not every hospital can afford to perform such operations.

Complications

The most severe consequence after surgery is considered “postcholecystectomy syndrome.” The incidence of this complication, according to various sources, ranges from 5 to 10%. Statistics show that the cause of consequences after surgery in 20–30% of cases is considered to be remaining stones. About 29% are papillary stenosis, and 15–20% occur if the length of the cystic duct stumps is greater than 10 mm.

Symptoms of “postcholecystectomy syndrome”

After a certain period, after removal of the gallbladder, attacks of hepatic colic, pain in the side, and obstructive jaundice may begin.

Treatment of the complication can be conservative or surgical. The first option is aimed at treating diseases that were the cause of cholecystectomy. If this does not cure the consequences after surgery, then surgery is indicated.

Repeated surgery is most often harder and more dangerous to perform than the first. According to doctors, repeated surgery helps to recover in 79% of cases and forget about pain in the side. If, after all the recommendations and indications, the patient refuses the operation, the complications become severe.

First year after cholecystectomy

Life after gallbladder removal begins differently for each person. Often, if the patient follows all the doctors’ recommendations, complications are rare. The main task of the patient after removal of the gallbladder is to force the bile ducts to work for themselves and for the operated organ. This adaptation may take from 6 to 12 months.

In medicine, there is the concept of “4 pillars”, which serves as the basis for the rehabilitation of the body after removal of the gallbladder:

1. Prescribing and taking medications. They will help the body adapt to working without the gallbladder. It is especially important to take medications in the first weeks after gallbladder removal. There are patients who do not agree to take medications. Doctors do not have the right to force people to take medications. The patient is independently responsible for his further well-being.
2. The diet must be strictly followed. Eating at least 5 times a day, the interval between feedings is 2-3 hours. Dinner should be no later than 2 hours before bedtime. It is recommended to drink no more than 1.5–2 liters of water per day.
3. Sticking to a diet. If it is not followed, then in most cases relapses of the disease occur. And the pain in the right side will begin to bother me again. The only drawback of the diet may be constipation. But this phenomenon is temporary, and after increasing the variety of the menu, constipation will go away.
4. Gymnastics. It is recommended to do special physical exercises for the anterior abdominal wall. It should be started one month after the gallbladder is removed. You can perform the exercises on your own or in a clinic under the supervision of doctors. This is especially true for patients with excess body weight. It is better not to do heavy housework (mopping floors, repairs); doctors advise you to take care of yourself and rest.

By adhering to the “4 pillars” rules, you can avoid consequences after surgery.

Diet

The prescribed diet after removal of the gallbladder is aimed at helping the body restore bile secretion functions. It is important to remember that the operation was caused by excessive stress on the digestive system. If you don’t change anything and continue your previous lifestyle (overeating, large gaps between meals), then most likely this will end in inflammatory processes of the bile ducts.

Nutrition in the first week after gallbladder removal:

• Day 1 – You can wet your lips with water, but do not drink.
• Day 2 – you are allowed to drink rosehip decoction and water.
• Day 3 – herbal decoctions, compotes and tea without sugar, low-fat kefir.
• Day 4–5 – pureed vegetable soups, mashed potatoes, juices (apple, pumpkin), boiled fish, egg white omelet, tea with sugar.
• Days 6–7 – crackers, biscuits, liquid porridge (oatmeal, buckwheat), boiled meat, cottage cheese, fermented milk products.

This diet should be followed for 2 months. After this, doctors advise switching to diet No. 5, which is not so strict. This is only if there are no serious consequences after the operation. If you follow all the rules and doctors’ recommendations, then you can forget about severe pain in the right side for a long time.

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What diseases are characterized by the formation of stones in the bile ducts?

Gallstone disease, cholecystitis, cholesterosis, biliary cirrhosis, cholelithiasis, etc.

What kind of disorders are these?

Gallstones and other diseases of the gallbladder and bile ducts are common disorders that often cause severe pain. Surgical treatment is the most effective; Deposits in the form of grains are removed, measures are taken to eliminate inflammation. Gallstones can be life-threatening.

What are the causes of gallstone formation?

Stones, or gallstones, are formed as a result of changes in the chemical composition of bile, which is involved in the digestion and absorption of fats. The stones are composed primarily of cholesterol, a mixture of calcium and bilirubin compounds, or a mixture of cholesterol and the pigment bilirubin. Stones form when the gallbladder becomes less efficient due to pregnancy, oral contraceptives, diabetes, celiac disease, cirrhosis of the liver, or pancreatitis.

Gallstone disease most often occurs between 20 and 50 years of age, with women getting sick 6 times more often, but after 50 years the incidence of the disease in both sexes levels off. Treatment is generally successful unless infection or complications occur.

Types of gallstones

The causes of diseases of the gallbladder and bile ducts are different and they also develop differently.

Every tenth patient with gallstones develops stones in the common bile duct, which block the passage of bile into the stomach. If in this case there is no infection, the prognosis is favorable.

Cholecystitis, an acute or chronic inflammation of the gallbladder, is usually caused by a stone lodged in the cystic duct. In this case, severe pain appears, the bladder becomes stretched, and surgery on the gallbladder is required. The acute form is more common in middle-aged people, the chronic form - in the older age group. For most people, treatment works well.

Cholesterosis (cholesterol polyps or deposits of cholesterol crystals on the lining of the gallbladder) can be caused by high levels of cholesterol and low levels of bile salts in bile. Surgery offers a high chance of cure.

Biliary cirrhosis sometimes develops following viral damage to liver cells and ducts, but the primary cause of the disease is unknown. Biliary cirrhosis usually leads to obstructive jaundice. Women aged 40 to 60 years get sick 9 times more often than men. Without a liver transplant, the prognosis is poor.

Gallstone ileus is caused by a stone stuck in an opening that opens into the colon. This disorder is more common in older people; surgery offers a good chance of cure.

After removal of the gallbladder, stones may remain in the common bile duct or the duct may become narrowed, which is observed in 1-5% of cases. The result is pain, colic, intolerance to fatty foods and intestinal disorders. Radiological procedures, endoscopic procedures and additional surgery provide a good chance of recovery.

What are the symptoms of gallstone disease?

Gallstones may not cause any symptoms, but in most cases the classic symptoms are attacks. Attacks often occur after eating fatty foods. Usually the attack begins at night with a sharp pain in the upper abdomen on the right side. The pain may radiate to the back, to the middle of the shoulder girdle, or to the front of the chest. The pain can be so severe that the person has to go to the hospital. Symptoms of gallstone disease are also intolerance to fatty foods, colic, belching, flatulence, intestinal disorders, increased sweating, nausea, vomiting, chills, slight fever, jaundice (in cases where the stone blocks the common bile duct) and clay-colored stool.

How is the disease diagnosed?

To detect stones in the gall bladder, ultrasound diagnostics and other research methods are used.

Ultrasound scanning can detect gallstones in 96% of cases.

Fluoroscopy makes it possible to differentiate cholelithiasis from pancreatic cancer in icteric patients.

Endoscopy with a special dye is used to examine the common bile duct and pancreatic duct. Endoscopy, performed through the mouth or rectum, may also show the presence of stones.

A radioisotope scan of the gallbladder reveals obstruction of the cystic duct.

Computed tomography, which is used in rare cases, helps differentiate jaundice with cholelithiasis from jaundice of other origins.

An X-ray of the abdomen detects calcified stones in 85% of cases, but does not detect cholesterol stones.

A blood test can help differentiate gallstone diseases from other conditions with similar symptoms (such as heart attacks, peptic ulcers, and hernias).

SELF-HELP

What to do after laparoscopy to speed up recovery

On the first day after laparoscopy, you may have some pain, but you will be able to eat normal food. In a few days, maybe a week, you will be able to return to your normal lifestyle. Use the helpful tips below to speed up your recovery.

In the hospital

Soon after the operation, you will be allowed to walk and will be advised to do deep breathing exercises and leg exercises every hour. Perform leg exercises in elastic stockings, which support the leg muscles, improve blood circulation and reduce the risk of blood clots.

Your doctor may prescribe a pain reliever to help you avoid pain when doing breathing and leg exercises. You may have some discomfort in your stomach, but it will subside after your first bowel movement.

At home

Do not lift heavy objects or strain yourself. However, you must walk every day.

Unless you have a food allergy or other medical condition that requires you to follow a specific diet, you can eat as usual.

CONVERSATION WITHOUT INTERMEDIARIES

Typical questions about the treatment of gallstone disease

Can I get better if I follow a low-fat diet?

No, this is a common misconception. The stones were not formed due to fatty foods, and a special diet will not get rid of them. Stones form when the liver secretes bile that contains too much cholesterol. In this case, cholesterol precipitates, forming stones.

Fatty foods cause an attack of cholelithiasis in those people who already have stones. Under the influence of fats, the gallbladder contracts, and part of the bile enters the duodenum and then into the small intestine. If stones block the flow of bile, severe abdominal pain, nausea, and vomiting may occur.

The doctor advises me to remove the gallbladder, but how will I live without a gallbladder?

The purpose of the gallbladder is to store bile until it is needed to digest fats in the small intestine. After the gallbladder is removed, the liver will secrete bile directly into the small intestine. Thus, the gallbladder is one of the few organs that you can live without.

Will I really be able to eat even deep-fried potatoes after my gallbladder is removed?

