Gallstone disease symptoms and treatment. Gallstone disease (GSD) - symptoms, causes, diet and treatment of gallstone disease
Chronic calculous cholecystitis- This is a disease in which stones form in the cavity of the gallbladder, which subsequently cause inflammation of the walls of the gallbladder.
Cholelithiasis refers to common diseases - occurs in 10-15% of the adult population. In women, this disease occurs 2-3 times more often than in men. Cholecystitis is an ancient human disease. The first gallstones were discovered during the study of Egyptian mummies.
Anatomy and physiology of the gallbladder
The gallbladder is a hollow, pear-shaped organ. The gallbladder is projected approximately in the middle of the right hypochondrium.The length of the gallbladder is from 5 to 14 centimeters, and the capacity is 30-70 milliliters. In the bladder, the bottom, body and neck are distinguished.
The wall of the gallbladder consists of mucous, muscular, and connective tissue membranes. The mucosa consists of epithelium and various glandular cells. The musculature is made up of smooth muscle fibers. At the neck, the mucous and muscular membranes form a sphincter that prevents the release of bile at the wrong time.
The bladder neck continues into the cystic duct, which then merges with the common hepatic duct to form the common bile duct.
The gallbladder is located on the lower surface of the liver so that the wide end of the gallbladder (bottom) slightly extends beyond the lower edge of the liver.
The function of the gallbladder is to store, concentrate bile and excrete bile as needed.
The liver produces bile and, as unnecessary, bile accumulates in the gallbladder.
Once in the bladder, bile is concentrated by absorption of excess water and trace elements by the epithelium of the bladder.
The secretion of bile occurs after eating. The muscular layer of the bladder contracts, increasing the pressure in the gallbladder to 200-300 mm. water column. Under the action of pressure, the sphincter relaxes, and bile enters the cystic duct. The bile then enters the common bile duct, which opens into the duodenum.
The role of bile in digestion
Bile in the duodenum creates the necessary conditions for the activity of enzymes in the pancreatic juice. Bile dissolves fats, which contributes to the further absorption of these fats. Bile is involved in the absorption of vitamins D, E, K, A in the small intestine. Bile also stimulates the secretion of pancreatic juice.
Causes of the development of chronic calculous cholecystitis
The main cause of calculous cholecystitis is the formation of stones.There are many factors that lead to the formation of gallstones. These factors are divided into: immutable (those that cannot be influenced) and those that can be changed.
Fixed Factors:
- Floor. Most often, women get sick due to the use of contraceptives, childbirth (estrogens, which are elevated during pregnancy - increase the absorption of cholesterol from the intestines and copious excretion with bile).
- Age. Persons aged 50 to 60 years are more likely to suffer from cholecystitis.
- genetic factors. These include - family predisposition, various congenital anomalies of the gallbladder.
- ethnic factor. The greatest number of cases of cholecystitis is observed in Indians living in the southwestern United States and in the Japanese.
- Food . Increased consumption of animal fats and sweets, as well as hunger and rapid weight loss can cause cholecystitis.
- Obesity. The amount of cholesterol in the blood and bile increases, which leads to the formation of stones
- Diseases of the gastrointestinal tract. Crohn's disease, resection (removal) of part of the small intestine
- Medications. Estrogens, contraceptives, diuretics (diuretics) - increase the risk of cholecystitis.
- Hypodynamia (fixed, sedentary lifestyle)
- Decreased tone of the muscles of the gallbladder
How are stones formed?
Stones are from cholesterol, from bile pigments and mixed.The process of formation of stones from cholesterol can be divided into 2 phases:
First phase- violation in bile of the ratio of cholesterol and solvents (bile acids, phospholipids).
In this phase, there is an increase in the amount of cholesterol and a decrease in the amount of bile acids.
An increase in cholesterol occurs due to a malfunction of various enzymes.
- decreased hydroxylase activity (affects cholesterol lowering)
- decreased activity of acetyl transferase (converts cholesterol to other substances)
- increased breakdown of fats from the fatty layer of the body (increases the amount of cholesterol in the blood).
The decrease in fatty acids occurs the following reasons.
- Violations of the synthesis of fatty acids in the liver
- Increased selection bile acids from the body (impaired absorption of fatty acids in the intestine)
- Violation of intrahepatic circulation
Second phase - bile saturated with cholesterol forms a stasis of bile (stagnation of bile in the bladder), then the process of crystallization occurs - forming crystals of cholesterol monohydrate. These crystals stick together and form stones of various sizes and compositions.
Cholesterol stones may be single or multiple and are usually round or oval in shape. The color of these stones is yellow-green. The sizes of stones vary from 1 millimeter to 3-4 centimeters.
Bile pigment stones are formed due to an increase in the amount of unbound, water-insoluble bilirubin. These stones are composed of various polymers of bilirubin and calcium salts.
Pigment stones usually small size up to 10 millimeters. Usually there are several pieces in the bubble. These stones are black or grey.
Most often (80-82% of cases) there are mixed stones. They consist of cholesterol, bilirubin and calcium salts. By the number of stones are always multiple, yellow-brown.
Symptoms of gallstone disease
In 70-80% of cases, chronic calculous cholecystitis develops asymptomatically for several years. Finding stones in the gallbladder in these cases occurs by chance - during an ultrasound done for other diseases.Symptoms appear only if the stone moves through the cystic canal, which leads to its blockage and inflammation.
Depending on the stage of cholelithiasis, the symptoms presented in the next section of the article are also distinguished.
Clinical stages of gallstone disease
1. Stage of violation physical and chemical properties bile.There are no clinical symptoms at this stage. The diagnosis can be made only by the study of bile. Cholesterol "snowflakes" (crystals) are found in bile. Biochemical analysis of bile shows an increase in the concentration of cholesterol and a decrease in the amount of bile acids.
2. Latent stage.
At this stage, there are no complaints from the patient. There are already stones in the gallbladder. Diagnosis can be made by ultrasound.
3. The stage of onset of symptoms of the disease.
- Biliary colic is a very severe, paroxysmal and sharp pain that lasts from 2 to 6 hours, sometimes more. Attacks of pain usually appear in the evening or at night.
The pain is in the right hypochondrium and spreads to right shoulder blade and right neck region. Pain occurs most often after a rich, fatty meal or after a lot of physical activity.
Products after taking, which may cause pain:
- Cream
- Alcohol
- cakes
- Carbonated drinks
Other symptoms of the disease:
- Increased sweating
- Chills
- Increase in body temperature up to 38 degrees Celsius
- Vomiting bile that does not bring relief
At this stage, complications such as:
Acute cholecystitis This disease requires immediate surgical intervention.
Hydrocele of the gallbladder. There is a blockage of the cystic duct by a stone or narrowing to a complete blockage of the duct. The release of bile from the bladder stops. Bile is absorbed from the bladder through the walls, and a serous-mucous secret is secreted into its lumen.
Gradually accumulating, the secret stretches the walls of the gallbladder, sometimes to a huge size.
Perforation or rupture of the gallbladder leads to the development of biliary peritonitis (inflammation of the peritoneum).
hepatic abscess. Limited accumulation of pus in the liver. An abscess forms when a section of the liver is destroyed. Symptoms: high temperature up to 40 degrees, intoxication, liver enlargement.
This disease is treated only surgically.
gallbladder cancer. Chronic calculous cholecystitis greatly increases the risk of cancer.
Diagnosis of gallstone disease
In the case of the above symptoms, you should consult a gastroenterologist or general practitioner.Conversation with a doctor
The doctor will ask you about your complaints. Reveal the causes of the disease. He will dwell in particular detail on nutrition (after taking, what foods do you feel bad about?). Then he will enter all the data into the medical record and then proceed to the examination.
Inspection
The examination always begins with a visual examination of the patient. If the patient at the time of examination complains of severe pain, then his face will express suffering.
The patient will be in a supine position with the legs bent and brought to the stomach. This position is forced (reduces pain). I would also like to note a very important sign, when the patient is turned over to the left side, the pain intensifies.
Palpation (palpation of the abdomen)
With superficial palpation, flatulence (bloating) of the abdomen is determined. It is also defined hypersensitivity in the right hypochondrium. There may be muscle tension in the abdomen.
With deep palpation, an enlarged gallbladder can be determined (normally, the gallbladder is not palpable). Also, with deep palpation, specific symptoms are determined.
1. Murphy's symptom - the appearance of pain during inspiration at the time of probing the right hypochondrium.
2. Ortner's symptom - the appearance of pain in the right hypochondrium, when tapping (percussion) on the right costal arch.
Ultrasound of the liver and gallbladder
On ultrasonography, the presence of stones in the gallbladder is well determined.
Signs of the presence of stones on ultrasound:
1. Presence of solid structures in the gallbladder
2. Mobility (movement) of stones
3. Ultrasonographic hypoechoic (visible as a white gap in the picture) trace below the stone
4. Thickening of the walls of the gallbladder more than 4 millimeters
Abdominal x-ray
Clearly visible stones, which include calcium salts
Cholecystography- study using contrast for better visualization of the gallbladder.
CT scan- performed in the diagnosis of cholecystitis and other diseases
Endoscopic cholangiopancreatography- used to determine the location of a stone in the common bile duct.
The course of chronic calculous cholecystitis
The asymptomatic form of cholecystitis lasts a long time. From the moment of detection of stones in the gallbladder within 5-6 years, only 10-20% of patients begin to develop symptoms (complaints).
The appearance of any complications indicates an unfavorable course of the disease. In addition, many complications are treated only surgically.
Treatment of gallstone disease
Stages of treatment:1. Prevention of stone movement and related complications
2. Litholytic (stone crushing) therapy
3. Treatment of metabolic (exchange) disorders
In the asymptomatic stage of chronic cholecystitis, the main method of treatment is diet.
Diet for gallstone disease
Meals should be fractional, in small portions 5-6 times a day. The temperature of the food should be - if cold dishes, then not lower than 15 degrees, and if hot dishes, then not higher than 62 degrees Celsius.Prohibited Products:
Alcoholic drinks
- legumes, in any kind of preparation
- high-fat dairy products (cream, full-fat milk)
- any fried food
- meat from fatty varieties (goose, duck, pork, lamb), lard
- fatty fish, salted, smoked fish, caviar
- any kind of canned goods
- mushrooms
- fresh bread (especially hot bread), croutons
- spices, spices, salinity, pickled products
- coffee, chocolate, cocoa, strong tea
- salty, hard and fatty types of cheese
Cheeses can be eaten, but low-fat
Vegetables should be consumed in boiled, baked form (potatoes, carrots). It is allowed to use finely chopped cabbage, ripe cucumbers, tomatoes. Green onion, parsley to use as an addition to dishes
Meat from non-fat varieties (beef, veal, rabbit), as well as (chicken and turkey without skin). Meat should be consumed boiled or baked. It is also recommended to use minced meat (cutlets)
Vermicelli and pasta allowed
Sweet ripe fruits and berries, as well as various jams and concoctions
Drinks: not strong tea, not sour juices, various mousses, compotes
Butter (30 grams) in dishes
Low-fat types of fish are allowed (perch, cod, pike, bream, perch, hake). It is recommended to use the fish in boiled form, in the form of cutlets, aspic
You can use whole milk. You can also add milk to various cereals.
