Stage 1 cholelithiasis is the most important thing. Symptoms of gallstone disease and methods of treatment at home - diet and lifestyle


Cholelithiasis or calculous cholecystitis is a common lesion of the biliary system in adults. It consists in the formation of stones from the contents of bile in the bladder, and because of them, the patency of the bile duct is impaired.

Gallstone disease is found in half of people over 70 years of age. This disease is associated with malnutrition, low mobility, pathological metabolism with endocrine diseases and obesity, chronic inflammatory diseases liver, intestines and gall bladder, previous injuries to the abdomen and spine.

Signs of cholelithiasis do not appear immediately, but years later, when the disease reaches the clinical stage. Before this, it is asymptomatic. It can be detected accidentally during duodenal intubation and bile analysis.

Main symptoms

The main symptoms of gallstone disease appear acute attacks. During the interictal period they may be absent or have insignificant severity.

Pain is an obligatory symptom; it occurs in paroxysms and is called “hepatic colic.” The character is sharp, cramping or stabbing. Localized in the hypochondrium on the right. Give to right shoulder blade, collarbone, arm, in upper jaw. Sometimes they disguise themselves as an attack of angina, shift to the middle of the chest, and are accompanied by palpitations. During a prolonged attack, after a few hours it is clearly located in the area of ​​the gallbladder.

The pain is caused by a reflex spastic contraction of the biliary tract in response to irritation from the inside by a moving stone. The second option is overstretching of the gallbladder due to excess bile due to impaired outflow.

During the interictal period, cholestasis (stagnation of bile) occurs in the small ducts of the liver. The liver capsule is overstretched and tense. The pain becomes constant, aching, dull, and occupies the entire right hypochondrium.

The pain is accompanied by nausea and vomiting. The symptom of vomiting is more associated with irritation of the pancreas. The more expressed she is, the more interested she is. Sometimes it is permanent. Vomit contains bile.

Symptoms indicating complete blockage of the bile duct are yellow discoloration of the sclera of the eyes and skin. This is due to the entry of bilirubin into the blood through damaged gallbladder walls and dilated vessels.

At the same time, there is not enough stercobilin in the intestines, so the stool becomes light-colored. And urine becomes dark due to increased urobilin.

With a long course of the disease, you can consider the symptoms of a cholesterol metabolism disorder: xanthelasma (small rashes in the form of flat grains) yellow color on the eyelids, on the skin of the hands, shoulders.

Symptoms of cholelithiasis accompanied by inflammation (calculous cholecystitis) give an increase in temperature from low to 39 degrees and signs of intoxication: headache, weakness, dizziness, loss of appetite.

Insufficient flow of bile into the intestines disrupts the digestion process and causes diarrhea, followed by constipation, and bloating.

A patient suffering from cholelithiasis is distinguished by a character trait: he is irritable, uncooperative, subject to mood swings, decisions often change and depend on his well-being, and it is difficult to work with him in a team.

Upon examination, the doctor discovers a dry tongue coated with yellow coating. Yellowed sclera and skin. During palpation of the abdomen in the right hypochondrium, one can feel a tense edge of the liver, an enlarged gall bladder, sharp pain when pressing at the point of projection of the bubble. The skin over the bladder area has hypersensitivity when touched. Here the compacted and tense muscles of the abdominal wall are determined.

Causes of exacerbation and consequences

Patients associate the manifestations of exacerbation symptoms with diet violations, alcohol intake, severe physical activity, nervous tension.

The transition of pain from cramping to constant intense pain indicates inflammation of the gallbladder (cholecystitis) or bile duct (cholangitis). Movement brings new pain, so patients prefer to lie on their right side and not move. The temperature rises to a significant level.

Prolonged intense pain with temperature and changes in the blood may indicate phlegmon of the gallbladder wall (a bag of pus is formed), because the stone not only disrupts the outflow of bile, but also compresses blood vessels. As a result, the wall becomes thinner. When a rupture occurs, symptoms of peritonitis appear: a flat “board-shaped” tense abdomen, sunken cheeks, severe intoxication in the form of impaired consciousness, a drop in blood pressure. This condition is life-threatening.

The formation of fistulous tracts between the gallbladder and the small intestine due to the independent breakthrough of a stone through the wall can be indicated severe diarrhea. This symptom is caused by an abundant bypass flow of bile.

There are known cases when large stones broke through the wall of the gallbladder, entered the intestines through the fistula, and then moved with the contents to the place of transition small intestine into the thick one (ileocecal angle) and blocked the sphincter located here. In this case, symptoms of intestinal obstruction appear: pain around the navel, impaired passage of gases and feces.

A rare disease that cannot be fully called the result of gallstone disease is gallbladder cancer. It occurs in one in a hundred patients. It is not entirely clear what comes first here: cancer or stones.

Examination methods

The following examination results help to establish the correct diagnosis:

  • general blood test (leukocytosis and accelerated ESR);
  • biochemical liver tests (transaminases, alkaline phosphatase, bilirubin, cholesterol);
  • visual identification of stones ultrasound examination(ultrasound) or x-ray;
  • Magnetic resonance and computed tomography serve as additional more precise methods diagnostics

If cholelithiasis is suspected, all symptoms must be compared with heart disease, lower lobe pneumonia, and acute intercostal neuralgia. This is the doctor's job. You should not try to make a diagnosis on your own. This only prolongs the time required for treatment.

Gallstone disease (cholelithiasis) is a disease characterized by the formation of stones (another name is calculi) in the gallbladder. Stones can also be found in bile ducts, this type of disease is called choledocholithiasis. Typically, stones form in the gallbladder. Those stones that are found in the bile duct most often enter there with the flow of bile from the gallbladder, but the primary formation of stones in the bile duct is also possible.

Currently, gallstones are detected in approximately every tenth adult. Women suffer from cholelithiasis two to three times more often than men. This is explained by the influence of the female sex hormone, estrogen, on the properties of bile. Under its influence, the cholesterol content in bile increases, it becomes more lithogenic, that is, capable of stone formation.