Yes, but not right away. Eat a low-fat diet for the first few weeks after surgery, then gradually increase the fat content. As your body adjusts to the absence of your gallbladder and the flow of bile into your small intestine stabilizes, your ability to digest fats will also be restored.

How is gallstone disease treated?

During an acute attack, tube insertion, intravenous fluids, and antibiotics are used. Usually, doctors immediately recommend surgery, giving the patient the choice of the most suitable procedure for him. Stones are removed either in the usual way or using laparoscopy (see WHAT TO DO AFTER LAPAROSCOPY TO ACCELERATE YOUR RECOVERY).

Other treatments

A low-fat diet can prevent gallstone attacks, and vitamin K reduces itching, jaundice, and bleeding (see TYPICAL QUESTIONS ABOUT CALLSTON TREATMENT).

Recently, a new method for removing stones has been proposed. A flexible catheter is inserted into the common bile duct and moved to the stone under fluoroscopic control. A special container is placed through the catheter, it is opened, capturing the stone, closed and pulled out through the catheter.

For people who are too weak to undergo surgery or who refuse surgery, chenodiol, which can dissolve some types of stones, may be recommended. However, this drug is designed for long-term treatment and has harmful side effects. Moreover, after stopping the medication, gallstones may reappear.

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Symptoms

Choledocholithiasis is a sluggish disease that may not express itself in any way for many months or even years. However, in cases where a stone gets stuck in the duct and turns into an obstruction, the following signs of disturbance occur:

• pain in the abdominal cavity, localized at the top of the right side or in the middle;
• increased body temperature;
• jaundice (yellowing of the skin and eyes);
• loss of appetite;
• nausea and vomiting;
• clay colored chair.

A stone in the gallbladder duct can cause both irregular and constant pain. At times the pain seems to calm down, only to sharply intensify after a certain period. Acute pain syndrome may lead to the need to urgently seek medical help. The most severe manifestations of the disorder are often confused with signs of cardiac pathology - for example, a heart attack.

Complications

A stone in the bile duct (the symptoms of which the patient ignores for a long time) can lead to infection of the biliary tract. Bacteria that multiply rapidly in the area of ​​the lesion can move inside the liver. The consequences of such an infection pose a direct threat to human life. In addition to bacterial damage, complications such as cholangiolytic cirrhosis or pancreatitis may also occur.

Causes

There are two types of stones: cholesterol and pigment stones.

Cholesterol formations are yellowish in color and are the most common. Scientists believe that stones of this type gradually build up from bile, which contains:

• too much cholesterol;
• excess bilirubin;
• not enough bile salts.

Cholesterol deposits also occur in the case of incomplete or too rare emptying of the gallbladder.

It is still unknown exactly why pigment stones form in the bile ducts. According to doctors, they are found in patients suffering from:

• liver cirrhosis;
• infectious diseases of the biliary tract;
• hereditary blood diseases leading to excessive production of bilirubin by the liver.

Risk factors

The risk group primarily includes people with a history of cholelithiasis and other pathologies associated with the functioning of the bile-producing organ and associated pathways. Moreover, such patients often have stones in the bile ducts after removal of the bladder. Gallstones are sometimes enough to cause significant discomfort and severe pain.

The following factors increase the risk of deposition of cholesterol and pigment formations in the excretory tract:

• obesity;
• a high-calorie diet that is high in fat and low in fiber;
• pregnancy;
• long fasting;
• rapid weight loss;
• lack of physical activity.

Some of these factors are quite easy to correct by making appropriate changes to your lifestyle.

Circumstances that cannot be changed include:

• age: stones are more often found in older people;
• gender: women suffer from this disease more often;
• nationality: Asians, Mexicans and American Indians are diagnosed with choledocholithiasis more often than other peoples;
• family history: according to some scientists, genetic characteristics may play a significant role in the development of predisposition to choledocholithiasis.

Diagnostics

If appropriate symptoms are present, the doctor will need to verify the presence of stones in the common bile duct. For diagnostic purposes, one of the following imaging studies is performed:

• transabdominal ultrasound examination - a procedure that uses high-frequency sound waves to study the condition of the liver, gallbladder, spleen, kidneys and pancreas;
• computed tomography of the abdominal cavity (cross x-ray);
• endoscopic ultrasound examination (an ultrasound probe is placed in a flexible endoscopic tube and passed through the oral cavity into the digestive tract);
• endoscopic retrograde cholangiography is a procedure that allows you to localize not only stones in the bile ducts, but also other pathological phenomena (tumors, areas of narrowing);
• magnetic resonance cholangiopancreatography - MRI of the gallbladder and pancreatic duct;
• percutaneous transhepatic cholangiogram - radiography of the bile ducts.

The doctor may also order one or more blood tests to determine whether there is an infection or not, while also checking whether the liver and pancreas are functioning properly. The following examinations are most often prescribed:

• general blood analysis;
• bilirubin test;
• pancreatic enzyme analysis;
• analysis of liver function.

Treatment

Stones from the bile duct must be removed to ensure normal patency and disappearance of pain. To relieve obstruction, doctors may recommend one of the following procedures:

• stone extraction;
• breaking cholesterol and pigment formations into fragments (lithotripsy, crushing);
• surgery to remove the gallbladder and duct obstruction (cholecystectomy);
• a surgical operation consisting of cutting the common bile duct to remove stones or facilitate their passage (sphincterotomy);
• biliary stenting.

Procedures

Endoscopic biliary sphincterotomy remains the most common treatment for choledocholithiasis. During this procedure, a special device shaped like a balloon or basket is placed into the blocked bile duct. With its help, obstruction of the pathways is eliminated. This method is proven to be effective in 85% of cases.

If the stone does not pass on its own and the doctor suspects that endoscopic biliary sphincterotomy will not be enough, lithotripsy is prescribed. In this procedure, the stones are crushed into small fragments to make them easier to remove or pass on their own.

A stone in the gallbladder duct may be adjacent to a similar formation in the organ itself. In such cases, the most effective treatment method is removal of the gallbladder. During surgery, the doctor will examine the duct to make sure it is normal.

If the stones cannot be completely removed surgically for any reason (or if you have long suffered from pain caused by stones in a blocked duct, but do not want to have your gallbladder removed), your doctor will recommend biliary stenting. The procedure involves inserting tiny tubes that widen the passage, thereby clearing obstructions and stones in the bile duct. The operation is gentle and provides effective prevention of cases of choledocholithiasis in the future. In addition, stents can protect against infectious diseases.

Prevention

If you have already experienced pain associated with choledocholithiasis, most likely the pain syndrome will recur - and more than once. Even removal of the gallbladder does not represent the best treatment: stones from the bile duct must be removed purposefully, otherwise there will be a risk of manifestation of the typical symptoms of the pathological condition.

However, in many cases, choledocholithiasis can be prevented. All you need to do is make small changes to your lifestyle. The risk of disease is significantly reduced by moderate physical activity and slight changes in diet. Doctors advise taking walks as often as possible and making sure you have plenty of plant fiber in your diet. It is advisable to reduce the consumption of saturated fats.

Long term forecast

In 2008, several well-known medical clinics in Canada and the United States conducted a study according to which approximately 14% of patients experience symptoms of bile duct stones again within fifteen years after the first occurrence of typical pain syndrome and appropriate treatment. Obviously, the removal of stones from the bile ducts is not always carried out with sufficient care, since there is reason to believe that recurrent disease is associated with an increase in the size of residual cholesterol formations.

Folk remedies

Alternative medicine is not considered a highly effective means of combating choledocholithiasis, however, according to some experts, simple folk remedies prepared at home can increase bile flow or prevent excessive production and accumulation of cholesterol.

Are you experiencing pain and suspect that it is caused by a stone in the bile duct? What to do if you can’t see a doctor yet? Try one of the following traditional methods.

Natural preparations

• Pour a tablespoon of apple cider vinegar into a glass of apple juice and stir. Drink every time you feel pain in the area of ​​the gallbladder and ducts. The product has an analgesic effect within 5-15 minutes.
• Add four tablespoons of lemon juice to a glass of water. Drink the mixture on an empty stomach every morning. Therapy continues for several weeks until stones are completely eliminated from the body.
• Boil a glass of water, add a teaspoon of crushed dried peppermint leaves, remove from heat, cover and leave for five minutes. Strain and add a teaspoon of honey. Drink warm mint tea twice a day for 4-6 weeks, preferably between meals.
• Prepare the vegetable mixture. To do this, squeeze the juice from one beet, one cucumber and four medium-sized carrots. Mix and drink twice daily. Follow these instructions for two weeks and you will notice how quickly your condition returns to normal.

Medicinal herbs

• Place a teaspoon of dried dandelion root powder in a glass. Fill with hot water, cover with a lid and leave for five minutes. Strain and add a little honey to improve the taste. Drink this dandelion tea two to three times a day for 1-2 weeks to dissolve stones in the ducts after gallbladder removal.
• Healing tea can also be prepared from other beneficial plants. Add two teaspoons of marshmallow root and one teaspoon of Mahonia holly to four glasses of water. Boil the mixture for 15 minutes, then remove from heat. Add two teaspoons of dried dandelion leaves and one teaspoon of dried peppermint leaves, then steep the tea for 15 minutes. Strain and drink throughout the day.

In addition, the tender green leaves of dandelion can be eaten directly - for example, steamed or added fresh to vegetable salads.

Dandelion is contraindicated in patients with diagnosed diabetes.

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It is important to know!

