Cholelithiasis gives pain in the back. Cholelithiasis

Gallstone disease is a disease of the gallbladder and bile ducts with the formation of stones. Although the correct name medical term wears as "cholelithiasis" - ICD-10 code: K80. The disease is complicated by inadequate liver function, hepatic colic, cholecystitis (inflammation of the gallbladder) and may be obstructive jaundice with the need for surgery to remove the gallbladder.

Today we will consider the causes, symptoms, signs, exacerbation, treatment of cholelithiasis without surgery with medical and folk remedies, what to do with an attack of pain, when surgery is needed. We will especially talk about the nutrition of patients (diet), menus that can and cannot be eaten during treatment without surgery and after it.

What it is?

Gallstone disease is a pathological process in which stones (calculi) form in the gallbladder and ducts. Due to the formation of stones in the gallbladder, the patient develops cholecystitis.

How gallstones form

The gallbladder is a reservoir for bile produced by the liver. The movement of bile along the biliary tract is ensured by the coordinated activity of the liver, gallbladder, common bile duct, pancreas, and duodenum. This ensures the timely entry of bile into the intestines during digestion and its accumulation in the gallbladder on an empty stomach.

The formation of stones in it occurs due to changes in the composition and stagnation of bile (dyscholia), inflammatory processes, motor-tonic disorders of bile secretion (dyskinesia).

There are cholesterol (up to 80-90% of all gallstones), pigment and mixed stones.

The formation of cholesterol stones contributes to the oversaturation of bile with cholesterol, its precipitation, the formation of cholesterol crystals. With impaired motility of the gallbladder, the crystals are not excreted into the intestine, but remain and begin to grow.
Pigmented (bilirubin) stones appear as a result of increased breakdown of red blood cells in hemolytic anemia.
Mixed stones are a combination of both forms. Contain calcium, bilirubin, cholesterol.

Occur mainly in inflammatory diseases of the gallbladder and biliary tract.

Risk factors

There are several reasons for the occurrence of gallstone disease:

excess secretion of cholesterol into bile
reduced secretion of phospholipids and bile acids into bile
bile stasis
biliary tract infection
hemolytic diseases.

Most gallstones are mixed. They include cholesterol, bilirubin, bile acids, proteins, glycoproteins, various salts, trace elements. Cholesterol stones contain mainly cholesterol, have a round or oval shape, a layered structure, a diameter of 4–5 to 12–15 mm, and are localized in the gallbladder.

Cholesterol-pigment-calcareous stones are multiple, have faces, the shape is different. Significantly vary in number - tens, hundreds and even thousands.
Pigment stones are small, multiple, hard, brittle, completely homogeneous, black in color with a metallic tint, located both in the gallbladder and in the bile ducts.
Calcium stones are composed of various calcium salts, bizarre in shape, have spike-like processes, light or dark brown in color.

Epidemiology

According to numerous publications throughout the 20th century, especially in the second half of it, there was a rapid increase in the prevalence of cholelithiasis, mainly in industrialized countries, including Russia.

Thus, according to a number of authors, the incidence of cholelithiasis in former USSR almost doubled every 10 years, and stones in the biliary tract were detected at autopsy in every tenth deceased, regardless of the cause of death. At the end of the 20th century, more than 5 million were registered in Germany, and in the USA more than 15 million patients with cholelithiasis, and about 10% of the adult population suffered from this disease. According to medical statistics, cholelithiasis occurs in women much more often than in men (ratio from 3:1 to 8:1), and with age, the number of patients increases significantly and after 70 years reaches 30% or more in the population.

The increasing surgical activity for cholelithiasis observed during the second half of the 20th century has led to the fact that in many countries the frequency of operations on the biliary tract has surpassed the number of other abdominal operations (including appendectomy). Thus, in the United States in the 70s, more than 250 thousand cholecystectomies were performed annually, in the 80s - more than 400 thousand, and in the 90s - up to 500 thousand.

Classification

Based on the features of the disease accepted today, the following classification is distinguished according to the stages that are relevant to it:

Stone formation is a stage that is also defined as latent stone bearing. In this case, there are no symptoms of cholelithiasis, but the use instrumental methods diagnosis allows you to determine the presence of stones in the gallbladder;
The physico-chemical (initial) stage - or, as it is also called, the pre-stone stage. It is characterized by changes occurring in the composition of bile. There are no special clinical manifestations at this stage, the detection of the disease at the initial stage is possible, for which it is used biochemical analysis bile on the features of its composition;
Clinical manifestations - a stage whose symptoms indicate the development of an acute or chronic form of calculous cholecystitis.