The mechanism of stone formation in gallstone disease

Stones are formed as a result of a violation of the chemical composition of bile. The gallbladder functions as a storage reservoir for bile, where bile “ripens”, acquiring the functions necessary for the digestive process, and from where it enters the duodenum. If the chemical balance of the components is disturbed, the bile secretes a sediment - small solid particles that settle to the bottom of the gallbladder. If the gallbladder does not work properly and the bile stagnates, these particles become nuclei for subsequent crystallization; that is, a “speck of dust” (microlith), remaining in the gallbladder, begins to grow and gradually turns into stone.


Gallstones vary in number, size and chemical composition. One may form big Stone, but more often many (tens and even hundreds) of smaller stones are formed. The stones range in size from millet grains (and smaller) to chicken egg. In 80% of cases, cholesterol (so-called cholesterol stones) is the main component of the stones; pigment (bilirubin) stones, calcareous stones and stones of mixed nature are also found.

Causes of gallstone disease

The main reason for the formation of gallstones is a combination of two factors - 1) increased content in the bile of certain substances (primarily cholesterol), when the limit of their solubility is reached and a precipitate begins to form, and 2) stagnation of bile. Emergence and development cholelithiasis can contribute to:

  • (hormonal changes promote the release of liver cells increased amount cholesterol);
  • reception oral contraceptives (hormone replacement therapy);
  • . Even slight weight gain due to fat accumulation is accompanied by an increase in cholesterol content in the bile;
  • fast weight loss, for example, due to fasting or following a diet inconsistent with doctors, can lead to changes in the composition of bile and stimulate the formation of stones;
  • sedentary lifestyle promotes the development of dyskinesia of the gallbladder and biliary tract and can lead to stagnation of bile;
  • genetic predisposition ;
  • various diseases(, Crohn's disease, liver cirrhosis, blood diseases, etc.)

With age, the likelihood of developing gallstone disease increases. People over 60 years of age are at increased risk of developing this disease.

Stages of development and forms of gallstone disease

Gallstone disease is a chronic disease that develops gradually over a long period of time (years). The following stages can be distinguished in its development:

  • change in the composition of bile (physico-chemical stage);
  • asymptomatic stone carriers(latent, hidden form). While the stones are small, the patient may not notice their presence in the gallbladder. At this stage, the disease is most often detected by ultrasound of the gallbladder (for example, with preventive examination);
  • clinical stage. At this stage, two forms of the disease are distinguished: biliary colic(acute form) and calculous(chronic form).

Gallstones injure the mucous membrane and often cause inflammation of the gallbladder (cholecystitis). Cholecystitis in most cases occurs precisely against the background of cholelithiasis.

Symptoms of gallstone disease

Acute calculous cholecystitis (biliary colic) caused by a violation of the outflow of bile from the gallbladder. The stone blocks the entrance to the bile duct or enters the bile duct and irritates the mucous membrane of its walls. Biliary colic (also called hepatic colic - based on the localization of pain in the liver) is manifested by symptoms such as:

  • severe pain in the right hypochondrium. The pain begins suddenly, often at night. The duration of an attack can vary from several minutes to several hours and even days. The nature of the pain is acute at first, then the pain becomes constant and dull;
  • strong;
  • , . An attack of vomiting does not bring relief; a high content of bile is found in the vomit;
  • temperature increase . During development purulent form illness, the temperature can rise to 38-39°C;
  • Yellowing of the skin and whites of the eyes, bloating, and constipation may occur.

If such symptoms occur, you should call an ambulance.

Symptoms chronic calculous cholecystitis appear less acutely. They may occur or worsen after eating large and fatty foods. However, it should be borne in mind that similar symptoms are characteristic of a number of other diseases.

The main symptoms of chronic calculous cholecystitis:

Flatulence

There is discomfort and bloating in the abdomen. In some cases, stool disorder is observed.

Methods for diagnosing cholelithiasis

When the first signs of discomfort appear in the right hypochondrium, you should contact. It will be necessary to undergo examination, including laboratory and instrumental studies.

General blood analysis

In case of cholelithiasis, attention is paid, first of all, to such indicators as the number of neutrophils in the blood and ESR. An increase in the number of neutrophils (neutrophilic leukocytosis) and ESR indicates the development of an inflammatory process (acute cholecystitis).

Biochemical analysis blood

Used to assess the condition of the liver (indicators such as ALT, AST, bilirubin, protein, alkaline phosphatase, CRP). If you have gallstones, this is important because the stone can block the bile duct and cause cholestasis (stagnation of bile), which can lead to liver damage.

Ultrasound of organs abdominal cavity

And, in particular, it allows you to detect stones in the gall bladder and cystic duct (their size and location). Stones in the general bile flow cannot always be seen using ultrasound. The study can also reveal inflammation or destruction of the walls of the gallbladder, expansion of the intra- and extrahepatic bile ducts. Ultrasound is the basic method for diagnosing cholelithiasis (cholelithiasis).

Endoscopic retrograde cholangiopancreatography

In some cases, ultrasound data is not enough (for example, if there is reason to suspect the presence of stones in the common bile duct). And then additional instrumental research is required. To clarify the diagnosis, a method (ERCP) is often used, which involves the introduction of a radiopaque substance into the extrahepatic bile ducts using endoscopic equipment. Next, an X-ray examination is performed to identify the stones.

Magnetic resonance imaging (MRI)

Currently, MRI cholangiography is increasingly used, the information content of which is comparable to ERCP.

MRI cholangiography is a non-invasive method. No contrast agent is required. The method allows you to obtain a computer reconstruction of a three-dimensional image of the biliary tract.

Treatment methods for gallstone disease

Treatment of cholelithiasis with conservative methods can only be effective if early stage- before the stones appear. Unfortunately, at this stage, rarely does anyone see a doctor. If the stones have already formed, treatment is usually possible only with surgical methods. Search conservative methods treatment of gallstone disease is often just an attempt to avoid the need to make a decision about surgery. Meanwhile, surgical treatment should not be postponed, since cholelithiasis is a serious disease.

If multiple stones or stones of significant size are identified, treatment of cholelithiasis is recommended operative method, namely, cholecystectomy (removal of the gallbladder). The indication for cholecystectomy is inflammatory process in the gallbladder (calculous cholecystitis).

At “Family Doctor” it is performed using the laparoscopic method.

