Treatment of bile stasis at home, tubage. International Student Scientific Bulletin Bile Thickening Syndrome in Children

Among the pathologies of digestion, gastroenterologists distinguish bile stasis, which is a syndrome indicating malfunctions in the hepatobiliary system: the bile-producing liver, the gallbladder (the bile depot, where it becomes more concentrated) or the biliary transport network (intra- and extrahepatic bile ducts).

Why is bile stasis dangerous?

This pathology is being diagnosed more and more often, so you should know how dangerous bile stasis is for the body. After eating, the fats contained in it begin to emulsify, but in order for lipids to be digested and lipophilic vitamins to be fully absorbed, in addition to gastric juice and pancreatic enzymes, bile acids and their salts are the main components of bile. From the gallbladder, they enter the duodenum, where the process of emulsification and colloidal hydrolysis of fats continues.

If bile stagnates (that is, it does not enter the intestinal section of the digestive tract), the activity of the intestinal enzyme lipase decreases, and fats are not completely broken down and enter the blood in a significant amount, making it difficult for the transformation of glucose into glycogen (which is fraught with the development of diabetes mellitus). Bile stasis is dangerous by reducing the excretion of excess cholesterol, which is present in the bile itself: it causes hypercholesterolemia (high cholesterol in the blood) and accelerates the development of atherosclerosis.

Stagnation of bile in the gallbladder often leads to its inflammation (secondary cholecystitis) or cholelithiasis (cholelithiasis). It is in the presence of stones in the gallbladder that acute and chronic cholecystitis with bile stasis most often develops.

You can simultaneously diagnose gastritis and bile stasis when the mucous membrane of the esophagus and stomach is exposed to bile acids that get there "reverse" from the duodenum - with chronic duodenogastric reflux (due to weakness of the cardiac sphincter of the esophagus).

The so-called sclerosing cholangitis - inflammation, fibrosis and strictures of the bile ducts - can lead to stagnation of bile in the ducts.

In violation of the circulation of bile acids in the gastrointestinal tract, the absorption of fats (fatty malabsorption) and fat-soluble vitamins decreases: retinol (vitamin A), ergocalciferol (vitamin D), tocopherol (vitamin E), phylloquinones (group K vitamins). The most well-known consequences and complications of vitamin A deficiency are deterioration of twilight vision, and vitamin D deficiency is osteomalacia (when a decrease in bone mineralization leads to their softening). At the same time, a simultaneous deficiency of vitamins A and D interferes with the absorption of calcium, which makes the bone tissue even less dense, that is, osteoporosis develops. A lack of vitamin K threatens to reduce blood clotting and the occurrence of hemorrhagic diathesis and bleeding.

A very real threat posed by chronic bile stasis is an increase in intestinal acidity, because bile - due to the presence of calcium cations in it - reduces the acidity of the contents of the stomach soaked in gastric juice, which passes into the intestinal stage of digestion. With stagnation of bile (cholestasis), an acid-base imbalance of the gastrointestinal tract is noted, and the result of acidification is ascites (dropsy) and poor bowel function due to the multiplication of pathogenic microbes.

When there is prolonged stagnation of bile in the liver, an increase in the level of chenodeoxycholic bile acid produced in the liver can lead to the death of hepatocytes and focal necrosis of the parenchyma. This is a very serious complication, since the liver is responsible for very important functions.

If there is stagnation of bile in the intestine, the toxicity of conjugated metabolic products and exogenous toxins (including those of bacterial origin) increases. Also, the consequences and complications relate to the synthesis of hormones, which is significantly reduced, since lipids are necessary for their production.

ICD-10 code

P59.1 Bile thickening syndrome

Epidemiology

According to studies, up to 70% of cases occur in extrahepatic bile stasis. Among women, this syndrome is more common - especially during pregnancy. Due to the immaturity of the liver enzyme system, newborns and children of the first two or three years of life are more prone to bile stasis.

According to experts, stagnation of bile in the liver occurs if there is liver cyst, malignant neoplasms or metastases.

Causes of bile stasis in the gallbladder and bile ducts include:

stones in the gallbladder;
tumors of the gallbladder or bile ducts;
inflammation in the neck of the gallbladder;
cystic formations of the common bile duct or its compression by a cyst localized in the pancreas;
compression and narrowing of the initial section of the common hepatic duct (Mirizzi syndrome);
violation of the functions of the valve system of the biliary tract (sphincters of Oddi, Lutkens, Mirizzi, Geister);
failures of the endocrine and paracrine mechanisms of the gastroduodenal stage of digestion associated with an imbalance of secretin, cholecystokinin, neurotensin and other intestinal hormones.

Risk factors

Physical inactivity and stagnation of bile are closely related: the less a person moves, the slower the metabolic processes in his body and the higher his risk of developing biliary duct dyskinesia or the formation of gallstones.

And stagnation of bile after removal of the gallbladder is called by experts as part of the typical postoperative consequences that occur due to the formation of scar tissue that narrows the gaps of the bile ducts.

An important dietary risk factor for biliary obstruction due to gallstones can be excessive sugar intake, as well as fat-containing foods that cause bile stasis.

Also, the real risk factors for stagnation of bile are alcohol abuse, overeating, obesity, inherited genetic predisposition to metabolic disorders.

Pathogenesis

The pathogenesis of bile stasis in the intrahepatic ducts is associated with infections, endocrine disorders, genetic metabolic disorders (thyrotoxicosis, amyloidosis of the liver or intestines) and iatrogenic effects. And the pathogenesis of stagnation of bile in the extrahepatic ducts (cystic, common hepatic and common bile) is due to changes in the composition of bile and an increase in its lithogenicity, anomalies of the biliary tract and their partial or complete obstruction.

Symptoms of bile stasis

First of all, it should be borne in mind that this condition may be asymptomatic. And the intensity and sequence in which the symptoms of bile stasis appear depend on the specific cause and the individual characteristics of the hepatobiliary system of the body. But the first signs are skin itching and changes in feces and urine. It is believed that itching during bile stasis is a reaction to an increase in the level of bile acids in the blood plasma, where they enter as a result of damage to liver cells by chenodeoxycholic acid.

Feces during bile stasis have a characteristic discoloration due to a violation of the elimination of the bile pigment bilirubin (which is normally oxidized to stercobilin, which turns feces brown and urine straw-yellow). Urine with stagnation of bile, on the contrary, becomes dark, because the level of urobilin (urine stercobilin) increases in it.

