In gallstone disease shown. Gallstone disease: symptoms, treatment, signs, causes

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What is gallstone disease?

In medicine, it is customary to distinguish between several variants of gallstone disease. Firstly, there is stone carrying, which is not always referred to as pathological conditions. A number of experts even suggest considering it separately from the actual calculous cholecystitis. Stone carriage is the process of formation of stones in the gallbladder, which is not accompanied by any symptoms or disorders. It occurs in almost 15% of the population, but is not always found. Often, stones are unexpectedly discovered during a prophylactic ultrasound or X-ray examination.

The second variant of the disease is actually cholelithiasis with all its symptoms and manifestations. Gallstones can cause a variety of disorders, most of which are related to the digestive process. Finally, the third variant of this pathology is biliary colic. These are sharp pains that usually appear in the right hypochondrium. In fact, colic is just a symptom of the disease. However, most patients are unaware of their illness or do not see a doctor until this symptom appears. Since biliary colic is an acute condition that requires urgent medical care, it is sometimes considered as a separate syndrome.

The prevalence of gallstone disease is not the same in different ages. In children and adolescents, this pathology is rarely found, since it takes quite a long time for the formation of stones. With age, the risk of stone formation increases, as does the risk of severe complications.

The prevalence of calculous cholecystitis by age is as follows:

• 20 - 30 years old– less than 3% of the population;
• 30 - 40 years– 3 – 5% of the population;
• 40 - 50 years old– 5 – 7% of the population;
• 50 - 60 years old– up to 10% of the population;
• Over 60 years old– up to 20% of the population, and the risk increases with age.

There are several theories about the causes this disease. Most experts are inclined to believe that calculous cholecystitis is the result of a whole complex of various factors. On the one hand, this is confirmed by statistical data, on the other hand, it does not explain the appearance of stones in those people who are not affected by these factors.

In many cases, with cholelithiasis, it is indicated surgery- removal of the gallbladder along with stones. This pathology occupies an important place in surgical hospitals. Despite the risk of serious complications that exists with cholelithiasis, mortality from it in developed countries is not high. The prognosis of the disease usually depends on timely diagnosis and proper treatment.

Causes of gallstone disease

The gallbladder itself is a small hollow organ with a volume of 30-50 ml. In the abdominal cavity, it is located in the upper right part, adjacent to the lower ( visceral) surface of the liver. It borders on the duodenum, the liver itself, the bile duct, and the head of the pancreas.

The following parts are distinguished in the structure of the gallbladder:

• Bottom- the upper part adjacent to the liver from below.
• Body- the central part bounded by the side walls of the bubble.
• Neck- the lower, funnel-shaped part of the organ, which passes into the bile duct.

The main function of the gallbladder is to store bile. Bile itself is formed by liver cells ( hepatocytes) and drains from there through the common hepatic duct. Since bile is necessary specifically for the digestion of fats after a meal, there is no need for its constant flow into the intestines. That is why it accumulates "in reserve" in the gallbladder. After eating, smooth muscles in the walls of the gallbladder contract, and there is a rapid release a large number bile ( which the liver itself is not capable of, since bile is formed in it gradually at the same rate). Due to this, fats are emulsified, they are broken down and absorbed.

Bile is a fluid produced by hepatocytes, the cells of the liver. Its most important components are cholic and chenodeoxycholic acids, which have the ability to emulsify fats. These acids contain a compound called cholesterol ( fat-soluble cholesterol). Also in bile there are compounds - phospholipids that keep cholesterol from crystallization. With an insufficient concentration of phospholipids, the so-called lithogenic bile begins to accumulate. It gradually crystallizes cholesterol and combines it into calculi - actually gallstones.

Bile also contains the pigment bilirubin. It is formed from hemoglobin after the breakdown of red blood cells ( red blood cells are destroyed by "old age" in 120 days). Bilirubin enters the bloodstream and is transported to the liver. Here it is conjugated contacts) with other substances ( to the bound fraction of bilirubin) and excreted in the bile. Bilirubin itself is toxic and can irritate certain tissues at high concentrations ( itching in the skin, irritation of the meninges, etc.). With an excessive concentration of bilirubin in the blood and bile, it can form compounds with calcium ( calcium bilirubinate), which form the stones. Such stones are also called pigment stones.

There are currently no single causes and mechanisms for the formation of gallstones in the gallbladder. However, there is an extensive list of various factors and comorbidities that greatly increase the risk of stone formation. Since none of them leads to cholelithiasis in 100% of cases, they are called predisposing factors. In practice, a patient with gallstone disease almost always has a combination of several of these factors.

It is believed that the risk of gallstones is directly related to exposure to the following factors:

• Cirrhosis of the liver. With alcoholic cirrhosis of the liver, changes in the composition of the blood occur. As a result, an increased formation of bilirubin is possible, and a higher likelihood of the formation of pigment stones.
• Crohn's disease. Crohn's disease is an inflammatory disorder of the digestive tract with a presumably autoimmune mechanism. The inflammatory process can develop in various parts of the gastrointestinal tract, but the intestines are more often affected. The disease is chronic and occurs with long periods of remission ( remission of symptoms). It is statistically noted that patients with Crohn's disease are more likely to form gallstones.
• Lack of plant fibers in food. Vegetable fibers are found mainly in vegetables and a number of grains. The lack of these products in the diet disrupts the functioning of the intestines, the excretion of feces worsens. Intestinal dysfunction is also reflected in the contractility of the gallbladder. There is a high risk of bile stasis, which predisposes to the formation of stones.
• Resection ( removal) ileum. Removal of part of the ileum is sometimes done when there are suspicious masses in it ( tumors), rarely - polyps, diverticula or after injuries of the abdominal cavity. Since a significant part of the nutrients is absorbed here, its removal affects the work of the digestive system as a whole. It is believed that the risk of gallstone formation in such patients is increased.
• Taking hormonal contraceptives ( COOK). It is noted that excess estrogen ( female sex hormones) is generally a predisposing factor for gallstone disease. The action of combined oral contraceptives ( COOK) is usually based precisely on an increase in the amount of estrogen. This may partly explain the higher prevalence of gallstone disease among women. In addition to COCs, an excess of estrogens can be observed in hormone-producing tumors and a number of gynecological diseases.
• Some hematological diseases. The pigment bilirubin, which often forms stones, is formed from hemoglobin. Hemoglobin enters the blood after the breakdown of red blood cells. Normally, a certain number of old cells are destroyed in the body. However, with a number of pathologies, hemolysis can occur - a one-time destruction of red blood cells in large quantities. Hemolysis can be triggered by infections, toxins, bone marrow disorders, and a number of other reasons. As a result, red blood cells are destroyed faster, more hemoglobin is released from them, and an excess amount of bilirubin is formed from it. Accordingly, the risk of gallstone formation increases.
• infectious process. Infectious processes at the level of the bile ducts can play a certain role. Most often, opportunistic pathogens from the intestine act as infectious agents ( coli, enterococci, clostridia, etc.). Some of these microbes produce a special enzyme called beta-glucuronidase. Once in the bile in the cavity of the bladder, these enzymes contribute to the binding of bilirubin into calculi.
• Sclerosing cholangitis. Sclerosing cholangitis is a pathology in which, against the background of chronic inflammation gradually narrows the lumen of the bile duct. Because of this, the outflow of bile is disturbed, it stagnates in the bladder, and there are favorable conditions to form stones. Thus, with this pathology, a violation of the outflow of bile precedes the formation of stones. First, the patient will develop jaundice and digestive disorders, and only then - colic due to the growth of stones and spastic contraction of the walls of the bladder.
• Some pharmacological preparations. Taking a number of medications especially long) can affect the functioning of the liver and through it - the composition of bile. As a result, bilirubin or cholesterol will precipitate with the formation of stones. This feature is seen in some drugs containing estrogens ( female sex hormones), somatostatin, fibrates.

Classification of gallstone disease

According to the chemical composition of the stones, the following types of cholelithiasis are distinguished:

• Cholesterol. Cholesterol is a normal component of bile, but excess cholesterol can lead to the formation of stones. This substance enters the body with food and must be properly absorbed in order to contribute to various physiological processes. Violation of absorption leads to its increased concentration in bile. Cholesterol stones are usually round or oval, reach 1 - 1.5 cm in diameter and are located more often at the bottom of the gallbladder.
• Bilirubin ( pigmented). The basis of these stones is the pigment bilirubin, which is formed after the breakdown of hemoglobin. Stones usually form when it is elevated in the blood. Pigment stones are smaller than cholesterol stones. Usually there are more of them in number, and they can be not only in the gallbladder, but also enter the bile ducts.

In general, the classification of the disease according to the chemical composition of the stones is rather of scientific interest. In practice, the manifestations of the disease will be similar, and it is almost impossible to distinguish these species by symptoms. However, the composition of the stones indicates concomitant disorders in the body, which also need to be corrected. In addition, as noted above, the method of drug dissolution of stones is not suitable in all cases.

According to the number of stones, single stones are distinguished, respectively ( less than 3) and multiple ( 3 or more) stones. In principle, the smaller the stones, the easier the treatment should be. However, here great importance also have their sizes. The manifestations of the disease with single or multiple stones are the same. Differences appear only with ultrasound, which visualizes the stones.

By size, it is customary to distinguish the following types of stones:

• Small. The size of these stones does not exceed 3 cm. If the stones are single and located in the bottom of the bladder, the patient usually does not have acute symptoms.
• Large. Large stones with a diameter of more than 3 cm often disrupt the outflow of bile and cause biliary colic and other pronounced manifestations of the disease.

Sometimes also pay attention to the localization of gallstones. Stones located in the fundus of the gallbladder are less likely to cause any symptoms. Stones located in the cervical region can block the bile duct and cause bile stasis. Accordingly, they are more likely to cause any symptoms associated with pain or digestive disorders.