In some cases, the fourth stage is also distinguished, which consists in the development of complications associated with the disease.

Symptoms of gallstone disease

In principle, cholelithiasis can proceed for a very long time without any symptoms or manifestations. This is due to the fact that the stones early stages small, do not clog the bile duct and do not injure the walls. The patient may long time not suspect at all that he has this problem. In these cases, they usually talk about stone-carrying. When the actual cholelithiasis makes itself felt, it can manifest itself in different ways.

Among the first symptoms of the disease, it should be noted heaviness in the abdomen after eating, stool disorders (especially after taking 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:

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. A periodic increase in temperature (wave-like) 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.
Pain in the right hypochondrium. Most typical manifestation cholelithiasis is the so-called biliary (biliary, hepatic) colic. It's an attack 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.
Fat intolerance. AT human body bile is responsible for the emulsification (dissolution) of 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 disorders can be manifested by diarrhea (diarrhea), accumulation of gases in the intestines (flatulence), unexpressed pain in the abdomen. All these symptoms are non-specific and can occur with various diseases of the gastrointestinal tract (gastrointestinal tract). Intolerance to fatty foods can also occur at the stage of stone bearing, 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.
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 due to the fact that 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, some hematological diseases or poisoning.

In general, the symptoms of gallstone disease can be quite diverse. There are various disorders of the stool, atypical pain, nausea, periodic bouts of vomiting. Most doctors are aware of this variety of symptoms, and just in case, they prescribe an ultrasound of the gallbladder to rule out gallstone disease.

An attack of gallstone disease

An attack of cholelithiasis usually means biliary colic, which is the most acute and typical manifestation of the disease. Stonecarrying does not cause any symptoms or disorders, and patients usually do not attach any importance to unexpressed digestive disorders. Thus, the disease proceeds latently (hidden).

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 taking a large number fatty food. Once during the period of exacerbation, discoloration of the stool can be observed. This is due to the fact that pigmented (colored) bile from the gallbladder does not enter the intestine. Bile from the liver drains only in small quantities and does not give an intense color. This symptom called acholia. In general, the most typical manifestation of an attack of cholelithiasis is the characteristic pain, which will be described below.

Diagnostics

Identification of symptoms characteristic of hepatic colic requires consultation with a specialist. Under the physical examination that he conducts, it means the identification of symptoms characteristic of the presence of calculi in the gallbladder (Murphy, Ortner, Zakharyin). In addition, a certain tension and soreness of the skin in the region of the muscles of the abdominal wall is revealed within the framework of the projection of the gallbladder. The presence of xanthomas on the skin is also noted ( yellow spots on the skin, formed against the background of a violation in the body of lipid metabolism), icterus of the skin and sclera is noted.

Delivery results general analysis blood determine the presence of signs indicating non-specific inflammation at the stage of clinical exacerbation, which in particular consist in moderation increase in ESR and in leukocytosis. In a biochemical blood test, hypercholesterolemia is determined, as well as hyperbilirubinemia and increased activity characteristic of alkaline phosphatase.

Cholecystography, used as a method for diagnosing cholelithiasis, determines an increase in the gallbladder, as well as the presence of calcareous inclusions in the walls. In addition, in this case, the stones with lime that are inside are clearly visible.

The most informative method, which is also the most common in the study of the area of interest to us and for the disease in particular, is ultrasound. abdominal cavity. When examining the abdominal cavity, in this case, accuracy is ensured with respect to identifying the presence of certain echo-impermeable formations in the form of stones in combination with pathological deformities that the walls of the bladder undergo during the disease, as well as with changes that are relevant in its motility. Well seen with ultrasound and signs indicating cholecystitis.

Visualization of the gallbladder and ducts can also be done using MRI and CT techniques for this purpose in specific areas. Scintigraphy, as well as endoscopic retrograde cholangiopancreatography, can be used as an informative method indicating violations in the processes of bile circulation.

Medical treatment of gallstone disease

Treatment cholelithiasis without surgery, it is used in the presence of cholesterol gallstones (X-ray negative) up to 15 mm in size with preserved contractility of the gallbladder and patency of the cystic duct.