Constipation and diarrhea with bile stasis are typical symptoms of this condition. Since bile acids play an important role in intestinal motility, their reduction in the intestinal lumen leads to constipation. And diarrhea during stagnation is associated either with an increased content of undigested fats in the stool (steatorrhea), or with changes in the intestinal microflora.

Changes in the color of the skin - jaundice - are not observed in all patients, however, at sufficiently high plasma levels of conjugated bilirubin, the skin, sclera, and mucous membranes become yellow. Yellow spots (xanthelasma) may appear on the eyelids, and patchy skin growths with cholesterol patches (xanthoma) appear around the eyes, in the palmar folds, under the breasts, on the neck and in the diaper area in infants.

Characteristic pains during stagnation of bile - dull paroxysmal, localized in the right upper quadrant of the abdomen (in the hypochondrium); can give upward and backward (to the collarbone, shoulder or shoulder blade); possible acute attacks in the form of colic.

Heartburn with bile stasis is often accompanied by a constant feeling of bitterness in the mouth, and dry mouth with bile stasis is also characteristic. Bile helps to break down proteins and nitrogenous bases contained in food, and bad breath due to bile stasis occurs due to poor digestion and absorption of proteins. By the way, bitter belching of bile often manifests itself and stagnation of bile after removal of the gallbladder.

Fever - temperature during stagnation of bile - evidence of the presence of an infection, for example, phlegmonous or gangrenous cholecystitis with cholelithiasis. High temperature can give sepsis, which develops after endoscopic diagnostic manipulations.

In addition, symptoms of bile stasis include nausea and vomiting; dizziness and feeling of general weakness; liver enlargement (hepatomegaly); increased pressure in the portal vein leading to the liver. With bile stasis in children, a lack of essential polyunsaturated fatty acids (linoleic, linolenic, arachidonic) can lead to growth retardation, damage to the peripheral nervous system, and dermatitis. Alopecia, that is, hair loss due to bile stasis, is also the result of a triglyceride deficiency.

Stagnation of bile during pregnancy

Clinical studies in recent years have shown that bile stasis during pregnancy is initiated by estrogens, which regulate most of the processes in the body of the expectant mother. So, pregnant women produce large hormones of secretin, and, therefore, more bile. But at the same time, the secretion of somatotropin growth hormone (GH) increases, and it blocks the hormone cholecystokinin, which is responsible for the contraction of the gallbladder and the common bile duct.

Bile stasis during pregnancy (idiopathic jaundice of pregnancy or obstetric cholestasis) is most often manifested by excruciating skin itching (especially of the palms of the hands and soles of the feet) by the middle of the second or third trimester - as the maximum level of estrogen is reached. In addition, there was a significant increase in serum levels of aminotransferase, alkaline phosphatase and unconjugated bile acids; other symptoms are rare. Within two to three weeks after childbirth, spontaneous relief and disappearance of all signs occurs.

The epidemiology of bile stasis in pregnant women demonstrates a 0.4-1% susceptibility to this condition in women in most regions of Central and Western Europe and North America, while in the Scandinavian and Baltic countries this figure reaches 1-2%, and in some regions of Latin America - up to 5-15%.

At the same time, the following consequences and complications of bile stasis in pregnant women are noted: premature birth (20-60%), staining of meconium in the amniotic fluid (more than 25%), fetal bradycardia (14%), fetal distress (22-40%), fetal loss (0.4-4%).

Stagnation of bile in 45-70% of women occurs in all subsequent pregnancies.

By the way, with itching and the absence of jaundice, bile stasis and allergies are often not differentiated, and patients turn to dermatologists who cannot help them in any way.

congestion of bile in a child

There are many reasons that cause stagnation of bile in a child, in particular:

absence of the gallbladder (agenesis);
doubling of the gallbladder (complete or rudimentary);
deepening of the gallbladder into the liver parenchyma;
diverticulum (protrusion of part of the wall) of the gallbladder;
congenital enlargement of the bile ducts inside the liver (Caroli syndrome);
congenital strictures in the presence of a common bile duct cyst;
a fairly common congenital (due to mutations in the gene of serine digestive enzymes), a violation of the synthesis of hepatic alpha-1 antitrypsin;
genetically determined reduction or complete absence of intrahepatic ducts (biliary atresia);
heterogeneous disorder of bile formation - progressive familial intrahepatic stasis (Byler's disease); pathogenesis is associated with mutations in the genes of the hepatocellular transport system; is diagnosed in one newborn out of 50-90 thousand.

In addition, bile stasis in a child of preschool and school age may have the same causes as in adults (see above). But most often the etiology is associated with impaired motility of the gallbladder and functional disorders of the biliary tract.

Diagnosis of stagnation of bile

In clinical practice, the diagnosis of bile stasis is carried out by examination, during which, in addition to collecting an anamnesis and examining the patient, such tests are taken as:

Instrumental diagnosis of pathologies during bile stasis is carried out using:

ultrasound examination (ultrasound) of the gallbladder, liver and small intestine;
dynamic cholescintigraphy;
esophagogastroduodenoscopy;
radioisotope hepatobiliary scintigraphy;
endoscopic cholangiography;
endoscopic retrograde radiography of the bile ducts and pancreas (ERCP).
CT or MRI of the digestive organs.

Differential Diagnosis

The task that differential diagnosis solves is to clearly distinguish between the problems of the hepatobiliary system that caused bile stasis, from hereditary defects in bile excretion (Rotor, Dubin-Johnson syndromes), unconjugated hyperbilirubinemia (Gilbert's syndrome), parenchymal jaundice, hematuria, carotenemia, erythropoietic porphyria, hepatic form of infectious mononucleosis, etc.

Treatment of stagnant bile

The principles on which the complex treatment of bile stasis is based: if the cause can be eliminated - etiological treatment, including surgical treatment; when the cause cannot be eliminated - symptomatic therapy with the maximum possible impact on individual pathogenetic components.