Not sour cottage cheese, non-sour fat-free yogurts are allowed
Effective treatment of cholecystitis, when symptoms are present, is possible only in a hospital setting!
Drug treatment of biliary colic (pain symptom)
Usually, treatment begins with M-anticholinergics (to reduce spasm) - atropine (0.1% -1 milliliter intramuscularly) or Platifilin - 2% -1 milliliter intramuscularlyIf anticholinergics do not help, antispasmodics are used:
Papaverine 2% - 2 milliliters intramuscularly or Drotaverine (Noshpa) 2% - 2 milliliters.
Baralgin 5 milliliters intramuscularly or Pentalgin also 5 milliliters are used as painkillers.
In case of very severe pain, Promedol 2% - 1 ml is used.
1. stones containing cholesterol
2. less than 5 millimeters in size
3. the age of the stones is not more than 3 years
4. no obesity
Use drugs such as Ursofalk or Ursosan - 8-13 mg per kilogram of body weight per day.
The course of treatment should be continued for 6 months to 2 years.
Method of direct destruction of stones
The method is based on the direct injection of a strong stone dissolver into the gallbladder.
Extracorporeal shock wave lithotripsy- crushing stones with energy shock waves generated outside the human body.
This method is carried out using various devices that produce different kinds waves. For example, waves created by a laser, an electromagnetic installation, an installation that produces ultrasound.
Any of the devices is installed in the projection of the gallbladder, then waves from various sources act on the stones and they are crushed to small crystals.
Then these crystals are freely excreted along with bile into the duodenum.
This method is used when the stones are no larger than 1 centimeter and when the gallbladder is still functioning.
In other cases, in the presence of symptoms of cholecystitis, surgery is recommended to remove the gallbladder.
Surgical removal of the gallbladder
There are two main types of cholecystectomy (removal of the gallbladder)1. Standard cholecystectomy
2. Laparoscopic cholecystectomy
The first type has been used for a long time. The standard method is based on abdominal surgery (with an open abdominal cavity). Recently, it has been used less and less due to frequent postoperative complications.
The laparoscopic method is based on the use of a laparoscope apparatus. This apparatus consists of several parts:
- high magnification video cameras
- different kinds of tools
Advantages of the 2nd method over the first:
1. Laparoscopic surgery does not require large incisions. The incisions are made in several places and are very small.
2. The seams are cosmetic, so they are practically invisible
3. Health is restored 3 times faster
4. The number of complications is ten times less
Prevention of gallstone disease
Primary prevention– is to prevent the formation of stones. The main method of prevention is sports, diet, exclusion of alcohol, exclusion of smoking, weight loss in case of overweight.Secondary prevention is to prevent complications. The main method of prevention is effective treatment chronic cholecystitis described above.
Why is gallstone disease dangerous?
Gallstone disease or calculous cholecystitis is the formation of stones in the gallbladder. Often this causes a pronounced inflammatory process and leads to the appearance severe symptoms. First of all, the disease is manifested by severe pain, a violation of the outflow of bile from the gallbladder, and digestive disorders. Treatment cholelithiasis usually referred to as a surgical profile. This is explained by the fact that the inflammatory process caused by the movement of stones poses a serious threat to the health and life of patients. That is why the problem is usually solved in the fastest way - removal of the gallbladder along with stones. Gallstone disease is dangerous, first of all, with the following complications:
- Gallbladder perforation. A perforation is a rupture of the gallbladder. It can be caused by the movement of stones or too much contraction ( spasm) smooth muscle of the organ. In this case, the contents of the organ enter the abdominal cavity. Even if there was no pus inside, the bile itself can cause serious irritation and inflammation of the peritoneum. The inflammatory process extends to intestinal loops and other neighboring organs. Most often, in the cavity of the gallbladder there are opportunistic microbes. In the abdominal cavity, they multiply rapidly, realizing their pathogenic potential and leading to the development of peritonitis.
- Empyema of the gallbladder. An empyema is a collection of pus in a natural body cavity. With calculous cholecystitis, the stone often gets stuck at the level of the bladder neck. At first, this leads to dropsy - the accumulation of mucous secretion in the cavity of the organ. The pressure inside increases, the walls stretch, but may contract spastically. This leads to severe pain - biliary colic. If such a clogged gallbladder becomes infected, the mucus turns into pus and empyema occurs. Usually pathogens are bacteria from the genera Escherichia, Klebsiella, Streptococcus, Proteus, Pseudomonas, less often Clostridium and some other microorganisms. They can be ingested through the bloodstream or travel up the bile duct from the intestines. With the accumulation of pus, the patient's condition worsens greatly. The temperature rises, headaches intensify ( due to absorption of waste products into the blood). Without urgent surgery, the gallbladder ruptures, its contents enter the abdominal cavity, causing purulent peritonitis. At this stage ( after the break) the disease often ends in the death of the patient, despite the efforts of doctors.
- Reactive hepatitis. The inflammatory process from the gallbladder can spread to the liver, causing inflammation. The liver also suffers from a deterioration in local blood flow. Typically, this problem unlike viral hepatitis) passes quite quickly after removal of the gallbladder - the main center of inflammation.
- Acute cholangitis. This complication involves blockage and inflammation of the bile duct. In this case, the outflow of bile is disturbed by a stone stuck in the duct. Since the bile ducts are connected to the ducts of the pancreas, pancreatitis can also develop in parallel. Acute cholangitis occurs with strong rise temperature, chills, jaundice, severe pain in the right hypochondrium.
- Acute pancreatitis. Usually occurs due to lack of bile ( that is not released from the clogged bladder) or blockage of the common duct. Pancreatic juice contains a large amount of strong digestive enzymes. Their stagnation can cause necrosis ( death) of the gland itself. This form of acute pancreatitis poses a serious threat to the patient's life.
- Biliary fistulas. If gallstones do not cause severe pain, the patient may ignore them for a long time. However, the inflammatory process in the organ wall ( directly around the stone) is still evolving. The destruction of the wall and its “soldering” with neighboring anatomical structures gradually occur. Over time, a fistula may form, connecting the gallbladder with other hollow organs. These organs can be the duodenum ( most often), stomach, small intestine, large intestine. There are also options for fistulas between the bile ducts and these organs. If the stones themselves do not bother the patient, then fistulas can cause air accumulation in the gallbladder, violations of the outflow of bile ( and intolerance to fatty foods), jaundice, vomiting of bile.
- Paravesical abscess. This complication is characterized by the accumulation of pus near the gallbladder. Usually, an abscess is delimited from the rest of the abdominal cavity by adhesions that have arisen against the background of an inflammatory process. From above, the abscess is limited to the lower edge of the liver. The complication is dangerous by the spread of infection with the development of peritonitis, impaired liver function.
- Scar strictures. Strictures are places of narrowing in the bile duct that prevent the normal flow of bile. In cholelithiasis, this complication may occur as a result of inflammation ( the body responds with excessive formation of connective tissue - scars) or as a consequence of an intervention to remove stones. Either way, strictures can persist even after recovery and seriously affect the body's ability to digest and absorb fatty foods. In addition, if stones are removed without removing the gallbladder, strictures can cause bile stasis. In general, people with these duct narrowings are more likely to relapse ( repeated inflammation of the gallbladder).
- Secondary biliary cirrhosis. This complication can occur if gallstones prevent the flow of bile for a long time. The fact is that bile enters the gallbladder from the liver. Its overflow causes stagnation of bile in the ducts in the liver itself. It can eventually lead to the death of hepatocytes ( normal liver cells) and their replacement with connective tissue that does not perform the necessary functions. This phenomenon is called cirrhosis. The result is serious violations of blood clotting, impaired absorption of fat-soluble vitamins ( A, D, E, K), accumulation of fluid in the abdominal cavity ( ascites), severe intoxication ( poisoning) organism.
Can calculous cholecystitis be cured without surgery?
Currently, surgical intervention remains the most effective and justified way to treat calculous cholecystitis. With the formation of stones in the gallbladder, as a rule, an inflammatory process develops, which not only disrupts the functioning of the organ, but also poses a threat to the body as a whole. Surgery to remove the gallbladder along with stones is the most appropriate treatment. In the absence of complications, the risk to the patient remains minimal. The organ itself is usually removed endoscopically ( without dissection of the anterior abdominal wall, through small holes).The main advantages of surgical treatment of calculous cholecystitis are:
- Radical solution to the problem. Removal of the gallbladder guarantees the cessation of pain ( biliary colic), since colic appears due to contractions of the muscles of this organ. In addition, there is no risk of recurrence ( repeated exacerbations) gallstone disease. Bile can no longer accumulate in the bladder, stagnate and form stones. It will go directly from the liver to the duodenum.
- Patient safety. Today, endoscopic removal of the gallbladder ( cholecystectomy) is a routine operation. The risk of complications during surgery is minimal. Subject to all the rules of asepsis and antisepsis, postoperative complications are also unlikely. The patient recovers quickly and can be discharged ( in consultation with the attending physician) a few days after the operation. After a few months, he can lead the most normal life, apart from a special diet.
- Ability to treat complications. Many patients go to the doctor too late, when complications of calculous cholecystitis begin to appear. Then surgical treatment is simply necessary to remove pus, examine neighboring organs, and adequately assess the risk to life.
Nowadays, there are several ways of non-surgical treatment of calculous cholecystitis. This is not about symptomatic treatment. muscle spasm relief, pain relief), namely, getting rid of stones inside the gallbladder. The main advantage of these methods is the preservation of the organ itself. With a successful result, the gallbladder is freed from stones and continues to perform its functions of accumulating and dosed bile secretion.
There are three main methods of non-surgical treatment of calculous cholecystitis:
- Medical dissolution of stones. This method is perhaps the safest for the patient. For a long time, the patient must take drugs based on ursodeoxycholic acid. It promotes the dissolution of stones containing bile acids. The problem is that even to dissolve small stones, it is necessary to take the medicine regularly for several months. If we are talking about larger stones, the course can be delayed for 1 - 2 years. However, there is no guarantee that the stones will dissolve completely. Depending on the individual characteristics of metabolism, they may contain impurities that will not dissolve. As a result, the stones will decrease in size, the symptoms of the disease will disappear. However, this effect will be temporary.