Kidney stone disease, or in medical language - nephrolithiasis, affects more and more people every year. The pathology is observed not only in adult men and women, but is also often diagnosed in children. This is due to various factors influencing the formation of calcium salts in the urine:

1. poor nutrition;
2. poor quality of fluid consumed;
3. genetic predisposition;
4. infectious diseases;
5. disruption of the endocrine system and other reasons.

Any person suffering from nephrolithiasis should know the symptoms of kidney stones passing out, and also have first aid skills if for some reason it is not possible to call a medical team.

Most people who lead an unhealthy lifestyle or suffer from one or another disease may develop sand in their kidneys. Over time, individual grains of sand are attracted to each other, forming larger particles - stones or concretions. Some patients with nephrolithiasis live with this pathology all their lives, and are not even aware of the formation of foreign bodies in the kidneys. But in some cases, a person begins to feel unbearable pain in the lumbar region, frequent urge to urinate, feverish conditions and other symptoms. All this indicates that the stone began its movement from the kidney through the ureter.

Kidney stones come in different structures and can be small or large. Some stones leave the organs on their own, without causing visible harm to human health. Other stones have sharp edges; when passing through the ureters, they scratch the mucous membrane, causing injury and inflammation of the tissue.

A picture is often observed when the stone has a diameter relatively larger than the opening of the ureter; in this case, the channel is blocked, and urine cannot naturally leave the human body. As a result, toxic substances are formed in the accumulated urine, which are subsequently absorbed back into the body. This condition is extremely dangerous and threatens acute intoxication of all organs and tissues.

A stone can leave the human body on its own only if the diameter of the stone is no more than 8-10 mm. The ureter has a diameter of about 8 mm, but when a slightly larger stone passes through it, the canal can stretch slightly. Larger stones are not able to come out on their own, and thereby cause terrible suffering to the patient. In this case, you can only help with special drugs that can dissolve the stone, or an operation during which the surgeon removes the stone from the ureter.

Kidney stone disease is often asymptomatic, but when certain causes occur, the stone begins to leave the kidney and move along the ureter. Various factors can provoke the movement of a stone:

1. lifting weights;
2. sudden change in body position;
3. jumping;
4. taking medications or drugs that have a diuretic effect.

As soon as the stone begins to move from the kidney to the ureter, a person experiences:

• Dull and aching pain.
• As a rule, pain manifests itself on the side of the lower back where the diseased kidney is located.
• If the stone has smooth edges and a small diameter, it can pass out on its own along with urine.
• Stones with sharp edges, moving along the ureter, begin to scratch the mucous membrane of the organ, as a result of which traces of blood are present in the patient’s urine.
• The passage of large diameter stones is accompanied by very severe cramping pain (renal colic). This state lasts from several minutes to several days.
• Since a large stone cannot pass through the ureter on its own, it causes blockage of the organ and interferes with the natural outflow of urine.
• If you do not seek help from medical personnel in a timely manner, acute renal failure develops.

In men and women, the passage of kidney stones occurs almost identically, the only difference being the painful syndrome. In the weaker sex, the pain begins in the lumbar region under the ribs, then gradually moves to the groin area and radiates to the labia.

In the stronger half of humanity, pain also occurs in the lumbar region, but as the stone moves through the ureter, the pain syndrome is observed in the groin area, often radiating to the scrotum and head of the penis.

When a person is diagnosed with nephrolithiasis, he should be careful about his health so as not to once again provoke the movement of kidney stones. But most people are not even aware of their illness and, as a rule, find out about it only when they seek medical help with acute unbearable pain.

You can understand that a stone is coming out of the kidneys by certain symptoms:

• Sharp, cramping pain. Initially, pain is felt in the side where the diseased organ is located, then, as the stones move, the pain moves to the groin and can radiate to the thigh.
• When a calculus gets stuck in the ureter, the patient experiences the most severe pain - renal colic. The person cannot find a place for himself, screams and rolls on the floor in pain, and has absolutely no control over his actions.
• The process of urination becomes more frequent, since due to blockage of the ureter, liquid cannot be eliminated from the body at one time.
• Urine becomes cloudy in color and sometimes contains blood.
• Renal colic is accompanied by an upset stomach and intestines: the patient experiences an attack of nausea and the urge to vomit, diarrhea.
• Sometimes the passage of kidney stones causes an increase in blood pressure, which cannot be reduced even with the help of medications.
• When more than 2/3 of the ducts are blocked by a stone, a person’s body temperature rises sharply. In most cases, the mark on the thermometer reaches a critical figure.

If the pain is too severe and the patient’s condition is worsening every minute, you should immediately call an ambulance to hospitalize the patient in a medical facility.

If symptoms of kidney stones appear, it is necessary to take first aid measures to eliminate pain and alleviate the patient’s condition:

1. A person suffering from nephrolithiasis must take any analgesic to eliminate the pain syndrome. In addition to painkillers, it is necessary to take an antispasmodic agent, for example, No-shpa. The antispasmodic will relieve the symptoms of renal colic, relax the walls of the ureters and expand the diameter of the organ. Antispasmodic drugs will work faster if they are administered by injection.
2. To quickly remove kidney stones, it is recommended to take a bath with hot water (no more than 39ᵒC) and lie in it for about half an hour. While the procedure lasts, you need to drink a warm diuretic mixture. If the patient shows signs of pyelonephritis, you should not take a bath under any circumstances.
3. After the water procedure, the patient must perform physical exercises that accelerate the movement of the stone along the ureter (climbing and descending stairs, bending, squats).
4. During each process of urination, the excreted urine is collected in a separate container in order not to miss the stone that comes out of the body. It is also necessary to pay attention to the color of the urine and the presence of blood in it. All this information must be shared with your doctor in order to prescribe an effective course of therapy.
5. The calculus that leaves the body is submitted to a laboratory for analysis to determine its composition. Based on the laboratory tests obtained, the doctor selects further treatment for the patient.

If the movement of stones occurs with vomiting, high fever, nausea and bleeding, self-medication is life-threatening. In this case, an ambulance is urgently called.

The passage of kidney stones is always very painful. A person suffering from nephrolithiasis should always be prepared for the possible movement of stones and be able to provide first aid. If symptoms of kidney stones appear for the first time, the patient must visit a doctor and begin treatment for the disease.

You can also get acquainted with the opinion of a specialist by watching this video, where he talks about kidney stones, and what needs to be done if the stones have passed.

source

There are a number of options for removing kidney stones at home. Our kidneys filter approximately 200 liters of blood every day. The slightest malfunction in the functioning of this organ can have a very bad effect on the condition of the body as a whole and cause a number of unpleasant diseases.

One of the most common causes of organ failure is kidney stones. It is easy to get rid of this phenomenon in medical hospitals, but most modern citizens are afraid to seek help from doctors or simply do not trust them. Today we will consider options for removing stones outside the hospital.

The first and easiest way to remove stones is to drink plenty of liquid. It is especially good to drink beer, which has a diuretic effect, but do not get carried away. Water, along with other types of liquid, carries away various toxins that accumulate in the body. If a person does not drink enough fluid throughout the day, the outflow of urine slows down and the crystals in its composition begin to grow together, forming foreign bodies. The amount of water you drink per day should be at least 10 glasses.

If stones already exist, then the patient needs to drink mineral waters, such as Borjomi or Essentuki. Depending on the type of stones, doctors adjust therapy. If the kidney stones are phosphate, then you need to drink Areni or Naftusya; in the case of oxalate neoplasms, you need to drink a mineral water called Sairme.

Oxalate stones are formed due to excessive consumption of chocolate, rhubarb, beets, strawberries, coffee, nuts and soda. As for nutrition, people who often develop kidney stones require a diet that includes a reduced amount of animal protein and salt.

There are a number of products that remove kidney stones at home. The first among these products I would like to mention is lemon. If you don’t know how to get rid of kidney stones, a folk recipe that consists of lemon juice, olive oil and water will help you. All ingredients are mixed together and consumed in the morning on an empty stomach, then at lunch and in the evening before meals. The duration of the course of such treatment should not exceed 10 days. The fact is that lemon juice is a very aggressive substance, and it can harm the functioning of the gastrointestinal tract. People with gastritis and ulcers are strictly prohibited from using this recipe for treatment.

Kidney stones can be removed using traditional medicine recipes, which involve treatment with improvised means and products that are likely to be found in everyone’s home. Among the most effective treatment methods are the following:

1. Grate the carrots on a coarse grater and pour boiling water over them. Leave the infusion overnight and then drink a glass once a day for a month. It is important to note that the infusion must be heated before use. The same can be done with carrot seeds; they also have a softening effect and remove kidney stones.
2. Black radish combined with honey will help get rid of stones in just a few steps. The mixture should be consumed half an hour before meals for a week.
3. The jar is filled with chopped onion rings and vodka is added. The mixture is infused for 11 days, then drunk 2 times a day before meals. It is important to mention that you only drink three tablespoons of liquid; you do not need to eat onions.
4. Watermelon rinds are cut into small pieces and dried in the sun. After that, they are crushed in a blender and boiled with a small amount of water for 5 minutes. Next, the mixture is cooled and consumed before meals for 2 weeks.
5. Cucumber, lemon and beet juice work very well against kidney stones. All of the above juices need to be mixed together and added 4 tablespoons to a glass of water. You need to drink juices for 14 days.
6. Dry figs are poured with milk and boiled for 5 minutes. Be sure to drink the decoction hot, otherwise it will have no effect. You need to consume the mixture until the stones come out.
7. For many centuries, birch sap helped our great-grandfathers get rid of problems associated with the kidneys and genitourinary system. If you drink a glass of birch sap a day, you will never be affected by kidney failure and neoplasms in the pelvic organs.
8. Dried apple peel mixed with hot water is very active in the fight against large stones.
9. Treating kidney stones can sometimes even be enjoyable. Cranberry juice, which is so popular with most modern gourmets, also very well reduces calcium levels and generally prevents the formation of kidney stones.
10. At least once a week it is recommended to eat boiled wheat and drink it with the water in which it was boiled.