If the stagnation of bile in the gallbladder or liver has not caused obstruction of the ducts, then drugs based on ursodeoxycholic acid, which is part of bile, are used. These include the hepatoprotective drug with choleretic (increasing bile synthesis) and choleretic effects Ursofalk (Ursochol, Cholacid, Ursosan, Ursoliv, Ukrliv, Choludexan and other trade names) in the form of capsules and suspensions for oral administration. It also reduces the production of cholesterol and its absorption in the small intestine, which reduces the likelihood of the formation of cholesterol-containing stones. Capsules and suspension are prescribed at 10-15-20 mg per kilogram of body weight per day (the doctor determines the specific dose); treatment is long.

Ursofalk can not be used for cirrhosis of the liver, acute cholecystitis or cholangitis, with calcified stones in the gallbladder and its dyskinesia, as well as in case of obvious functional insufficiency of the liver, pancreas or kidneys. And among the side effects of ursodeoxycholic acid, pain in the upper abdomen, moderate diarrhea, and the formation of bile calcifications are noted.

Almost always, choleretic agents are prescribed for stagnation of bile, such as Allohol, Hofitol (Artichol, Cynarix), Holiver, Odeston (Gimecromon, Cholestil, Holstamin forte, etc.). Ademetionine (Heptor, Heptral) is recognized as the most effective hepatoprotector.

Allochol (consisting of dry bile, extracts of nettle and garlic and activated charcoal) promotes the production of bile, so it is not used in acute forms of hepatitis, liver dysfunction and obstructive jaundice. Allochol tablets are taken after meals - 2 tablets three times a day. In some, the drug can cause skin allergies and diarrhea.

Tablets (and solutions for oral and parenteral administration) Hofitol contain an extract of the leaves of the artichoke seed, which promotes the promotion of bile, increased diuresis and metabolism of cholesterol. The drug in the form of tablets is taken three times a day, 1-2 tablets (before meals), the solution - 2.5 ml (for children - 0.6-1.25 ml). Hofitol can cause hives; it is contraindicated for use in gallstones, biliary obstruction and liver failure.

And the choleretic agent Holiver, in addition to artichoke extract, contains extracts of bile and turmeric, which stimulate the synthesis of bile acids and the release of hepatic bile. The remedy is also effective for constipation associated with intestinal dysbiosis and flatulence. Contraindications are similar to Hofitol; standard dosage - 2-3 tablets 3 times a day (before or after meals).

Cholagogue tablets Odeston (based on 7-hydroxy-4-methylcoumarin) not only accelerate the circulation of bile, but also relieve spasms. It is recommended to take one tablet (0.2 g) three times a day for 10-14 days, half an hour before meals. Odeston is contraindicated in nonspecific ulcerative colitis and any diseases of the gastrointestinal tract with ulcerations, obstruction of the bile ducts, hemophilia; not used in the treatment of children. Side effects of the drug are manifested in the form of diarrhea, epigastric pain, increased formation of intestinal gases.

The drug Ademetionine (S-adenosyl-methionine) contributes to the normalization of liver function and metabolism. It is prescribed 2-3 tablets per day; contraindications of the drug relate to individual intolerance, use in the treatment of children and pregnant women (in the I-II trimesters). A possible side effect is discomfort in the hypochondrium.

In addition, in the treatment of stagnation of bile, pharmaceutical choleretic collections of medicinal plants are used. For example, choleretic collection No. 2 (flowers of immortelle sandy, yarrow grass, peppermint leaves, coriander seeds) or collection No. 3 (flowers of calendula, tansy and pharmacy chamomile and mint leaves). A decoction is prepared from dry raw materials - a tablespoon per glass of water (boil for no more than 10 minutes and leave for half an hour in a sealed container, strain and add boiled water to the original volume). Cholagogue fees should be used after consulting a doctor; drink decoctions before meals twice a day - 100 ml each.

Rose hips also have choleretic properties: you can prepare an infusion of dry berries or take Holosas (a dessert spoon a day, children - half a teaspoon). You should also take vitamins A, C, D, E, K.

Homeopathy

Of the homeopathic remedies for the treatment of bile stasis, Galstena (tablets for resorption under the tongue and drops) and Gepar compositum (solution in ampoules for parenteral use) can be used.

Both preparations contain many components, but each contains spotted milk thistle (Silybum marianum) or milk thistle (in the form of plant seed extract). Among the active substances of milk thistle, the flavonolignan complex (silibinin, silybins, isosilybins, silicristin, isosilicristin, silydianin and dihydroquercetin) has a particular benefit to the liver. Milk thistle also contains vitamin K and ω-6 fatty linoleic acid.

Galsten's drug stimulates the production of bile and activates its movement from the liver to the gallbladder and further, relieves spasms and inflammation. Doctors recommend taking this remedy one tablet (under the tongue) twice a day; drops - 7-10 drops three times a day (between meals). The instructions indicate adverse allergic reactions, and only hypersensitivity is indicated in the contraindications. However, Galstena contains Chelidonium majus, that is, celandine, and this plant is known to be poisonous (due to the presence of isoquinoline alkaloids) and can cause cramps, intestinal cramps, salivation and uterine muscle contractions.

The homeopathic preparation Gepar compositum consists of 24 active substances (one of them is milk thistle). It is used by intramuscular or subcutaneous injection - one ampoule every 3-7 days for 3-6 weeks. Side effects include urticaria and itching.

Surgical treatment

To date, depending on the etiology and localization of bile stasis, surgical treatment includes such types of surgical intervention as:

laparoscopic removal of stones in cholelithiasis and bile duct stones (endoscopic lithoextraction);
removal of a cyst or tumor that prevents the outflow of bile;
installation of stents in the bile ducts;
balloon expansion (dilatation) of the lumen of the bile ducts with their obstruction;
drainage of the common bile duct (choledochostomy);
expansion of the gallbladder or its ducts with stenting and the formation of bilidigestive anastomoses;
operations on the sphincters of the gallbladder;
removal of the gallbladder (cholecystectomy).

In case of biliary atresia (see the section - Stagnation of bile in a child), the ducts in the liver are created surgically: children of the first two months undergo a reconstructive operation (portoenterostomy), but liver transplantation may also be required.