Contraindications for drug dissolution of gallstones:

inflammatory diseases small and large intestine;
obesity;
pregnancy;
"disabled" - non-functional gallbladder;
acute inflammatory diseases of the gallbladder and biliary tract;
stones with a diameter of more than 2 cm;
liver disease, diabetes, peptic ulcer stomach and duodenum, chronic pancreatitis;
pigment or carbonate stones;
gallbladder cancer;
multiple calculi that occupy more than 50% of the volume of the gallbladder.

Ursodeoxycholic acid preparations are used, the action of which is aimed at dissolving only cholesterol stones, the drug is taken for 6 to 24 months. But the probability of recurrence after the dissolution of the stones is 50%. The dose of the drug, the duration of administration is established only by a doctor - a therapist or a gastroenterologist. Conservative treatment is possible only under medical supervision.

Shock wave cholelithotrepsy is a treatment by crushing large stones into small fragments using shock waves, followed by the administration of bile acid preparations (ursodeoxycholic acid). The chance of recurrence is 30%.

Cholelithiasis can be asymptomatic or asymptomatic for a long time, which creates certain difficulties in its detection in the early stages. This is the reason for late diagnosis, at the stage of already formed gallstones, when the use of conservative methods of treatment is limited, and the only method of treatment remains surgical.

Treatment of folk remedies for gallstone disease

I will give an example of several recipes for dissolving stones. There are a large number of them.

Green tea. Drink as a prophylaxis against gallstone disease, since green tea prevents stone formation.
Cowberry leaves. The leaves of this plant help dissolve gallstones. Pour 1 tablespoon of dry lingonberry leaves with a glass of boiling water, leave for 20-30 minutes. We take 2 tablespoons 4-5 times a day.
Ivan-tea or narrow-leaved fireweed. Brew in a thermos 2 tablespoons of dry leaves of willow-tea, pour boiling water (0.5 l). Insist 30 minutes. Drink 100 ml of tea an hour before meals three times a day for six months. You can insist on the same tea leaves as long as the tea has color. Consult your doctor before use as stones can be moved.

The main thing in the treatment of folk remedies for cholelithiasis is to make sure that you have cholesterol stones that can be dissolved. To do this, it is necessary to undergo an ultrasound (stones are visible) and an x-ray (cholesterol stones are not visible).

After that, visit a phytotherapist and choose the most effective combination of herbs for your case. In parallel with the use of folk remedies, it is necessary to adhere to the principles of a balanced diet - sometimes only a change in nutrition allows you to get rid of small cholesterol stones. It is also necessary to devote time to physical activity - walking, a little exercise in the morning - that is, to move more.

Diet for gallstone disease

It is necessary to limit or eliminate fatty, high-calorie, cholesterol-rich foods from the diet, especially with a hereditary predisposition to cholelithiasis. Meals should be frequent (4-6 times a day), in small portions, which helps to reduce the stagnation of bile in the gallbladder. The food should contain a sufficient amount of dietary fiber, due to vegetables and fruits. You can add food bran (15g 2-3 times a day). This reduces the lithogenicity (tendency to stone formation) of bile.

The therapeutic diet for cholelithiasis lasts from 1 to 2 years. Compliance with the diet is the best prevention of exacerbations of gallstone pathology, and if you do not adhere to it, then serious complications may develop.

The consequences of non-compliance include: the occurrence of atherosclerosis, the appearance of constipation, dangerous with stones in the bladder, an increase in the load on the gastrointestinal tract and an increase in the density of bile. A therapeutic diet will help to cope with excess weight, improve the intestinal microflora and protect the immune system. As a result, a person's mood improves, sleep normalizes.

In severe cases, non-compliance with the diet leads to ulcers, gastritis, colitis. If you want to recover from pathology without surgery, then diet is a paramount requirement.

Operation

Patients should undergo elective surgery before the first attack of biliary colic or immediately after it. This is due to the high risk of complications.

After surgical treatment it is necessary to follow an individual dietary regimen (frequent, fractional nutrition with the restriction or exclusion of individually intolerable foods, fatty, fried foods), compliance with the regime of work and rest, physical education. Eliminate the use of alcohol. Perhaps spa treatment after surgery, subject to stable remission.