There are also the following forms of the course of the gallstone disease itself:

• latent form. In this case, we are talking about stone-carrying, which does not manifest itself in any way and is discovered, as a rule, by chance.
• Symptomatic uncomplicated form. This form is characterized by various digestive symptoms or pain in the form of typical biliary colic. In other words, there are manifestations typical for this pathology.
• Symptomatic complicated form. In this case, the patient has not only symptoms characteristic of cholelithiasis, but also signs of damage to other organs. It can be atypical pain, liver enlargement, etc.
• atypical form. As a rule, this form of the disease includes unusual manifestations of cholelithiasis. For example, the pain syndrome can sometimes occur not in the form of biliary colic, but mimic the pain of appendicitis ( in the right lower abdomen) or angina ( chest pain). In these cases, making a correct diagnosis is difficult.

Stages of gallstone disease

In the course of gallstone disease, the following stages can be distinguished:

• Physico-chemical stage. At this stage, there are no stones in the gallbladder yet, but the patient has the prerequisites for their appearance. There is a violation of the formation of normal bile. The liver begins to produce lithogenic bile rich in cholesterol, or the patient has an increased secretion of bilirubin. In both cases, direct prerequisites for the formation of stones are created. Sometimes this stage is also called predisease. It is very difficult to detect violations in the formation of bile. Actually, there are no stones in the gallbladder yet, and special tests are needed to identify physico-chemical changes. A bile sample can be obtained by probing, but it is not prescribed to patients without any pathologies as a preventive or diagnostic method. Sometimes the procedure is prescribed for those patients who have diseases that predispose to the formation of stones ( hemolytic anemia, elevated level cholesterol, liver disease, etc.). However, in general, the disease at the stage of predisease is not diagnosed.
• Stone carrier. At the stage of lithiasis, stones of various sizes can be found in the gallbladder ( even large), but there are no symptoms of the disease. Stones may be detected by ultrasound or X-ray, but these diagnostic methods are also usually not prescribed during a preventive examination. Thus, cholelithiasis at this stage is usually diagnosed by chance.
• clinical stage. The onset of the clinical stage almost always coincides with the first attack ( first ever biliary colic). Patients may already suffer from vague pain in the right hypochondrium or periodic stool disorders. However, in this regard, they do not always go to the doctor. With colic, the pain is very strong, so it usually becomes the reason for a full examination. The clinical stage is characterized by periodic colic, intolerance fatty foods and other typical symptoms. Diagnosing the disease during this period is usually not difficult.
• Complications. The stage of complications in cholelithiasis can occur quite quickly. In some patients, literally on the second or third day after the first colic, the temperature rises, there are constant dull pains in the abdomen and other symptoms that are rare in the uncomplicated course of the disease. In fact, the onset of this stage depends on the movement of stones and the entry of pathogenic microbes into the gallbladder. In many patients, it never occurs. The stage of clinical complications can last for years and end with a successful recovery ( removal or dissolution of stones).

Symptoms and signs of gallstone disease

Among the first symptoms of the disease, it should be noted heaviness in the abdomen after eating, stool disorders ( especially after eating fatty foods), nausea, and mild jaundice. These symptoms can appear even before severe pain in the right hypochondrium - the main symptom of cholelithiasis. They are explained by unexpressed violations of the outflow of bile, which makes the process of digestion worse.

The most typical for gallstone disease are the following symptoms and signs:

• Pain in the right hypochondrium. Most typical manifestation cholelithiasis is the so-called biliary ( biliary, hepatic) colic. This is an attack of acute pain, which in most cases is localized at the intersection of the right costal arch and the right edge of the rectus abdominis muscle. The duration of an attack can vary from 10-15 minutes to several hours. At this time, the pain can be very strong, give to the right shoulder, back or other areas of the abdomen. If the attack lasts more than 5 - 6 hours, then you should think about possible complications. The frequency of attacks can be different. It often takes about a year between the first and second attacks. However, in general, they increase over time.
• Temperature rise. An increase in temperature usually indicates acute cholecystitis, which often accompanies cholelithiasis. An intense inflammatory process in the right hypochondrium leads to the release into the blood active substances contributing to the rise in temperature. Prolonged pain after colic with the addition of fever almost always indicates acute cholecystitis or other complications of the disease. Periodic rise in temperature ( undulating) with a rise above 38 degrees may indicate cholangitis. However, in general, fever is not an obligatory symptom in cholelithiasis. The temperature can remain normal even after severe prolonged colic.
• Jaundice. Jaundice occurs due to stagnation of bile. The pigment bilirubin is responsible for its appearance, which is normally excreted with bile into the intestine, and from there it is excreted from the body with stool. Bilirubin is a natural metabolic product. If it ceases to be excreted with bile, then it accumulates in the blood. So it spreads throughout the body and accumulates in the tissues, giving them a characteristic yellowish tint. Most often, in patients, the sclera of the eyes turn yellow first, and only then the skin. In fair people, this symptom is more noticeable, and in dark people, unexpressed jaundice can be missed even by an experienced doctor. Often, simultaneously with the appearance of jaundice in patients, the urine also darkens ( dark yellow but not brown). This is because the pigment begins to be excreted from the body through the kidneys. Jaundice is not an obligatory symptom in calculous cholecystitis. Also, it does not appear only with this disease. Bilirubin can also accumulate in the blood in hepatitis, cirrhosis of the liver, certain hematological diseases or poisoning.
• Fat intolerance. AT human body bile is responsible for emulsification ( dissolution) fats in the intestines, which is necessary for their normal breakdown, absorption and assimilation. In cholelithiasis, stones in the neck or bile duct often block the path of bile to the intestines. As a result, fatty foods are not broken down normally and cause intestinal disturbances. These disturbances may be manifested by diarrhea ( diarrhea), accumulation of gases in the intestines ( flatulence), unexpressed pain in the abdomen. All of these symptoms are nonspecific and can occur in various diseases of the gastrointestinal tract ( gastrointestinal tract). Intolerance to fatty foods can also occur at the stage of stone carrying, when other symptoms of the disease are still absent. At the same time, even a large stone located at the bottom of the gallbladder may not block the outflow of bile, and fatty foods will be digested normally.

How does an attack of gallstone disease manifest itself?

Biliary colic usually appears suddenly. Its cause is a spasm of smooth muscles located in the walls of the gallbladder. Sometimes the mucous membrane is also damaged. Most often this happens if the stone is displaced and stuck in the neck of the bladder. Here it blocks the outflow of bile, and bile from the liver does not accumulate in the bladder, but flows directly into the intestines.

Thus, an attack of cholelithiasis is usually manifested by characteristic pains in the right hypochondrium. In parallel, the patient may experience nausea and vomiting. Often an attack occurs after sudden movements or exertion, or after eating a large amount of fatty foods. Once during the period of exacerbation, discoloration of the stool can be observed. This is due to the fact that pigmented ( painted) bile from the gallbladder. Bile from the liver drains only in small quantities and does not give an intense color. This symptom is called acholia. In general, the most typical manifestation of an attack of cholelithiasis is the characteristic pain, which will be described below.

Pain in gallstone disease

The most common form of pain in cholelithiasis is biliary colic. It occurs suddenly, patients themselves often feel that the cause of pain is muscle spasm. The pain gradually increases and usually reaches a peak after 30 to 60 minutes. Sometimes colic goes away even faster ( in 15 - 20 minutes), and sometimes lasts several hours. The pain is very strong, the patient does not find a place for himself and cannot take a comfortable position so that the pain completely disappears. In most cases, it is with the onset of biliary colic that patients turn to a doctor for qualified help, even if they previously ignored all the symptoms of the disease.

Pain in biliary colic can be given to the following areas:

• lower right abdomen can be confused with appendicitis);
• "under the spoon" and in the region of the heart;
• in the right shoulder;
• in the right shoulder blade;
• in the back.

Often pain occurs when pressing on the corresponding area or when tapping on the right costal arch. It should be remembered that pain in the right hypochondrium ( and even biliary colic) do not always indicate the presence of gallstones. They can be observed in cholecystitis ( inflammation of the gallbladder) without the formation of stones, as well as with biliary dyskinesia.

Gallstone disease in children

In most children, gallstone disease manifests itself differently than in adults. Biliary colic occurs rarely. The most common clinical picture symptoms and manifestations) gastritis, peptic ulcer, colitis and other diseases of the gastrointestinal tract. An acute inflammatory process rarely complicates the course of the disease. Fat intolerance, stool disorders, nausea and vomiting are common.

Confirmation of the diagnosis and treatment of pathology is not much different from those in adults. Cholecystectomy ( removal of the gallbladder) is rarely required. Sometimes surgical correction of anomalies of the bile ducts is necessary.

Gallstone disease during pregnancy

The following factors influence the development of gallstone disease during pregnancy:

• Mechanical compression of an organ. The growth of the fetus during pregnancy causes an increase in pressure in the abdominal cavity. Many organs move upward as they grow, and in the third trimester, with the maximum size of the fetus, the pressure becomes maximum. Bending the gallbladder and squeezing the bile ducts can provoke an attack of the disease. Most often this happens in cases where gallstones are already present, but the woman does not know about it.
• Hormonal changes. Pregnancy is associated with significant hormonal changes in a woman's body. During this period, the concentration of a number of hormones in the blood increases, which contribute to the formation of stones. For example, the hormone estriol, among other beneficial effects, increases blood cholesterol levels. Progesterone, which is also high, impairs motility ( cuts) of the walls of the gallbladder, which causes stagnation of bile. Under the influence of these hormones, as well as due to a sedentary lifestyle, an intensive process of stone formation begins. Of course, it does not go far in all patients, but only in those who are predisposed to it ( There are other predisposing factors).
• Changes in the diet. Many women experience changes in taste preferences during pregnancy and, as a result, changes in their diet. An excess of foods rich in fats can provoke an attack, and the disease will move from stone-carrying to the stage of clinical manifestations. The mechanism of such exacerbation is rather simple. The gallbladder gets used to secrete bile in certain quantities. Regular intake of fatty foods requires more intensive formation and secretion of bile. The walls of the organ are intensely reduced, and this leads to the movement of the stones present there.
• Taking certain medications. During pregnancy, patients various reasons A number of drugs may be prescribed to promote the formation of gallstones. This can provoke an attack of the disease.