Alternative treatment

Among the variety of recipes for alternative treatment of this pathology, the most adequate advice can be distinguished:

Consume for 1-1.5 months a mixture of home-made juices - carrot, apple and beetroot (in equal proportions); you should drink 150 ml of this juice (an hour after eating).
Drink natural apple cider vinegar by adding a tablespoon to a cup of apple juice or water with lemon juice; you can also put a teaspoon of honey there.
Take mummy dissolved in water for two weeks (tablet 0.2 g per 500 ml); drink the entire amount per day (in divided doses, half an hour before meals). Between courses of application, it is advised to take 5-7-day breaks. A full cycle of such mummy therapy can last 3-5 months. True, the popular recipe does not mention that with such volumes of use of this biostimulant, there may be diarrhea, increased heart rate and increased blood pressure.

Also, alternative treatment suggests using oats and preparing a decoction from it: pour a tablespoon of whole grains with two glasses of water and boil for about half an hour; drink 15-20 minutes before meals 3-4 times during the day (drink the entire amount per day). However, it should be borne in mind that oats act as a laxative and lower blood pressure.

Persimmon with stagnation of bile will help to cope with diarrhea (for this it is recommended to prepare a decoction). Persimmon contains a lot of beta-carotene and vitamin C, as well as manganese - a cofactor for the synthesis of the antioxidant enzyme superoxide dismutase, which increases the resistance of mucous membranes. Other powerful antioxidants found in persimmons include lycopene and cryptoxanthin. But pomegranate not only promotes hematopoiesis, but also has choleretic properties; however, this fruit promotes constipation.

Bile in the human body is produced by liver cells - hepatocytes. This yellow biological fluid is a viscous structure. It contains the main components - special acids, phospholipids, bilirubin, immunoglobulins and cholesterol. These substances provide the main function - enzymatic, resulting in a transition from gastric to intestinal digestion.

Bile must have a certain consistency. For a number of reasons, this liquid can become more concentrated. This phenomenon is called the syndrome of thickening of bile. With its development, congestion in the gallbladder is observed. A person develops digestive problems, inflammation develops, the patency of the biliary tract decreases due to the high probability of the formation of stones in them. The disease has certain causes, requires instrumental and clinical diagnosis, treatment and transition to a special diet.

Danger of bile stasis

According to the anatomical structure, the gallbladder is a small container. Each meal is accompanied by the accumulation in this "reservoir" of bile, which is produced by liver cells. Then such a substance enters the duodenum through the bile ducts, where it directly participates, and also stimulates important digestive processes.

Thickening and further stagnation of bile are dangerous factors that can significantly worsen a person’s health and provoke dangerous complications:

violation of the process of digestion of food;
development of gallstone disease;
progression of inflammatory processes characteristic of cholecystitis;
the occurrence of structural changes in liver tissues, leading to organ dysfunction (including cirrhosis of the liver);
development of osteoporosis;
violation of metabolic processes due to insufficient absorption of vitamins and trace elements.

Causes of thickening of bile

Several factors can provoke pathological processes that cause bile stasis syndrome, which can be combined into three groups:

functional disorders of the liver, difficulty in patency in the bile ducts that occur against the background of diseases of the gastrointestinal tract (gastritis, peptic ulcer of the stomach and duodenum, intestinal infections, inflammatory processes in the pancreas and liver, congenital pathologies of the gallbladder and its ducts);
the presence of pathologies of other organs and systems (diseases of the pelvic organs, obesity, metabolic disorders, diabetes mellitus, diseases of the nervous system, allergic manifestations);
the influence of adverse external factors (exposure to toxins of various nature, drugs, alcohol, products that enter the body during smoking and malnutrition).

Symptoms of the syndrome may appear during pregnancy. They can also be provoked by a sedentary lifestyle, a change in diet, a surgical intervention, the result of which is the removal of the gallbladder. The likelihood of developing pathology increases in the presence of a genetic predisposition.

Characteristic symptoms

To understand that in the human body bile changes its consistency, becomes thick, unpleasant symptoms help. Special signs of pathological processes are observed in different age groups - in adults, in children, including infants.

In adults

Bile thickening syndrome in adults is accompanied by severe symptoms. The patient may indicate a regular repetition and a combination of symptoms:

the presence of heartburn, belching, a feeling of bitterness in the mouth;
the appearance of a feeling of nausea, sometimes accompanied by vomiting;
pain in the hypochondrium (right) and in the epigastrium;
frequent diarrhea;
discoloration of feces to light, urine, on the contrary, acquires a dark color;
severe fatigue, weakness, general loss of strength;
changes in the condition of the skin (itching, dryness, rashes, jaundice);
sclera, mucous membranes of the mouth, tongue may acquire a yellowish tint;
there is nocturnal insomnia, severe daytime sleepiness.

During pregnancy

During the period of expectation of a child, “perestroika” processes take place in the female body - the hormonal background changes, the internal organs change their location, are squeezed. Such phenomena contribute to the development of cholestasis. Pregnant women also have characteristic manifestations:

pain sensations accompany eating, active movement of the fetus and can last up to two hours;
pain occurs simultaneously with the reaction of the digestive system (nausea, belching, heartburn);
sweating may increase, chills and a slight increase in body temperature are observed.

In newborns

In infants, signs of pathology at its initial stage in most cases do not appear, the picture of the disease becomes bright during the onset of complications. In newborns, the following symptoms indicate bile thickening syndrome:

loss of appetite, sometimes complete refusal of food;
the baby's skin becomes very dry and turns yellow, rashes may appear on it;
the child is often naughty, does not sleep well;
urine darkens, feces become light;
food is not retained in the stomach, vomiting occurs.

Diagnostic measures

When symptoms of cholestasis appear, the doctor prescribes additional studies to clarify and confirm the diagnosis. The patient needs to undergo the following instrumental and laboratory procedures:

Treatment methods used

In the treatment of bile thickening syndrome and its stagnation, a complex of therapeutic measures and procedures is used. The basis is not only the use of drugs that help restore the functions of organs, systems with pathological changes and eliminate characteristic symptoms, but also a special diet, herbal medicine, physical activity, homeopathic remedies. In some cases, the patient is prescribed a surgical operation.

Drug Overview

Drug treatment is indicated after a reliable establishment of the cause that caused the change in the characteristics of bile. After receiving the results of instrumental, laboratory diagnostics, the patient can receive a prescription for drugs from one, but more often from several groups:

choleretic drugs necessary to regulate the formation of bile in the liver (Odeston, Allochol, Karsil);
hepatoprotectors - to restore liver function, regulate its work ("Essentiale", "Lecithin", "Legalon", "Sirepar", "Karsil", "Erbisol");
cholekinetics - to increase the tone, contractility of the walls of the gallbladder ("Cholecystokinin", "Holosas", "Magnesium sulfate", "Flamin", "Berberine");
anti-inflammatory drugs;
antibiotics;
antispasmodics - are shown to relax the muscles of the digestive organs ("Spazmalgon", "No-shpa").