- Ultrasonic crushing of stones. Today, crushing stones with the help of ultrasonic waves is a fairly common practice. The procedure is safe for the patient, easy to perform. The problem is that the stones are crushed into sharp fragments, which still cannot leave the gallbladder without injuring it. In addition, the problem of stagnation of bile is not solved radically, and after a while ( usually several years) stones can form again.
- laser removal stones. It is used quite rarely due to the high cost and relatively low efficiency. Stones are also subjected to a kind of crushing and fall apart. However, even these parts can injure the mucous membrane of the organ. In addition, there is a high risk of recurrence ( re-formation of stones). Then the procedure will have to be repeated.
When is surgery needed for gallstone disease?
Gallstone disease or calculous cholecystitis in the vast majority of cases at a certain stage of the disease require surgical treatment. This is due to the fact that the stones that form in the gallbladder are usually found only with a pronounced inflammatory process. This process is called acute cholecystitis. The patient is concerned about severe pain in the right hypochondrium ( colic), which are exacerbated after eating. The temperature may also rise. In the acute stage, there is a possibility of serious complications, so they are trying to solve the problem radically and quickly. Cholecystectomy is such a solution - an operation to remove the gallbladder. Cholecystectomy involves the complete removal of the bladder along with the stones it contains. With an uncomplicated course of the disease, it guarantees a solution to the problem, since the bile formed in the liver will no longer accumulate and stagnate. The pigments simply won't be able to form stones again.
There are many indications for cholecystectomy. They are divided into absolute and relative. Absolute indications are those without which serious complications can develop. Thus, if the operation is not performed when there are absolute indications, the life of the patient will be endangered. In this regard, doctors in such situations always try to convince the patient of the need for surgical intervention. There are no other treatments available or they will take too long and increase the risk of complications.
Absolute indications for cholecystectomy in cholelithiasis are:
- A large number of stones. If gallstones ( regardless of their number and size) occupy more than 33% of the organ volume, cholecystectomy should be performed. It is almost impossible to crush or dissolve such a large number of stones. At the same time, the organ does not work, since the walls are very stretched, they contract poorly, stones periodically clog the neck area and interfere with the outflow of bile.
- Frequent colic. Attacks of pain in cholelithiasis can be very intense. Remove them with antispasmodic drugs. However, frequent colic suggests that drug treatment is not successful. In this case, it is better to resort to the removal of the gallbladder, regardless of how many stones are in it and what size they are.
- Stones in the bile duct. When the bile ducts are blocked by a stone from the gallbladder, the patient's condition worsens greatly. The outflow of bile stops completely, the pain intensifies, obstructive jaundice develops ( due to the free fraction of bilirubin).
- Biliary pancreatitis. Pancreatitis is an inflammation of the pancreas. This organ has a common excretory duct with the gallbladder. In some cases, with calculous cholecystitis, the outflow of pancreatic juice is disturbed. The destruction of tissues in pancreatitis endangers the life of the patient, so the problem must be urgently solved by surgical intervention.
Separately, it should be noted the surgical treatment of complications of acute cholecystitis. In this case, we are talking about the spread of the inflammatory process. Problems with the gallbladder are reflected in the work of neighboring organs. In such situations, the operation will include not only the removal of the gallbladder with stones, but also the solution of the resulting problems.
Surgical treatment without fail may also be necessary for the following complications of gallstone disease:
- Peritonitis. Peritonitis is an inflammation of the peritoneum, the membrane that covers most of the abdominal organs. This complication occurs when the inflammatory process spreads from the gallbladder or perforation ( gap) of this organ. Bile, and often a large number of microbes, enters the abdominal cavity, where intense inflammation begins. The operation is necessary not only to remove the gallbladder, but also to thoroughly disinfect the abdominal cavity as a whole. It is impossible to postpone surgical intervention, since peritonitis is fraught with the death of the patient.
- Bile duct strictures. Strictures are called narrowing of the canal. Such narrowing can be formed due to the inflammatory process. They obstruct the outflow of bile and cause stagnation in the liver, although the gallbladder itself can be removed. Surgery is needed to remove strictures. As a rule, the narrowed area is expanded or a bypass is made for bile from the liver to the duodenum. In addition to surgery effective solution this problem does not exist.
- accumulation of pus. Purulent complications gallstone disease occurs when an infection enters the gallbladder. If pus accumulates inside the organ, gradually filling it, such a complication is called empyema. If pus accumulates near the gallbladder, but does not spread through the abdominal cavity, they speak of a paravesical abscess. The patient's condition with these complications is greatly deteriorating. The risk of spreading the infection is high. The operation includes removal of the gallbladder, emptying the purulent cavity and thoroughly disinfecting it to prevent peritonitis.
- Biliary fistulas. Gallbladder fistulas are pathological openings between the gallbladder ( less commonly by biliary tract) and neighboring hollow organs. Fistulas may not cause acute symptoms but they violate natural process outflow of bile, digestion, and also predispose to other diseases. The operation is performed to close pathological openings.
How to treat gallstone disease with folk remedies?
In the treatment of gallstone disease, folk remedies are ineffective. The fact is that with this disease, stones begin to form in the gallbladder ( usually crystals containing bilirubin). It is almost impossible to dissolve these stones with folk methods. For their splitting or crushing, respectively, powerful pharmacological preparations or ultrasonic waves. However, folk remedies play a role in the treatment of patients with gallstone disease. Possible effects of medicinal plants in gallstone disease are:
- Relaxation of smooth muscles. Some medicinal plants relax the muscular sphincter of the gallbladder and the smooth muscles of its walls. This relieves pain attacks usually caused by spasm).
- Decreased bilirubin level. Elevated levels of bilirubin in bile especially if it's been stuck for a long time) may contribute to the formation of stones.
- outflow of bile. Due to the relaxation of the sphincter of the gallbladder, the outflow of bile occurs. It does not stagnate, and crystals and stones do not have time to form in the bubble.
Thus, the effect of the use of folk remedies will be predominantly preventive. Patients with abnormal liver function or other factors predisposing to gallstone disease will benefit from periodic treatment. This will slow down the formation of stones and prevent the problem before it occurs.
For the prevention of gallstone disease, you can use the following folk remedies:
- radish juice. Black radish juice is diluted with honey in equal proportions. You can also cut a cavity in a radish and pour honey into it for 10-15 hours. After that, a mixture of juice and honey is consumed 1 tablespoon 1-2 times a day.
- barberry leaves. Green leaves of barberry are thoroughly washed with running water and filled with alcohol. For 20 g of crushed leaves, 100 ml of alcohol are needed. Infusion lasts 5 - 7 hours. After that, the tincture is drunk 1 teaspoon 3-4 times a day. The course lasts 1 - 2 months. It can be repeated after six months.
- Rowan tincture. 30 g of rowan berries pour 500 ml of boiling water. Insist 1 - 2 hours ( while the temperature drops to room temperature). Then the infusion is taken half a glass 2-3 times a day.
- Mummy. Shilajit can be taken both for the prevention of stone formation, and for cholelithiasis ( if the diameter of the stones does not exceed 5 - 7 mm). It is diluted in a ratio of 1 to 1000 ( 1 g mummy per 1 liter of warm water). Before meals, drink 1 glass of solution, three times a day. This tool can be used no more than 8 - 10 days in a row, after which you need to take a break of 5 - 7 days.
- Mint with celandine. Equal proportions of the dry leaves of these herbs are consumed as an infusion. For 2 tablespoons of the mixture, 1 liter of boiling water is needed. Infusion lasts 4 - 5 hours. After that, the infusion is consumed 1 glass per day. Sediment ( grass) is filtered before use. It is not recommended to store the infusion for more than 3 - 4 days.
- Highlander snake. To prepare a decoction, you need 2 tablespoons of dry chopped rhizome, pour 1 liter of boiling water and cook for 10-15 minutes over low heat. 10 minutes after turning off the fire, the broth is decanted and allowed to cool ( usually 3 - 4 hours). The decoction is taken 2 tablespoons half an hour before meals twice a day.
To prevent stagnation of bile using blind probing, pharmacological preparations or some natural mineral water. Water or medicine should be drunk on an empty stomach, after which the patient lies on his right side, placing under right hypochondrium (on the area of the liver and gallbladder) warm heating pad. You need to lie down for 1 - 2 hours. During this time, the sphincter will relax, the bile duct will expand, and the bile will gradually come out into the intestines. The success of the procedure is indicated by dark stools with bad smell In a few hours. It is advisable to consult with your doctor about the method of blind probing and its expediency in each specific case. After the procedure, you need to follow a low-fat diet for several days.
Thus, folk remedies can successfully prevent the formation of gallstones. At the same time, the regularity of treatment courses is important. It is also advisable to undergo preventive examinations with a doctor. This will help to detect small stones ( using ultrasound) in case folk methods do not help. After the formation of stones, the effectiveness of traditional medicine is greatly reduced.
What are the first signs of gallstone disease?
Cholelithiasis can be secretive for a long time, without manifesting itself. During this period in the patient's body there is stagnation of bile in the gallbladder and the gradual formation of stones. Stones are formed from pigments found in bile ( bilirubin and others), and resemble crystals. The longer the stagnation of bile, the faster these crystals grow. At a certain stage, they begin to injure the inner shell of the organ, interfere with the normal contraction of its walls and prevent the normal outflow of bile. From this point on, the patient begins to experience certain problems. Usually, gallstone disease manifests itself for the first time as follows:
- Heaviness in the abdomen. A subjective feeling of heaviness in the abdomen is one of the first manifestations of the disease. Most patients complain about it when they see a doctor. The severity is localized in the epigastrium ( under the pit of the stomach, in the upper abdomen) or in the right hypochondrium. It can appear spontaneously, after physical exertion, but most often - after eating. This feeling is due to stagnation of bile and an increase in the gallbladder.
- Pain after eating. Sometimes the first symptom of the disease is pain in the right hypochondrium. In rare cases, it is biliary colic. It is a severe, sometimes unbearable pain that can radiate to the right shoulder or shoulder blade. However, often the first attacks of pain are less intense. It is rather a feeling of heaviness and discomfort, which, when moving, can turn into stabbing or bursting pain. Discomfort occurs an hour and a half after eating. Especially often pain attacks are observed after taking a large number fatty foods or alcohol.
- Nausea. Nausea, heartburn, and sometimes vomiting can also be the first manifestations of the disease. They also usually appear after eating. The connection of many symptoms with food intake is explained by the fact that the gallbladder normally releases a certain portion of bile. It is needed for emulsification ( a kind of dissolution and assimilation) fats and activation of certain digestive enzymes. In patients with gallstones, bile is not excreted, food is digested worse. Therefore, nausea occurs. Backward reflux of food into the stomach leads to belching, heartburn, gas accumulation, and sometimes vomiting.