Complications

The appearance of stones is fraught not only with a violation of the functions of organs, but also with the occurrence of inflammatory changes in the gallbladder and organs located nearby. So, because of the stones, the walls of the bladder can be injured, which, in turn, provokes the occurrence of inflammation. Provided that the stones pass through the cystic duct with bile from the gallbladder, the outflow of bile can be difficult. In the most severe cases, stones can block the entry and exit of the gallbladder by getting stuck in it. With such phenomena, stagnation of bile occurs, and this is a prerequisite for the development of inflammation. The inflammatory process can develop over several hours, and over several days.

Under such conditions, the patient may develop an acute inflammatory process of the gallbladder. In this case, both the degree of damage and the rate of development of inflammation can be different. So, both a slight swelling of the wall and its destruction and, as a result, a rupture of the gallbladder are possible. Such complications of gallstone disease are life-threatening. If the inflammation spreads to the abdominal organs and the peritoneum, then the patient develops peritonitis. As a result, toxic shock and multiple organ failure can become a complication of these phenomena. In this case, there is a violation of the work of blood vessels, kidneys, heart, brain. With severe inflammation and high toxicity of microbes that multiply in the affected wall of the gallbladder, toxic shock can occur immediately.

In this case, even resuscitation measures do not guarantee that the patient will be able to get out of this state and avoid death.

Prevention

To prevent the disease, it is useful to carry out the following activities:

do not practice long-term therapeutic starvation;
for the prevention of cholelithiasis, it is useful to drink enough liquid, at least 1.5 liters per day;
in order not to provoke the movement of stones, avoid work associated with prolonged stay in an inclined position;
follow a diet, normalize body weight;
increase physical activity, give the body more movement;
eat more often, every 3-4 hours, to cause regular emptying of the bladder from accumulated bile;
women should limit the intake of estrogen, this hormone contributes to the formation of stones or their increase.

For the prevention and treatment of cholelithiasis, it is useful to include in the daily diet a small amount (1-2 tsp) of vegetable oil, preferably olive oil. Sunflower is absorbed only by 80%, while olive is completely. In addition, it is more suitable for frying because it forms less phenolic compounds.

The intake of vegetable fat stimulates the activity of the bile bladder, as a result of which it gets the opportunity to empty itself at least once a day, preventing congestion and the formation of stones.

To normalize metabolism and prevent gallstone disease, magnesium should be included in the diet. The trace element stimulates intestinal motility and bile production, removes cholesterol. In addition, a sufficient intake of zinc is necessary for the production of bile enzymes.

With cholelithiasis, it is better to stop drinking coffee. The drink stimulates the contraction of the bladder, which can cause blockage of the duct and subsequent attack.

Mankind has known about this disease since ancient times. A huge number of books and articles are devoted to this disease. Despite this, many people do not know what kind of help should be provided to patients during an attack of cholelithiasis. What symptoms are typical for him, what can be done for a person, what drugs can help? These are questions that need to be sorted out.

What is JCB?

An attack of first aid is discussed in the article) is a fairly relevant topic, because cholelithiasis is a common ailment. With this disease, stones accumulate in the bile ducts. They are cholesterol and pigment. The first of these are the most common. The composition of cholesterol stones includes cholesterol, mucin, bilirubinate, phosphate, calcium carbonate and palmitate, as well as other substances.

Pigment stones are divided into black and brown. Black structures are mainly found in the gallbladder. They are formed from calcium bilirubinate and other bilirubin compounds, calcium carbonate and phosphate salts, mucin, and other substances. Brown stones are most often found in the bile ducts. These structures consist of calcium salts of unconjugated bilirubin with the inclusion of cholesterol, protein.

Risk factors

An ailment in which symptoms of an attack of gallstone disease can appear occurs due to various reasons. One of the risk factors is female gender. Statistics show that in the representatives of the beautiful half of humanity, the named disease develops much more often than in men. Another equally important risk factor is age. gallstones found in many people over 60 years of age.

Obesity plays a significant role in increasing the incidence of gallstone disease. Overweight people produce bile that is supersaturated with cholesterol. Another very significant factor is pregnancy. In pregnant women, estrogen levels rise. Because of this, the secretion of cholesterol into the bile increases.

Other risk factors that cause gallstone disease (attack) are:

rapid and significant weight loss;
diabetes;
diseases of the small intestine;
taking oral contraceptives.

Asymptomatic and dyspeptic forms of the disease

Some people have stones in the gallbladder, but patients do not complain. This form of the disease is called asymptomatic (latent). Experts consider it as a period of cholelithiasis, because, according to statistics, after about 10 or 15 years, 30-50% of people experience symptoms of the disease and complications.