Folk recipes

To alleviate the condition of patients - adults and children - the doctor may recommend traditional medicine. Natural medicines should have choleretic, anti-inflammatory, strengthening properties. It is these qualities that the following medicinal raw materials have:

herbs - sweet clover, sandy immortelle, knotweed, corn stigmas;
fresh vegetable and fruit juices (carrots, beets, apples);
oats (seeds);
mummy (aqueous solution).

The doctor regulates the individual scheme and personal course of treatment, as well as the peculiarities of the preparation of medicines.

Homeopathy

With stagnation of bile, an alternative type of treatment is also used - homeopathy. Popular drugs are:

injection solution "Gepar compositum" (contains more than 20 active ingredients);
drops and tablets "Galsten" on the basis of milkweed spotted.

During the treatment, the effect is achieved - the production of bile improves, its transport function, the development of inflammation is prevented, the muscular activity of the organs is regulated. Medicines can cause side effects, in which case you should stop treatment and consult a specialist.

Exercises

For the correction and prevention of congestion in the liver and gallbladder, it is recommended to increase physical activity. The easiest way to achieve this goal is to walk daily. Its duration should be at least an hour.

Doctors advise for patients a complex of therapeutic exercises. It includes such exercises: turns, tilts of the body, lifting the legs up from a prone position - while performing breathing exercises.

The digestive system of an adult works in a habitual and formed cycle. To maintain stable digestion, assimilation and breakdown into components of the food consumed, a sufficient amount of bile and pancreatic juice is constantly secreted into the cavity of the gastrointestinal tract. Each digestive secret has its own concentration, balanced composition, which allows you to organize the rapid processing of fats, carbohydrates, proteins, amino acids, vitamins and minerals. The greatest load falls on the gallbladder, inside which such necessary bile is collected. As soon as it becomes too thick, it begins to slowly move along the ducts and enters the duodenum in a much smaller amount. In this regard, the process of the intestines, stomach, liver, pancreas is disrupted. A person begins to experience painful symptoms, and irreversible processes gradually develop in the gallbladder itself and its ducts. Let us consider in more detail why bile is taken in clots, loses its former fluidity, and what methods exist for its liquefaction.

Signs of putty bile appear as the disease progresses. Too thick digestive secret accumulates in the gallbladder, its circulation slows down and such a physiological phenomenon as stagnation occurs.

In this case, a sick person begins to feel the following unpleasant symptoms:

If several of the listed symptoms are present at the same time and the disease state of the body gradually increases, then it is necessary to get an appointment with a gastroenterologist as soon as possible and undergo a comprehensive examination of the body, as well as the organs of the digestive system themselves. In the early stages of the development of the disease, bile liquefaction can be achieved by saturating your diet with foods that form a therapeutic diet that does not allow the secret of the gallbladder to become thick.

Causes of pathology

There are a large number of negative factors of external and internal effects on the human body, the presence of which provokes the formation of too thick bile, which is not capable of fully ensuring the digestive process. The following causes of excessive thickening of bile are distinguished:

poisoning with toxic compounds, which occurred with constant human contact with harmful chemical compounds, or a single intake of poisons of various concentrations;
negative heredity on the part of parents in whose family there were genetic pathologies of the gallbladder;
diseases of the glands of the endocrine system, which are responsible for the production of hormones that regulate the digestive cycle;
improperly organized nutrition, too rare meals, or snacks that cannot replace a full meal;
long-term drug therapy with the intake of a large number of potent drugs, the pharmacological formula of which negatively affected the liver;
overweight, extreme obesity, which continues to progress and spread to the liver tissue;
frequent stressful situations, psycho-emotional stress;
weakness of the muscle fibers that form the circumference of the sphincter of the gallbladder (especially often develops in people who have previously undergone treatment of the gallbladder using surgical methods);
the presence of concomitant diseases of the digestive system (acute or chronic pancreatitis, cholecystitis, gastric ulcer, gastritis, duodenal erosion).

The consumption of fried, smoked, pickled, spicy and too fatty foods has a very great influence on the density of bile.

Under the influence of the dishes of this group, the potential of the gallbladder and liver tissues wears out, the muscle activity of these organs of the digestive system decreases, and bile does not liquefy over a long period of time.

To what doctor to go and what inspections pass or take place?

Over many years of studying and treating such a physiological phenomenon as excessive bile density, a set of diagnostic measures has been formed that allow you to fix the pathology as accurately as possible, spending a minimum amount of time on the whole process.

Having found the symptoms described above, you should immediately contact a gastroenterologist who will conduct an initial examination, perform palpation of the abdomen and prescribe the following types of tests to the patient:

blood from a finger to determine its main vital cells;
morning urine on an empty stomach, so that the doctor has an idea about the possible presence of inflammation in the gallbladder area, impurities of unprocessed bile;
venous blood, which is subjected to biochemical analysis for the concentration in the body of toxic compounds, harmful substances, dead hepatocytes and other signs indicating pathology of liver tissues;
Ultrasound diagnostics of the abdominal organs and directly the gallbladder itself, in which too thick bile accumulates, which must be urgently liquefied.

The latter diagnostic method is the most effective in terms of determining the concentration and density of bile. The main thing is that the ultrasound examination should be performed in the morning, and the patient himself should not eat for 8-10 hours before the diagnostic measures. In addition to the consistency of the bile secretion, this technique allows you to detect inflammatory processes in the organ, as well as the possible presence of stone deposits in it.

What to do and how to treat thick bile?

Such a pathological condition associated with a stable circulation of bile in the ducts requires complex treatment. For this purpose, both traditional medicines are used, and a special dietary food is formed that contributes to the dilution of bile. Consider all directions of the therapeutic course, which restores the normal consistency of the bile secretion.

Preparations

Modern pharmacology offers three main groups of medicines designed to thin too thick bile. These are choleretics, synthetic hydrocholeretics and extracts of medicinal plants. The latter contain a completely natural biochemical formula, have a minimum number of side effects and contraindications.