- Stool changes. As mentioned above, bile is necessary for the normal absorption of fatty foods. With uncontrolled secretion of bile, prolonged constipation or diarrhea may occur. Sometimes they appear even before other symptoms typical of cholecystitis. For more late stages stool may be discolored. This means that the stones clogged the ducts, and bile is practically not excreted from the gallbladder.
- Jaundice. Yellowing of the skin and sclera of the eyes is rarely the first symptom of gallstone disease. It usually occurs after digestive problems and pain. Jaundice is caused by stagnation of bile not only at the level of the gallbladder, but also in the ducts inside the liver ( where bile is produced). Due to a violation of the liver, a substance called bilirubin accumulates in the blood, which is normally excreted with bile. Bilirubin enters the skin, and its excess gives it a characteristic yellowish tint.
It is usually difficult to make a correct diagnosis based on the first symptoms and manifestations of gallstone disease. Nausea, vomiting and indigestion can also occur with disorders in other organs of the digestive system. To clarify the diagnosis, an ultrasound is prescribed ( ultrasound procedure) of the abdominal cavity. It allows you to detect a characteristic increase in the gallbladder, as well as the presence of stones in its cavity.
Can calculous cholecystitis be treated at home?
Where the treatment of calculous cholecystitis will take place depends entirely on the condition of the patient. Hospitalization is usually subject to patients with acute forms of the disease, but there may be other indications. At home, gallstone disease can be treated with medication if it occurs in a chronic form. In other words, a patient with gallstones does not need urgent hospitalization unless they have acute pain, fever, and other signs of inflammation. However, sooner or later the question of surgical elimination of the problem arises. Then, of course, you need to go to the hospital. In general, it is recommended to hospitalize the patient in the following cases:
- Acute forms of the disease. In the acute course of calculous cholecystitis, a serious inflammatory process develops. Without proper patient care, the course of the disease can become very complicated. In particular, we are talking about the accumulation of pus, the formation of an abscess or the development of peritonitis ( inflammation of the peritoneum). In the acute course of the disease, hospitalization should not be postponed, since the above-mentioned complications can develop within 1 to 2 days after the first symptoms.
- The first signs of the disease. It is recommended that patients who present with symptoms and signs of calculous cholecystitis be admitted to the hospital for the first time. There they will do all the necessary research within a few days. They will help to figure out what kind of disease the patient has, what his condition is, whether there is a question of urgent surgical intervention.
- Accompanying illnesses . Cholecystitis can develop in parallel with other health problems. For example, in patients with chronic heart failure, diabetes mellitus or other chronic diseases, it can cause an exacerbation and a serious deterioration in the condition. To carefully monitor the course of the disease, it is recommended to put the patient in the hospital. There, if necessary, he will be quickly provided with any assistance.
- Patients with social problems. Hospitalization is recommended for all patients who cannot receive urgent care at home. For example, a patient with chronic cholelithiasis lives very far from the hospital. In the event of an exacerbation, it will not be possible for him to quickly provide qualified assistance ( usually about surgery.). During transportation, serious complications may develop. A similar situation arises with older people who have no one to look after at home. In these cases, it makes sense to operate even a non-acute process. This will prevent an exacerbation of the disease in the future.
- Pregnant women. Calculous cholecystitis in pregnancy carries a higher risk for both mother and fetus. In order to have time to provide assistance, it is recommended to hospitalize the patient.
- Patient's wish. Any patient with chronic cholelithiasis can own will go to the hospital for surgical removal of gallstones. This is much more profitable than operating on an acute process. Firstly, the risk of complications during surgery and in the postoperative period is reduced. Secondly, the patient himself chooses the time ( vacation, scheduled sick leave, etc.). Thirdly, he deliberately excludes the risk of repeated complications of the disease in the future. The prognosis for such elective operations is much better. Doctors have more time to carefully examine the patient before treatment.
At home, the disease can be treated under the following conditions:
- chronic course of gallstone disease ( no acute symptoms);
- final diagnosis;
- strict adherence to the instructions of a specialist ( regarding prevention and treatment);
- the need for long-term medical treatment ( for example, non-surgical dissolution of stones can take 6 to 18 months);
- the possibility of caring for the patient at home.
Is it possible to play sports with gallstone disease?
Gallstone disease or calculous cholecystitis is a fairly serious disease, the treatment of which must be taken very seriously. The formation of gallstones may not cause noticeable symptoms at first. Therefore, some patients, even after accidentally discovering a problem ( during preventive ultrasound examination) continue to lead a normal life, neglecting the regimen prescribed by the doctor. In some cases, this can lead to accelerated progression of the disease and deterioration of the patient's condition. One of the important conditions of the preventive regimen is the limitation of physical activity. This is necessary after the discovery of stones, during the acute stage of the disease, as well as during treatment. At the same time, we are talking not only about professional athletes, whose training requires all the strength, but also about everyday physical activity. At each stage of the disease, they can affect the development of events in different ways.
The main reasons for limiting physical activity are:
- Accelerated production of bilirubin. Bilirubin is a natural metabolic product ( metabolism). This substance is formed during the breakdown of hemoglobin - the main component of red blood cells. The more physical activity a person performs, the faster red blood cells break down and the more hemoglobin enters the blood. As a result, the level of bilirubin also rises. This is especially dangerous for people who have bile stasis or a predisposition to the formation of stones. The gallbladder accumulates bile with a high concentration of bilirubin, which gradually crystallizes and forms stones. Thus, people who already have cholestasis ( bile stasis), but the stones have not yet formed, heavy physical exercise not recommended for preventive purposes.
- Movement of stones. If the stones have already formed, then serious loads can lead to their movement. Most often, stones are located in the area of the bottom of the gallbladder. There they can cause a moderate inflammatory process, but do not interfere with the outflow of bile. As a result of physical activity, intra-abdominal pressure rises. This is reflected to some extent in the gallbladder. It is compressed, and the stones can set in motion, moving to the neck of the organ. There, the stone gets stuck at the level of the sphincter or in the bile duct. As a result, a serious inflammatory process develops, and the disease acquires an acute course.
- Progression of symptoms. If the patient already has digestive disorders, pain in the right hypochondrium or other symptoms of gallstone disease, then physical activity can provoke an exacerbation. For example, pain due to inflammation can turn into biliary colic. If the symptoms are caused by the movement of stones and blockage of the bile duct, then they will not disappear after the cessation of exercise. Thus, there is a chance that even a single exercise ( running, jumping, lifting weights, etc.) can lead to urgent hospitalization and surgery. However, we are talking about people who already suffer from a chronic form of the disease, but do not comply with the regimen prescribed by the doctor.
- Risk of complications of gallstone disease. Calculous cholecystitis is almost always accompanied by an inflammatory process. At first, it is caused by mechanical trauma to the mucous membrane. However, many patients develop infectious process. As a result, pus may form and accumulate in the bladder cavity. If, under such conditions, intra-abdominal pressure rises sharply or the patient makes a sharp bad turn, the swollen gallbladder may burst. The infection will spread throughout the abdominal cavity, and peritonitis will begin. Thus, sports and physical activity in general can contribute to the development of serious complications.
- Risk of postoperative complications. Acute cholecystitis often needs to be treated surgically. There are two main types of operations - open, when an incision is made in the abdominal wall, and endoscopic, when removal occurs through small openings. In both cases, after the operation, any physical activity is contraindicated for some time. With open surgery, healing takes longer, more sutures are placed, and the risk of divergence is higher. With endoscopic removal of the gallbladder, the patient recovers faster. As a rule, full-fledged loads are allowed to be given only 4-6 months after the operation, provided that the doctor does not see other contraindications for this.
- daily walks for 30 - 60 minutes at an average pace;
- gymnastic exercises without sudden movements with limited load on the abdominal press;
- swimming ( not for speed) without diving to great depths.
Is pregnancy dangerous with gallstone disease?
Gallstone disease in pregnant women is a fairly common occurrence in medical practice. On the one hand, this disease is typical for older women. However, it is during pregnancy that there are quite a few prerequisites for the appearance of stones in the gallbladder. Most often it occurs in patients with a hereditary predisposition or with chronic liver diseases. According to statistics, an exacerbation of gallstone disease usually occurs in the third trimester of pregnancy. The prevalence of this problem during pregnancy is explained as follows:
- Metabolic changes. As a result of hormonal changes, the metabolism in the body also changes. This can lead to accelerated stone formation.
- Motility changes. Normally, the gallbladder stores bile and contracts, releasing it in small portions. During pregnancy, the rhythm and strength of its contractions are disturbed ( dyskinesia). As a result, bile stasis can develop, which contributes to the formation of stones.
- Increased intra-abdominal pressure. If a woman already had small gallstones, then the growth of the fetus can lead to their movement. This is especially true in the third trimester, when the growing fetus pushes the stomach up, colon and gallbladder. These organs are compressed. As a result, the stones located near the bottom of the bubble ( at the top of it), can enter the bile duct and block it. This will lead to the development of acute cholecystitis.
- Sedentary lifestyle. Pregnant women often neglect walking or elementary physical exercises, which contribute, among other things, to the normal functioning of the gallbladder. This leads to stagnation of bile and acceleration of the formation of stones.
- Diet change. Changes in food preferences can affect the composition of the microflora in the intestine, impair motility bile ducts. If at the same time the woman had a latent ( asymptomatic) form of gallstone disease, the risk of exacerbation greatly increases.
Exacerbation of gallstone disease during pregnancy is especially dangerous for the following reasons:
- high risk of rupture due to increased intra-abdominal pressure;
- high risk of infectious complications ( including purulent processes) due to weakened immunity;
- fetal intoxication due to the inflammatory process;
- malnutrition of the fetus due to poor digestion ( food is absorbed worse, as bile does not enter the duodenum);
- limited treatment options not all drugs and treatments that are commonly used for gallstone disease are suitable for pregnant women).
In the absence of complications of gallstone disease, the prognosis for the mother and child remains favorable. If the patient turned to a specialist too late, and the inflammatory process began to spread in the abdominal cavity, the question of extracting the fetus by caesarean section may be raised. At the same time, the prognosis worsens somewhat, since we are talking about a technically complex surgical intervention. It is necessary to remove the gallbladder, remove the fetus, carefully examine the abdominal cavity to prevent the development of peritonitis.
What are the types of calculous cholecystitis?
Calculous cholecystitis is not the same for all patients. This disease is caused by the formation of stones in the gallbladder, due to which an inflammatory process develops. Depending on how exactly this process will proceed, as well as on the stage of the disease, there are several types of calculous cholecystitis. Each of them has not only its own characteristics of the course and manifestations, but also requires a special approach to treatment. From the point of view of the main manifestations of the disease(clinical form)There are the following types of calculous cholecystitis:
- stone carrier. This form is latent. The disease does not show up. The patient feels great, does not experience any pain in the right hypochondrium, or problems with digestion. However, the stones have already formed. They gradually increase in number and size. This will happen until the accumulated stones begin to disrupt the functioning of the organ. Then the disease will begin to manifest. Stone carriers can be detected during a preventive ultrasound examination. It is more difficult to notice the stones on the overview x-ray abdominal cavity. When a stone carrier is found, there is no question of an emergency operation. Doctors have time to try other treatments.