Manifestations of gallstone disease during pregnancy generally do not differ much from manifestations in other patients. The most typical acute pain in the right hypochondrium ( biliary colic). With difficulty in the outflow of bile, darkening of the urine may be observed ( it is saturated with bilirubin, which is not excreted in bile). It is also noted that toxicosis of pregnant women and a number of other complications of pregnancy are more common.

Diagnosis of gallstone disease usually does not cause difficulties. Already in the first trimester of pregnancy, a competent doctor will conduct an ultrasound scan of the abdominal organs, which will reveal stone carrying. After that, an attack can be recognized even by typical symptoms. If the stones were not detected earlier, then the diagnosis is somewhat more complicated. Atypical distribution of pain during an attack is possible, since many organs of the abdominal cavity are displaced.

The most difficult stage is the treatment of patients with cholelithiasis during pregnancy. Many drugs that can help are not prescribed because of the threat to the fetus. However, during colic, in any case, pain is relieved by antispasmodics. Pregnancy is also not an absolute contraindication for surgery and removal of the gallbladder along with stones. In these cases, they try to give preference to endoscopic methods. At the same time, there are no large seams that can subsequently disperse during childbirth. Patients with cholelithiasis are hospitalized for constant monitoring and a more thorough examination. If possible, try to contain exacerbations with the help of diet and other preventive measures to perform surgery after childbirth ( eliminate the risk to the child). Non-surgical stone treatment sonication or dissolution) should not be used during pregnancy.

It should also be noted that various complications of cholelithiasis are more common in pregnant women. This is due to the weakening of the immune system during this period and the frequent displacement of stones. Self-medication in these cases is unacceptable, since the acute inflammatory process provoked by stones can threaten the life of both the mother and the fetus.

Complications of gallstone disease

In most cases, complications of cholelithiasis arise due to the occurrence and spread of inflammatory process in the abdominal cavity. The immediate cause is trauma to the walls of the gallbladder with sharp edges of stones ( does not happen with all types of stones), blockage of the bile ducts and stagnation of bile. The most common complications of the surgical profile and disorders in the digestive system.

In the absence of timely treatment of gallstone disease, the following complications are possible:

• Empyema of the gallbladder. An empyema is a collection of pus in the gallbladder cavity. This happens only if pyogenic microorganisms get there. Most often these are representatives of the intestinal microflora - Escherichia, Klebsiella, Proteus. Stones clog the neck of the gallbladder, and a cavity is formed in which these microorganisms can freely develop. As a rule, the infection enters here through the bile ducts ( from the duodenum), but in rare cases, it can also be introduced with blood. With empyema, the gallbladder is enlarged, painful on pressure. Perhaps an increase in temperature, a significant deterioration in the general condition. Empyema of the gallbladder is an indication for urgent removal of the organ.
• wall perforation. Perforation is the perforation of the wall of the organ through and through. As a rule, it occurs in the presence of large stones and high pressure inside the organ. Provoke a rupture of the gallbladder can physical activity, sudden movement, pressure on the right hypochondrium ( e.g. seat belt when braking). This complication is the most dangerous, since it causes bile to flow into the free abdominal cavity. Bile has a strong irritant effect and quickly causes inflammation of the sensitive peritoneum ( membrane that covers the abdominal organs). Microbes can also enter the free abdominal cavity from the gallbladder cavity. The result is a serious condition - biliary peritonitis. Inflammation captures the right upper part of the abdominal cavity, but can spread to other areas. The main symptoms of perforation are the appearance of a sharp severe pain, an increase in temperature, a rapid deterioration in general condition, an increase in heart rate and respiration. In this case, the patient will be saved only by a large-scale surgical intervention in combination with intensive antibiotic therapy. However, even timely hospitalization of the patient does not give a 100% guarantee of a successful recovery.
• Hepatitis. In this case, it's not about viral hepatitis (which are the most common), but about the so-called reactive hepatitis. It is explained by the proximity of the inflammatory focus, stagnation of bile, the spread of infection ( if there are microbes in the gallbladder). As a rule, such hepatitis responds well to treatment and quickly passes after removal of the gallbladder. Its main symptoms are heaviness in the right hypochondrium and an enlarged liver.
• Acute cholangitis. Acute cholangitis is an inflammation of the bile ducts that connect the gallbladder and duodenum. As a rule, it is caused by the entry of a smaller stone into the duct itself and damage to the mucous membrane. Unlike cholecystitis, which can occur without acute severe symptoms, cholangitis is almost always accompanied by high temperature, pain and jaundice.
• Acute pancreatitis. The excretory duct of the pancreas before flowing into the duodenum is connected to the bile duct. If a small stone from the gallbladder becomes lodged at the level of the common duct, bile can enter the pancreas. This organ produces digestive enzymes that can break down proteins. These enzymes are normally activated by bile in the duodenum and break down food. Their activation in the cavity of the gland itself is fraught with destruction of the tissues of the organ and an acute inflammatory process. Pancreatitis is manifested by severe girdle pain in the upper abdomen. As a rule, the pain appears suddenly. This disease poses a serious threat to life and requires urgent surgical treatment.
• Fistula formation. A fistula is a pathological connection of one hollow organ with another. Usually it is the result of a long-term inflammatory process with the gradual destruction of the wall. Fistulas of the gallbladder can connect its cavity directly with the abdominal cavity ( clinically resembles a perforation), intestines or stomach. In all these cases, there will be serious problems with digestion, periodic pain.
• Cirrhosis of the liver. In this case, we are talking about the so-called secondary biliary cirrhosis of the liver. Its cause is the accumulation of bile in the intrahepatic ducts, as it does not flow into the overflowing gallbladder. After a while, liver cells cease to function normally and die. In their place, connective tissue is formed, which does not perform the functions that were performed by hepatocytes ( liver cells). The main symptoms are bleeding disorders ( the liver produces the substances necessary for this process), intoxication of the body with its own metabolic products, stagnation of venous blood in the portal vein, which passes through the liver. The progression of the disease leads to hepatic coma and death of the patient. Despite the fact that liver cells recover well, treatment cannot be delayed. Cirrhosis is an irreversible process, and the only effective method treatment is transplantation ( transfer) organ.
• Neoplasms of the gallbladder. Malignant neoplasms can appear in the gallbladder due to prolonged ( for many years) of the inflammatory process. Bile itself plays a certain role in this, with which some toxic substances can be released from the body. Tumors of the gallbladder can compress the bile ducts, duodenum, grow into neighboring organs, disrupting their functions. Like all malignant neoplasms, they pose a direct danger to the life of the patient.

Stones in the gallbladder are a symptom of cholelithiasis, cholelithiasis. Bile contains components that can precipitate, accumulate and form seals - stones in the cavity of the gallbladder or bile ducts. The presence of such inclusions leads to violations of the outflow of bile, inflammatory processes in the membranes of the bladder, infection of the organ and reduces the efficiency of the biliary system of the body.

Why do gallstones form in the gallbladder?

Among the factors provoking the process of formation of stones in the gallbladder, there are leading and additional, concomitant factors:

• the leading factor is considered to be an increase in such a characteristic of bile as lithogenicity, which occurs as a result of excessive intake of cholesterol;
• , or a decrease in the functional ability of the gallbladder to contract and push bile into the ducts;
• hypertension of bile in the organ due to narrowing of the neck of the gallbladder, which also leads to stagnation of bile;
• localized or general infectious processes that reduce the efficiency of the activity of the organs of the hepatobiliary system.

There are various risk factors that increase the likelihood of developing cholelithiasis and the formation of gallstones:

• belonging to the female sex: women suffer from stones that form in the gallbladder, much more often than men;
• elderly and senile age;
• the period of pregnancy, since an increase in estrogen levels promotes the secretion of cholesterol into bile;
• irrational diets, fasting, weight loss for various reasons;
• long courses of parenteral nutrition;
• long-term use of drugs containing estrogen, oral contraceptives, sandostatin, ceftriaxone, etc.;
• diabetes;
• some diseases of the gastrointestinal tract, hepatobiliary organs, etc.

There are Tirek and Faber formulas that allow, by external signs, to suspect a high probability of a patient having stones in the gallbladder. According to experts, in the group with the highest number of diagnosed bile stones are women with blond hair and skin, with a history of pregnancy, overweight, over the age of 40, with excessive gas formation (flatulence).

Forms of gallstone disease and symptoms of gallstones

Among the clinical forms of gallstone disease, the following are distinguished:

• latent form or the so-called stone carrier;
• dyspeptic form of the disease;
• pain form, accompanied by seizures;
• painful torpid form;
• cancerous.

A significant number of patients with cholelithiasis (60-80%) in the presence of gallstones have no symptoms and manifestations of the disease. However, this period represents a latent form of the disease rather than a static one. According to observations, up to 50% of patients within 10 years after the discovery of stones in the gallbladder consult a doctor about the onset of symptoms indicating the development of other forms of cholelithiasis and its complications.

The dyspeptic form is clinically expressed in disorders of the functioning of the organs of the gastrointestinal tract. Most often, this is expressed in the appearance after eating a feeling of heaviness in the epigastric region, increased gas formation, bloating, heartburn, bitterness in the mouth. This form is often combined with paroxysmal pain, or manifestations of biliary colic, since palpation can detect pain at characteristic points.

Painful paroxysmal form manifests itself in biliary colic and is the most common option. clinical form cholelithiasis, diagnosed in 75% of patients. The disease manifests itself in the form of sudden, recurring attacks of pain in the right hypochondrium with possible irradiation to the back or to the right shoulder blade. The attack may be accompanied by nausea, reflex vomiting, which does not bring relief. With an attack lasting more than 6 hours, acute cholecystitis is diagnosed.
The torpid form of cholelithiasis is accompanied by constant dull pain in the projection of the gallbladder without periods of remission and the absence of pain.
In about 3% of cases, cholelithiasis is accompanied by the development of tumor formations. According to various sources, from 80 to 100% of cancer patients with cancerous tumors in the gallbladder have stones in the cavity of the organ. Presumably, neoplasms arise as a result of changes chemical composition bile in cholelithiasis, prolonged irritation and traumatization of the inner membranes of the bladder with gallstones, infection.