Gallstones need to be treated before they lead to complications.

Each method has its own application and contraindications, which, if ignored, can lead to serious consequences for human health. Application traditional methods Therapy is justified only to relieve an attack, as well as to prevent subsequent stone formation.

Radical treatment of the disease

Surgery for gallstone disease is the gold standard for treating this pathology. Its goal is to remove the container for stones, avoiding recurrences of biliary colic, as well as preventing the appearance of obstructive jaundice, cholangiogenic sepsis, and biliary peritonitis. Performed as planned, that is, before complications develop, the operation is safe - only 1 in 1000 people have a risk of dying. The chance of a complete recovery after the operation is about 95%.

Indications for the operation are:

  1. the diameter of the stones is more than 1 cm;
  2. “disabled” gallbladder;
  3. multiple stones;
  4. the patient has diabetes mellitus;
  5. stones are formed by calcium salts, bilirubin or are of mixed origin;
  6. stones (stones) are located in such a way that there is a high probability of blocking the bile ducts;
  7. the patient travels a lot;
  8. the walls of the gallbladder containing stones are inlaid with calcium salts - a “porcelain” gallbladder.

Warning! Of course, the operation cannot be performed on everyone - there are contraindications due to general condition.

In addition, the method as an independent method does not eliminate the cause of cholelithiasis. After cholecystectomy (the so-called operation to remove the bladder), stones can form in the liver ducts or the stump of the extrahepatic bile ducts. However, only surgical treatment of the pathology, subject to subsequent adherence to a diet, can permanently rid a person of gallstones.

The operation can be performed in two ways - abdominal and laparoscopic.

Abdominal surgery

This is a “big” operation in which general anesthesia A large incision is made on the front wall of the abdomen. As a result of this access, surgeons can thoroughly examine and palpate all bile ducts, perform local ultrasound or radiography with contrast to remove all existing stones. The method is indispensable for inflammatory and scarring processes in the area under the liver.

The disadvantages of this intervention are:

  • long recovery period after surgery;
  • greater chance of developing postoperative hernias;
  • cosmetic defect;
  • complications develop more often after surgery.

Laparoscopic method

The laparoscopy operation performed for cholelithiasis is an intervention under visual control using a fiber optic device connected to a monitor through several small incisions on the abdominal wall.

The laparoscopic method has many advantages over abdominal surgery: the wound does not hurt so much and does not last so long, it does not limit breathing; intestinal paresis is not expressed; not such a strong cosmetic defect. There are also negative aspects to laparoscopic cholecystectomy - more contraindications to the operation. Thus, it cannot be performed not only in case of severe disorders of the heart, blood vessels and lungs, but also in the following cases:

  • obesity;
  • late pregnancy;
  • obstructive jaundice;
  • fistulas between internal organs and bile ducts;
  • gallbladder cancer;
  • adhesions in the upper parts of the abdominal cavity;
  • if more than 2 days have passed since the illness;
  • cicatricial changes in the hepatobiliary zone.

In 5% of cases, the difficulties of performing laparoscopic intervention are revealed only during the process. In this situation, you have to immediately switch to abdominal surgery.

Non-surgical treatment

Treatment of gallstone diseases can be carried out without surgery - using non-contact crushing of stones or dissolving them with medication.

Drug litholysis

In order to dissolve small stones, preparations of special bile acids, similar to those found in human bile, can be used. Such substances, taken in tablet form, reduce the absorption of cholesterol by the small intestine. As a result, less cholesterol enters the bile ducts, and due to the formation of liquid crystals with such acids, the cholesterol contained in the stones is partially dissolved.

Bile acid preparations are effective not only for dissolving stones, but also for preventing their formation:

  • for abnormal biliary tract;
  • for obesity;
  • after a course of a diet with reduced energy value;
  • after gastric surgery.

Bile acid preparations are contraindicated for:

    1. disabled gallbladder;
    2. pigment or carbonate stones;
    3. if the stones occupy more than half the volume of the bladder;
    4. during pregnancy;
    5. if gallbladder carcinoma is diagnosed.

Warning! Medications are used to dissolve only cholesterol stones smaller than 2 cm in diameter, which are visible not only on ultrasound, but also on plain radiography. They are prescribed only by a gastroenterologist. The course of treatment is at least six months, but there is evidence that, even after completely dissolving, the stones recur in half of the cases.

Hardware dissolution of stones

Stones with a small diameter (up to 2 cm) can be crushed by a shock wave or laser beam directed at the gallbladder area, after which their fragments are removed naturally. Such operations are called “lithotripsy” (shock wave or laser) and are performed in a hospital. This is explained by the fact that after this procedure there is a high chance of complications associated with the wandering of small fragments of stones, which can only be treated surgically.

Warning! Lithotripsy is performed only with normal contractility of the gallbladder; it cannot be performed with cholecystitis. The procedure itself is practically painless, but removing stone fragments is very unpleasant.

Treatment of cholelithiasis folk remedies sets itself 2 goals:

  1. stop an attack of biliary colic;
  2. prevent further stone formation.

In order to avoid further stone formation, it is recommended to use the following recipes:

  • Squeeze juice from cucumber, carrots and beets, mix it in equal parts. Start by taking 1 glass of this juice, add another 200 ml per dose every month. Course – 6 months.
  • Drink 1 glass of freshly squeezed beet juice, which has been infused for 2-3 hours in the refrigerator, on an empty stomach.
  • Pour 1 tablespoon of immortelle flowers into 200 ml of boiling water, boil for half an hour in a water bath, cool for 45 minutes. Take 100 ml twice a day.
  • Dry watermelon rinds in the oven, chop, add water in a 1:1 ratio, boil for half an hour. You should drink this decoction 200-600 ml per day, divided into 4-5 doses.

It is important to remember that an integral part of the fight against pathology is adherence to a dietary diet. To learn more about this, we recommend that you read the article:.

Gallstone disease is a relatively common disease, with more than 10% of the adult population of European countries having this disease. In most cases, cholelithiasis is detected during a routine abdominal ultrasound and may be asymptomatic.

Stones are small, hard deposits that can form in the gallbladder.