- Dyspeptic form. In this form, the disease is manifested by a variety of digestive disorders. It can be difficult to suspect cholecystitis at first, since there are no typical pains in the right hypochondrium. Patients are concerned about heaviness in the stomach, in the epigastrium. Often after a large meal especially fatty foods and alcohol) there is an eructation with a taste of bitterness in the mouth. This is due to violations of bile secretion. Also, patients may have problems with the stool. In this case, an ultrasound examination will help confirm the correct diagnosis.
- biliary colic. In fact, biliary colic is not a form of gallstone disease. This is a common specific symptom. The problem is that in the acute stage of the disease, severe pain attacks often appear ( every day and sometimes more). The effect of antispasmodic drugs is temporary. Gallbladder colic is caused by painful contraction of smooth muscles in the walls of the gallbladder. They are usually observed with large stones, overstretching of the organ, ingress of a stone into the bile duct.
- Chronic recurrent cholecystitis. The recurrent form of the disease is characterized by repeated bouts of cholecystitis. The attack is manifested by severe pain, colic, fever, characteristic changes in blood tests ( increases the level of leukocytes and the erythrocyte sedimentation rate - ESR). Relapses occur when unsuccessful attempts at conservative treatment. Medicines temporarily bring down the inflammatory process, and some medical procedures can temporarily improve the outflow of bile. But as long as there are stones in the gallbladder cavity, the risk of recurrence remains high. Surgery ( cholecystectomy - removal of the gallbladder) solves this problem once and for all.
- Chronic residual cholecystitis. This form is not recognized by all experts. It is sometimes spoken of in cases where an attack of acute cholecystitis has passed. The patient's temperature decreased, and the general condition returned to normal. However, the symptoms remained moderate pain in the right hypochondrium, which is aggravated by palpation ( palpation of this area). Thus, we are not talking about a complete recovery, but about the transition to a special form - residual ( residual) cholecystitis. As a rule, over time, the pain disappears or the disease worsens again, turning into acute cholecystitis.
- angina pectoris form. Is rare clinical form calculous cholecystitis. Its difference from others is that the pain from the right hypochondrium spreads to the region of the heart and provokes an attack of angina pectoris. Heart rhythm disturbances and other symptoms may also be observed. of cardio-vascular system. This form is more common in patients with chronic ischemic heart disease. Biliary colic in this case plays the role of a kind of "trigger". The problem is that due to an attack of angina pectoris, doctors often do not immediately detect the main problem - the actual calculous cholecystitis.
- Saint's syndrome. It is a very rare and poorly understood genetic disease. With it, the patient has a tendency to form stones in the gallbladder ( actually calculous cholecystitis), which appears to be due to the absence of certain enzymes. In parallel, diverticulosis of the colon and diaphragmatic hernia are observed. This combination of defects requires a special approach in treatment.
Good day, dear readers!
In today's article, we will consider with you such a disease as cholelithiasis, as well as its signs, causes, diagnosis, treatment, diet and prevention. So…
What is gallstone disease?
Gallstone disease (GSD)- a disease that is characterized by the formation of stones (calculi) in the gallbladder or bile ducts.
Another name for the disease is cholelithiasis.
The main symptoms of gallstone disease are colic in the right hypochondrium, heaviness in the abdomen and yellowing of the skin.
The main cause of gallstone disease is a violation of cholesterol, bilirubin and some other metabolic processes, in which bile pigments, "bad" cholesterol, salts, some types of protein and other substances settle in the gallbladder and its ducts. Over time, these substances begin to stick to each other and harden, forming the so-called stones.
One of the most popular consequences of finding stones in the bile organs is development.
The development of gallstone disease
Before understanding the process of formation of stones in the gallbladder and its ducts, we will try to plain language describe what these organs are and what function they perform in the life of the body.
The gallbladder is an organ, a kind of reservoir for bile, connected to the liver, pancreas and duodenum. In the gallbladder, bile particles are separated from water, i.e. in this organ there is a concentration of bile, which, when food, especially heavy food, is injected by the gallbladder into the initial section of the small intestine (duodenum 12), where this secret contributes to the digestion of food.
The bile ducts are the ducts through which the liver, gallbladder, pancreas, and duodenum are connected.
Bile is a liquid secret produced by the liver, which enters the gallbladder through the hepatic duct, where, as we have already said, it is concentrated (separated from water). Bile is necessary for the normal digestion of food.
Now let's proceed to the consideration of the development of gallstone disease.
Certain factors, such as pregnancy, taking certain medicines(especially affecting the metabolism of cholesterol and bilirubin), obesity, starvation, eating junk food, metabolic disorders, diabetes mellitus and other pathologies lead to bile stagnation in the gallbladder. The particles of which bile actually consists begin to “stick together”, forming small seals from themselves, which increase in size over the years. The bile ducts are much smaller than the bladder, and therefore, at a certain time, for example, when the body is shaken, the stone enters the duct and gets stuck in it, forming a blockage (obturation). Sometimes the stone hardly passes through the lumen of the bile duct, "scratching" its walls. But both cases cause strong feelings in a person. sharp pains in the area where the movement or jamming of the stone occurs. In rare cases, stones form in the bile ducts themselves.
Gallstones are seals ranging in size from a few millimeters to several centimeters, formed mainly from cholesterol deposits, calcium salts, various pigments (bilirubin is a bile pigment), proteins and other substances. Stones, or as they are also called in the scientific world - stones, can be of various shapes, sizes, and also based on various particles, with a predominance of one or another substance. The structure of stones can be crystalline, layered, fibrous or amorphous.
The next stage in the development of cholelithiasis depends on the localization of the blockage of the duct. If this occurs before the main bile duct, i.e. immediately behind the gallbladder, bile from the liver enters immediately into small intestine, however, the lack of its concentration leads to poor digestion of food. In addition, bile acids begin to circulate in the body without a controlling organ (bladder), which leads to the fact that an aggressive secret begins to harm the body, because. it is the bladder that regulates when bile is needed in the intestines and when it is not.
If the stone clogs the lumen of the common bile duct, then the bile, only already concentrated, from an overabundance returns back to the liver, and begins to affect it. This leads to toxic hepatitis.
If the stone clogs the lumen of the common duct near the duodenum itself, then the pancreas also enters the affected area.
With all these blockages, you need to understand that bile cannot enter the small intestine in sufficient quantities, or even enter the small intestine at all, while food cannot be digested normally. At the same time, if it is impossible to excrete from the body, bile begins to poison the body, sometimes infectious microorganisms appear in it, which contributes to the development of life-threatening consequences.
Of course, the above process is very superficial, but the overall picture of the state of affairs, I think, is now clear.
Treatment of gallstone disease is aimed at removing stones from the body without damaging the gallbladder and biliary tract. Usually treatment is conservative, but some situations can only be solved surgically.
Statistics of the disease
Gallstone disease from year to year is becoming more and more common disease of many people around the world. So, some authors point to an increase in the number of cases of cholelithiasis among residents of the CIS countries, every 10 years, almost twice.
The proportion of women who have gallstones compared to men is usually between 2:1 and 8:1. Another factor in which the number of patients with this pathology increases is age, the older the person, the higher the risk of manifestation of the disease.
If we talk about the total number of patients with cholelithiasis - 10% of the world's population, over the age of 70 years, the number of patients is up to 30%.
If we talk about the geography of the spread of the disease, then the number of cases is most common in developed countries - the USA, Europe, the CIS countries, while food is consumed mainly plant origin – Southeast Asia, India, Japan, cases of gallstone disease are minimal. Of course, in addition to food, movement also plays a big role, because. in underdeveloped countries people are for the most part constantly on the move.
Gallstone disease - ICD
ICD-10: K80.
The process of development of gallstone disease takes a long time - from the beginning of the formation of stones to the first signs of the disease, it can take from 5 to 10 years. This is due to the fact that the presence of stones in the gallbladder does not disturb a person in any way, and pain appears only when they enter the biliary tract and begin to injure
The first signs of gallstone disease
- Yellowing of the skin, sclera of the eyes, mucous membranes of the oral cavity;
- Sharp colic in the right hypochondrium (biliary colic), which appear when the stone moves along the biliary tract;
- Feeling of heaviness in the abdomen, frequent belching;
- Feeling of bitterness in the mouth.
The main symptoms of gallstone disease
- biliary or hepatic colic (acute sharp pains in the right hypochondrium with recoil to the right shoulder blade, forearm, arm, lower back, sternum and even neck), appearing mainly after eating spicy, spicy, fried and fatty foods, drinking alcoholic beverages, stress, heavy physical exertion or shaking the body;
- Nausea, (sometimes with bile), after which the feeling of relief usually does not come;
- Yellowness of the skin, sclera of the eyes, mucous membranes of the oral cavity ();
Additional symptoms:
- Increased body temperature - up to;
- increased sweating;
- discoloration of feces;
- Dull pain in the liver, which develops as a result of the expansion of the bile ducts of this organ, which leads to an increase in the liver in volume;
- Seizures.
Symptoms may vary depending on the location of the blockage of the bile ducts by stones, as well as concomitant diseases.
Complications of gallstone disease
Complications of gallstone disease include:
- (inflammation of the gallbladder);
- Cholangitis (inflammation of the bile ducts);
- Acute biliary pancreatitis;
- Fistula formation;
- Toxic hepatitis;
- Cancer of the pancreas, liver and other organs of the gastrointestinal tract.
Causes of gallstone disease
Among the main reasons for the formation of stones in the gallbladder and bile ducts are:
- Stagnation of bile in the gallbladder;
- Ultra-high concentration of bile;
- Violation of metabolic processes in the body, in particular bilirubin, cholesterol, lipids (fats, phospholipids, etc.) and other substances, which often provoke diseases such as fermentopathy, metabolic syndrome, and others;
- Dyskinesia of the biliary tract;
- , passing into ;
- Hypofunction of liver cells;
- Diseases of the pancreas and other organs of the gastrointestinal tract;
- Hemolytic anemia;
- Congenital anomalies in the structure of the organs of the gastrointestinal tract;
- The presence of scars, tumors, adhesions, kinks, inflammatory and other pathological changes and processes in the bile ducts;
- The presence of an infection in the body, especially Escherichia coli.