Among the general symptoms inherent in most patients with gallstones, the following signs of the disease can be distinguished:

• pain or discomfort on palpation in the right hypochondrium, a feeling of heaviness in the epigastric region associated with the intake of spicy, fatty, fried foods or alcohol;
• change in stool color, discoloration;
• the presence of bowel dysfunction: constipation, unstable, irregular stools, flatulence, etc .;
• complaints of heartburn, bitter taste in the mouth, etc.

Therapy of cholelithiasis: how to treat stones in the gallbladder?

Complicated forms of cholelithiasis and prevention of their complications are subject to treatment. In the presence of stones without a clinical picture of cholecystitis, therapy consists in following a diet, regimen, maintaining an active lifestyle to reduce the likelihood of bile stasis and related complications, as well as taking drugs that destroy the structure of stones (Chenofalk, Ursosan and others). With single inclusions of calculus stones and no signs of disease in modern medicine use the method of shock wave therapy.

Meals should be frequent, fractional, with small portions of food. Fatty, spicy, fried foods, alcohol are excluded from the menu. It is necessary to monitor the amount of cholesterol in the meals consumed and include foods rich in plant fiber (cereals, greens, vegetables) in the diet.

Conservative treatment during acute attacks can be both a method of therapy and a type of preoperative preparation in patients with a destructive form of cholecystitis. Conservative therapy includes several procedures and techniques, the basis of which is the well-known formula "cold, hunger and peace":

• complete hunger with vomiting, if the attack is not accompanied by vomiting, you can drink water;
• cold (ice) on the area of ​​the right hypochondrium, the method of local hypothermia to reduce inflammation and hypertension of the gallbladder;
• antibacterial drugs in the inflammatory process;
• detoxification therapy and forcing the withdrawal of fluid from the body with diuretic drugs;
• relief of pain attacks with analgesics (Maxigan, Analgin) and antispasmodic drugs (Papaverine, No-Shpa, Baralgin, Platifillin, etc.) or combined medicines with analgesic and antispasmodic effects.

How to treat stones in the gallbladder in additional ways? In addition to directed actions and drugs, auxiliary therapy is prescribed: drugs that stimulate the release of bile acids, enzymes for the digestive system, including those that break down fats, medicines to restore balance in the composition of bile, as well as lithotripsy method, both shock wave and drug, and litholysis method for crushing or dissolving calculus stones. Crushed stones are able to go out on their own along with feces.

Surgical treatment as a method of therapy is prescribed for frequent attacks of acute cholecystitis, large stones, destructive course of the disease and the presence of severe complications. Methodology surgical treatment may be based on open or laparoscopic penetration and different options gallbladder manipulation.

The therapy is carried out exclusively under the supervision of doctors, since independent attempts to take drugs for crushing and removing stones can lead to blockage of the bile ducts, obstructive jaundice, acute cholecystitis and other complications of the disease.

Most often, the surgical method of therapy is used in patients with acute cholecystitis that is not cured by other types of treatment in a state life threatening patient. In acute destructive cholecystitis, the operation is performed in the first 24-48 hours after hospitalization. The choice of surgical intervention (cholicisectomy, removal of the gallbladder, or decompression with the removal of infected bile) depends both on the nature of the inflammatory process and the disease, and on physical condition patient.

Cholelithiasis(cholelithiasis) is a disease, the main symptom of which is the presence of one or more stones in the biliary tract and / or gallbladder.

According to the forms, the following flow options are distinguished:

• asymptomatic,
• dyspeptic,
• painful torpid,
• pain attack,
• cancer (more often seen as a complication).

Predisposing factors

Stones in cholelithiasis are classified according to their chemical composition into cholesterol, pigment (bilirubin predominates), mixed and calcareous (there are calcium deposits).

Symptoms of the disease appear when stones move along the ducts. If the stone lies still, there may be no pain and the patient does not feel sick.

According to statistics, gallstone disease in women is more common.

The main risk factors are female gender, age over 40 years, excessive fullness or sudden weight loss, long-term use of oral contraceptives and other medications, pregnancy.

In cholelithiasis, there are local factors of stone formation, which consist in chemical changes in the bile itself, the motility of the bladder and bile ducts with the development of increased pressure in them, as well as in the attachment of an infectious agent.

However, despite the allocation of the age criterion among the main risk factors, cholelithiasis in children is increasingly common. Not proper nutrition, physical inactivity, overweight do not bypass the younger population of the Earth, which is why the disease is getting younger from year to year.

Stages of gallstone disease

Expressed manifestations occur after a certain time from the onset of the development of cholelithiasis. The slow course of the disease has stages. There are 3 main stages:

• chemical;
• latent;
• clinical.

The very initial preclinical stage is characterized by changes in the "chemistry" of bile. It gradually increases the content of cholesterol, and bile acids and phospholipids, on the contrary, are observed in smaller quantities. All this leads to changes in physical property bile as lithogenicity, that is, the ability to precipitate. She rises. The bile itself becomes thick, cloudy, and its microscopic examination reveals cholesterol crystals. The stage is reversible when carrying out the necessary therapeutic measures.

In the second stage, against the background of already existing chemical disorders in the composition of bile, an inflammatory factor joins. This can be explained by the direct damaging effect of cholesterol and bilirubin granules on the mucosa of the bladder itself and the excretory ducts. In response to this, mucus begins to be actively produced. She, in turn, "cements" the existing crystals into larger micelles and flakes. However, this stage also proceeds for a long time and is asymptomatic (even despite the already beginning stagnation of bile).

In the third stage, the patient may develop various symptoms (depending on the form of the disease), varying from their total absence to biliary colic, forcing "to climb the wall" from an intense pain syndrome.

Classification of gallstone disease

According to the severity, it is customary to distinguish 3 main varieties: mild, moderate and severe, in accordance with the number of pain episodes.

The lung is usually manifested by dyspeptic symptoms and a periodic feeling of heaviness in the right hypochondrium in the projection of the gallbladder. Attacks may be absent or appear quite rarely.

The average degree, along with typical painful exacerbations, is manifested by vomiting, fever, and sometimes jaundice. Episodes are frequent, especially against the background of diet and regimen violations.

A severe degree torments the patient almost constantly. The pain does not go away even after stopping the attack. Complications often develop. Treatment is surgical only.

Forms of cholelithiasis

As mentioned above, there are 5 main varieties.

The asymptomatic form, or stone carrying, may not manifest itself in any way during life. The disease is known only during additional methods studies (ultrasound, x-ray) of concomitant pathology or in the section.

The dyspeptic form is established in the presence of symptoms of gastric and / or intestinal dyspepsia. Belching, heartburn, bitterness in the mouth, a feeling of heaviness in the upper abdomen, nausea, bloating and flatulence come to the fore.

Painful torpedo (permanent) form is characterized by dull pain on the right under the ribs. The pain does not go away, but only changes its intensity against the background of dietary disorders or emotional stress. In such patients, a "bilious" character appears in the form of irritation, fatigue and weakness.

Painful attack (recurrent) form is also manifested by attacks of pain syndrome. Colic develops at night. It is preceded by provoking factors in the form of overeating, stress, active sports. The duration of the episode is up to several days. An antispasmodic is prescribed for relief.

However, is it possible to use this or that medicine for cholelithiasis, only the doctor will say. Especially if you pay attention that often an attack of biliary colic can mimic angina pectoris.

The mechanism of development of biliary colic

The exacerbation of the disease always comes suddenly.

The main danger is that a stone (a mobile calculus of small size) can clog the bile duct at any level, disrupting bile excretion.

But the liver produces bile regularly. Therefore, the latter will accumulate in the bile ducts, gradually expanding the lumen of the ducts and increasing the pressure in them. Thus begins an attack of gallstone disease. The liver at this point also has a hard time. Gradually, bile begins to enter the bloodstream due to the proximity of the intrahepatic bile and blood vessels, having a direct toxic effect on everything. internal organs including the brain. Hence the symptoms of intoxication appear.

Why is this pathology dangerous?

Itching in cholelithiasis appears due to the effect on the skin of bile acids entering it with blood through the capillaries. This is manifested by the development of jaundice (yellowing skin and mucous membranes).

If the stone is stuck at the level of the cystic duct (connects the bladder to the rest of the bile duct system), dropsy or empyema of the gallbladder is possible with excessive stretching of the tissues due to the large accumulation of bile and pus in its lumen. And the most formidable complication is considered to be perforation (rupture) of the bladder or ductal wall with the development of limited or diffuse peritonitis (inflammation of the peritoneum).

Due to the peculiarities of the anatomy of the ductal system, cholelithiasis and pancreatitis are often combined. The latter can be both a concomitant pathology and a complication of cholelithiasis.

Gallstone disease and cholecystitis are related diseases that occur when the calculus is located directly in the bladder cavity. Constant exposure to the walls injures its internal mucosa, as a result of which acute inflammation with related symptoms. In addition to cholecystitis, cholangitis can develop - inflammation of the tissues of the ducts of the entire bile excretion system.

What can not be eaten with gallstone disease?

Most often, the patient is prescribed a lifelong diet with restrictions on fat, pickles, smoked and fried foods. Many people ask, is it possible to eat jellied meat? With gallstone disease, the answer to this question is ambiguous. Strict restrictions include the exclusion from the diet of by-products and their derivatives, especially during an exacerbation of the disease. Therefore, if the composition of the product is unknown, it is better not to use it. With self-preparation of dishes on lean meat (beef, chicken, turkey), some indulgences are possible. If you really want to, then in small quantities you can eat jelly with cholelithiasis. The only thing that matters here is the portion size.

Mineral water for cholelithiasis is allowed only non-carbonated. Therefore, even during the period of remission, it is better to release carbon dioxide from it so as not to provoke an exacerbation due to an increase in pressure in the intestines.

Whom to go to for treatment?

Specialists involved in the diagnosis and treatment of gallstone disease are a general practitioner, a surgeon and a gastroenterologist.