The formation of gallstones is usually slow. Most gallstones do not cause pain or other symptoms and do not require treatment. Stones can vary in size from a few millimeters to several centimeters in diameter.

The formation of gallstones occurs because certain substances present in bile reach or exceed their solubility limits. When bile oversaturated with these substances is concentrated in the gallbladder, they precipitate from the bile solution in the form of microscopic crystals. Crystals become trapped in the gallbladder if the motility of the gallbladder itself is impaired and normal outflow is obstructed. Over time, the crystals grow and coalesce to form macroscopic stones. Occlusion (blockage) of the bile ducts causes complications of gallstone disease.

The modern concept of gallstone disease distinguishes the following forms of the disease:

- Symptomatic cholelithiasis is a condition accompanied by the occurrence of biliary colic. Biliary colic is severe or severe pain in the epigastrium or right hypochondrium, lasting about 30 minutes. Biliary colic may be accompanied by nausea, vomiting and headache.
- Asymptomatic cholelithiasis is a form of the disease that does not cause biliary colic.
- Gallstones may also be present in the common bile duct rather than in the gallbladder itself. This condition is called choledocholithiasis.
- Secondary stones of the common bile duct. In most cases, common bile duct stones initially form in the gallbladder and move into the common bile duct. That's why they are called secondary stones. Secondary choledocholithiasis occurs in approximately 10% of patients with gallstones.
- Primary stones of the common bile duct. Less commonly, stones form in the common bile duct itself (so-called primary stones). They are usually of the brown pigmented type and are more likely to cause infection than secondary gallstones.
- Acalculous disease of the gallbladder. Gallbladder disease can occur without stones. This condition is called acalculous gallbladder disease. In this condition, a person has symptoms of gallstones, but there is no evidence of stones in the gallbladder itself or the bile ducts. It can be acute or chronic. Acute acalculous gallbladder disease usually occurs in patients with concomitant diseases. In these cases, inflammation occurs in the gallbladder. This inflammation usually occurs as a result of decreased blood supply or the inability of the gallbladder to contract properly and clear its bile. Chronic acalculous gallbladder disease, also called biliary dyskinesia, appears to be caused by muscle defects or other problems in the gallbladder that interfere with the natural contractions needed to clear the gallbladder.

Classification of gallstones and the mechanism of their formation

There are 2 main substances involved in the formation of gallstones: cholesterol and calcium bilirubinate.

Cholesterol gallstones

More than 80% of gallstones contain cholesterol as a major component. Liver cells secrete cholesterol into the bile, as well as phospholipids (lecithin) in the form of small spherical membrane vesicles called unilamellar vesicles. Liver cells also secrete bile salts, which are powerful means necessary for the digestion and absorption of dietary fats. Bile salts in bile dissolve unilamellar vesicles to form soluble aggregates called mixed micelles. This occurs primarily in the gallbladder, where bile is concentrated, absorbing electrolytes and water.

Compared to vesicles (which can accommodate up to 1 cholesterol molecule for every lecithin molecule), mixed micelles have a lower cholesterol carrying capacity (about 1 cholesterol molecule for every 3 lecithin molecules). If bile contains relatively high percent cholesterol in the blood to begin with, then, as bile becomes more concentrated, the progression of vesicle dissolution can lead to a condition in which cholesterol accumulates due to decreased micelle capacity and residual vesicles. As a result, the bile is oversaturated with cholesterol, and the formation of cholesterol monohydrate crystals begins.

Thus, the main factors that determine the formation of cholesterol gallstones are:

  • The amount of cholesterol secreted by liver cells in relation to lecithin and bile salts. The liver produces too much cholesterol in bile.
  • The degree of concentration and degree of stagnation of bile in the gallbladder.
  • The gallbladder is unable to contract normally, so bile stagnates. The cells lining the gallbladder are unable to effectively absorb cholesterol and fats from the bile.

Calcium, bilirubin and pigment gallstones

Bilirubin is a substance usually formed by the breakdown of hemoglobin in red blood cells. It is excreted from the body with bile. Most of the bilirubin is contained in bile in the form of glucuronide conjugates (direct bilirubin), which are quite soluble in water and stable, but a small part consists of indirect bilirubin. Free bilirubin such as fatty acid, phosphates, carbonates and other anions, as a rule, form insoluble precipitates with calcium. Calcium enters bile passively along with other electrolytes.

Under conditions of high heme fluidity, chronic hemolysis or cirrhosis, indirect bilirubin may be present in the bile in higher concentrations than normal. The calcium bilirubinate can then crystallize out of solution and eventually form stones. Over time, various oxidations cause the bilirubin deposits to change color, and the stones become pitch black. These stones are called black gallstones. Black pigment stones represent 10-20% of all gallstones. People with hemolytic anemia, an anemia in which red blood cells are destroyed at an abnormally high rate, are more likely to develop them.

Bile is generally sterile, but in some unusual circumstances it can become colonized by bacteria. Bacteria hydrolyze bilirubin, and the resulting increase in indirect bilirubin can lead to the precipitation of calcium bilirubinate crystals. Bacteria can also hydrolyze lecithin to release fatty acids, which can also bind calcium that precipitates from the bile solution. The resulting stones have a clay-like consistency and are called brown pigment stones. Unlike cholesterol or black pigment stones, which form almost exclusively in the gallbladder, brown pigment gallstones often form deposits in the bile ducts. They contain more cholesterol and calcium than black pigment stones. The infection is playing important role in the development of these stones.

Brown pigment stones are more common in Asian countries.

Mixed gallstones

Mixed stones are a mixture of pigment and cholesterol stones. Cholesterol gallstones can become infected with bacteria, which in turn can cause inflammation of the gallbladder lining. As a result, over time, cholesterol stones can accumulate a significant portion of calcium bilirubinate, enzymes from bacteria and white blood cells, fatty acids and other salts, forming mixed gallstones. Large stones may develop with a shell-like rim of calcium on the surface, and may be visible on conventional x-ray films.