Factors that increase the risk of developing cholelithiasis (cholelithiasis)
- Improper nutrition - starvation, overeating or long periods of time between meals;
- The use of harmful, spicy, fatty, fried and spicy foods;
- Sedentary lifestyle;
- Excess weight, ;
- Taking certain medications: hormonal contraceptives, estrogens, fibrates, Okreotide, "" and others.
- Pregnancy, especially multiple;
- Gender - in women, the number of cases with gallstone disease is several times higher than in men;
- Age (especially after 70 years) - the older the person, the greater the likelihood of stones;
- Heredity.
Types of gallstone disease
JCB is classified as follows:
By localization of cholelithiasis
- Cholecystolithiasis- stones form in the gallbladder;
- Choledocholithiasis- Stones form in the bile ducts.
According to the composition of stones:
cholesterol stones- consist mainly of cholesterol deposits, and partly of salts, bilirubin (bile pigment), various minerals, protein and other substances. Painted in shades of yellow. Cholesterol stones are found in 80% of all cases of cholelithiasis.
Pigmented (bilirubin) stones- consist mainly of bilirubin, calcium salts and partially cholesterol deposits. Painted in dark brown or black. The formation of pigmented calculi is usually promoted by impaired liver function, infectious diseases of the bile ducts, and frequent hemolysis.
Lime stones. The main part of the stones consists of impurities of lime salts.
Mixed stones. The most popular type of stones, which consist of all of the above substances.
Stages of gallstone disease:
Stage 1 (initial, physico-chemical or pre-stone stage, primary stones). It is characterized by structural changes in the composition of bile, as well as the absence of clinical manifestations (symptoms) of the disease. Violations can be detected only with the help of a biochemical analysis of bile.
Stage 2 (formation of stones, latent stone-carrying). It is characterized by the absence of clinical manifestations, only occasionally some discomfort in the abdomen can be felt. You can detect the presence of stones using instrumental diagnostics (ultrasound, x-ray).
Stage 3 (secondary stones). It is characterized by the presence of symptoms of cholelithiasis, may be accompanied by the development of cholecystitis.
4 stage. It is characterized by a number of complications caused by cholelithiasis.
Diagnosis of gallstone disease
Diagnosis of gallstone disease includes the following examination methods:
- Anamnesis;
- abdominal cavity;
- Oral cholecystography;
- Retrograde cholangiopancreatography;
- Biochemical analysis of bile;
- Scintiography of the biliary system.
Treatment of gallstone disease is aimed at removing stones from the body, as well as normalizing the functioning of all organs and their appendages involved in the production, passage and excretion of bile.
Treatment for gallstone disease usually includes the following methods:
1. Removal of gallstones and their removal from the body:
1.1. Medicinal method of removing stones;
1.2. Ultrasonic method;
1.3. laser method;
1.4. External shock wave lithotripsy (ESWLT);
1.5. Surgical method (operation);
1.6. Why you can't remove your gallbladder
2. Diet.
1. Removal of gallstones and their removal from the body
1.1 Medicinal method of stone removal
Removal of gallstones with the help of drugs involves the use of drugs that normalize the composition of bile and metabolism, which leads to the gradual splitting of stones. It is prescribed mainly in the presence of small stones, or after the ultrasonic method of their removal.
The disadvantage of this method of removing stones is the long-term use of drugs, which, firstly, are relatively expensive means, and their use should usually be made for at least 6 months. Secondly, through prolonged use of drugs, it is not uncommon for patients to develop additional unpleasant symptoms that can worsen an already difficult course of cholelithiasis.
Drugs intended for the splitting of stones and their removal from the body are based in most cases on bile acids.
Among the drugs for the treatment of GSD can be identified: ursodeoxycholic acid (Ursonan, Ursodex, Exhol), chenodeoxycholic acid (Chenosan, Henofalk, Henohol), herbal remedies(extract of immortelle sandy).
Additionally, drugs are prescribed that stimulate the contraction of the gallbladder, which helps to push the stones out of themselves and their further removal from the body.
Among the drugs that stimulate the gallbladder, we can distinguish: Zixorin, Lyobil, Holosas.
1.2 Ultrasonic stone removal
The ultrasonic method of removing gallstones is performed using special ultrasonic medical equipment, which, using wave action on the gallstone, crushes it into smaller particles.
The disadvantage of this method is the possibility of the formation of pointed fragments, which can damage their mucous membranes when leaving the gallbladder and bile ducts. To prevent such a result, after ultrasound treatment prescribe medications, which we talked about a little higher. The medicine splits sharp corners along with small stones and removes their remnants from the body without possible complications.
1.3 Laser stone removal method
The laser method for removing gallstones is performed using special laser medical equipment. The essence of the method lies in the implementation of a small puncture in the human body, through which a special laser is directed directly to the stone itself, which destroys the calculus into smaller particles.
The disadvantage of this method of removing stones is the possible risk of burns on the mucous membranes of the digestive tract, which can later provoke the development of an ulcer. In addition, as in the case of the ultrasound method, particles of destroyed stones can have sharp edges that can damage the bile ducts when they leave the body. Therefore, after the removal of calculi with a laser, medications are also prescribed.
1.4. External shock wave lithotripsy (ESWLT)
Removing stones with a remote control shock wave lithotripsy(ESWLT) is carried out using powerful electrical discharges caused by an electromagnetic generator. The equipment generates pulsed discharges of high and low density, alternating one after another, which, when exposed to the calculus, destroy its structures, after which the stone disintegrates.
The disadvantage of this method is a large number of possible complications, the main of which are biliary colic, the development of acute cholecystitis, pancreatitis, obstructive jaundice, hematoma of the liver and gallbladder.
1.5. Surgical method of stone removal (surgery)
Open cholecystectomy. It is the most popular and cheapest method of removing gallstones. Indications for an open operation are the presence of large stones in the gallbladder and its ducts, frequent severe pain and the development of complications of cholelithiasis.
Lack of surgical direct removal stones is an injury (cut) of tissues over a large area - a cut of about 15-30 cm, removal of the gallbladder, the risk of complications - from internal bleeding and infection to death (from 1% to 30%, especially the percentage increases with septic shock and other serious complications of cholelithiasis).
Laparoscopic cholecystectomy. Laparoscopic cholecystectomy, unlike open cholecystectomy, involves a gentle method of stone removal, which is performed using a laparoscope. To do this, several small (up to 1 cm) incisions are made, through which, using a laparoscope (a thin tube with a video camera for observation and accuracy) surgical intervention) from the body gets the gallbladder with stones. The main advantage is minimal trauma to body tissues. However, the risk of serious complications still remains.
In both the first and second cases, there are contraindications for the surgical method of removing stones, therefore, only the attending physician decides whether to perform the operation or not, and only on the basis of a thorough diagnosis of the body.
1.6. Why you can't remove your gallbladder
As we said at the beginning of the article, the gallbladder plays one of the important roles in the digestive process. This organ accumulates bile, where it is concentrated, after which, when food enters the body, the gallbladder throws bile into the initial section of the small intestine (duodenum), where the food goes through the process of digestion.
If there is no gallbladder, the bile will be more liquid, less concentrated, circulating through all the organs that are part of the so-called "choleretic system" without a controlling organ. These processes ultimately lead to poor digestion of food, the development of a number (, esophagitis, and others). At the same time, patients whose gallbladder was removed often feel heaviness in the abdomen, pain in the right hypochondrium, a feeling of bitterness in the oral cavity and metallic taste food.
But the saddest thing in this picture is that in case of non-compliance preventive measures, stones may reappear, but already in themselves biliary tract(choledocholithiasis), because the composition of bile, if you do not change your lifestyle, will not change.
Thus, it can be noted that the treatment of cholelithiasis by removing the gallbladder along with stones is carried out only at least when conservative methods of treatment have not led to the desired result.
A diet for gallstone disease is usually prescribed after the removal of gallstones. This is due to the fact that even without the presence of a gallbladder, calculi can form again, but already in the biliary tract. The diet is aimed at preventing the re-development of cholelithiasis.
After removing the stones, diet No. 5, developed by M.I. Pevzner. Its basis is eating food with a minimum amount of fat and eating in small portions (4-5 times a day).
What can you eat with gallstone disease: low-fat meats and fish, cereals (rice, oatmeal, buckwheat) low-fat dairy products (milk, sour cream, kefir, cottage cheese), eggs (1 per day), bread (preferably yesterday or the day before yesterday), olive oil, any vegetables and fruits (all , except for sour ones), tea, weak coffee with milk, compotes, juices.
What not to eat with gallstone disease: fatty, spicy, spicy, fried and smoked foods, sausages, canned food, fatty meats and fish (pork, domestic duck, catfish, crucian carp, carp, bream), lard, animal fats, pickled vegetables, spinach, legumes, alcohol, strong coffee, soda, grape juice, muffins, chocolate.
Important!
Before using folk remedies for the treatment of gallstone disease, be sure to consult your doctor!
You also need to understand that the following remedies are aimed at removing stones, so their movement through the bile ducts to exit the body may be accompanied by colic, bouts of nausea and pain.
Birch. 2 tbsp. spoons of birch leaves, collected and dried in the spring, pour a glass of boiling water and put on a slow fire. It is necessary to boil the product until its volume is halved. After that, the product must be cooled, filtered and taken throughout the day for 3 sets, half an hour before meals. The course of treatment is 3 months.
Radish with honey. Squeeze out the juice from the radish, mix it with, in a ratio of 1: 1 and take 1 time per day, starting with 1/3 cup, and over time, the dose should be increased to 1 cup per day.
Rowan red. To remove stones from the gallbladder and its ducts, you can eat 2 cups of fresh fruits of wild red mountain ash daily. To improve the taste properties, berries can be consumed mixed with honey, granulated sugar or bread. The course of treatment is 6 weeks.
Olive oil. Every day, 30 minutes before meals, you need to take olive oil. In the first days - ½ teaspoon, after 2 days - 1 teaspoon, then 2 teaspoons, etc., increasing the dosage to ½ cup. The course of treatment is 1 month.
Dill. 2 tbsp. Spoons of dill seeds pour into a thermos and fill them with 500 ml of boiling water. Let the remedy brew for about 5 hours, strain and drink the prepared infusion 1 cup, 2 times a day, for 30 days.
Echinacea and currant. Mix 2 tbsp. spoons of echinacea leaves and blackcurrant, after which 4 tbsp. spoons of the mixture pour 1 liter of boiling water and set aside the means for infusion, for 2 hours. After that, strain the infusion and add ordinary water to it to get 1 liter of the product. The resulting medicine should be taken 50 ml, 4 times a day, for 6 months.
Prevention of gallstone disease
Prevention of gallstone disease includes the following recommendations:
- Try to eat mostly natural food (of plant origin), which is enriched and;
- Avoid or minimize the consumption of unhealthy and unhealthy foods;
- Move more, do morning exercises;
- Do not leave to chance any, especially the gastrointestinal tract, so that they do not become chronic;
- Do not allow the presence of extra pounds of body weight, avoid;
- Refrain from drinking alcoholic beverages;
- Try not to take medications without consulting your doctor;
- Observe;
- Follow the work/rest/healthy sleep schedule;
- Avoid .