For many patients, surgical treatment is recommended for certain indications. Without surgery, the patient is released only with an asymptomatic form or with his categorical refusal.

Treatment with folk remedies is indicated in the interictal period after prior consultation with a doctor.

If you experience symptoms similar to the picture of the disease, you should immediately seek medical help, as the disease can be insidious. The hospital will provide first aid, and the doctor will give recommendations on further tactics for managing the patient.

Symptoms

Gallstone disease is a common disease of the gastrointestinal tract in the human population, in which the gallbladder and bile ducts are affected as a result of the formation of stones and the development of a local inflammatory process. The highest incidence is observed in countries with a high standard of living, which is most likely due to dietary habits. Women are more susceptible to the disease than men.

The symptoms of gallstone disease are varied and depend on the location and size of the formed stones, on the patient's comorbidities, and on the timeliness of the start of treatment.

Clinical stages of gallstone disease

The development of symptoms in cholelithiasis occurs with a certain pattern, so it is possible to distinguish the stages of the disease based on the patient's complaints:

• Biochemical disorders in the composition of bile. There are no symptoms of gallstone disease. The only way to make a diagnosis is bile sampling and microscopy. It contains small crystals of cholesterol. In a biochemical blood test: an increase in cholesterol and a decrease in the concentration of bile acids.
• Latent or hidden stage. The patient has no complaints. When conducting an ultrasound of the liver and biliary tract, stones in the gallbladder can be detected.
• The stage of peak or the onset of symptoms of gallstone disease. Biliary colic appears - acute pain attacks lasting from an hour to five hours, most often developing at night. The pain is localized in the region of the right hypochondrium and spreads up the right half of the back. Appears, as a rule, after errors in the diet or with excessive physical exertion.
• Stage of development of complications. With the progression of the disease and the lack of adequate treatment, complications from the gallbladder, liver and other organs appear.
• The recovery stage is characterized by the disappearance of the symptoms of the disease.

Asymptomatic gallstone disease

As the name implies, with this variant of gallstone disease, a person does not present any complaints associated with the pathology of the gastrointestinal tract. Symptoms of the disease appear only when the stones begin to move or when their size increases. On average, this happens 5-10 years after the appearance of the first stones. It is important to note that among all people with gallstones, 70-80% do not have clinical manifestations of the disease.

This group of people, when detecting the presence of calculi in the gallbladder and biliary tract, requires careful observation and the choice of the most rational treatment tactics (first of all, this is a diet correction).

All symptoms of gallstone disease can be divided into several groups, differing in the cause of occurrence and their severity.

Pain syndrome, or biliary colic

Pain syndrome (or biliary colic) is a set of symptoms that develop when the cystic duct is blocked by a stone. by the most common symptom with cholelithiasis, there is periodic pain in the right hypochondrium or in the middle of the upper abdomen of an acute cutting nature. Often the pain is intermittent, which may be due to the movement of the stone in the gallbladder. The pain syndrome is not specific, which can make it difficult to make a correct diagnosis.

An attack of biliary colic has several features. The main symptom is a sharp, stabbing pain in the upper abdomen with predominant localization in the right hypochondrium. The pain may radiate to the area of ​​the right shoulder blade and shoulder. Sometimes the pain can spread beyond the sternum and to the left side of the chest, simulating an angina attack. Changing the position of the body does not bring relief. Nausea and vomiting may occur.

The duration of the pain attack is from one hour to several hours. If the pain does not disappear, then this can be regarded as a symptom of acute cholecystitis or other diseases. Characteristic development of biliary colic in the morning or at night. The patient cannot find a comfortable painless position and is constantly moving. It is possible to develop against the background of this nervous excitement.

Pain is usually due to errors in the diet (eating fatty, fried and / or plentiful food). In women, the onset of a painful attack is often associated with the onset of menstruation or with childbirth. The appearance of bloating, heartburn, heaviness in the abdomen are not associated with diseases of the gallbladder and may indicate a concomitant pathology of the stomach. After the pain attack has passed, there is a sharp pain when pressing on the right costal arch.

According to the latest scientific data, a number of symptoms (such as the appearance of bitterness in the mouth, flatulence, nausea, a feeling of discomfort and pain in the right hypochondrium, periodic intolerance to dairy food) cannot be unambiguously regarded as manifestations of gallstone disease. The incidence of such complaints does not differ between patients with and without gallstones.

Symptoms of inflammation of the gallbladder

In a certain percentage of cases of cholelithiasis, an inflammatory process develops in the gallbladder (acute cholecystitis), provided that the outflow of bile into the biliary tract is blocked by a stone. In general, the symptoms are very similar to an attack of biliary colic, but have a number of features.

The pain appears in the region of the right hypochondrium and is dull, pressing. Continues for several days and may also move to the back or left side chest. In addition to pain, an intoxication syndrome develops associated with an inflammatory process: an increase in body temperature to 38-39 degrees, headache, a feeling of general weakness. These symptoms do not occur in classic uncomplicated biliary colic. Very often there is nausea and repeated vomiting.

If you experience these symptoms, you should immediately contact medical institution for getting emergency care. Since a delay in the beginning of treatment even for several hours can result in the development of severe complications (up to death).

Symptoms of chronic inflammation of the gallbladder

Chronic cholecystitis occurs with a long course of cholelithiasis and is characterized by the development of a weak inflammatory process in the wall of the gallbladder against the background of periodic movement of stones. The patient has a long subfebrile temperature body (up to 38 degrees) for several weeks or months.

Perhaps the development of cholecystocardial syndrome, manifested by pain in the heart, the appearance of which is associated with hyperactivation of the vagus nerve. A sick person easily indicates the exact localization of heart pain.

A sick person, after eating, experiences swelling and discomfort in the abdomen, the appearance of nausea. These symptoms are not specific and do not directly indicate the pathology of the gallbladder. Very often with chronic cholecystitis, long-term diarrhea occurs (5-10 bowel movements per day, for at least three months). At the same time, feces have a modified appearance: becomes less saturated in color and is characterized by the appearance of a small amount of whitish mucus (this reflects a violation of the secretion of bile into the intestinal lumen). Perhaps the paradoxical development of constipation associated with impaired intestinal motility and intra-intestinal digestion of food.

Symptoms of stones in the bile ducts

Symptoms of choledocholithiasis (stones entering the common bile duct from the gallbladder) are similar to those of cholecystitis, but other complaints may also occur.

As a result of a violation of the outflow of bile through the common bile duct, mechanical jaundice occurs - the patient has yellowing of the skin, sclera of the eyes and visible mucous membranes. Very often, nausea appears on the background of eating and diarrhea develops (feces are light, dirty in color). Urine becomes dark in color.

If an inflammatory process joins, then there is strong pain in the right hypochondrium and in the middle of the upper abdomen, fever, chills, bouts of nausea and vomiting. If these symptoms appear, you should immediately contact a medical institution.

Symptoms from other organs

Despite the strict localization of the process in the gallbladder, against the background of cholelithiasis, functional and organic changes develop in other organs of the body, this is most pronounced in the central nervous system.

There is a certain mask of gallstone disease: a person becomes depressed, becomes hypochondriacal. There is a process of asthenization of the personality: intellectual work is poorly tolerated, the emotional coloring of sensations fades away. Phobias often develop.

With cholelithiasis, vegetative dystonia develops, manifested by a decrease blood pressure, periodic dizziness, the development of migraine-type headaches, sleep disturbances of a different nature, excessive sweating, nervous excitement, etc.

An unusual consequence of cholelithiasis is the development of an allergic syndrome in humans. Exacerbation of cholecystitis is often accompanied by urticaria, pollinosis, the occurrence of drug and food allergies, bronchospasm. At the same time, allergic conditions are long, difficult to treat. The use of antibiotics in this case can contribute to the deterioration of the condition.

Complications of gallstone disease

One of the most common complications of cholelithiasis is chronic inflammation in the gallbladder with the development of chronic cholecystitis. Symptoms of cholecystitis are described above. When stones enter the bile ducts, acute or chronic cholangitis develops.

Jaundice often occurs due to a violation of the outflow of bile. In this case, yellowing of the skin and sclera in humans, as well as other nonspecific symptoms, is observed. Most often, jaundice develops due to blockage of the bile duct by stones.

One of the most dangerous complications cholelithiasis is considered the development of phlegmon of the gallbladder. In this case, the gallbladder ceases to receive adequate blood supply, and dystrophic processes begin in it, which can lead to its rupture. As a result, aggressive contents enter the abdominal cavity and cause the development of diffuse peritonitis.

No less formidable complication is the development of pancreatitis. The pancreas has an excretory duct that flows into the common bile duct. As a result, if the gallstone blocks the path below the confluence of the pancreatic duct, the outflow of pancreatic juice will be disturbed. This, in turn, will lead to damage to the pancreatic tissue and the development of acute pancreatitis, which is a life-threatening condition. Clinically, this will be manifested by the appearance of acute cutting pain in the left side of the abdomen, repeated profuse vomiting and the development of a strong intoxication syndrome: body temperature rises to 39-40 degrees, severe headache and general weakness appear.

A serious complication of cholelithiasis and any long-term inflammatory processes in the gallbladder is the development of cancer. Clinically, cancer is manifested by a syndrome of small signs: an increase in body temperature up to 38 degrees for several months, weight loss, general weakness, malaise, poor tolerance for physical and intellectual labor.

If you experience any of the symptoms described above, you should immediately contact a medical institution for specialized medical care. This state requires prompt diagnosis and treatment.

Diagnostics

Gallstone disease is characterized by the formation of stones in the lumen of the gallbladder. This is a serious disease that requires a rapid diagnostic process and the appointment of adequate treatment. These tasks are performed by a gastroenterologist.

Necessary measures for the examination of a patient with suspected gallstone disease are:

• General and biochemical blood tests to assess general state the patient's body.
• Coprogram.
• Ultrasound examination of the liver and gallbladder is the most commonly used examination method.
• Fibroesophagogastroduadenoscopy, which allows to assess the condition of the duodenum and the secretion of bile.
• X-ray examination (plain x-ray and CT) can visualize gallstones.
• Cholecystocholangiography and endoscopic retrograde cholangiopancreatography, modern methods of visualization of the biliary tract.