Causes of gallstone disease

The main reasons for the development of gallstone disease are:

- Genetic predisposition. Having a family member or close relative with gallstones may increase your risk. Up to one-third of cases of painful gallstones may be due to genetic factors. A mutation in the ABCG8 gene significantly increases the risk of gallstones. This gene controls the level of cholesterol carried from the liver to the bile duct. This mutation can cause cholesterol to be transported at a high rate. Defects in the transport of proteins involved in bile lipid secretion predispose some people to gallstone disease, but this alone is not sufficient to cause gallstone formation. Research shows that the disease is complex and may result from interactions between genetics and the environment.

- Race. Gallstones are related to diet, especially fat intake. The incidence of gallstone disease varies between countries and regions. For example, people from Latin America and Northern Europeans have a higher risk for gallstones than people of Asian and African descent. People of Asian descent suffer from brown pigment stones.

- Floor. The ratio of women to men is 2-3 women: 1 man. In general, women have an increased risk because estrogen stimulates the liver to remove cholesterol from the blood and send it into bile.

- Pregnancy. Pregnancy increases the risk of developing gallstones, and pregnant women with gallstones are more likely to have symptoms of gallstones. Surgery should be delayed until after delivery if possible. In fact, symptoms of gallstones may go away on their own after childbirth. If surgery is necessary, laparoscopy is the safest approach.

- Hormone replacement therapy. Several large studies have shown that replacement therapy hormone therapy the risk of developing gallstones, hospitalization for gallbladder disease, gallbladder disease, or surgery doubles or triples. Estrogen increases levels of triglycerides, substances that increase the risk of developing cholesterol stones.

- Age. Gallstone disease in children is relatively rare. When gallstones occur in this age group, they are more likely to be pigment stones. Girls and boys are at the same risk. The risk increases if there are the following factors:

  • Injury spinal cord
  • History of abdominal surgery
  • Sickle cell anemia
  • Violations immune system
  • Receiving nutrition through a vein (intravenous)

- Obesity and sudden weight changes. Overweight is a significant risk factor for the development of gallstones. The liver produces supersaturated cholesterol, which enters the bile and settles in the form of cholesterol crystals. Rapid weight loss diets stimulate a further increase in cholesterol production in the liver, leading to cholesterol oversaturation and increasing the risk of gallstones by 12% after 8 to 16 weeks of a calorie-restricted diet and the risk to more than 30% within 12 to 18 months after surgery. gastric bypass surgery. The risk of gallstone disease is highest with the following diets and weight fluctuations:

  • Losing more than 24% of your weight
  • Weight loss greater than 1.5 kg per week
  • Low fat diets, low calorie diets

- Metabolic syndrome and hypertriglyceridemia. Metabolic syndrome is an increase in the mass of visceral fat, especially abdominal fat, a decrease in the sensitivity of peripheral tissues to insulin and high blood sugar, accompanied by impaired carbohydrate, lipid, purine metabolism, as well as low HDL ( good cholesterol), high triglyceride levels and high blood pressure. Research shows that metabolic syndrome is a risk factor for the development of gallstones.

- Diabetes. People with diabetes have a higher risk of developing gallstones and have a higher risk of the gallbladder disease acalculous cholecystitis. Gallbladder disease may progress more quickly in patients with diabetes mellitus, which are already, as a rule, complicated by infections.

- Long-term intravenous nutrition. Long-term intravenous feeding reduces bile flow and increases the risk of gallstones. About 40% of patients on intravenous nutrition develop gallstones.

- Crohn's disease. Crohn's disease , inflammatory disease intestines, leading to deterioration of reabsorption (absorption) of bile salts from digestive tract, which significantly increases the risk of gallbladder diseases. Patients over 60 years of age and those who have had multiple bowel surgeries (particularly in the small and large intestine) are at particularly high risk.

- Cirrhosis of the liver. Liver cirrhosis is a major risk for gallstones, particularly gallstones.

- Organ transplantation. Transplantation bone marrow or solid organs increases the risk of developing gallstones. Complications can be so serious that some organ transplant centers require the patient's gallbladder to be removed before performing the transplant.

- Medicines. Octreotide (Sandostatin) poses some risk of developing gallstones. In addition, cholesterol-lowering drugs known as fibrates and thiazide diuretics may slightly increase the risk of gallstones.

- Blood diseases. Chronic hemolytic anemia, including sickle cell anemia, increases the risk of pigmented gallstones.

- Heme iron. High intake of heme iron found in meat and seafood leads to gallstones in men. The stones are not associated with diets of foods high in non-heme iron. These products include beans, lentils, and other grains.


1. Pain or biliary colic. The most common symptom of gallbladder disease is called biliary colic. periodic pain, which is localized either in the middle or in the upper right part of the abdomen. Its symptoms can be very nonspecific. A typical attack of biliary colic has a number of features:

The main symptom is usually a persistent attack or It's a dull pain in the upper right side of the abdomen next to chest, which can give in top part backs. Some patients with biliary colic experience chest pain. Changing positions usually does not relieve symptoms.
- Biliary colic usually lasts from 1 to several hours. If it lasts longer, it may be a symptom of acute cholecystitis or more serious diseases.
- Episodes of colic usually occur at the same time of day, but less than once a week.
- Large meals or fatty foods may cause pain, but this usually occurs several hours after eating and often wakes the patient during the night.
- Digestive problems such as belching, a feeling of unusual heaviness in the abdomen after eating, bloating, heartburn (a burning sensation behind the breastbone), as a rule, are not related to gallbladder disease. Reasons that may cause these symptoms are: peptic ulcer or stomach upset for an unknown reason.

2. Symptoms of inflammation of the gallbladder (acute calculous cholecystitis, acalculous gallbladder disease). 1 to 3% of people with symptoms of gallstones develop inflammation in the gallbladder (acute cholecystitis), which occurs when stones block the duct. The symptoms are similar to those of biliary colic, but are more persistent and severe. They include:

Pain in the upper right side of the abdomen, dull and constant, lasting for several days and intensifying with inspiration. The pain may also radiate to the back or under the shoulder blades, to the left behind the sternum.
- Approximately one third of patients experience fever and chills, which do not occur with uncomplicated hepatic colic.
- Nausea and vomiting may occur.
Anyone experiencing these symptoms should see a doctor. Acute cholecystitis can progress to gangrene or cause perforation of the gallbladder without proper treatment. Infection develops in approximately 20% of patients with acute cholecystitis, which also increases the danger from this condition. People with diabetes are especially at risk for serious complications.