Another form of gallstone disease is dyspeptic. Sick people complain of functional disorders of the gastrointestinal tract. The following symptoms are observed (they usually occur after eating, especially if fried, fatty, spicy foods, alcoholic drinks were consumed):

feeling of heaviness in the epigastrium and right hypochondrium;
bitter taste in the mouth;
heartburn;
excessive accumulation of gases in the intestines;
unstable chair.

Hepatic (biliary) colic

Asymptomatic and despeptic forms of cholelithiasis are not the only ones. Specialists also distinguish hepatic. This is the most common clinical form diseases. It is detected in 75% of sick people suffering from cholelithiasis.

Hepatic (biliary) colic is characterized by sudden onset and recurring symptoms of an attack of gallstone disease. In some patients, they occur due to malnutrition and physical activity. In other people, it is not possible to identify provoking factors. Attacks begin at night, during sleep.

Symptoms of an attack of gallstone disease

The attack of the disease is manifested by pain. In most cases, it is localized in the epigastrium, sometimes it is felt in the region of the xiphoid process. Possible irradiation of pain in the right shoulder or in the region of the right shoulder blade. Discomfort sensations in intensity and nature can be different: stabbing, pressing, cramping.

In addition to pain, there may also be suspicious signs such as nausea, vomiting with an admixture of bile, which does not bring relief. However, it is worth noting that these symptoms of an attack of gallstone disease are quite rare. They occur in a small number of sick people.

On examination, specialists notice the following objective signs in their patients:

anxiety, restlessness (sick people rush about and try to take a position in which the pain would recede);
increased heart rate up to 100 beats per minute;
the tongue is moist, covered with a whitish coating;
the abdomen is swollen, its right half lags behind in the act of breathing;
with percussion and palpation of the abdomen, people complain of sharp pain in the region of the right hypochondrium.

Duration and frequency of seizures

Pain in people with gallstone disease comes on suddenly. The duration of the attack can be from 15 minutes to 8 hours. Sometimes the pain is excruciating for 12 hours. This happens with the development of acute cholecystitis. When the attack of the disease passes, the pain disappears. There is only an unpleasant sensation in the abdomen.

The frequency of attacks in the disease is individual. In some sick people, symptoms of biliary colic can occur every day, in the second - once a week, in others - once a month. It is extremely rare that there is only one pain attack.

First aid

If symptoms of an attack of gallstone disease occur, it is urgent to call a doctor. Before the arrival of a specialist, the patient should be given first aid:

ensure peace (recommended bed rest);
give a heating pad (it must be placed on the area of the right hypochondrium);
offer to take a warm bath.

At the time of an attack of gallstone disease, it is allowed to give medications: antispasmodics ("Drotaverin", "No-shpa") in combination with analgesics ("Spazmalgon", "Baralgin"). You can also wait for the doctor to arrive. The specialist will tell you how to relieve an attack and administer the necessary medications in a certain dose:

"No-shpu" (intramuscularly 2 ml);
"Papaverine", 2% (intramuscularly 2 ml);
"Baralgin" (intravenous 5 ml);
"Atropine", 0.1% (subcutaneously 1 ml).

Other dangerous conditions may be hidden behind the symptoms of an attack of gallstone disease. To confirm the diagnosis, you need to detailed analysis blood, ultrasound or x-ray. If there is evidence, specialists will perform the following actions:

cleaning bile ducts;
surgical removal of existing stones, gallbladder.

Nutrition Features

An attack of gallstone disease, the symptoms, the treatment of which is known to every gastroenterologist, is familiar to many people firsthand. However, not everyone thinks about prevention. In preventing the occurrence of attacks of gallstone disease, a change in your daily menu will greatly help.

First, refractory fats should be abandoned. Due to insufficient intake of bile, the activity of a special enzyme, lipase, decreases. This, in turn, leads to poor digestion and absorption of fats. People feel pain, cramps, bloating. Only butter and vegetable oils are allowed.

Secondly, you should exclude from your menu Rye bread, mushrooms, peas, beans, nuts, millet, chocolates, coffee, cocoa, sweet dough. These products cause an exacerbation, because their digestion requires the tension of the enzyme systems of the human body.