General and biochemical blood test

Conducting a general and biochemical blood test allows you to assess the general condition of the patient and detect a number of concomitant diseases. Biochemical analysis allows you to assess the degree of violation of bilirubin metabolism and help diagnose jaundice at an early stage of occurrence. For this purpose, the total bilirubin and its direct fraction are determined. In addition, in the biochemical study of blood, an increase in cholesterol and alkaline phosphatase activity is noted.

Coprogram

Evaluation of the patient's stool allows you to see signs of insufficient secretion of bile into the intestinal lumen. This is accompanied by a change in the color of the feces - it becomes dirty whitish. The coprogram of such a patient contains a large amount of undigested fats.

Ultrasound of the liver and gallbladder

The initial stage of gallstone disease is sludge in the gallbladder. This concept refers to any thickening of bile, which is visualized using ultrasound. That is why the ultrasound method of research is referred to as an early diagnosis of this disease. Ultrasound of the abdominal organs allows to assess the degree of development of cholelithiasis and the presence of echopositive inclusions in the cavity of the gallbladder - stones of various composition. In addition to this, at this method examination assesses the condition of the walls and motility of the gallbladder, the patency of the biliary system.

Fibroesophagogastroduadenoscopy

This procedure allows you to assess the condition of the mucous membranes of the esophagus, stomach and duodenum. The last organ is of the greatest interest. With FEGDS, it is possible to directly monitor the final sections of the biliary tract and evaluate the secretion of bile, due to the simultaneous taking of its contents from the intestinal lumen.

X-ray examination

X-ray methods of examination - a survey radiograph of the abdominal organs and CT scan, due to the high resolution, allow you to see the stones in the lumen of the gallbladder in the picture. Computed tomography also serves as an excellent method for assessing the functional and anatomical state of the gallbladder.

Cholecystocholangiography and endoscopic retrograde cholangiopancreatography

They are invasive examination methods, while during the last of them it is possible to remove small stones from the bile ducts, which is undoubtedly a big plus. This procedure is performed only in the conditions of the surgical department.

Treatment

Gallstone disease requires an integrated approach to treatment, consisting of non-drug, drug and surgical methods.

As non-pharmacological means diet and lifestyle adjustments are used, as well as various physiotherapy procedures.

Drug therapy involves the use of special drugs taken orally through the mouth that can dissolve gallstones.

Minimally invasive and invasive surgical techniques allow the direct removal of gallstones and are today considered the best choice for the treatment of gallstone disease.

Gastroenterologists and general surgeons are involved in the treatment of gallstone disease.

Non-drug therapy

A very important factor influencing the course of gallstone disease is human nutrition. Therefore, with the development of the disease, it is necessary to pay great attention to the diet of the patient. It is necessary to eat often (5-6 times a day) and eat small meals - this prevents stagnation of bile in the gallbladder and contributes to its regular emptying. From the foods taken, it is necessary to exclude any fatty, fried or spicy foods, alcoholic beverages, egg yolks, raw vegetables and fruits.

The patient is also shown physiotherapy, since physical activity helps to activate digestion and empty the gallbladder.

Possible use in the treatment of gallstone disease folk remedies. However, this method of treatment has not shown its effectiveness in monotherapy, and can only be used as an additional treatment against the background of standard medical and surgical means.

Medical therapy

Treatment of gallstone disease begins without surgery, but with the help of therapeutic agents. For this purpose, ursodeoxycholic acid preparations (ursoflk, ursosan) are used, which have the ability to dissolve gallstones in the lumen of the gallbladder. An important condition for oral litholytic therapy with ursodeoxycholic acid is the radiolucency of gallstones and the preservation of good contractility of the gallbladder. The diameter of the stones should be no more than 10 mm. If these conditions are met, then drug therapy.

The duration of therapy with ursodeoxycholic acid preparations is from 6 to 12 months. Such a long period of drug administration allows complete dissolution of small stones in most patients.

For the appointment of oral litholytic therapy, there are contraindications: frequent attacks of biliary colic, the presence of severe complications of gallstone disease, diarrhea, post-resection conditions small intestine and pregnancy.

In addition to dissolving stones, drug therapy has other goals, one of which is to improve the outflow of bile through the biliary tract by relaxing smooth muscle sphincters. For this, non-selective antispasmodics (No-shpa, papaverine) are most often used, as well as a number of anticholinergics (Buscopan, Metacin). The use of these drugs can facilitate the outflow of bile from the gallbladder and reduce the risk of developing biliary colic.

An important task facing doctors in the treatment of gallstone disease is the need to correct the intestinal microflora. For this, both antibacterial agents and a number of eu- and probiotics are used.

Surgery

Surgery is the treatment of choice for gallstone disease. Surgical methods for the treatment of gallstone disease are divided into two large groups:

• Minimally invasive (contact litholysis and extracorporeal shock wave lithotripsy (ESWLT);
• Invasive (cholecystectomy, cholecystolithotomy and cholecystostomy).

To date, contact litholysis is practically not used in healthcare, as there are much safer and more effective methods for treating gallstone disease. The essence of contact litholysis is the direct introduction into the gallbladder of substances that can dissolve gallstones of any chemical composition.

Extracorporeal shock wave lithotripsy (ESWLT) is a treatment for gallstone disease that uses a shock wave to destroy gallstones. To create an influencing factor, various installations are used to crush the whole stone into small fragments and sand, which can independently exit through the bile ducts into the duodenum. The technique is very safe and practically non-traumatic, however, the limiting factor in its use is the low rate of effectiveness of treatment - in 20-40% of cases, the resulting fragments cannot enter the common bile duct and tend to overlap with the development of an attack of biliary colic and jaundice.

There are a number of absolute indications for invasive surgical treatment methods:

• Previous severe attacks of biliary colic;
• Identification of large stones in the gallbladder that can cause damage to the wall of the organ;
• Precancerous changes in the gallbladder;
• A large number of mobile small stones that can enter the common bile duct and cause the development of obstructive jaundice.

A relative indication for surgical intervention is the presence of a latent or dyspeptic form of cholelithiasis in a patient.

There are three types of surgery for gallstone disease. The most commonly performed classic cholecystectomy, which consists in removing the entire gallbladder along with stones. At the same time, there are several varieties of it, depending on the operational access and the order in which structures are allocated for deletion. Usually, a skin incision is made on the anterior abdominal wall, the surgeon enters the abdominal cavity and carefully examines the gallbladder and the anatomical structures adjacent to it. After this, the gallbladder is isolated and carefully removed. Such a “wide” access makes it easy to navigate in the surgical wound and conduct a qualitative examination of the organs, but at the same time, severe tissue trauma is observed, and the time of the postoperative period is lengthened.

Therefore, in recent years, less invasive methods of cholecystectomy have been increasingly used: through mini-accesses or with the help of laparoscopic equipment.

Laparoscopic removal of the gallbladder has a number of advantages: a small number of incisions and cosmetic benefits of the operation, a decrease in the duration of the postoperative period and the risk of complications.

Cholecystolithotomy is the introduction of litholytics into the gallbladder using laparoscopic access. After the litholytic has had an effect on the stones, the contents of the gallbladder are aspirated, washed several times, after which the incision on its wall is sutured. This technique is not used so often and is inferior in its effectiveness to laparoscopic cholecystectomy.

When symptoms appear renal colic it is necessary to immediately seek professional help in a medical institution.

Medications

Medical practice shows that the formation of stones in the gallbladder and biliary tract is the most common ailment among morbidities in the world. The disease proceeds for a long time, creating discomfort for patients who often complain of pain in the right hypochondrium and in the right side of the abdomen. With a latent form, migraine, neuralgia, dizziness may appear. In addition, complications of gallstone disease can be provoked by other serious illnesses. Therefore, it is important to start timely treatment and take all measures to combat the disease. The initial stage of gallstone disease is treated with conservative methods. Drugs for gallstone disease are prescribed by a specialist. Their action is aimed at the focus of the development of the disease, the removal of pain, the destruction and washing out of stones. In this article, we will take a closer look at some of them.

Preparations for the treatment of gallstone disease

• No-shpa
• Allochol
• Karsil
• Essentiale Forte
• Ursosan
• Holenism

No-shpa

No-shpa is a myotropic antispasmodic. The action of the drug is aimed at relieving acute pain. The drug has a wide range of applications, as it can be administered orally or parenterally to the patient. No-shpa acts quickly and for a long time. Even small doses of the drug are highly effective, its use is safe both in adults and in children. childhood. serious side effects during the period of use of no-shpy by patients were not detected. This drug is available, inexpensive and effective tool to fight gallstone disease.

The dosage form of the drug is available in: capsules, tablets, injection solutions. No-shpa with cholelithiasis has its own contraindications. Before using the drug, you should read the instructions, methods of application and dosage.

Allochol

Allochol belongs to the group of choleretic drugs. Independent application medicines without a doctor's recommendation can cause colic attacks. Therefore, Allohol is taken according to the doctor's prescription, according to the instructions. The specialist prescribes the medicine when symptoms of biliary dysmotility, cholecystitis, liver tissue damage appear. The action of allochol in cholelithiasis is aimed at normalizing the process of bile formation, improving liver function, and improving the secretion of the digestive organs. The drug prevents the process of putrefaction and fermentation in the intestines.

The dosage form of the drug is presented in tablets for adults and children. Allochol should not be used in acute forms of hepatitis, liver dystrophy, jaundice, intolerance to its components. More detailed information on contraindications is indicated in the instructions for the drug. No side effects were found when using the drug, in some cases it can cause allergic reactions or diarrhea. With such manifestations, the drug should be discontinued.

Karsil

Karsil contains a dry extract of milk thistle, therefore it is a medicine plant origin. The drug normalizes the effect on the cell membranes of liver cells, stabilizes fat metabolism, has an antitoxic effect, restores hepatocytes, and protects liver cells from negative influences. It was noted that the drug helps to improve appetite, promotes weight gain. Karsil is prescribed for toxic liver damage, after hepatitis, cirrhosis and steatosis of the liver, for preventive measures. Children under 12 years of age are not allowed to take the drug.