Herbs that remove kidney stones were known to our great-grandmothers, but I would like to specifically mention parsley. It not only removes toxins from the body, cleanses internal organs and increases potency in men, but also helps break up kidney stones, which are then easily removed along with sand. Parsley extract is even used to make effective medicines. At home, medications can be replaced with regular parsley tea. It is important to leave tea for half an hour before drinking, and then drink 3 times a day before meals.

Nettle tincture is also very popular; it can be infused with vodka. You can also make tea by mixing nettle with mint and juniper.

Basil infusion is very effective in the process of removing kidney stones. The only disadvantage of this option is the long-term treatment: you need to drink a decoction of basil for at least six months.

Bear's ear grass is familiar to few; the second name of this plant is bearberry. If you ask at the pharmacy, they will definitely offer you an already dried mixture. Bearberry has a disinfectant and diuretic effect, it is very effective in treating diseases of the bladder, urinary tract and kidneys.

Healers and traditional healers recommend mixing hemp seed with milk. But before mixing, the seed needs to be ground in a meat grinder so that it becomes powdery. Milk with hemp powder is steamed and consumed a glass a day for a week. According to many, in a couple of days you will notice a significant improvement in your condition, the pain will go away, and the stones will come out without effort.

Aspen bark and its leaves are also actively used in folk medicine to get rid of cystitis, bladder diseases and kidney stones. The bark or leaves are steamed with boiling water and drunk 3 tbsp. l. 2 times a day.

Corn silks, along with cherry stalks and honey, are brewed in boiling water and consumed as tea for 3 weeks. The amount of the drink is not limited, since excessive consumption of tea will not cause any harm; rather, on the contrary, it will quickly cleanse the body of toxins and toxic substances that accumulate in the body.

I collect pine cones in the spring, when they are still green, put them in a pan and add water so that it fills the pan by a third. The cones are brought to a boil and the broth is allowed to brew for half an hour. Drink the tincture 3 times a day after meals. This treatment option will get rid of stones in a week.

You can remove kidney stones using horsetail. A decoction from it should be drunk on an empty stomach and combined with a diet. You need to drink the infusion and stick to the diet for 3 months. Often a stone preparing to be released causes excruciating pain to a person, therefore, before helping to remove it, it is necessary to crush it into sand. Small grains of sand are passed out in urine much more easily than large stones. The benefit of the decoction is explained by the fact that, before expelling the stone from the kidney, horsetail softens it and reduces pain.

It is important to note the fact that before starting self-treatment for kidney stones and using herbal decoctions, you should definitely consult a doctor. Sometimes stone-removing foods or infusions may cause allergies or be contraindicated for you to consume due to the presence of additional diseases, such as diabetes or ulcers.

If the above methods do not produce results within a month, and the pain does not stop, do not tempt fate and immediately seek help from medical staff.

source

Complete collection and description: where kidney stones go and other information for human treatment.

Pain in the side against the background of kidney stones becomes quite pronounced when a kidney stone passes through the ureter. What to do and how to relieve the pain? Especially if the stone gets stuck in the ureter.

The main causes of severe pain in the side or lower back when a stone moves from the kidney to the ureter are the following factors:

• The stone gets stuck in the ureter, blocking the flow of urine.
• Stagnation creates conditions for the accumulation of urine in the renal collecting system.
• An increase in intrapelvic pressure leads to irritation of nerve receptors.
• Blood flow in the renal arteries is disrupted, which causes ischemia of the renal parenchyma.

If a stone comes from the kidney, the pain will be comparable to the sensations a woman feels during the pushing period of labor. With one significant addition - with the birth of the baby, the pain disappears, but with a stone stuck in the ureter, severe pain lasts a long time and will not immediately disappear even with treatment.

Macroliths or coral stones are inactive, so it is extremely rare that a large stone moves towards the ureter. Sand will come out of the kidneys with minimal sensation. Typically, pain occurs when moving microliths, the size of which does not exceed 10 mm. The movement of a stone from the kidney to the ureter is provoked by the following factors:

• one-time large intake of fluids;
• running or brisk walking;
• jumping or team sports;
• riding a bicycle or motorcycle over rough terrain;
• severe shaking when driving a car on a rough road.

Sudden onset pain primarily occurs in the lower back or side, but almost immediately begins to move down through the lower abdomen to the groin and thigh. A person cannot find a comfortable position - with any change in body position, nothing changes. The severity of the pain syndrome is so strong that screams and moans are possible. It is at this moment that first aid should be provided before the doctor arrives, but you just need to know what you can do and what you cannot do.

Before the doctor appears, the main thing to do is to try to relieve the pain. However, all methods of pain relief can be used only if you are 100% sure that the pain syndrome is caused by the passage of a kidney stone. This is usually possible with repeated episodes of renal colic.

If severe pain in the right side appears for the first time and no previous examination for kidney stones has been carried out, then the only emergency treatment option will be to take any antispasmodic drug. This measure will somewhat reduce the intensity of the pain syndrome. An emergency physician will be able to distinguish the movement of a stone from the right kidney from acute appendicitis or an attack of cholelithiasis.

If the pain is on the left, then taking strong painkillers will hide from the doctor acute conditions not related to the kidneys (perforation of hollow organs, intestinal obstruction, splenic infarction). Pain in the back and lower back can be caused by pathologies of the spine (dorsopathy, osteochondrosis, herniated disc).

If the diagnosis of nephrolithiasis was made earlier and the stone comes out of the kidney not for the first time (repeated episode of renal colic), then you can safely use the following remedies:

• any method of thermal treatment on the area of ​​pain (hot heating pad on one side, bath with water temperature about 40°);
• ingestion of medications with analgesic and antispasmodic effects;
• It is advisable to use injectable drugs, but only if there is a medical worker nearby who can give intramuscular or intravenous injections.

Even if the acute pain has disappeared, you cannot refuse a doctor’s examination and further treatment in a hospital. This is necessary due to the following factors:

• getting rid of unpleasant sensations is not at all a criterion that the stone has passed from the kidney;
• if the calculus comes from the kidney, then this is always accompanied by difficulty in the outflow of urine, which can cause dangerous complications (hydronephrosis, acute pyelonephritis with suppuration, renal failure);
• after the end of the analgesic effect, the pain will return with renewed vigor.

When a stone passes from the kidney through the ureter to the urinary tract, it is always accompanied by severe pain. Before the medical team arrives, you can try to provide first aid, but only if you are completely confident in the diagnosis. All basic treatment measures to get rid of renal colic will be performed by a doctor.

Urolithiasis is the formation of stones in the organs responsible for filtering and removing urine from the body. At the initial stage of the disease, no special signs are noted. But when the calculus reaches a large size or begins to move from its place, renal colic occurs.

Pain when stones pass from the kidneys is caused by irritation by the sharp edges of the mucous membrane. And if it passes into the ureter and clogs the urine output, then severe pain develops as a result of stretching of the kidney cavities with symptoms of hydronephrosis.

The passage of kidney stones in men and women may be accompanied by the following symptoms:

1. Severe pain at the site where the stone passes, in the lumbar region, with radiation to the thigh, genital area and groin. The pain can be paroxysmal or constant. At this time, the person cannot find a certain position and often screams and moans. It goes away after taking antispasmodics. But it stops completely only after the calculus comes out. The severity of colic can be so severe that it can only be relieved by administering narcotic analgesics.
2. Often the patient feels a frequent urge to empty the bladder. In this case, there is severe discomfort and burning. If the stone stops at the exit of the bladder, the stream of urine may become intermittent. You can urinate only when you change your body position.
3. The body's reaction to the removal of sand and stones may be an increase in temperature and blood pressure.
4. Sand and blood are found in the urine.
5. When the outflow is disrupted as a result of bilateral blockage of the ureters, anuria is noted.

Many people will be interested in the question of how long it takes for a stone to pass out of the ureter. The fact is that if the volume of the calculus exceeds the lumen of the organ, then the only way to get rid of it is through lithotripsy or surgery.

The pain that the patient suffers during the passage of the stone greatly reduces his quality of life. And a violation of the outflow of urine can lead to various complications (pyelonephritis, hydronephrosis, the formation of a bedsore at the site of a solid formation, the development of renal failure).

How to speed up the passage of a kidney stone? Before doing this, you need to consult your doctor. If sand and small diameter stones are present, the following methods should be used:

1. Drink at least 1.5-2 liters of liquid per day.
2. Take medications to dissolve stones as recommended by a specialist.
3. Follow a diet, which may vary depending on the quality of the formations.
4. Perform special exercises to remove their kidneys.