Sand and stones formed in the gallbladder interfere with the normal renewal of bile, change the mechanism of its action. To treat and prevent these processes, traditional healers advise what to do. An attack can be prevented if:

be treated olive oil. This product helps to accelerate the crushing of stones in the internal organ. Folk healers recommend daily, before bedtime, take 1 tbsp. l. oil and then drink the juice squeezed from half a lemon. Duration of application folk remedies may be 1 week. At this time, you need to adhere to a plant-based diet, do not smoke, do not drink alcoholic beverages, coffee, do not eat foods that provoke bloating.
Drink herbal decoction. First, they make a collection of mint, chamomile and immortelle in a ratio of 2: 1: 1. Then brew 1 tbsp. l. mixture in 0.5 liters of hot water. The resulting medicine is kept on low heat for 30 minutes. The finished broth is filtered and drunk 0.5 cups four times a day, half an hour before meals.
Eat a lemon on an empty stomach for 3 days. This fruit is peeled and passed through a meat grinder. Add 0.5 tsp to the resulting mixture. soda.

So, you became aware of what an attack of gallstone disease is. Symptoms, first aid - this is what all people should be aware of, because no one is immune from the disease. Also, do not forget that the occurrence of gallstone attacks can be prevented. Prevention should include the observance of a rational diet, reduction or elimination in the gallbladder (the fight against adynamia, frequent use food), timely treatment existing chronic diseases.

If a person has developed an attack of gallstone disease, the symptoms will be quite specific. They are represented mainly by pain. Gallstone disease is a very common disease. With it, stones form in the cavity of the gallbladder and excretory ducts. The causes of the development of the disease are a violation of cholesterol metabolism, poor nutrition, obesity, diseases of the digestive system.

Development of the disease

The development of gallstone disease proceeds in 3 stages. There are no symptoms in the first two stages. They appear only when calculous cholecystitis develops. The transition is pretty hard. Lack of proper care can lead to complications and even death of a sick person. The main manifestation of an attack is hepatic (biliary) colic.

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This is a pain syndrome. It occurs suddenly against the background of a normal state. The pain is acute, felt in the right hypochondrium or epigastric zone. The nature of the pain and its intensity are different. It is piercing, cutting. The symptom can last for several hours, which causes great discomfort to the patient.

After 1-2 hours, pain is felt in the projection of the gallbladder on abdominal wall. Irradiation most often occurs in the back, right shoulder blade or shoulder. The pain may also radiate to the neck. In some patients, pain is felt in the region of the heart. It can easily be confused with an angina attack. In the event that the attack lasts more than 6 hours, acute cholecystitis can be suspected.

Colic is a symptom of both acute and chronic inflammation gallbladder in the acute stage. In 70% of patients, after the first attack, a second one develops. In the period between the onset of symptoms, the person feels well. A feature of pain in biliary colic is its increase in the first hour. Then the pain becomes permanent.

In most cases, the symptoms of the disease during an attack appear at night. Strengthening of the pain syndrome is observed in the supine position on the left side and when air is inhaled. Such patients often take a forced position (lying on the right side with the lower limbs pulled up).

The mechanism of colic

The appearance of pain during an attack of gallstone disease is due to the following factors:

irritation of the organ or its bile ducts with a stone;
stretching of the bladder wall;
increased pressure in the organ cavity;
muscle spasm.

Endocrine factors also play an important role. Against the background of cholelithiasis, the production of norepinephrine and serotonin is disrupted. The latter is responsible for pain threshold. Its deficiency lowers the pain threshold, which negatively affects the condition of a sick person. Norepinephrine works in the opposite way. It activates the antinociceptive (pain-relieving) system of the body.

The presence of stones in the gallbladder leads to stretching of the membrane. This organ consists of several membranes, one of which is muscular. Stimulation of specific receptors leads to muscle spasm. The contraction is due to the active entry of calcium ions into the muscle cells. This process proceeds with the participation of various neurotransmitters (acetylcholine, norepinephrine, serotonin, cholecystokinin).

The attack itself occurs in the presence of provoking factors. Very often, colic appears with errors in nutrition. Provoke an attack can eat fatty foods (meat, mayonnaise, butter, lard, fried potatoes), spices, smoked foods. It is possible to develop biliary colic against the background of stress, various infections, drinking alcohol and when working with a tilt of the body.

Other signs of illness

An attack of gallstone disease can be manifested by the following symptoms:

nausea;
vomiting;
bloating;
tension in the abdominal muscles;
an increase in body temperature;
chills;
jaundice;
impaired consciousness;
drop in blood pressure.