Karsil is available in the form of capsules and dragees. Side effects of the drug cause diarrhea, dyspepsia, nausea. In rare cases, observed: skin rash, itching. After discontinuation of the drug side effects stop.

Essentiale Forte

Essentiale Forte in cholelithiasis is used to prevent the appearance of gallstones. There are a number of liver diseases, hepatitis, psoriasis, cholestasis and others for the use of the drug. The main components of the drug are aimed at normalizing the metabolism in liver cells. Available in capsules and solution for injection. Can be used by adults and children over 12 years of age, as well as pregnant women.

Phospholipids

Phospholipids contained in the preparation reduce the lithogenicity of bile. Therefore, Essentiale Forte is prescribed in complex therapy to prevent the formation of stones in the gallbladder. Side effects that may occur as a result of taking the medicine: diarrhea, nausea, bloating. When the dose is reduced, side effects usually disappear.

Ursosan

Ursosan, like the previous drug, belongs to the group of hepatoprotectors. The drug is prescribed as a choleretic agent. In the case of gallstone disease, use on mild stage, with inflammation and dyskinesia of the biliary tract. A drug based on ursodeoxycholic acid replaces it with a shortage in the patient's body. The effect of Ursosan is achieved if the stones do not exceed 1.5 cm in diameter. At this stage of the course of the disease, stones are excreted from the body almost painlessly.

The drug is available in the form of capsules. Reception is long, can be up to two years. Contraindications include: hypersensitivity to the components of the drug, liver failure, cirrhosis of the liver, infectious diseases of the biliary tract in an acute form. Side effects may include constipation, diarrhea, and nausea. In rare cases, calcification of stones.

Holenzim

Cholenism in cholelithiasis is taken with extreme caution. The animal components included in the composition have a choleretic effect. Cholenism increases the formation of bile and improves its outflow from the biliary tract. Regular use of the drug improves the functioning of the digestive system, helps digestibility of fats, proteins, carbohydrates. The acids that make up the drug stimulate the liver to produce good quality bile.

It is prescribed for patients leading a sedentary or immobile lifestyle, people who eat junk food, in case of violation of chewing function.

The form of the drug is available in tablets. Take according to the instructions. Indicated for adults and children over 12 years of age. Cholenism is contraindicated in jaundice, pancreatitis, individual intolerance to the components of the drug. The drug in some cases has side effects that manifest themselves in the appearance allergic reactions, sneezing, tearing, skin rash.

Antispasmodics and painkillers for gallstone disease

Gallstones are hard formations that migrate, causing sharp pain. Pain occurs in the right side and in the epigastric region. If the patient has repeated bouts of pain, you should immediately take antispasmodic and analgesic drugs. The action of drugs is aimed at the rapid removal of attacks of gallstone disease. If the stones blocked the ducts, you need to call ambulance and give an injection before the arrival of doctors of a strong antispasmodic and analgesic.

Hirudotherapy

Treatment with leeches contributes to the restoration of the gallbladder. Such a tool helps to thin the blood and promotes movement through the vessels. Accordingly, the cells of the gallbladder begin to receive a sufficient amount of oxygen and nutrients. A gastroenterologist prescribes hirudotherapy sessions, the duration of which depends on the stage of the disease. Specialized doctors determine active points on the body and leeches make bites in these places, providing an anesthetic and antimicrobial effect. Hirudotherapy helps to relieve inflammation, removes toxins, saturates with oxygen.

Apart from traditional medicine and treatment medicines there are methods traditional medicine. Practice shows that folk remedies in combination with general therapy effectively help to cope with the disease. The main preparations contain herbal preparations from: chamomile, wormwood, fennel, mint, etc. Any actions aimed at self-treatment should take place according to the recommendations of doctors. It is necessary to strictly adhere to the recipe and instructions attached to the drugs.

Folk remedies

Eating foods high in cholesterol, not exercising enough, or being overweight can cause gallstones to form. This disease is called gallstone disease. It may be hereditary. Symptoms of the disease vary depending on the stage of its development.

Treatment of gallstone disease with folk remedies has been practiced quite effectively since ancient times. They fight the disease with various herbs, infusions, decoctions. Vegetables and fruits are beneficial in the diet. In the acute course of the disease, the patient is prescribed a special diet to stop the development of the inflammatory process. Therapeutic starvation for cholelithiasis is prescribed if the patient has biliary colic during the period of exacerbation of the disease. In this case, the patient can only use mineral water. The patient is recommended to give Essentuki No. 4 and No. 17, Borjomi.

Phytotherapy for gallstone disease

This type of treatment is aimed at removing stones and preventing the appearance of new deposits in the gallbladder. Vegetable raw materials effectively fight stone formation. The most common of them is black radish juice. The raw material prepared from it with the addition of honey helps in preventing the development of the disease. To cleanse the ducts, a herbal collection of celandine, mint and golden volodushka is used. A decoction of this collection normalizes the stool, improving bowel function. In addition, rose hips are used to dissolve stones. But its roots, or rather a decoction based on them, are a more effective remedy.

In case of gallstone disease, chamomile flowers are used. Pharmacy chamomile acts as an antimicrobial, anti-inflammatory agent.

Herbs for gallstone disease can cope with the disease at any stage of the disease. However, all actions of self-treatment should be carried out according to the recommendations of the attending physician.

Gallstone disease: alternative treatment

In addition to phytotherapy, there are a number of effective means to fight disease. These include mummy - a drug that restores the metabolism in the human body. The medicine restores and enhances immunity, providing antibacterial and anti-inflammatory effects.

Green tea can help relieve pain. The drink lowers cholesterol in the body, improves the functioning of the gallbladder. Juices are also indicated for use during an exacerbation of the disease: fresh barberry, strawberries, carrots, cabbage, lingonberries. Vegetable, berry and fruit juices contribute to the dissolution of stones, have a choleretic effect.

The patient should strictly adhere to proper nutrition. Exclude fatty and spicy foods, alcohol, carbonated drinks from the diet. It is strictly forbidden to overeat, it is better to eat up to 5 times a day in small portions. Animal fats are poorly absorbed by the body. Therefore, they should also be excluded from the menu. During the period of illness, it is better to use olive oil, which is especially effective for stagnation of bile.

Therapy should include a complex of folk remedies and diet. A doctor will help you choose the most appropriate method of treatment and recipes for traditional medicine for gallstone disease. If you suspect or the first signs of an illness appear, you should contact a gastroenterologist or therapist who will identify the stage of the disease and prescribe the appropriate treatment. In severe cases when folk methods are not effective, the only way to get rid of stones is surgery.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

Cholelithiasis (other name cholelithiasis ) is a disease characterized by the occurrence of stones in the bile ducts. In particular, stones are formed in the gallbladder (we are talking about cholecystolithiasis ) and in bile ducts(in this case it develops choledocholithiasis ).

The occurrence of stones in the process of development of cholelithiasis occurs due to the deposition of insoluble components of bile. These components are calcium salts , bile pigments , as well as certain types proteins . Also, in some cases, there are stones that are pure in terms of chemical composition. Stones that form in the bile ducts and bladder are divided into cholesterol , pigmented , as well as rare ones that make up . When it comes to mixed stones, they usually consist of 70% cholesterol.

In women, one of the provoking factors is the bearing of a child. In the process of fetal growth, the gallbladder is compressed, resulting in stagnation of bile. In the last stages of pregnancy, bile is saturated with cholesterol, which also contributes to the formation of stones. Gallstone disease often manifests itself in a woman after the second pregnancy.

Cholesterol stones often form when a person has other diseases of the gallbladder or gastrointestinal tract. Cholesterol concentration increases with irritable bowel syndrome , dysbacteriosis .

Therefore, cholelithiasis is a polyetiological disease caused by various factors, the combination of which ultimately leads to the formation of stones in the gallbladder.

Symptoms of gallstone disease

Gallstone disease manifests itself in a person very different symptoms. Specialists distinguish several different forms of the disease. it latent , dyspeptic , painful torpid and paroxysmal pain forms.

When the period of the latent form of the disease ends, the patient may initially note the manifestation of dyspeptic disorders. After some time, he already has a moderate pain syndrome, and later the person is already worried about periodic attacks biliary colic . But not always gallstone disease develops exactly according to the described pattern.

Stones in the gallbladder or ducts do not always provoke the clinical manifestations of the disease. Sometimes the presence of a single calculus in the area of ​​the bottom of the gallbladder does not cause the manifestation of tangible symptoms. The duration of the latent form of the disease can be from 2 to 11 years.

In the transition to the dyspeptic form of the disease, the patient already has general dyspeptic disorders, which often manifest themselves in diseases of the gastrointestinal tract. In the region of the right hypochondrium and epigastrium, a feeling of heaviness is noted, dryness and bitterness periodically appear in the mouth. Seizures possible, constant belching , and unstable chair . In this case, the patient feels bad after eating fatty and spicy foods. Such symptoms occur at this stage of the development of the disease regularly.

With a painful torpid form of cholelithiasis, pronounced attacks of pain in a person are not observed. Sometimes there is a dull and aching pain in the epigastrium, a feeling of severe heaviness in the right hypochondrium. More intense pain occurs after violations of the rules of nutrition in cholelithiasis. In addition, the pain becomes intense after strong shaking, palpable physical activity, unpleasant emotions, changing weather conditions. The pain often radiates to the right shoulder and right shoulder blade. Some people suffer from frequent nausea, heartburn, bloating, and a constant feeling of being unwell. Symptoms of gallstone disease in women are characterized by increased pain on the days of menstruation. This form of the disease can last even several decades, accompanied in the absence of adequate therapy by bouts of biliary colic or acute.

Painful paroxysmal form is also called biliary colic . It proceeds in waves: against the background of a normal state, a severe attack of colic suddenly occurs. Moreover, such attacks can occur both after a few days, and after several years. Pain in biliary colic is very sharp, stabbing or tearing. It is localized in the right hypochondrium or in the epigastric region. At the same time, a person suffers severe torment, cannot find a suitable position for the body, even screams in pain.