How to speed up the exit from the ureter? If it gets stuck in this organ, then the symptoms become very pronounced. To help with this condition, you can do the following:

1. Take an analgesic or antispasmodic. In this case, no-spa or papaverine in the maximum single dosage helps best.
2. Sit in a hot bath for 15-20 minutes, while drinking liquid or a decoction of diuretic herbs.
3. After this, you should do exercises to remove the stone from the ureter - jump, stand on your toes, drop sharply on your heels, do bends. This will allow it to pass into the bladder.
4. After this, it is best to urinate in the bowl to make sure that the foreign body comes out.
5. To get the most objective picture, you should go for an ultrasound, and also give the stone for examination. This will make it possible to determine its qualitative composition and determine the tactics of treatment and prevention of further stone formation.

If at the peak of an attack the temperature, pressure rises, or hematuria begins, then it is not worth the risk. You need to immediately call an ambulance, and before the doctor arrives, take an antispasmodic and put a heating pad on the sore spot.

Treatment of the kidneys after the passage of a stone must begin immediately. To do this, you need to go to the doctor and undergo a comprehensive examination, since there may still be stones in the kidneys and other organs. If present, a urologist or nephrologist can make recommendations on how to carry out subsequent therapy. This may be taking lithilytic drugs, using remote or contact lithotripsy, endoscopic or abdominal surgery.

In the event that a new stone is not detected, all preventive measures must be taken. To do this you should:

1. Follow a diet (which is prescribed individually, depending on the qualitative composition of the stone, as well as taking into account concomitant diseases).
2. Drink enough fluids (provided there are no contraindications). Water should only be used in purified form.
3. Use courses of treatment with decoctions of anti-inflammatory and diuretic herbal preparations. Drink juices and fruit drinks made from lingonberries and cranberries, which have antibacterial properties.
4. Perform special exercises from time to time.
5. Monitor your weight and metabolism, lead an active lifestyle.
6. Treat urinary tract infections in a timely manner and sanitize sources of chronic infection throughout the body.
7. Be examined by ultrasound from time to time to rule out relapse.
8. If symptoms of urolithiasis develop, immediately go to see a doctor, and in an acute condition, call an ambulance.

How to expel kidney stones to relieve the body of pain and suffering?

This question is worth its weight in gold. People, having discovered a stone or stones in themselves, begin to ask this question, because they understand what consequences may occur.

I get stones all the time. What I feel? My leg always hurts. From the description of the symptoms of urolithiasis, this is considered pain in the groin. I feel like my leg is being unfastened. Sometimes the process is very long – it constantly drags on and on. It gets boring with its tediousness and really gets on your nerves. I try not to endure or procrastinate until it gets worse, but to get down to business right away. The main thing is that I know how kidney stones come out, and I imagine the whole process.

I want to warn you right away that I use this method of removing the stone because I know for sure that my stone is small and is capable of coming out on its own. I undergo an ultrasound of the kidneys and an ultrasound of the bladder, and make sure that the size of the stones is no more than 2-5 mm, only then I get down to business. If your stone is larger in size, then you should think about whether it is worth using this method? Renal colic is a terrible thing and should not be allowed to happen.

So, My actions:

1. The first thing I do is drink at least a liter of water - the stone can only pass through urine. It would be good to drink some kind of diuretic. Phytolysin (suitable during pregnancy), pol-pal, or any other diuretic will do. Watermelon is also good, if it’s in season, of course.
2. I give my body physical activity. For example, I take my daughter’s jump rope and jump. It’s funny, of course, a 43-year-old man jumping on a skipping rope, but my family has already gotten used to it. You can use any other physical activity associated with shaking the body - football, volleyball, basketball, even just running. It is very effective to go out into the entrance and jump off the steps. I go down this way, then get up, and jump off again. This causes the stone to move towards the ureter.
3. After this, I take no-shpa to relax the smooth muscles of the urinary tract
4. And immediately take a hot bath. Heat dilates the urinary ducts. The temperature of the water in your bath should be as hot as possible, but such that it can be maintained for quite a long time - at least an hour. While taking a bath, it is necessary to maintain the water temperature
5. After the bath I drink water again and jump rope.

All this is done in order to ensure the passage of the kidney stone with maximum comfort and minimal losses. Delighted by the wide path that has opened, pushed by a large amount of urine, the stone rushes towards the exit. If desired, you can catch it - if you urinate in some kind of dish or through a sieve.

What I do won't suit everyone. Not all people can jump rope and take a hot bath for health reasons. But they can be replaced: a jump rope for walking, a bath for a hot heating pad in the lumbar region and ureters. So go ahead, the method is correct.

I am pleased to share with you my experience on how to get rid of kidney stones. What methods do you use?

1. An easy way to remove kidney stones using juniper
2. How to dissolve kidney stones? Fir oil and knotweed!
3. A young woman got rid of oxalate stones with the help of a watermelon diet
4. Sand in the kidneys, treatment with folk remedies - the experience of one pensioner
5. How to remove sand from your kidneys in one day - a real story

Renal colic: painful, scary, incomprehensible.

This material is for educational purposes only and should not be used as a guide to diagnosing or treating renal colic at home. All therapeutic and diagnostic measures must be carried out under the supervision and with the participation of a certified urologist.

In addition, even with “banal” urolithiasis, serious complications are possible, which, if treated inadequately or untimely, can lead to kidney loss or even death.

What is renal colic?

Let us turn to the urology textbook for students (Lopatkin N.A.): “Renal colic is an attack of acute pain, the most characteristic symptom of kidney and ureteral stones. The cause is a sudden cessation of urine flow caused by a stone blocking the upper urinary tract.”

What are the manifestations of renal colic?

The most typical, although optional, sign of renal colic is its acute onset. Intense pain in the lower back (on one side) occurs suddenly; for illustration, let me quote the words of one of the patients: “I was riding in the elevator, and suddenly I got such a headache that I sat right on the floor...”. The pain is constant and does not go away with changes in body position. Attempts to find a position in which the pain would decrease do not yield results. Bilateral renal colic is possible, but extremely rare.

Having once experienced an attack of sudden severe pain in the lumbar region, a person will remember them until the end of his days. In terms of the intensity of the pain syndrome, renal colic can only be compared with myocardial infarction or perforation of a stomach ulcer. Often, patients with renal colic are transported from the ambulance to the urologist's office on a gurney, because the pain makes it difficult for them to even walk. For pain relief, as a rule, drugs such as analgin, no-spa or ketorol are traditionally used, but in some cases pain can only be relieved with opiates.

In addition to pain, renal colic may be accompanied by the appearance of blood in the urine (hematuria), nausea and vomiting, as well as frequent urination in small portions (pollakiuria or dysuria).

At the same time, there are cases where the passage of a stone from the kidney with a violation of the outflow of urine through the ureter occurs without pronounced symptoms. Patients describe their complaints very vaguely and cannot clearly indicate the side and nature of the pain. Such renal colic, detected by chance, for example, during ultrasound examination, is called atypical.

Why does vomiting often occur with renal colic?

The reason lies in anatomy, or rather, in the structure of the nervous system. The kidneys, like the gastrointestinal tract, are innervated by the celiac plexus (sometimes also called the solar plexus). Intense irritation of this plexus when the outflow of urine from the kidney is disrupted is similar to irritation of the stomach or intestines during, for example, poisoning. Vomiting occurs reflexively. That is, our body tries to get rid of the irritant in this way. As a rule, vomiting brings little relief. In case of severe nausea, the drug cerucal is prescribed (which in Western countries is included in the standard treatment regimen for renal colic). For the same reason, due to irritation of the celiac nerve plexus when a stone passes through the ureter, constipation and bloating may occur, which requires adherence to a certain diet, which will be discussed below.

Why do you feel like you always want to go to the toilet?

Again, it’s all about the peculiarities of innervation. The so-called “false urges” that occur with renal colic are associated with irritation of the nerve endings in the ureter when the stone reaches its lower third. At the same time, pain may appear in the groin, scrotum, and head of the penis. As a rule, these sensations disappear immediately after the stone passes. The appearance of frequent urination during renal colic is a good prognostic sign; most likely, the stone has passed almost the entire length of the ureter and is in close proximity to the bladder. At the same time, it should be remembered that the narrowest part of the ureter is the place of its connection with the bladder (the so-called juxtavesical and intramural sections). To clarify the location and size of the stone, excretory urography is indicated.

What diseases can cause renal colic?

The cause of renal colic is a violation of the outflow of urine through the ureter. In the vast majority of cases, this is a ureteral stone, but similar pain can also occur when the ureter is blocked by a blood clot, for example, due to injury or tumor, in severe purulent pyelonephritis with such a rare complication as necrotizing papillitis, in tuberculosis, in a tumor of the ureter or urinary tract. bladder with narrowing of the lumen of the ureter. In addition, renal colic can occur when the ureter is ligated during surgery on the pelvic organs (for example, hysterectomy), which, unfortunately, is not so rare, or due to compression of the ureter from the outside by enlarged lymph nodes or a retroperitoneal tumor.

What can provoke an attack of renal colic?

Usually our patients find it difficult to answer what, in their opinion, could provoke an attack of renal colic. Pain can appear during rest, at rest, during sleep, or when performing everyday, habitual activities. Sometimes an attack is preceded by a long drive on a bumpy road, water stress (for example, eating watermelon or drinking beer), a blow to the back or a fall (including due to an accident) - that is, factors that can “move” the stone from its place. From personal experience, I can say that I have repeatedly observed how renal colic (usually salt colic, which goes away after a few hours) occurred soon after starting to take herbal preparations aimed at preventing urolithiasis.

Pregnancy can also promote the passage of kidney stones due to the physiological expansion of the upper urinary tract observed in the third trimester.