In medical practice, the following drugs are used:

What kind of remedy to choose for the treatment of the patient, its dosage and duration of the therapeutic course, is determined exclusively by the gastroenterologist who is observing the patient.

Each clinical case is individual, so some people may need 10 days to restore the normal consistency of the bile secretion, and another person with a more complex case of the disease will need at least 1 month for the density of bile to return to normal. Self-treatment is strictly prohibited, as it can cause an exacerbation of the disease and worsen the general condition of the digestive system.

Products that thin bile

There are certain types of foods that help thin bile that is too thick, while others, on the contrary, have the opposite properties. Patients with concentrated and viscous bile are advised to adhere to the following menu:

fresh vegetable salads with lots of parsley, dill and other herbs, seasoned with sunflower oil;
cereal porridges boiled in water without adding butter;
oven baked fruits;
stewed cabbage or vegetable stew;
chicken broth, which is used with gray slightly stale bread or crackers;
not strong green tea with sugar;
lean chicken breasts cooked in a steam bath or boiled in lightly salted water;
berry jelly, rosehip compotes, chamomile tea;
pasta from durum wheat.

Before forming a diet menu, it is recommended to undergo a preliminary consultation with your doctor. It is possible that the doctor will advise you to include additional foods in the diet, which will also help thin the thick bile. The main thing to remember is that fatty, fried, smoked and protein foods make the bile secret too concentrated and viscous.

A clinical case from the practice of pediatric pulmonology is presented. The presence of a diagnosis of "Bronchiolitis" in the patient, as well as syndromes of thickening of bile and malabsorption, led the diagnostic search beyond bronchopulmonary pathology. This work is indicative of how our body is a holistic mechanism in which one syndrome can be the cause of various diseases. The work is devoted to topical issues of one of the most common hereditary diseases in children. What changes in the liver and gallbladder are typical for a child with moderate intestinal symptoms and a predominantly pulmonary form of the disease. The expediency of further examination and diagnosis is shown. We also consider bile not just as a product of the activity of hepatocytes involved in the digestive chain, but also as a bactericidal product.

bile thickening syndrome

cystic fibrosis

bronchiolitis

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2. Shabalov N. P. - “Neonatology: a guide for doctors” - St. Petersburg,. T. 1, 2. -2012

3. Agadzhanyan N.A., Smirnov V.M. - "Normal Physiology" - Moscow, 520p. - 2009

4. Krasovsky S.A., Samoilenko V.A., Amelina E.L. "Cystic fibrosis: diagnosis, clinic, basic principles of therapy" - magazine "Atmosfera. Pulmonology and Allergology" - №1, 2013

5. Belle-van Meerkerk G1, van de Graaf EA, Kwakkel-van Erp JM, van Kessel DA, Lammers JW, Biesma DH, de Valk HW. - "Diabetes before and after lung transplantation in patients with cystic fibrosis and other lung diseases" - 2012 - Pubmed.

6. Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA - "Neonatal cystic fibrosis screening test" - 2016 - Medline Mohan K, Miller H, Dyce P, Grainger R, Hughes R, Vora J, Ledson M, Walshaw M. - "Mechanisms of glucose intolerance in cystic fibrosis" - 2011 - Pubmed.

Bile thickening syndrome (BCS) is a syndrome that develops as a complication of hemolytic disease of the newborn. At the same time, an increase in the intensity of jaundice is noted from the end of the first week of life, accompanied by an increase in the size of the liver, sometimes significant, and partial discoloration of the stool.

Bile is a product of the activity of hepatocytes. Yellow, brown or greenish, bitter tasting, odorous fluid accumulated in the gallbladder.

Bile performs the following functions:

emulsification of fats, that is, their splitting to the smallest components;
the ability to dissolve products of lipid hydrolysis, thereby improving their absorption and transformation into end products of metabolism;
regulating, since the liquid is responsible not only for the process of bile formation and its secretion, but also for motility;
bile is responsible for the secretory function of the small intestine, that is, for the ability to produce digestive juices;
inactivation of pepsin and neutralization of the acid components of the gastric contents that enter the duodenal cavity, thereby protecting the intestine from the development of erosion and ulceration;
bacteriostatic properties, due to which the inhibition and spread of pathogens in the digestive system occurs;
replaces gastric digestion with intestinal by limiting the action of pepsin and creating the most favorable conditions for the activity of pancreatic enzymes, especially lipase.

Let us dwell on the sixth (6) point in more detail. By studying the intestinal microflora: we know that intestinal microorganisms that synthesize vitamins K, E and B vitamins (B6, B12) are suppressed by the growth of pathological microorganisms. That is, the development of putrefactive processes takes place, which entails a general decrease in immune resistance.

Consequently, CVJ, the absence or small flow of bile into the lumen of the small intestine, leads to a decrease in the bactericidal properties of digestive juices and the active growth, development and function of pathological microflora.

In addition, bile thickening syndrome (BCS) may be one of the earliest clinical manifestations of cystic fibrosis.

The classic "diagnostic triad" for cystic fibrosis is:

Positive sweat test (sweat chloride level over 60 mEq/L);

Pulmonary syndrome;

intestinal syndrome.

In this case, a combination of any two of these three signs is enough to make a diagnosis of cystic fibrosis.

The clinical manifestation is exocrine insufficiency, which occurs in most patients with cystic fibrosis and manifests itself in a violation of fat assimilation, steatorrhea, and a lag in physical development. Violation of the stool occurs from the first days of life in 47% of patients with cystic fibrosis, and by the year - in 76%. Patients who do not receive appropriate treatment are characterized by a secondary deficiency of fat-soluble vitamins - A, E, D and K.

Bronchopulmonary changes dominate the clinical picture of cystic fibrosis, determining the prognosis of the disease in 95% of patients. During the first year of life, symptoms of damage to the respiratory system appear: persistent dry cough, asthma attacks, shortness of breath. The cough is usually worse at night or on waking.

As a rule, the inflammatory process in the bronchi is preceded by a viral infection of the nasopharynx, larynx, trachea (respiratory syncytial viruses, adeno- and rhinoviruses, influenza viruses, parainfluenza), which inevitably leads to the death of ciliated epithelial cells and the addition of bacterial flora.

Mucostasis and chronic bronchial infection become the background for repeated respiratory episodes: bronchiolitis, bronchitis, pneumonia.