Sometimes such attacks appear for no reason, but very often they are provoked by fatty or spicy foods, other deviations from the diet, as well as alcohol intake, physical or emotional stress. Women often suffer from colic on the days of menstruation, during pregnancy. Pain in biliary colic often gives under the right shoulder blade, in the collarbone and supraclavicular region, neck, right shoulder, behind the sternum. In more rare cases, the pain radiates to the region of the heart and may be mistaken for an attack. Often during pain, nausea, vomiting of bile, which does not bring relief to the patient, is noted. If during an attack of biliary colic a person suffers from indomitable vomiting, then this may indicate that the pancreas was also involved in the pathological processes.

The most severe attacks of colic are noted in those people who have small stones in the gallbladder. People suffering from biliary colic have a bitter taste in their mouths, heartburn can torment them, and they cannot tolerate fried and fatty foods.

Diagnosis of gallstone disease

Diagnosis in the case of cholelithiasis, as a rule, does not cause particular difficulties if the patient develops an attack of biliary colic. It is more difficult to diagnose the disease in the presence of fuzzy pain, dyspeptic symptoms, or symptoms of pathology of other organs of the gastrointestinal tract. One of highlights in the process of diagnosis is the correct anamnesis, from which the doctor can learn about all the features of the course of the disease.

In the process of diagnosis, an informative method is a laboratory study of blood, as well as feces and urine.

Sometimes patients with suspected gallstones are prescribed duodenal sounding. Holding biochemical research bile allows you to evaluate the properties of bile, which to some extent depend on the presence of a pathological process in the biliary tract. However, due to the possibility of exacerbation of the disease after duodenal sounding, radiological and ultrasonographic research methods are now more often used to confirm the diagnosis. To fully verify the correctness of the diagnosis, ultrasound is performed, as well as the method of oral cholecystography and infusion cholegraphy. Modern Method cholangiography allows you to get pictures of the biliary tract after direct injection of a contrast agent into them. This is done through endoscopy, piercing the abdominal wall. The study also uses computed tomography and magnetic resonance imaging.

Treatment of gallstone disease

In order for the treatment of cholelithiasis to have the most tangible effect, it is important to approach the principles of therapy differently in patients of different ages, on different stages illness. The presence or absence of complications should also be taken into account. For all patients who have been found to have gallstones, proper nutrition is important for gallstone disease.

If the patient has an exacerbation of the disease, an attack of biliary colic, he should not eat at all for one or two days in order to provide a sparing regimen for the pancreas. Next, you should eat only boiled, pureed, low-fat foods.

In an acute attack of the disease, the patient is prescribed medicines with analgesic effect. In especially severe cases, it is possible to prescribe narcotic analgesics, as well as the introduction of antispasmodic drugs intravenously. If the development of inflammation in the biliary tract was detected during the diagnostic process, they are included in the course of complex therapy. If cholelithiasis accompanies, it is advisable to take enzyme preparations -, festala , Creona .

It is also possible to prescribe drugs that improve liver function -, hepatitis , . If only solitary, floating gallstones are found, treatment may consist of trying to dissolve them. As drugs that contribute to the dissolution of stones, drugs are used chenodeoxycholic or ursodeoxycholic acids .

For the dissolution of stones to be successful, it is important that the normal functions of the gallbladder are preserved, there is no inflammation in the biliary tract and gallbladder. Specified drugs help to reduce the synthesis of cholesterol, reduce its excretion with bile, contribute to the separation of cholesterol crystals from stones and their excretion with bile.

Such treatment can last more than six months. For the period of treatment, it is important for the patient to follow a diet that will include a minimum of cholesterol and plenty of fluids. However, such treatment is contraindicated for pregnant women, since the drugs can have a negative effect on the fetus.

Shock wave cholelithotripsy - This is a modern method of treating cholelithiasis, which consists in crushing stones. For this, a sound wave is used. For crushing to be successful, the size of the stone should not be more than 3 cm in diameter.

Surgery for cholelithiasis involves the complete removal of the gallbladder. Today, laparoscopic cholecystectomy is predominantly used for this. This method of removing the gallbladder is much less traumatic, postoperative period lasts for a much shorter period of time. Such an operation can be done if the goal is to remove stones from the gallbladder.

With stones in the bile duct, a combined operation is performed: the gallbladder is removed using the laparoscopic method, and stones are removed from the bile ducts using an endoscope and sphincterotomy.

Diet, nutrition for gallstone disease

Treatment of this disease is impossible without strict adherence to certain principles of nutrition. A diet for gallstones can effectively relieve the frequent occurrence of unpleasant symptoms of gallstone disease.

Its main principle is the restriction of food that contains cholesterol. People with gallstones should not eat cheese, brains, egg yolk, liver, sausages, pork, fatty dairy products, duck and goose meat.

If the patient has a presence, then he needs to exclude easily digestible carbohydrates from the menu.

It is important to eat protein-rich foods on a regular basis. The diet for cholelithiasis involves the use of fish, poultry, rabbit, low-fat cottage cheese. To reduce the cholesterol content in foods, they should be boiled, but do not drink the broth. Food should be consumed in baked, boiled, stewed form. If the meat is baked, then the skin must be removed before eating it.

Vegetable salads dressed with kefir, olive oil. You can’t eat fresh bread: it’s better to take a slightly stale piece of bread or a cracker. It is important to increase your regular fiber intake by introducing as many vegetables as possible into your diet. You should not limit the daily consumption of liquid drinks, as they contribute to the release of toxins from the body, and also support normal metabolic processes.

A diet for gallstones excludes the inclusion of soda, ice cream, and chocolate in the diet. Fatty meals significantly load the gallbladder. You should eat in relatively small portions, dividing the total daily ration into 6-7 meals.

Prevention of gallstone disease

In order to prevent the development of gallstone disease, it is important to promptly eliminate all the causes that contribute to the disruption of metabolic processes and stagnation of bile. People who are prone to the formation of gallstones, as well as those who suffer from other diseases of the gastrointestinal tract, should pay special attention to the diet, excluding, if possible, food that is forbidden to be consumed with a special diet. It is necessary to eliminate constipation, do not wear tight belts, ensure an everyday active lifestyle.

Due to the fact that in the body the synthesis of cholesterol comes from glucose, it is important not to abuse sugar, as well as products containing it.

Due to the fact that the intensive growth of stones is observed mainly at night, you should try to empty your gallbladder before going to bed. To do this, about two hours before bedtime, you can use choleretic products - tea or kefir with honey, mineral water.

If a patient is diagnosed with a latent course of the disease, he should visit a gastroenterologist at least once a year.

Complications of gallstone disease

If in the process of development of gallstone disease, inflammation, infection, or blockage in the biliary tract develops due to the movement of stones, then clinical picture disease changes significantly. With blockage of the duct or neck of the gallbladder, gradual development is possible dropsy of the gallbladder . In this case, a person suffers from a severe attack of pain, and after a while the doctor can feel the enlarged gallbladder. If the patient develops dropsy, then sharp attacks of pain are gradually replaced by a feeling of heaviness in the right hypochondrium. There is no increase in body temperature or changes in laboratory research blood. But when the infection joins, it develops already empyema of the gallbladder . With such a diagnosis, a sharp deterioration in the patient's condition occurs: he is overcome by pain, chills, and there is a significant increase in body temperature.

If there is a complete blockage of the entrance to the gallbladder with a stone, the outflow and flow of bile becomes impossible. As a result, the bubble will atrophy over time.

Sometimes a certain movement of stones contributes to the entry of bile into the duodenum. At the same time, a person develops jaundice . The consequence of stagnation of bile in the liver is. Also, inflammation of the biliary tract, provoking, can become a complication of cholelithiasis.

If the process becomes chronic, then this is fraught with the manifestation of irreversible changes: , cholangiohepatitis , hepatic-renal insufficiency . As complications of a progressive disease, it is also possible to develop bile peritonitis , . Such conditions must be urgently treated exclusively by surgery.

The most common complication of cholelithiasis is destructive cholecystitis , gallbladder perforation .

A serious complication of the long-term presence of stones can be the development gallbladder cancer . Rarely occurs gallstone .

List of sources

• Ilchenko A.A. Diseases of the gallbladder and biliary tract. Guide for doctors. Moscow: MIA, 2011;
• Gallstone disease / S. A. Dadvani [et al.]. - M.: Vidar-M Publishing House, 2000;
• Leishner U. A practical guide to diseases of the biliary tract. M.: Publishing House GEOTAR-MED. 2001;
• Kozyrev, M.A. Diseases of the liver and biliary tract: textbook. allowance / M. A. Kozyrev. - Minsk: Bel. science, 2002.

Why is it necessary to follow a diet after gallbladder removal?

Many people who have had their gallbladder removed do not understand why they need a diet, because the gallbladder is gone! And there are no stones either ... Why do we need to eat differently?

I explain: they removed the consequence - stones and the bubble in which they form, and she herself disease - metabolic disorder - has not gone away you continue to live with her. Now stones can form in the bile ducts, which is much more dangerous. And proper rational nutrition, which we usually call a diet, gradually normalizes metabolism and you will get rid of gallstone disease forever.

Moreover, if in the presence of the gallbladder, the bile in it became concentrated, which made it possible for her to exhibit disinfectant properties and kill pathogenic microbes, now she enters directly into the duodenum- constantly, not having where to accumulate. This bile cannot help in the digestion of a large amount of food, since there is no reservoir where it accumulated - the bladder is removed.

It is for this reason that it is recommended fractional meals 5-6 times throughout the day and avoid irrational consumption of fatty foods. Yes, fat is needed, but in small amounts. It is also necessary to drink plenty of water - at least 1.5 liters, which will thin the bile. And stick to the list of allowed and prohibited foods for cholelithiasis (remember - the disease has not gone away!), Which is given above.

I hope that the article was useful for you and helped you deal with such a complex phenomenon as gallstone disease, its symptoms and causes, surgical treatment and nutrition in the formation of gallstones.

Be healthy! We eat rationally and correctly!