And yet, in the vast majority of cases, renal colic occurs spontaneously, without any provoking factors.

What is the mechanism of pain in renal colic?

Pain occurs due to impaired blood circulation in the kidney due to a sharp increase in pressure in the collecting system. The following happens: urine continues to flow into the renal pelvis, it cannot pass through the ureter, as a result, the enlarged pelvis and calyx “burst” the kidney from the inside, which leads to compression of the renal tissue and the vessels passing through it. Pain similar in mechanism and intensity occurs during myocardial infarction, when blood circulation in the corresponding area of ​​the heart muscle is disrupted due to blockage of a coronary vessel.

The intensity of pain does not depend on the location or size of the stone. A severe attack of renal colic can be caused by the passage of a stone whose diameter does not exceed 1-2 mm. Therefore, there is a common expression among urologists: “Stones are like dogs: the smaller, the meaner.”

What diseases are similar to renal colic?

Pain similar to renal colic can be caused by acute appendicitis, ectopic pregnancy, torsion of an ovarian cyst, acute pleurisy, pneumonia, kidney infarction, herpes, osteochondrosis, myocardial infarction, and so on. It is obvious that self-medication is unwise and dangerous, especially since renal colic has clear signs that are revealed during a standard instrumental examination in a hospital setting. Treatment should be carried out only after an examination confirming the diagnosis, preferably under the supervision of a hospital urologist who has the ability, if necessary, to hospitalize the patient.

What causes the appearance of blood in urine?

The appearance of blood in the urine (hematuria) is caused by traumatic damage to the wall of the ureter with a stone and is a very characteristic, but not obligatory sign of renal colic. In the case of complete kidney blockage, when urine completely stops flowing into the bladder due to a stone, or when the stone has a smooth surface, a general urine test may remain normal. Conversely, when bleeding from the kidney, renal colic itself may be caused by blockage of the ureter not with a stone, but with blood clots.

Can a stone pass out of the ureter and remain in the bladder?

This is possible, but unlikely. The lumen of the urethra is much wider than the lumen of the ureter, so stones, as a rule, are not retained in the bladder. But, as you know, there are exceptions to any rule. In a number of conditions, and, above all, in the presence of BPH (prostate adenoma) or urethral stricture, the likelihood of stone retention in the bladder increases sharply. In most cases, such a stone is removed through the urethra without resorting to open surgery.

What diagnostic methods are used for renal colic?

The beginning of any examination is to examine the patient and find out the history of the disease (amnesis). Thirty years ago, an aphorism was popular among doctors: “A carefully collected anamnesis is half the diagnosis,” however, in the 21st century, of course, the leading role in the diagnosis of renal colic belongs to ultrasound examination (ultrasound) of the kidneys and x-ray of the urinary system with a contrast agent (so called excretory or intravenous urography). In addition, a general urine test and a complete blood count are performed.

What does an inspection reveal?

In a patient with renal colic, upon examination, it is possible to detect pain in the kidney area, sometimes along the ureter; in addition, the examination allows, as a first approximation, to exclude acute surgical diseases, and in men, diseases with colic-like manifestations, such as acute prostatitis and diseases scrotal organs.

What information does ultrasound (ultrasound) provide?

Ultrasound examination impresses with its safety, accessibility, low cost and the ability to quickly, sometimes in a few seconds, confirm the presence of renal colic.

The most striking and frequently observed sign of renal colic on ultrasound is the expansion (dilatation) of the collecting system of the kidney. Sometimes you can see stones in the uppermost or lowermost part of the ureter or directly in the kidney or bladder; in addition, ultrasound allows you to exclude a tumor of the kidney or bladder, assess the condition of the renal parenchyma, surrounding fiber, kidney mobility, etc.

Unfortunately, not all patients with renal colic have a characteristic ultrasound picture, which may be due to anatomical features (for example, the presence of an intrarenal pelvis) and the duration of renal colic (after several days, the expansion of the collecting system may disappear, although the stone is this remains in the ureter, and the kidney does not excrete urine) and simply with insufficiently good conditions for ultrasound (for example, in obese patients or with increased gas formation). In addition, as a rule, ultrasound does not allow assessing the condition of the ureter along its entire length and identifying the stone located in it, as well as determining its size. That is why it is necessary to combine ultrasound of the urinary system with excretory urography.

What is excretory urography?

The gold standard in diagnosing renal colic is an X-ray examination of the urinary system with contrast (excretory urography). It is performed as follows: first, a picture is taken without the drug ( survey urography), then a radiopaque contrast agent is injected intravenously ( contrast), which has two remarkable properties: firstly, it is very quickly taken up by the kidneys and excreted in the urine, and secondly, this substance does not transmit x-rays. Thus, by taking pictures after the administration of contrast, we can monitor the progress of urine through the urinary tract and identify or exclude the presence of an obstruction (stone) in the ureter. In addition, we receive important information about the anatomy of the urinary tract, the condition of the opposite healthy kidney, etc. Most often, in case of renal colic, with the help of this study it is possible to clearly trace where the stone is located and what its size is, and, therefore, to assess the likelihood of its spontaneous passage during stone-expelling therapy.

Contraindications to excretory urography are thyrotoxicosis (increased thyroid function) and allergy to iodine. In addition, excretory urography is not performed in the presence of chronic or acute renal failure, as well as in low blood pressure.

Why do a general urinalysis and a general blood test be performed?

First of all, to exclude the inflammatory process in the kidney. Disturbances in the outflow of urine from the kidney create favorable conditions for inflammation (so-called obstructive pyelonephritis), which is manifested by fever, general malaise and characteristic changes in urine and blood tests. The likelihood of developing acute pyelonephritis depends on a number of factors, including gender: in men it is tens of times less than in women. In addition, if there is doubt about the diagnosis, the appearance of blood in the urine serves as an additional argument in favor of renal colic.

What is “salt” renal colic?

There are often cases when, after pronounced renal colic, relief occurs very quickly, although it is not possible to catch the stone even with a careful examination of the urine sediment. Ultrasound and x-ray also do not reveal the stone, although all other signs of renal colic are present. In such cases they talk about salt renal colic.

What other diagnostic methods are used for renal colic?

In addition to ultrasound and excretory urography, in rare cases, multislice computed tomography (MSCT) with contrast and three-dimensional reconstruction is performed, as well as radioisotope testing of renal function - dynamic nephroscintigraphy. In addition, to assess the patency of the ureters, chromocystoscopy is sometimes performed (intravenous administration of a urine coloring substance (indigo carmine) followed by observation of the area of ​​the ureteral orifices) or the release of urine from the orifices is recorded using Doppler scanning. However, ultrasound and excretory urography still remain routine methods.

What can be done for renal colic at home before the ambulance arrives?

The simplest and most accessible remedy for an attack of renal colic is a hot bath or shower.

Since the ambulance does not always arrive quickly, especially in a city like Moscow overloaded with traffic jams, and the pain can be unbearable, you need to know how you can alleviate your condition before the doctor arrives. To reduce pain, traditional drugs are used: no-spa, baralgin, dexalgin, ketonal.

Neither attempts to find a “comfortable position,” nor artificially induced vomiting, nor an enema or gastric lavage with “potassium permanganate” (this also happens) bring relief. In a hospital setting, a number of drugs are used for pain relief, including (rarely) narcotics.

How is renal colic treated?

First of all, it is necessary to determine what disease caused the renal colic. In most cases, this is urolithiasis (UCD). The examination allows you to assess the size and location of the stone, sometimes its composition, and determine the likelihood of its passage when appropriate therapy is prescribed. If this probability is low, then the issue of surgical treatment is immediately considered, which means a whole range of manipulations, ranging from extracorporeal lithotripsy (crushing using mechanical waves focused on the stone) and ending with open surgery. However, it should be noted that in urological clinics, equipped with all modern methods of treating urolithiasis, open operations are performed in less than 3% of patients.

What is stone expulsion (lithokinetic) therapy?

If, during examination of the patient, a ureteral stone is detected, the size and location of which allows us to hope for its spontaneous passage, then medications are prescribed that accelerate this process and alleviate the patient’s suffering. Typically, the treatment regimen includes:

Antibiotics (to prevent pyelonephritis)

Antispasmodics (to dilate the ureter)

Alpha blockers (to relax ureteral smooth muscle cells)

Nonsteroidal anti-inflammatory drugs (NSAIDs) (to relieve swelling of the ureter at the site of the stone and for pain relief)

In addition, steroid hormones, calcium channel blockers, antiemetics, herbal preparations, etc. are used.

Do I need to follow any diet while passing a stone?

Yes. When a stone passes, we often encounter intestinal dysfunction, which is associated with irritation of the celiac nerve plexus. Most often, we are talking about constipation, bloating of the intestines, less often the passage of a stone is accompanied by painful nausea and even vomiting, which can force one to abandon wait-and-see tactics.

To normalize intestinal function, it is necessary to refrain from eating gas-forming foods (brown bread, cabbage, zucchini, legumes, drinks with a high sugar content, including juices and carbonated drinks).

Fluid consumption should be within 1.5 - 2 liters.

If there is no stool for 2-3 days, laxatives or a cleansing enema are prescribed.

What to do if the temperature rises during stone passage?