3. Symptoms of chronic cholecystitis. Chronic gallbladder diseases such as chronic cholecystitis, includes gallstones and mild inflammation. In such cases, the walls of the gallbladder may become rigid and lose their elasticity. Symptoms chronic disease gallbladder include the following:

Complaints of bloating, nausea and abdominal discomfort after eating. These symptoms are the most common, but they can be vague and difficult to distinguish from similar complaints in people who do not have gallbladder disease.
- Chronic diarrhea (4 - 10 bowel movements every day for at least 3 months).

4. Symptoms of stones in the common bile duct (choledocholithiasis). Stones entering the common bile duct can cause symptoms similar to those of gallstones, but they can also cause the following symptoms:

Obstructive jaundice (yellowing of the skin and eyes)
- Dark urine, light, clay-gray feces
- Fast heartbeat and sharp drop blood pressure
- Fever, chills, nausea and vomiting, severe pain in the right upper abdomen. These symptoms also indicate an infection in the bile ducts (so-called cholangitis). As with acute cholecystitis, patients who have these symptoms should seek medical help immediately.
- Stones that do not cause symptoms rarely lead to problems and complications. Death, even from symptomatic gallstones, is very rare. Serious complications are also rare. If they occur, complications usually develop from stones in the bile ducts, or after surgery. However, stones can cause obstruction at any point along the ducts that carry bile. In such cases, symptoms may develop.
- In most cases, when stones block the cystic duct, which leads from the gallbladder to the common bile duct, pain (biliary colic), infection and inflammation (acute cholecystitis) occur.

Diagnosis of cholelithiasis

Clinical diagnosis cholelithiasis can be diagnosed when biliary colic or indigestion occurs, accompanied by painful sensations. It should be noted that gallstone disease is often asymptomatic or with partial symptoms and her diagnosis is made by chance.

The following diagnostic methods are usually used:

Abdominal ultrasound, which can reveal the presence of gallstones, as well as their number;
- Echo endoscopy can be used as diagnostic method in cases of cholelithiasis with uncertain results ultrasound diagnostics;
- CT scan(CT) allows you to determine the calcium content in gallstones;
- Scintigraphy of the gallbladder (radioisotope study).

Treatment of cholelithiasis (cholelithiasis)

There is now almost unanimous agreement that asymptomatic cholelithiasis should be observed rather than immediately treated with surgery. Since only 1% -2% of patients per year experience pathological symptoms, observation of asymptomatic cholelithiasis seems to be the most logical solution. If symptoms appear, a question is raised about surgical intervention- cholecystectomy.

Symptomatic gallstone disease requires immediate treatment. Most often, treatment is surgical and rarely done with non-surgical therapy. With the advent of laparoscopic cholecystectomy, a short hospitalization period and minimal postoperative complications sick. This technique applies mainly to uncomplicated cholelithiasis and acute cholecystitis. Laparoscopic surgery, laparoscopic cholecystectomy, is the most common technique today. It allows you to remove the gallbladder without large incisions and with high precision.

Alas, removal of the gallbladder - cholecystectomy, today remains the most effective method treatment, and avoids the recurrence of gallstones.

At the same time, common bile duct stones can be removed using endoscopic methods.

The so-called transluminal surgery has received a new word in the treatment of cholelithiasis. This is a procedure where flexible instruments are inserted into the lumen of a hollow organ through natural openings. human body and through a cut in the wall internal organ are brought directly to the object being operated on. Working instruments can be inserted through an incision in the wall of the stomach, vagina or rectum. At the same time, the skin remains intact. Several clinics in the US and Europe perform operations such as transvaginal cholecystectomy and transgastric cholecystectomy, which are still considered experimental.

Conservative therapy may be considered for symptomatic patients with mild form diseases, small size cholesterol stones. Such patients are prescribed treatment with chenodeoxycholic acid or ursodeoxycholic acid (Ursofalk, Ursosan), which can dissolve cholesterol gallstones. However, such treatment can last about 2 years or more, and you are not insured against the reappearance of stones after the end of treatment. In some cases, antibiotics are required to fight the infection. The success rate of this treatment is about 50%, and the risk of relapse within 5 years is 10%. Treatment should be carried out under regular monitoring Ultrasound of the abdominal cavity.

Treatment is also possible with shock wave lithotripsy. The essence of this method is to bombard cholesterol stones shock waves. This method is intended for single gallstones or less numerous stones, preferably less than 15 mm. The stone fragments are further dissolved by bile acids (ursodeoxycholic acid), until all stone fragments completely disappear from the gallbladder. However, this method is Lately is used less and less due to high degree occurrence of relapse.

Complications of cholelithiasis (cholelithiasis) or what happens if gallstone disease is not treated

- Infections. The most serious complication of acute cholecystitis caused by cholelithiasis is infection, which develops in approximately 20% of cases. Extremely dangerous and life-threatening if it spreads to other parts of the body (sepsis). In this case, emergency surgery is often required. Symptoms of infection include fever, rapid heartbeat, rapid breathing, and confusion.

- Gangrene and abscess. Severe inflammation can cause an abscess and necrosis (destruction) of tissue in the gallbladder, leading to gangrene. At high risk are men over 50 years of age who have a history of cardiovascular diseases and high infection rates.

- Perforation (rupture) of the gallbladder. An estimated 10% of cases of acute cholecystitis caused by gallstones result in gallbladder perforation, a life-threatening condition. In general, it occurs in people who have waited too long to seek help or in people who do not respond to treatment. Gallbladder perforation is most common in people with diabetes. The risk of perforation increases with a condition called emphysematous cholecystitis, in which gas forms in the gallbladder. Once the gallbladder wall has been perforated, the pain may be temporarily relieved. This dangerous misconception threatens the development of peritonitis and the spread of infection into the abdominal cavity.

- Empyema. Pus in the gallbladder (empyema) occurs in 2 - 3% of patients with acute cholecystitis. Patients usually experience severe abdominal pain for more than 7 days. A medical examination often does not always reveal the cause immediately. Empyema can be life-threatening, especially if the infection spreads to other parts of the body.