Case from clinical practice

On December 5, 2017, Child A, 15 days old (born on November 21, 2017), was admitted to the Regional Children's Clinical Hospital (ODKB, Karaganda) with complaints of shortness of breath, frequent cough, runny nose, anxiety, and fever up to 38.0 . I got sick for the first time. Born from the 1st pregnancy, 1x delivery on time, weighing 3600 grams, height 55 cm. Breastfed from the 1st day of birth. vaccinated at the maternity hospital. On the "D" account is not included. Mom denies contact with tuberculosis-infectious patients. Allergy anamnesis is calm, heredity is not burdened.

At the time of treatment, according to the mother, the child is sick for the second (2) day. The disease began with nasal congestion, followed by a cough. Independently took "Ambrobene" five (5) drops three (3) times a day, rubbed the chest with lamb fat. The condition did not improve, but was aggravated by shortness of breath. The ambulance was called, taken to the emergency room of the CSTO, hospitalized in the 6th department, 13th ward.

The condition at the time of the examination is assessed as moderate - due to: respiratory failure syndromes (1st degree), bronchial obstruction, intoxication and catarrhal phenomena.

Objectively: body temperature T - 37.0 C0, heart rate - 146 per minute, respiratory rate - 64 per minute, body weight 3450 grams.

The child's state of health is moderately disturbed, restless. Consciousness is clear. Appetite saved. The physique is correct.

The skin is yellow, Kramer's yellowness is equal to 4 zones (head, chest, limbs), there are rashes on the face in the cheeks, scalp, and back. The subcutaneous fat layer is poorly developed, evenly distributed. Peripheral lymph nodes are not enlarged.

The osseous-articular system without deformation, movement in the joints in full.

Nasal breathing is difficult due to rhinorrhea. The pharynx is hyperemic, on the visible mucous membrane of the mouth there are whitish cheesy deposits.

Cough dry, unproductive, frequent. Shortness of breath of a mixed nature, with the participation of auxiliary muscles, indrawing of the lower parts of the chest. The chest is cylindrical, both halves are involved in the act of breathing, symmetrical. Auscultatory picture in the lungs: weakened breathing, there are wheezing - moist fine bubbling on inspiration, dry whistling on exhalation. Percussion box tone.

The region of the heart is not changed in appearance, the boundaries of relative cardiac dullness are: upper - 2nd intercostal space, right - along the right parasternal line, left - 1 cm outward from the left mid-clavicular line. Heart sounds are clear, rhythmic.

The tongue is moist and clean. The abdomen is of normal shape, palpation is available in all departments, tense, painless. The liver is enlarged by 3 cm. The stool is mushy, greasy, there are shiny drops, fetid, from birth it goes up to 8-9 times a day. Urination free, painless.

Neurological status: a large fontanel measuring 5 cm x 6 cm, a small fontanel is open. There is a cephalohematoma 4 cm x 3 cm.

KLA dated 05/12/17: hemoglobin Hb - 153 g/l, color index CP - 1.0, erythrocytes - 4.5 * 1012 / l, ESR - 3 mm / h, platelets - 509 * 109 / l, leukocytes - 12.7 * 109 / l, lymphocytes - 26.2%, monocytes - 23.0%, eosinophils - 7.1%, basophils - 1.1%.

Conclusion: thrombocytosis.

Coprogram from 09/12/17: leukocytes - 0-1 units, consistency - mushy, color - light yellow, neutral fat +++, fatty acids +++, mucus +.

Chest X-ray (plain, in direct projection) dated 06/12/17: no focal lesions.

GDZ ultrasound from 06/12/17: Bile thickening syndrome.

Diagnosis: Acute bronchiolitis.

According to IMCI: Severe pneumonia.

Associated diagnoses: Atopic dermatitis. Conjugative jaundice. Stomatitis. Cephalhematoma.

Conducted treatment: Diet HB, mode 3a-free.

Ambro solution 7.5 mg/ml (1 ml, orally) 2 times a day; Sodium chloride solution for infusion 0.9% (3 ml, inhalation) 4 times; Prednisolone solution 30 mg / ml (0.2 ml, intramuscularly) 2 times; allergopress solution 2% 1 time per day; cefuroxime 650 2 times a day.

From the above clinical case, the following syndromes can be distinguished: pulmonary (cough with sputum difficult to separate, wheezing in the lungs, bronchial obstruction), intestinal (increased defecation, stool with drops of fat, asthenia, weight loss). As you know, it is enough to have two clinical manifestations out of three to suggest violations of the exocrine system, more precisely such a pathology as cystic fibrosis. To confirm or refute the diagnosis, it is necessary to prescribe specific diagnostic measures - a sweat test (the level of sweat chlorides is more than 60 meq / l); Ultrasound of the pancreas, biochemical blood test (direct and indirect bilirubin).

In this patient, the prescribed treatment led to an improvement in the dynamics, but the condition should not be overlooked as a “false positive” dynamics, since the manifestation of the pulmonary syndrome of the disease “cystic fibrosis” is treated in an analogous way. But by establishing the diagnosis of cystic fibrosis at an early age, we can prevent its formidable manifestations.

Children who are diagnosed early in life and begin treatment at a young age may have better nutrition, growth, and lung function.

Cystic fibrosis causes thick, sticky mucus to form in the lungs and digestive tract. This can lead to breathing and digestion problems.

Also, based on our diagnostic search, bile thickening syndrome, as an independent disease, can lead to a decrease in the bactericidal properties of digestive juices and the active growth, development and function of pathological microflora. Not to mention the consequences of hypovitaminosis of vitamins K, E and group B, which develops as a natural oppression and replacement of the normal intestinal microflora with a pathological one, which will lead to a general decrease in the body's resistance to infectious invasions.

Bibliographic link

Amanbekova Zh.E., Akshalov A.R. BILE CONCESSION SYNDROME - IS IT JUST A SYNDROME OR ONE OF THE MANIFESTATIONS OF A TERRIBLE DISEASE // International Student Scientific Bulletin. - 2018. - No. 4-1 .;
URL: http://eduherald.ru/ru/article/view?id=18603 (date of access: 02/07/2020). We bring to your attention the journals published by the publishing house "Academy of Natural History"

Thick bile in the gallbladder is often referred to in the medical literature as "biliary sludge". This pathological change not only disrupts the process of digestion, but is also regarded as a stage preceding. In 18% of cases, biliary sludge disappears irrevocably within 2 years after the onset, but in 14% it ends with the formation of gallstones. To understand how to thin bile, you should familiarize yourself with the mechanism of its thickening.