Which doctor should I contact for gallstone disease?
Video about gallstone disease
- a disease of the gastrointestinal tract, in which solid formations - stones - appear in the gallbladder or ducts. This is a fairly common disease, characteristic of the elderly: in Europe, it affects more than a third of all women and a quarter of all men. If it is detected at an early stage, it is possible to treat cholelithiasis without surgery using traditional and traditional medicine methods.
The main cause of cholelithiasis is a metabolic disorder.
The main cause of cholelithiasis is a metabolic disorder, leading to stagnation of bile in the ducts and an increase in the amount of various salts in it. Calcium salts, bilirubin and some other substances are mainly involved in the formation of stones.
Over time, the number of dense particles increases, the size of the stone increases, and it can completely clog the bile duct. As soon as the movement of bile through the duct is disturbed, the walls of the bladder begin to stretch, and this leads to severe pain(biliary colic).
If timely measures are not taken, this condition can cause an inflammatory process - cholecystitis, and in the future the inflammation can spread to other organs. There are several common causes leading to the formation of stones:
- Violation of the diet. This is overeating and starvation: both of them lead to a violation of the formation and outflow of bile. The lack of a clear diet also has a negative impact on the functioning of the gallbladder. Sedentary work, constant lack of movement.
- Physical inactivity has become a real disease of the twenty-first century, and it leads to a number of diseases. Lack of movement impedes the work of the digestive tract and leads to stagnation of bile with an increase in its density.
- Biliary dyskinesia is a functional disorder associated with a violation of the outflow of bile due to improper contraction of the gallbladder and ducts. Since bile cannot leave the ducts, the increased salt concentration leads to the gradual formation of solid particles.
- Pregnancy and taking hormonal contraceptives. A change in the hormonal form is reflected in the work of the gastrointestinal tract and can also be one of the reasons for the formation of stones.
Diagnosis of cholelithiasis is carried out using ultrasound or radiographic examination: these methods will allow you to see the stones and evaluate their size in order to select the appropriate ones.
Therapeutic methods for the treatment of gallstone disease
Lithotripsy is an extracorporeal effect of a shock wave that allows the destruction of stones.
Surgical intervention is used only if the stones have reached a large size, and their presence in the gallbladder poses a serious threat. If the size of solid formations does not exceed 2-3 cm, the following methods of therapeutic treatment will be prescribed:
- Strict. It will normalize the work of the digestive tract and ensure the stable functioning of the gallbladder. Serious restrictions are introduced in nutrition: fatty, fried, spicy foods, carbonated drinks, sweets, and alcohol are excluded from the diet. The daily ration should be divided into 4-6 small portions in order to digestive tract worked constantly without much load. The basis of the diet should be vegetable fermented milk products, it is useful to use bran. The established diet must not be violated: overeating or eating prohibited foods can provoke biliary colic with acute pain.
- Reception special preparations to dissolve gallstones. The active components of the drugs are ursodeoxycholic and chenodeoxycholic acid, they allow you to remove single small solid formations. However, such treatment is applicable only in the early stages of the disease, and the result may be unstable. The drugs are taken for at least a year, but after their withdrawal, stones may begin to form again. It is important to remove the very cause of metabolic disorders in order for the treatment to give the expected result.
- Lithotripsy is an extracorporeal exposure to a shock wave that allows you to destroy stones with a diameter not exceeding 3 cm. Solid formations are destroyed to small particles that leave the gallbladder through the ducts, and then exit with feces. This treatment does not cause pain, the procedure can be performed on an outpatient basis.
However, if therapeutic methods do not give results, the surgeon will have to remove the gallbladder. Today there are several methods of surgical intervention, but in any case, restrictions on the diet and lifestyle of the patient will persist for life.
Sanatorium-resort treatment of cholelithiasis
Sanatorium-and-spa treatment is an effective method of treating cholelithiasis.
One of the effective methods is a comprehensive spa treatment. In the conditions of the sanatorium, it is possible to create the most suitable regimen for the patient, which will normalize and provide the necessary level of physical activity. Sanatorium-resort treatment involves several areas:
- Limited motor activity. Patients are prescribed therapeutic walking with stops, while any sudden movements and active sports are excluded. The complex of physical activity includes special therapeutic exercises for diaphragmatic breathing - they contribute to greater activity of the bile ducts and the elimination of bile stasis. All exercises are carried out at a slow pace, if necessary, frequent stops are made.
- Treatment of small and medium degree mineralization. Water contributes to active bile formation and its removal from the ducts, in addition, they relieve pain and prevent spasms of smooth muscles. Most often, Borjomi, Smirnovskaya, Slavyanovskaya and some other waters are prescribed, the course of treatment is from three weeks to a month, after six months it must be repeated.
- Treatment with nitrogen and oxygen mineral baths. The water temperature should not exceed 35-37 degrees, you need to stay in the bath for 15 minutes. Usually the course of treatment is 10 procedures.
- climatic factors. The health and well-being of the patient is positively affected by being in the resort area itself: sunbathing, fresh air, the correct daily routine, special nutrition, etc. This method has proven its effectiveness, and it can be no less effective than conventional ones.
However, treatment in sanatorium conditions is not available to everyone, and it is problematic to create the same regimen at home. However, in alternative medicine, there are dozens of remedies that promote the outflow of bile and successfully combat gallstone disease.
Treatment with folk remedies
Folk remedies are also great help in the treatment of gallstone disease.
Traditional medicine also offers several directions for the treatment of gallstone disease. First of all, it is herbal medicine with the use of various herbal decoctions and tinctures, acupuncture, homeopathic remedies.
However, none are able to completely replace the official therapy and can only serve as its complement. In addition, most herbal preparations have their own contraindications, and their use must be discussed with your doctor.
Any alternative treatment should be extended in time, herbal medicine lasts at least 2 to 5 years. Long-term observation of patients shows that with the regular use of folk remedies, good health can be maintained for years. Particularly popular in traditional medicine enjoys several fees that have proven effective.
Gallstones and their relationship with dietary errors
The bile produced by the liver is a colloidal solution in which cholesterol, bilirubin, bile acids and salts are in suspension. If, due to errors in nutrition or for some other reason, the balance of bile components is disturbed, then they precipitate in the form of sediment, forming stones of different composition and different sizes. That is, gallstone disease (GSD) develops. Most often, stones have a cholesterol composition, since with poor nutrition of this particular substance, the liver produces the most.
Irrational nutrition refers to such a regimen when a person rarely eats (with breaks of 5 hours or more between meals), when he likes to eat in large portions, often has fried foods on the menu, prefers fatty meats and smoked meats, is fond of rich pastries, high-calorie confectionery and various snacks. These foods are high in cholesterol and require the liver to produce large amounts of bile in order to break down the incoming excess fats. And with irregular nutrition and overeating, bile is produced unevenly, often stagnates in the gallbladder and ducts. All these problems with bile secretion lead to the formation of stones that settle in the gallbladder and provoke calculous cholecystitis, often ending in cholecystectomy.
Obesity can be the cause of the formation of cholelithiasis - when the liver produces excess cholesterol. Passion for diets for quick weight loss - when the synthesis of bile acids that break down cholesterol is disturbed in the liver. At first, gallstones in the gallbladder are very small, resemble grains of sand and do not bother the patient, so they can only be detected by ultrasound, and if found, you should immediately start diet therapy in order to avoid surgery in the future.
Diet for gallstone disease in the first asymptomatic stage
The course of cholelithiasis is conditionally divided into three stages. The first of them proceeds almost imperceptibly for a person. At this stage, under the influence of excess fats and “fast” carbohydrates entering the body with food, too much cholesterol becomes in the bile. At the same time, the content of bile acids that can break down its excess decreases, and there are also fewer phospholipids that help maintain cholesterol particles in suspension.
It is impossible to feel these changes in the composition of bile, but on an ultrasound of the gallbladder or a biochemical analysis of its contents, one can detect "cholesterol flakes", crystallizing grains of sand in the form of sediment (sludge). In this stage, cholelithiasis can last for many years and not give symptoms. But if it was possible to establish it with some diagnostic studies, the doctor will immediately recommend a therapeutic and prophylactic diet so that in the future it would not be necessary to treat inflammation, it was possible to avoid stones and surgery to remove them.
The essence of diet therapy at this stage of cholelithiasis consists in fractional regular meals (at least 5 times a day in portions of 500-600 g) with a decrease in the calorie content of the diet (especially with overweight), with a restriction in the menu of fatty and fried foods rich in cholesterol foods. Be sure to adjust not only the amount of food and the frequency of meals, but also the amount of water consumed per day - it should be at least two liters. A sufficient amount of water affects the composition of bile and its free flow. In the daily menu, you should increase the content of vegetables and fruits, nuts, legumes, since vegetable proteins and fiber help reduce the concentration of cholesterol in bile. Mandatory moderate physical activity is recommended to avoid stagnation of bile.
Nutrition that prevents exacerbation of gallstone disease with formed stones
Most often, gallstone disease is found in people at its second stage: bile begins to stagnate, the mucous membranes of the gallbladder are damaged and bile acids begin to leave through its walls, and stones form in the bladder. Usually they lie at the bottom and do not manifest themselves in any way, but sometimes they can enter the bile duct and cause inflammation, cholecystitis develops. If the stones are small, they are subsequently excreted from the body, the work of the biliary system is getting better again, however, the stones found in the gallbladder require a strict correction of nutrition in order to avoid complications, obstruction of the bile duct and subsequent cholecystectomy.
First of all, bile stasis should be eliminated. To do this, you need to sit down at the dinner table at least 5 times a day, preferably at the same time, eat slowly, chewing your food well. There are no restrictions on the composition of the diet at this stage of cholelithiasis, although it is recommended not to drink alcoholic beverages.
The diet for gallstones should be complete, but with a restriction of dishes that affect cholesterol metabolism: hard-boiled eggs and scrambled eggs, fried potatoes and meat, liver dishes, fatty fish. It is recommended not to get carried away with cereals and flour products, as they contribute to the oxidation of bile and the loss of cholesterol.
In order to establish the production of bile acids in the liver, the menu must contain complete proteins (lean meat, cottage cheese), vegetable oil, easily digestible carbohydrates (sugar, honey, fruits). To prevent constipation, you need to eat at least 0.5 kg of fruits and vegetables every day, drink fresh juices(this is especially useful in the morning). In addition, green leafy vegetables, broccoli, avocados are good source magnesium, which improves the excretion of cholesterol from the body. All these measures will help stop the development of cholelithiasis and avoid surgery.