An increase in temperature may be a sign of kidney inflammation (acute pyelonephritis). In such cases, hospitalization and drainage (ensuring the outflow of urine) of the kidney using a ureteral catheter or nephrostomy are necessary, after which antibacterial therapy can be carried out. Acute obstructive pyelonephritis is a dangerous and rapidly developing process. Kidney abscess, the development of urosepsis, and even the death of the patient can be a consequence of late seeking help. In rare cases, 2-3 days are enough for the development of purulent melting of the kidney with the formation of an abscess, therefore, if fever appears during a course of stone-expelling therapy, it is necessary to urgently contact a urologist to continue treatment in a hospital setting.

How long can I wait for the stone to come out?

We usually prescribe stone expulsion therapy for 10-15 days. If during this time it does not produce results, a follow-up examination and a revision of treatment tactics are necessary. As a rule, extracorporeal or contact lithotripsy is indicated; in some cases, continued conservative treatment is possible. If the stone remains in one place for a long time, then as a result of swelling and inflammation of the ureteral wall, fibrosis develops (formation of scar tissue), which seems to “fix” the stone in this position. Such so-called “impacted” stones are difficult to crush, both during remote and contact lithotripsy. When removing such stones, there is a high risk of injury to the ureter, which may require open plastic surgery to remove.

Unfortunately, we often have to deal with a rather frivolous attitude towards this disease, both on the part of some doctors (usually not urologists) and on the part of patients. The consequences of such an attitude are very dire.

How can you “help” a stone pass out of the ureter?

First, let's talk about what not to do.

First of all, there is no need to try to “squeeze out” the stone by drinking plenty of fluids; it is enough to maintain fluid intake at 1.5-2 liters per day. (In the auditorium of the Urology Clinic on Pirogovka (MMA named after I.M. Sechenov) there is a poster: “It is not urine that drives stones, but the skill of the doctor”). The fact is that when a stone is in the ureter, the kidney practically does not work and all urine is excreted by the second healthy kidney. The advancement of the stone is carried out due to contractions of the ureter similar to intestinal peristalsis.

Recommendations like “jumping on one leg” or “running up the stairs” are also devoid of any meaning, although at the beginning of the 20th century, industrially produced mechanisms were proposed for “shaking out” stones from patients, which today are of only historical interest.

The main “help” for the stone lies in strictly following the recommendations given by your urologist and adhering to the terms of treatment. If conservative therapy is ineffective within 10-15 days, hospitalization for lithotripsy is indicated.

What is extracorporeal lithotripsy (ESLT)?

This is a method of breaking up urinary stones using mechanical waves focused under X-ray or ultrasound guidance on the stone. The method has been used for more than 20 years and has proven itself as a first-line method. The main advantage is its non-invasiveness, that is, there is no need to introduce any instruments into the patient’s body. When the indications for the use of this method are correctly determined, the effectiveness of extracorporeal lithotripsy exceeds 95%.

What is contact lithotripsy?

This is a method of breaking up urinary stones using a laser or mechanical energy transferred to the stone through direct contact with it. The method is invasive. Cystoscopy (instrumental examination of the bladder) is performed, then the ureteroscope is inserted into the ureter to the stone. Crushing is carried out under visual control. This method is most effective in removing stones from the lower third of the ureter.

What is a "stone path"?

During DLT (distance lithotripsy) of a ureteral stone, its fragments can form a “chain” in the lower segment of the ureter, which has a characteristic appearance on an x-ray and is called a “stone path”.

Is there anything I need to do if the pain goes away but the stone does not come out?

Yes. The ureteral stone must be removed. In my memory, there are several patients in whom, in the absence of any complaints, we found “forgotten” ureteral stones.

This situation always leads to the death of kidney tissue due to the development of hydronephrosis. All these cases ended with the removal of the stone along with the ureter and kidney (nephrectomy), therefore, if 2-3 weeks after the start of stone-expelling therapy, the pain has passed, but the stone has not passed, it is necessary to perform excretory urography - the simplest and most accessible method for assessing the condition and patency ureters.

What opportunities for diagnosing and treating renal colic are there at the City Clinical Hospital named after. S.P. Botkin?

Currently, we can proudly say that our hospital has all the existing modern methods for both diagnosing and treating urolithiasis. In most cases, to decide on treatment tactics for urolithiasis, we perform kidney ultrasound and excretory urography. In difficult situations, multislice computed tomography (MSCT) can be performed.

In four urological departments of the State Clinical Hospital named after S.P. Botkin, we have two units for remote lithotripsy (crushing stones), equipment for contact laser lithotripsy. Since 1986, in the urological clinic of the hospital named after S.P. Botkin, endoscopic (through a puncture in the lumbar region) methods for removing kidney stones (percutaneous puncture nephrolitholapaxy (PCNL)) are widely used. This method can be used to remove kidney stones of any size, including staghorn stones.

How can you avoid recurrence of renal colic after stone passage?

The likelihood of recurrent renal colic is not so high. Thus, according to the results of one study, when observing patients who had suffered renal colic for 10 years, repeated attacks occurred in only 25%. Following simple recommendations will greatly reduce the risk of recurrent urolithiasis. First of all, we are talking about the drinking regime and dynamic monitoring (periodically (every 3-6 months) ultrasound of the kidneys and a general urine test). In some cases, medications are prescribed for the drug prevention of urolithiasis (UCD).

Obviously, the greater the volume of urine excreted per day, the lower the concentration of salts dissolved in it and, therefore, the less likely the formation of new stones. Therefore, we recommend that all patients with urolithiasis increase their fluid intake. This is what is called the “drinking regime”.

If you are predisposed to the formation of kidney stones, you should drink at least 2-3 liters of fluid per day, and even more in hot weather. It should be understood that the formation of urine is not the only way to remove water from our body, although it is the most obvious. Even in normal cool weather, together with exhaled air, stool and sweat, we lose about 25-30% of the water we drink. In the heat of summer, fluid consumption should be increased so that the daily volume of urine is at least 1.5 -2 liters.

The easiest way to judge whether you're drinking enough is to look at the color of your urine. If it is almost colorless or slightly yellow, you are drinking enough. Conversely, deep yellow urine indicates that your chance of experiencing renal colic again is very high.

What medications are used to prevent urolithiasis?

There are a number of drugs proposed for the prevention (more precisely, metaphylaxis - prevention of relapses) of urolithiasis, however, there are no clear recommendations for determining the indications for their use and the duration of treatment. After determining the type of stone, drugs are prescribed that affect the pH of urine, xydiphon, madder, Uralit-U, blemaren. If there is a tendency to form urate stones, allopurinol is used to reduce the level of uric acid in the blood. The most popular drugs of herbal origin among urologists are: phytolysin, pol-pal, cystone, Canephron N. This choice is explained, first of all, by the safety of treatment. The purpose of a specific drug and the duration of its use are determined individually based on the patient’s age, the nature of the stones, the presence of concomitant pyelonephritis, etc.

In Russia, these are Caucasian Mineral Waters, primarily Zheleznovodsk. For people who have the opportunity to spend their holidays outside our homeland, we can recommend the Italian resort of Fiuggi, when visiting which you can combine relaxation and treatment with an interesting excursion program. Our experience shows that Fiuggi mineral water helps remove small kidney stones, normalize urine tests and has a beneficial effect on the course of chronic pyelonephritis.

You can ask your questions about the diagnosis and treatment of renal colic by phone: 518-58-70

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Urologists encounter urolithiasis more often than other ailments

Urolithiasis is one of the most common urological diseases. It can be asymptomatic for a long time, and then make itself known with acute pain, which twists a person at the most inopportune time and in the most inopportune place. How to detect this insidious disease in time? What new methods of treating urolithiasis have appeared today?

Don't give yourself a colic

Urolithiasis (or urolithiasis) has been known since ancient times. Urine stones have even been found in Egyptian mummies. Today, urologists encounter this disease most often - it is for this reason that up to 40% of patients turn to them. As a rule, the disease affects able-bodied people (20–55 years old), and in most cases, men (they suffer from urolithiasis (UCD) three times more often than women). Despite the relatively benign course and high effectiveness of existing treatment methods, the insidiousness of urolithiasis lies in the ability of kidney stones to migrate into the ureter, causing an attack of acute pain - renal colic. It manifests itself as unbearable pain in the lower back. This pain is cramping and can last for several hours or even days, periodically subsiding and renewing. Patients constantly change position, cannot find a place for themselves, often moan and even scream. At the peak of pain, vomiting, fever, and chills are possible. This condition in most cases requires emergency hospitalization.

But many people do not even suspect the presence of urolithiasis for the time being: for a long time, urolithiasis can be completely asymptomatic. Especially if the stones are located in the kidneys: such patients often find out about the disease by chance, during a routine ultrasound examination. You can suspect that you have urolithiasis by periodically appearing dull, aching pain in the lumbar region or lower abdomen. What is important: they are always associated with movement (including shaking, riding), changes in body position, urination or physical activity. Often, patients with urolithiasis also have blood in their urine (also after exercise). Another symptom that may indicate urolithiasis is frequent urination.

If you have the above symptoms, you should immediately consult a urologist. Under no circumstances should the disease be neglected, since stones in the kidneys and ureters will, over time, inevitably lead to the development of inflammation in these organs, and in the worst case scenario, to the loss of a kidney. “Modern diagnostics make it possible to detect kidney stones before the onset of an acute condition, when no unpleasant symptoms bother a person. The easiest way to detect urolithiasis is an ultrasound, but the “gold diagnostic standard” is a computed tomography scan of the kidneys. This method allows you to detect 94–100% of stones,” says Igor Semenyakin, head of the department of X-ray shock wave stone crushing of City Clinical Hospital No. 50, a doctor of the highest qualification category.