- Fistula. In some cases, inflammation of the gallbladder spreads and leads to perforation of nearby organs, such as small intestine. In such cases, a fistula is formed between the organs, which is a canal or hole. Sometimes, in such cases, gallstones can actually pass into the small intestine. This can be very serious and requires immediate surgery.

- Gallstone obstruction. Gallstone blockage of the intestine is known as gallstone ileus. It primarily occurs in patients over 65 years of age and can sometimes be fatal. Depending on where the stone is located, surgery may be required to remove it.

- Infection of the common bile duct (cholangitis). Common bile duct infection is very dangerous serious illness. If antibiotics are prescribed immediately, the infection is cured in 75% of patients. If cholangitis is not controlled, the infection can spread and become life-threatening.

- Pancreatitis. Common bile duct stones are responsible in most cases for causing pancreatitis (inflammation of the pancreas).

- Gallbladder cancer. Gallstones occur in about 80% of people with gallbladder cancer. There is a strong relationship between gallbladder cancer and cholelithiasis, chronic cholecystitis and inflammation. Symptoms of gallbladder cancer usually do not appear until the disease has reached an advanced stage, and may include weight loss, anemia, recurrent vomiting, feeling foreign body stomach. However, this cancer is very rare, even among people with gallstones.

- Gallbladder polyps. Polyps (growths) are sometimes detected during diagnostic tests to detect gallbladder disease. Small gallbladder polyps (up to 10 mm) do not pose a particular risk, but large ones (more than 15 mm) pose a certain risk of cancer, so the gallbladder must be removed. Patients with polyps 10 - 15 mm are at lower risk, but they should still discuss gallbladder removal with their doctor.

- Primary sclerosing cholangitis. Primary sclerosing cholangitis is rare disease, which causes inflammation and scarring in the bile ducts. It is associated with a risk (7 - 12%) of gallbladder cancer. Its cause is unknown, although cholangitis tends to affect young men with nonspecific ulcerative colitis. Polyps are often found in this condition and have a very high probability of being cancerous.

- Abnormal ring-shaped pancreas (congenital). With this rare condition, which is present in the patient from birth, the junction of the common bile duct and the main pancreatic duct is outside the wall of the small intestine and forms a long channel between the two channels. This problem poses a very high risk of developing bile duct cancer.

- Porcelain gallbladder. The gallbladder is called porcelain when its walls are calcified, i.e. covered with a layer of calcium. Porcelain gallbladder is associated with a very high risk of cancer. This condition may develop due to chronic inflammatory reaction, which may, in fact, be responsible for the risk of cancer. The risk of developing cancer also depends on the presence of specific factors, such as partial calcification of the inner lining of the gallbladder.

Prognosis of cholelithiasis

Gallstone disease often has good prognosis, because symptomatic cases are most often treated with surgery, while asymptomatic cases are monitored.

Nutrition and diet as a prevention of gallstone disease

Diet may play a role in the formation of gallstones. Following products may influence:

- Fats. Although fats, especially saturated fats found in meat, butter and other animal products, have been linked to gallstone attacks, some studies have shown a lower risk of gallstones in people who consume foods containing monounsaturated fats, found in olive and canola. oil, or Omega-3 fatty acids contained in rapeseed, flaxseed, and fish oil. Fish fat may be especially useful for patients with high level triglycerides, because it improves the emptying effect of the gallbladder.

- Cellulose. High fiber and dietary fiber intake is associated with a lower risk of gallstones.

- Nuts. Research shows that people can reduce their risk of developing gallstones by eating more nuts (peanuts and tree nuts, walnuts and almonds).

- Fruits and vegetables. People who eat plenty of fruits and vegetables have a lower risk of developing symptomatic gallstones, which require gallbladder removal.

- Sugar. High sugar intake is associated with an increased risk of developing gallstones. Eating foods high in carbohydrates (such as pasta and bread) may also increase your risk because carbohydrates are converted to sugar in the body.

- Alcohol. Several studies have found a lower risk for gallstones with alcohol consumption. Even a small amount of(30 grams per day) reduces the risk of gallstones in women by 20%. Moderate consumption (defined as 1 to 2 glasses of wine per day) also protects the heart. It should be noted, however, that even moderate alcohol consumption increases the risk of breast cancer in women. Pregnant women, people who cannot drink in moderation, and people with liver disease should not drink at all.

- Coffee. Research shows that drinking coffee every day may reduce the risk of gallstones. The caffeine contained in coffee is believed to stimulate gallbladder contraction and reduce the concentration of cholesterol in bile. However, drinking other caffeinated drinks such as cola and tea does not have any benefit.

Preventing Gallstones During Weight Loss

Maintaining a normal weight and preventing rapid weight loss are keys to reducing the risk of gallstones. Taking ursodeoxycholic acid during weight loss may reduce the risk for people who are losing weight quickly. This medicine is usually used to dissolve existing gallstones. Orlistat (Xenical), an obesity drug, may also protect against gallstones during weight loss. The drug helps reduce bile acids and other components involved in gallstone production.

Effect of cholesterol-lowering drugs on gallstone formation

Although it would be reasonable to believe that drugs used to lower cholesterol levels can protect against the formation of gallstones, most studies have not found evidence that these drugs protect the gallbladder. Lowering blood cholesterol levels has no effect on gallstone cholesterol levels.

Every third mature (after 40 years) woman and every fourth man is found to have an accumulation of stones (calculi) in the gall bladder. So common metabolic pathology- gallstone disease (GSD, cholelithiasis) - initially asymptomatic and only when the stones move, it provokes biliary colic. Despite the seriousness of the disease, surgery is advisable only for repeated pain attacks.

Causes

GSD is a metabolic disease associated with impaired synthesis of bilirubin, cholesterol and the accumulation of calcium salts in bile. The consistency of the secreted bile changes, it becomes thicker and settles on the walls of the gallbladder. Stone formation is promoted by stagnation in the gallbladder. The gradual calcification of sediments leads to the formation of dense formations (stones) of different diameters: from a large number of small grains of sand to one large formation the size of a walnut.

Cholesterol formations are layered, round/oval in shape, 4–15 mm in diameter, usually located in the gallbladder. Pigment stones (the main part of which is bilirubin) are black, shiny, uniform in structure and small in size. Multiple clusters of them can be detected both in the bile ducts and in the bladder itself.