Bile is a suspension of bile acids and pigments, cholesterol, proteins, phospholipids, some ions and mucus. It becomes thick when the ratio of these constituent components is violated. Most often this occurs against the background of a disorder of the contractile activity of the gallbladder.

Several risk factors can be combined with each other. Given the variety of causes of thick bile, it is better to entrust their search to a doctor.

Biliary sludge in children

Special consideration deserves the syndrome of thickening of bile in newborns. Reasons why it may occur:

Hemolytic disease of the newborn - the destruction of red blood cells due to the incompatibility of the blood of the mother and fetus. More often occurs against the background of Rhesus conflict. An increase in the viscosity of bile is associated with excessive formation of bilirubin due to the breakdown of red blood cells.
Total parenteral nutrition (bypassing the gastrointestinal tract). There is no proper stimulation of the motility of the biliary tract. An excess of protein hydrolysates and fat emulsions in parenteral solutions leads to a change in the properties of bile.
Prolonged use of diuretics. The risk group includes children with bronchopulmonary dysplasia (chronic lung damage) who are administered furosemide.

With proper therapy, thick bile syndrome in newborns can be corrected. It disappears without a trace with the timely elimination of its main cause. In complicated cases, pigment stones can form in the gallbladder.

Symptoms

Thickening of bile is often hidden and is an accidental diagnostic finding during ultrasound. With the progression of the pathology, the following complaints may appear:

Feeling of heaviness, sensation of pain in the right hypochondrium.
Bitterness in the mouth;
Heartburn;
Nausea;
Vomiting of bile (the contents of the stomach become greenish-yellow);
Skin itching (with progression of stagnation of bile);
Yellowness of the skin, sclera of the eyes;
Darkening of the urine and discoloration of the stool.

Non-specific, but often accompanying biliary sludge complaints are flatulence and decreased appetite. The occurrence of at least one of the symptoms is the basis for visiting a gastroenterologist.

Diagnostics

Instrumental research methods help to detect pathology. The main ones are:

Ultrasound of the abdominal organs. The most common ultrasound picture: a crescent-shaped sediment layer in the lower part of the gallbladder.
duodenal sounding. Allows you to evaluate the composition of bile and its quantity. A special probe is inserted into the region of the duodenum, through which the secreted bile is captured. The method helps to detect giardiasis.
MRI. X-ray research method that allows you to find anatomical features that interfere with the normal outflow of bile. In particular, MRI can detect a tumor that compresses the biliary tract.

Thickening of bile is not always accompanied by a sharp deviation of laboratory parameters from the norm. Changes in the biochemical analysis of blood often indicate a significant severity of the pathological process. Indicators to pay attention to:

Bilirubin. The increase is mainly due to the direct fraction.
Cholesterol. A high level does not necessarily indicate thick bile, but is a risk factor.
Transaminases (enzymes involved in intracellular metabolism). An increase in the activity of ALT (to a greater extent) and AST (to a lesser extent) indicates a possible inflammatory process in the liver.

Principles of therapy

Medical treatment

With insufficient muscle activity of the gallbladder, cholecystokinetics are used. They accelerate the excretion of bile by contracting the walls of the organ and reflex relaxation of the bile ducts. One medicinal representative is Holosas based on rose hips. With spastic etiology of stagnation of bile, drugs with a cholespasmolytic effect are used (Cholagol, drotaverine).

The second therapeutic task is to stimulate the secretion of bile. Apply choleretics (Allochol). Liquefaction of bile is achieved with the help of hydrocholeretics. This group includes mineral waters, for example, Essentuki and Izhevskaya.

Important! Choleretics can be used only after the restoration of patency and normalization of the motility of the biliary tract. Stimulation of bile production against the background of its poor outflow will lead to aggravation of congestion.

For the prevention of stone formation, agents are used that dissolve a thick precipitate in bile. One of the representatives is Ursosan. Ursodeoxycholic acid protects liver cells, has a choleretic effect.

Tyubazh

The procedure represents the emptying of the gallbladder by simultaneously taking a choleretic agent and warming up the liver area. There are two types: probe (a tube is inserted into the duodenum through which a choleretic drug is administered) and blind (the medicine is taken orally on its own).

Tubeless tubage at home can be carried out, but only after the permission of the attending physician. Mineral water ("Essentuki", "Borjomi") is suitable as a stimulant for the production of bile. You can use mannitol and sorbitol.

Phytotherapy

Assign single and multi-component choleretic fees. Cholekinetics: yarrow, three-leaf watch, dandelion. Stimulate the secretion of bile: corn stigmas, wild rose. Relax the muscles of the gallbladder: calendula, St. John's wort. Mint is both a choleretic and a cholespasmolytic.

Important! The use of choleretic teas, folk remedies (for example, olive oil) without examination by a doctor is not recommended. The selection of the drug should take into account the type of biliary tract motility disorder, otherwise the pathology can be aggravated.

Diet

How to liquefy bile in the gallbladder in addition to taking medication? Proper nutrition has a significant impact. Principles:

Increasing the daily intake of clean water. You should limit the consumption of carbonated drinks, coffee, strong tea.
Fractionality. You need to eat every 3 hours in small portions.
Limiting the intake of fatty, fried, spicy foods, confectionery.
Temperature regime. Food should not be too hot or cold, otherwise it will irritate the walls of the digestive tract.
Preference for boiled and steamed foods.

Lifestyle Correction

Choleretic drugs alone are not enough to permanently get rid of the disorder. It is recommended to increase physical activity, normalize body weight. Stress should be avoided as much as possible, since any pronounced emotional stress is fraught with gallbladder motility disorders.

Conclusion

Thick bile is a signal of the possible imminent occurrence of calculous cholecystitis. Biliary sludge requires not only proper treatment, but also compliance with secondary prevention measures. If you do not change your lifestyle after therapy, in 6 out of 10 cases it reappears. To correctly eliminate the pathology, you need to contact a gastroenterologist. He will help you find out the cause of thick bile, select the treatment and indicate which individual risk factors you need to pay attention to so as not to run into a problem again.