Sour and spicy foods lead to the appearance of stones

Today it is recognized that the basis for the formation of stones is metabolic disorders. It leads to the formation of insoluble salts, from which stones are formed - urates, phosphates, oxalates, etc. But even with a congenital tendency to urolithiasis, it will not develop if there are no predisposing factors. First of all, these include nutrition and drinking regime. So, spicy and sour foods increase the acidity of urine, making stones easier to form. In addition, stones “grow” more readily among lovers of protein diets (especially those with a predominance of animal protein) and fans of refined sugar, as well as among those who abuse foods or medications containing calcium. Urolithiasis can also be caused by a lack of vitamins A and group B, some metabolic diseases (including gout), injuries and bone diseases (osteomyelitis, osteoporosis), chronic diseases of the gastrointestinal tract, lack of water in the body (including due to infectious disease or poisoning), various diseases of the kidneys and genitourinary system (pyelonephritis, cystitis, prostate adenoma, prostatitis and others).

Kidney stones can be single or multiple (there are “constellations” that include up to 5000 stones!). The size of the pebbles also varies - from grains of sand with a diameter of 1 millimeter to kilogram giants. There are cases described when the mass of the stone reached 2.5 kilograms! In most cases, stones form in one of the kidneys, but in 9–17% of cases, urolithiasis is bilateral.

Treatment largely depends on the location, size, composition of the stone and the presence or absence of complications. In some cases (when the disease does not produce symptoms or the patient is simply afraid of surgery), the tactics of active monitoring of stones are allowed. But, as research results show, within 5 years, approximately 75% of observed patients have disease progression, and 26% ultimately resort to surgical treatment. In some cases, the prescription of special medications helps the stone pass. But often the pills turn out to be useless, and one day a stone gets stuck in the ureter, blocking its lumen and disrupting the outflow of urine from the kidney. This situation can cause acute, life-threatening inflammation of the kidney. In such cases, the patient requires emergency surgery. Well, since the process of stone formation is based on metabolic disorders, often after surgical removal of stones the disease recurs - and stones form again. About 50% of patients with recurrent stones have only 1 relapse in their entire lives, however, severe recurrent stones are observed in 10% of patients.

The history of the names of urinary stones is fascinating. For example, struvite is named after the Russian diplomat and naturalist G.Kh. von Struve. Stones made from calcium oxalate dihydrate (oxalates) are often called weddelites, because similar ones are often found in rock samples taken from the bottom of the Weddell Sea in Antarctica.

We crush stones with ultrasound

Until recently, all patients with kidney or ureteral stones faced serious abdominal surgery, followed by a long recovery. But recently, modern minimally invasive techniques have appeared that make it possible to treat urolithiasis, as they say, with little blood. One of such operations, as Dr. Igor Semenyakin says, is the so-called percutaneous lithotripsy. Today this technology is called the most progressive in the world. It allows you to instantly and completely remove large stones - and of almost any size. Through a small puncture in the lumbar region, a special instrument is inserted into the patient under ultrasound and X-ray control - a nephroscope, which “sees” the stones. “New instruments make it possible to narrow punctures to 5 mm - through such “holes” we can completely remove stones up to 3 cm in size,” notes Igor Vladimirovich. When the target is found, surgeons use a nephroscope to approach the stones with a lithotripter probe, which crushes them into small pieces. Large fragments are removed using forceps, and small fragments are washed out with a stream of water.

Traditionally, such an operation ends with drainage of the operated kidney with a special nephrostomy tube, with which the patient is forced to live for several days (until the urine is completely cleared). However, recently surgeons have been mastering a drainage-free method using a special hemostatic matrix. Like mounting foam, the gel fills the wound channel, sealing it and preventing bleeding. In addition, this technology reduces the risk of infectious complications in the postoperative period. And most importantly, the patient does not need to install any tube. According to Igor Semenyakin, when using a hemostatic matrix, the patient’s stay in the hospital is reduced by 4–5 days. Most often, after such operations, people are discharged home the next day.

Another modern technique is remote crushing of urinary tract stones using special acoustic waves emitted by a shock wave generator. This method is rightfully considered the least traumatic, since it does not require incisions or the use of any endoscopic instruments. Advanced methods include transurethral contact lithotripsy: during such an operation, access to the stone is carried out using a special instrument - a ureteroscope, inserted into the ureter through the urethra. Thanks to the built-in optical system, all manipulations are performed under the visual supervision of a doctor. If the size and composition of the stones are optimal, ultrasonic lithotripsy is possible - destroying them with ultrasound. “Today we perform such operations on patients (both Muscovites and all Russians) completely free of charge,” says Igor Semenyakin.

Diet can protect you from surgery

And yet, it is better not to bring the situation to the point of surgery, no matter how modern and good it may be. And prevention can help a lot with this. Without preventive measures within 5 years, in half of the patients who got rid of stones, they form again. The main component of prevention should be diet and a special drinking regime. People who have been diagnosed with or have already had kidney stones removed need to drink more than 2 liters of water daily: on an empty stomach, after meals, between meals, and before bed. It is advisable that part of the liquid be taken in the form of cranberry juice, which has a strong diuretic effect. If you drink tap water, be sure to buy a water filter and drink only filtered water. The more the patient drinks, the greater the chance that the sand will leave the body on its own, without having time to form into stones.

The diet for urolithiasis is aimed at reducing the concentration of stone-forming substances in the urine, which, in turn, helps stop the growth of small stones and can even lead to the dissolution of large ones. The principles of the diet depend on the chemical composition of the stones. So, with urate stones, you will have to limit the consumption of animal protein (especially in fried and smoked forms, as well as in the form of meat broths), legumes (beans, peas), chocolate, cocoa, coffee. It is recommended to consume approximately 1 gram of protein per kilogram of body weight per day. You should completely avoid alcohol and spicy foods.

If you have calcium stones, it is necessary to limit the consumption of lactic acid products, cheese, lettuce, sorrel, carrots, black currants, strawberries, coffee, black tea, cocoa. But the amount of other vegetables and fruits should be increased as much as possible: eating foods rich in fiber has a positive effect on the state of metabolism. You will have to be very careful with vitamin C: you can eat no more than 4 grams per day. Higher doses promote stone formation.

If you have phosphate stones, you should limit your intake of all dairy products, eggs, vegetables and fruits. But it is useful to eat as much meat, fish, and flour dishes as possible.

Doctors note that urolithiasis is often found in obese patients. Therefore, losing weight by reducing caloric intake reduces the risk of disease. Another important component of prevention should be a healthy lifestyle. Fitness and sports should become a healthy habit for patients with ICD, especially if their professions require low physical activity. In addition, such patients should avoid emotional stress.

ATTENTION! Patients with urolithiasis, in whom the size and shape of the stones allow us to hope that they will go away on their own, are indicated for treatment in sanatoriums with mineral waters. The diuretic effect of mineral waters often promotes the spontaneous passage of stones.

If you need a pawnshop that evaluates jewelry not only by weight and fineness, but also taking into account precious and semi-precious stones, then “Aleph” will buy or accept your jewelry as collateral at a cost close to the market, taking into account a comprehensive assessment, we can offer our clients competitive prices for products with precious and semi-precious stones.

Buying semi-precious stones in Moscow

Although semi-precious stones cannot be classified as the first category of stones, diamonds, rubies, emeralds, sapphires, they cannot be called cheap either. A natural stone of superior quality, excellent color and clarity, expertly cut and set into gold jewelry, can be worth much more than the price of the metal used and the work of the jeweler himself.

Many pawnshops do not even value precious stones, not to mention semi-precious ones, since they sell the products to the factory, but our main activity is the sale of jewelry, so we offer some of the most favorable conditions for the purchase of semi-precious natural stones.

How is gold jewelry with semi-precious stones valued?

Valuation at a pawn shop is completely free. Our gemologist, using special equipment, will carefully check the product itself and the stone and determine the final market value of this jewelry. If the assessment suits you, we will conclude a deal. Among the factors influencing the price, it is necessary to note the following: the condition in which the jewelry is located, in order for it to be sold, it must be attractive externally and internally, and not have various breakages and deformations. The newer and more beautiful the jewelry, the more expensive it is, accordingly. The stone itself - its exact value can only be determined by a specialist when studying the stone directly on the spot. Packages, receipts, certificates - if they are available, do not forget to take them, this will affect the final amount that we are willing to pay.

Do you buy semi-precious stones separately from the product?

Usually no, only in the product, but it happens that a stone may interest us. If you are sure that this is exactly the case, send good, clear photographs by email: [email protected] and we will give you an answer.

Price for purchasing semi-precious stones

We cannot tell you in advance, by phone or by mail, the exact price for which we will accept the jewelry, only an approximate price. To do this accurately, we need to fully examine the product itself on site. The weight and gold content of the metal, the quality and size of the stone, this is not all that is used to evaluate it, since we do not buy by weight, we must examine each piece of jewelry individually.

What semi-precious stones can be sold?

We buy jewelry with amethyst, aquamarine, garnet, rock crystal, topaz, peridot, citrine, quartz, agate, aventurine, turquoise, malachite, ametrine, jade, amber, jasper. The main thing is that it is a piece of jewelry using precious metals, gold, silver or platinum.

In some cases, we may consider purchasing or pledging items made from natural stones, boxes, figurines, watches, etc. If you need an assessment of such items, write to us by email, we will definitely take a look and give an answer.