Calcium stones have Brown color of varying saturation (from light to dark) and an asymmetrical shape with characteristic spikes. In most cases, stones have a mixed composition and look like an accumulation of tens or hundreds of tiny formations different shapes with angular edges. Factors that provoke stone formation in the gallbladder:

  • eating disorders (irregular eating, fasting, overeating) and unhealthy diet ( overuse fried/fatty foods);
  • low physical activity, sedentary work;
  • obesity, diabetes;
  • taking oral contraceptive pills;
  • gastrointestinal pathology (gastrointestinal duct dyskinesia, chronic cholecystitis, pancreatic diseases, intestinal and liver pathology);
  • pregnancy;
  • helminths;
  • old age (the contractility of smooth muscles decreases physiologically).

Clinical picture of cholelithiasis

In most cases (60–80%), cholelithiasis is asymptomatic and is detected by ultrasound or x-ray. Stone carriers may not know about their disease for years and note only periodic heaviness/a feeling of fullness in the right hypochondrium and a temporary loss of appetite, until the first attack of biliary colic occurs - the stones enter the duct and clog it. It can be triggered by a festive feast or driving with shaking (by car on a dirt road, by bicycle).

Symptoms of cholelithiasis in women often occur after wearing shapewear, which disrupts blood flow and prevents the flow of bile. An attack of colic usually occurs suddenly, often in the evening or at night, and lasts from 20–30 minutes to 3–8 hours. Symptoms of biliary colic:

  • sharp pain in the right hypochondrium with possible irradiation to the right arm and shoulder blade;
  • increased sweating;
  • belching;
  • bloating;
  • nausea, vomiting without relief;
  • unstable stool (dyspeptic form);
  • bitterness in the mouth.

Small stones usually pass independently through the ducts and, once in the duodenum, are subsequently excreted in the feces. Painful symptoms eliminate themselves, but this does not mean that the process of stone formation has stopped. But in only 50% of patients, exacerbation of cholelithiasis recurs in the next year.

An attack that lasts 12 hours or more indicates persistent blockage of the ducts and the development of acute cholecystitis. Often the temperature rises, mechanical jaundice is possible (yellowish spots on the palms and yellowness of the sclera), discoloration feces(stool looks like white clay) and some darkening of the urine (excretion of bilirubin through the kidneys).

Complications

Patients with cholelithiasis are prone to the following painful conditions:

  • cholangitis;
  • pancreatitis;
  • cholestasis - blockage of the common bile duct and complete cessation of bile outflow;
  • acute cholecystitis;
  • perforation of the bladder wall and the formation of peritonitis, abscess (in severe cases, a person develops toxic shock and the likelihood of death).

Diagnosis of cholelithiasis

If you suspect stones in the bile ducts and bladder, you should contact a gastroenterologist. Diagnostic complex includes:

  • general blood test (signs of inflammation - leukocytosis, elevated ESR);
  • biochemistry (high liver parameters);
  • duodenal intubation;
  • cholecystocholangiography - x-ray with a contrast agent administered orally or intravenously;
  • retrograde cholangiopancreatography ( endoscopic examination with the ability to remove small stones from the ducts);
  • computed tomography with contrast injection.

How to treat gallstones?

Therapeutic tactics directly depend on the frequency of painful attacks and the patient’s condition. If biliary colic occurs for the first time and results in successful passage of stones into the intestines, surgical intervention inappropriate. Radical measures are used only for persistent blockage of the bile duct (emergency surgery), when large quantities and large stone sizes, with frequent repeated attacks, when the risk severe complications increases 4 times.

Treatment without surgery

The fundamental part of non-surgical treatment is aimed at normalizing nutrition:

  • 4 – 6 meals a day in small portions;
  • exclusion of fatty/fried foods, smoked meats, hot spices, soda and chocolate;
  • refusal of alcohol (often paroxysmal pain in the liver area in men is triggered by alcohol consumption);
  • emphasis in creating a diet on dairy and herbal products(especially useful in terms of recovery digestive function wheat bran).

Drug therapy includes drugs that dissolve stones (their composition is dominated by chenodeoxycholic and ursodeoxycholic acids). However, effectiveness is observed only when single X-ray negative stones (mainly cholesterol) no larger than 2 cm in size are detected. The drugs are taken for up to 1.5 years, such treatment does not exclude stone formation in subsequent years. Some clinics perform contact dissolution - administration remedy directly into the cavity of the gallbladder.


Shock wave lithotripsy is the extracorporeal destruction of cholesterol stones of no more than 3 pieces and up to 3 cm in diameter. Fragments of crushed stones with a diameter of 1 - 2 mm are painlessly excreted in the feces. The procedure is performed on an outpatient basis and requires high-tech equipment in the clinic. Within 5 years after lithotripsy, half of the patients are diagnosed with a relapse of the disease if the patient has not revised his diet and metabolic processes remained at the same level.

There are many ways to remove stones using folk remedies: decoction of birch leaves, beet syrup, infusion of dill seeds, juice sauerkraut etc. However, it should be remembered that treatment with home remedies:

  • requires a long time to achieve the effect;
  • some recipes are dangerous in terms of exacerbation of the disease and the beginning of the movement of large stones, which is fraught with acute symptoms;
  • is used only as a supplement to medical prescriptions and must be discussed with the treating gastroenterologist.

Surgery

Standard radical treatment GSD is a cholecystectomy - excision of the gallbladder. Open cholecystectomy (resection through a large incision in the abdominal wall) is inferior to laparoscopic surgery (surgical procedures are performed through 4 punctures or through 1 puncture in the navel area). The latter operation is easier to tolerate recovery period after it it lasts less, the cosmetic effect (lack of long scars) is also of considerable importance. Contraindications to laparoscopic cholecystectomy are limited to suspicion of peritonitis.

Prevention

To avoid stone formation in the gallbladder, you must follow basic rules healthy lifestyle:

  • Balance your diet and avoid overeating.
  • Quit alcohol and smoking.
  • Lead an active lifestyle (do small stretches during sedentary work).
  • Treat diseases of the digestive tract.
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