Gallstone disease (cholelithiasis or, as it is incorrectly called, cholelithiasis) is a disease associated with a violation of the metabolism of cholesterol and bilirubin, resulting in the formation of stones (stones) in the gallbladder (cholecystolithiasis) and / or in the bile ducts (choledocholithiasis).
This disease is in third place in terms of prevalence after cardiovascular pathology and diabetes mellitus. It is more common in economically developed countries among people whose work is associated with stressful situations and leading a sedentary lifestyle.
How gallstones form
The gallbladder is a reservoir for bile produced by the liver. The movement of bile along the biliary tract is ensured by the coordinated activity of the liver, gallbladder, common bile duct, pancreas, and duodenum. This ensures the timely entry of bile into the intestines during digestion and its accumulation in the gallbladder on an empty stomach.
The formation of stones in it occurs due to a change in the composition and stagnation of bile (dyscholia), inflammatory processes, motor-tonic disorders of bile secretion (dyskinesia).
There are cholesterol (up to 80-90% of all gallstones), pigment and mixed stones.
The formation of cholesterol stones contributes to the oversaturation of bile with cholesterol, its precipitation, the formation of cholesterol crystals. With impaired motility of the gallbladder, the crystals are not excreted into the intestine, but remain and begin to grow.
Pigmented (bilirubin) stones appear as a result of increased breakdown of red blood cells in hemolytic anemia.
Mixed stones are a combination of both forms. Contain calcium, bilirubin, cholesterol.
Occur mainly in inflammatory diseases of the gallbladder and biliary tract.
Causes of gallstone disease
1. Inflammation of the biliary tract (cholecystitis, cholangitis).
Infection plays a role in the formation of stones. Bacteria are able to convert bilirubin, soluble in water, into insoluble, which precipitates.
2. Endocrine disorders:
- diabetes;
Hypothyroidism (insufficient secretion of hormones thyroid gland);
- violation of estrogen metabolism, with various gynecological diseases, taking contraceptives hormonal drugs, pregnancy.
There is a violation of the contractile function of the gallbladder, stagnation of bile.
3. Violation of cholesterol metabolism:
- atherosclerosis;
- gout;
- obesity.
With an increase in cholesterol levels, conditions are created for the formation of stones.
4. Hyperbilirubinemia - an increase in the level of bilirubin with an increase in its content in bile:
- hemolytic anemia.
5. Hereditary predisposition.
6. Starvation, irregular meals cause disruption of the normal function of the gallbladder.
7. Excessive consumption of food rich in animal fats, cholesterol. This contributes to a shift in the reaction of bile to the acid side, which leads to the formation of stones.
Symptoms of gallstone disease
For a long time, the disease can be asymptomatic and become a finding on ultrasound. With the migration of stones, the attachment of infection in the gallbladder and ducts, symptoms appear. Symptoms of gallstone disease depend on the location of the stones, their size, the activity of inflammation, as well as the damage to other digestive organs.
When stones leave the gallbladder and move through the bile ducts, an attack of biliary colic occurs. Provoke an attack of errors in nutrition, especially the abuse of fatty foods, vibration, stressful situations. The pain is sudden, sharp in the upper abdomen, in the right hypochondrium, radiates to the right shoulder blade, right shoulder. Often, pain in gallstone disease is accompanied by nausea, vomiting that does not bring relief, dry mouth. Soothes itchy skin.
Perhaps the appearance of yellowness of the sclera and skin, darkening of urine and discoloration of feces.
The duration of the pain attack is from several minutes to several hours, the pain subsides on its own or after anesthesia.
Symptoms of biliary colic do not always have a classic manifestation, they can often resemble other diseases: right-sided pneumonia, acute appendicitis, especially when it is not in its typical position, liver abscess, renal colic- at urolithiasis, acute pancreatitis.
It can be manifested by cholecystocardiac syndrome, when pain in the heart is the only symptom of cholelithiasis.
To establish an accurate diagnosis, when the first signs of the disease appear, you need to urgently consult a doctor - a general practitioner, a family doctor.
Examination for gallstone disease
Instrumental methods of diagnostics.
1. Ultrasound of the abdominal organs - the main and most effective method diagnosis of gallstone disease. It reveals the presence of stones in the gallbladder, thickening of the walls of the gallbladder, its deformation, dilation of the bile ducts.
Its main advantages are non-invasiveness (non-traumatic), safety, accessibility and the possibility of repeated conduction.
2. X-ray examination of the abdominal cavity - to detect X-ray positive carbonate stones.
3. Endoscopic retrograde cholangiopancreatography (with suspicion of the presence of stones in the bile ducts).
4. In controversial cases, magnetic resonance cholangiography is used, it allows you to accurately assess the condition of the biliary tract thanks to two- and three-dimensional images; computed tomography.
Laboratory research.
1. Total bilirubin and its fractions, transaminases. Examine to assess the functional state of the liver.
2. Lipidogram. Determine the level of cholesterol, triglycerides. With their increase, it is necessary to carry out therapy aimed at reducing these indicators, for the prevention of stone formation.
Obligatory examination of the surgeon - for the choice of treatment tactics.
Treatment of gallstone disease.
In cholelithiasis, surgical and conservative treatment is used.
Medical treatment of gallstone disease
A conservative method is used in the presence of cholesterol gallstones (X-ray negative) up to 15 mm in size with preserved contractility of the gallbladder and patency of the cystic duct.
Contraindications for drug dissolution of gallstones:
Acute inflammatory diseases gallbladder and biliary tract;
- stones with a diameter of more than 2 cm;
- liver disease, diabetes mellitus, peptic ulcer stomach and duodenum, chronic pancreatitis;
- inflammatory diseases of the small and large intestines;
- obesity;
- pregnancy;
- "disabled" - non-functioning gallbladder;
- pigment or carbonate stones;
- cancer of the gallbladder;
- multiple calculi that occupy more than 50% of the volume of the gallbladder.
Ursodeoxycholic acid preparations are used, the action of which is aimed at dissolving only cholesterol stones, the drug is taken for 6 to 24 months. But the probability of recurrence after the dissolution of the stones is 50%. The dose of the drug, the duration of administration is established only by a doctor - a therapist or a gastroenterologist. Conservative treatment possible only under medical supervision.
Shock wave cholelithotrepsy is a treatment by crushing large stones into small fragments using shock waves, followed by the administration of bile acid preparations (ursodeoxycholic acid). The chance of recurrence is 30%.
Cholelithiasis long time may be asymptomatic or oligosymptomatic, which creates certain difficulties in its detection in the early stages. This is the reason for late diagnosis, at the stage of already formed gallstones, when the use conservative methods treatment is limited, and the only method of treatment remains surgery.
Surgical treatment of gallstone disease
Patients must be subjected to planned operation before the first attack of biliary colic or immediately after it. This is due to the high risk of complications.
After surgical treatment, it is necessary to follow an individual dietary regimen (frequent, fractional meals with the restriction or exclusion of individually intolerable foods, fatty, fried foods), adherence to the regime of work and rest, and physical education. Eliminate the use of alcohol. Perhaps spa treatment after surgery, subject to stable remission.
Complications of gallstone disease.
When an infection is attached, acute cholecystitis develops, empyema (a significant accumulation of pus), cholangitis (inflammation of the bile ducts), which in turn can lead to the development of peritonitis. The main symptoms are sharp, intense pain in the right hypochondrium, chills, fever, severe weakness, impaired consciousness.
Choledocholithiasis (stones in the bile duct) with the development of obstructive jaundice. After one of the attacks of biliary colic, skin itching, yellowness of the sclera and skin, discolored feces, darkening of the urine appear.
With prolonged blockage of the cystic duct and the absence of infection, dropsy of the gallbladder occurs. Bile is absorbed from the bladder, but the mucosa continues to produce mucus. There is an increase in the size of the bubble. It is manifested by attacks of biliary colic, subsequently the pain subsides, there remains heaviness in the right hypochondrium.
Against the background of long-term cholelithiasis, gallbladder cancer often occurs,
acute and chronic pancreatitis develops. With prolonged blockage of the intrahepatic bile ducts, secondary biliary cirrhosis develops. Large gallbladder stones practically do not migrate, but they can lead to the formation of a fistula between the gallbladder and duodenum. As a result of the stone falling out of the bladder, it begins to migrate and can lead to the development of intestinal obstruction.
Untimely removal of the gallbladder (cholecystectomy) is one of the reasons for the development of postcholecystectomy syndrome.
Complications pose a threat to the life of the patient and require immediate examination by the surgeon and hospitalization in a surgical hospital.
Prevention of gallstone disease.
Even after a successful operation, relapses occur in 10% of cases. Lifestyle changes are needed to prevent the development of new stones. Classes in the gym, outdoor activities, contribute to the outflow of bile, eliminate its stagnation. It is necessary to gradually normalize body weight, this will reduce the hypersecretion of cholesterol.
Patients who are forced to take long-term estrogens, clofibrate, ceftriaxone, octreotide should undergo an ultrasound examination to timely detect changes in the gallbladder. With an increase in cholesterol levels in the blood, statins are recommended.
Diet for gallstone disease
Limit or exclude fatty, high-calorie, cholesterol-rich foods from the diet, especially with a hereditary predisposition to cholelithiasis. Meals should be frequent (4-6 times a day), in small portions, which helps to reduce the stagnation of bile in the gallbladder. The food should contain a sufficient amount of dietary fiber, due to vegetables and fruits. You can add food bran (15g 2-3 times a day). This reduces the lithogenicity (tendency to stone formation) of bile.
Consultation of a doctor on gallstone disease
Question: what is the name of the disease, cholelithiasis or cholelithiasis?
Answer: according to the international classification of diseases, the name "cholelithiasis" does not exist, there is only gallstone disease.
Question: What medications, folk remedies, spa treatment remove stones from the gallbladder?
Answer: There are no such drugs. All choleretic drugs for cholelithiasis should be taken strictly as directed and under the supervision of a physician. Self-medication in such a situation is not safe due to the high risk of complications. With elective cholecystectomy (surgery to remove the gallbladder), the mortality rate is 0.5%, and with cholecystectomy for acute cholecystitis (and this is a complication of self-medication), the mortality rate reaches 20%. Spa treatment in the presence of stones in the gallbladder is contraindicated.
Question: Should the patient be observed after surgery for cholelithiasis, which specialist, for how long and with what medicines to carry out postoperative treatment?
Answer: Patients after surgical treatment are observed by a family doctor, therapist. Every year they undergo dispensary examination, ultrasound examination of the abdominal organs, control of lipidogram, liver tests. Based on the examination data, diagnostic studies, the doctor recommends a set of necessary medical and recreational measures to prevent the development of a relapse of the disease.
Therapist Vostrenkova I.N.