During an attack, pain is almost always combined with nausea.

In severe cases, vomiting develops, which does not improve the person's condition. There may be a bitter taste in the mouth. Permanent sign gallstone disease is jaundice. It is caused by stagnation of bile and an increase in the level of bilirubin in the blood. In such people, the skin acquires a yellowish tint.

Possible yellowing of the sclera. In the case of blockage of the common bile duct by a stone, jaundice is very pronounced. Discoloration of feces and darkening of urine are often observed. Other symptoms of gallstone disease include loose stools. The temperature rarely exceeds 38ºC.

Severe fever and chills during an attack indicate the addition of a secondary infection and the development of purulent processes. In this situation, urgent hospitalization is required. Objective signs of a gallstone attack include abdominal tenderness, liver enlargement, positive Ortner, Ker, Murphy, and Mussy symptoms. Ortner's symptom is positive on the right.

To determine it with the edge of the palm, you need to beat on the lower costal arches on the right and left. If there is pain, then the symptom is positive. Gallstone disease can lead to the following complications:

inflammation of the bile ducts (cholangitis);
empyema (accumulation of pus) of the gallbladder;
dropsy;
perforation of the organ wall with a stone;
peritonitis;
secondary pancreatitis;
cirrhosis of the liver.

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In an acute attack of gallstone disease, hospitalization is required. The patient is laid on the right side and soothed. Spasmolytics and NSAIDs are used. In a hospital setting, an examination is carried out.

If necessary, antibiotics are prescribed and detoxification therapy is organized. According to indications, an operation is performed. Thus, the main symptom of cholelithiasis during an exacerbation is intense paroxysmal pain.

Often, back pain indicates diseases of the gallbladder. Short-term pain does not cause severe discomfort, but constant pain in the back and may indicate serious problems with the biliary tract.

because of inflammatory process, which occurs in the liver, the pain syndrome begins to spread to the region of the spine, as the pain is transmitted through nerve fibers from one organ to another.

Symptoms

Can an unpleasant sensation in the gallbladder radiate to the back? This question often worries people who have experienced discomfort in the right hypochondrium and back for a long time. All this indicates diseases of the biliary tract, the causes of which are:

infection,
not proper nutrition,
chronic cholecystitis due to past liver diseases, for example, Botkin's disease.

Acute cholecystitis caused by stones is accompanied in the area of the shoulder and right shoulder blade. Often people confuse this phenomenon with neuralgia.

In order not to confuse the symptoms of diseases, please note that with inflammation of the bladder, pain in the back is always accompanied by pain in the right hypochondrium.

As soon as such symptoms appear, you should immediately go to a specialist for a correct diagnosis.

Absolute indications for contacting a specialist

When the pain radiates to the back for several days, then this is an occasion to consult a specialist. Most likely, this condition is caused by stones in the bile ducts.

They provoke inflammation, and their movement along the ducts that has begun can lead to death due to blockage of the duct. What other symptoms are cause for concern? These are the following:

back pain appeared;
body temperature rises;
worried about nausea and belching;
painful manifestations are aggravated after eating;
severe spasm lasts longer than 15 minutes.

All this is a reason to turn to a gastroenterologist. To make an accurate diagnosis, you will need to consult a hepatologist and a therapist.

Surgery

When diagnosing serious problems with the biliary tract, surgery may be required.

During the operation, the gallbladder is removed, then the person is prescribed a special diet and a course of taking special drugs. Even after a successful operation, complications can occur.

Why does my back hurt after gallbladder removal? The reasons for this phenomenon are postoperative period there may be several. The most common is the development of postcholecystectomy syndrome.

It is characterized by severe pain in the hypochondrium on the right side, which radiate to the back. The reasons for the development of this syndrome include:

incomplete elimination of the inflammatory process;
damage to neighboring organs during the operation;
a pathology that was not detected during surgery, for example, a stone stuck in the duct;
violation of the prescribed diet.

If, after removal of the gallbladder, the back hurts, then you should immediately go for an examination, which includes:

urine and blood test,
blood chemistry,

After surgery, it is required to follow all the instructions of a specialist in order to exclude complications. Diet is key during this period. The diet should be completely changed, all fatty foods are excluded.

Prevention

To prevent problems with this delicate organ digestive system, you should take care of it in advance. The requirements for prevention are quite simple, the main condition is to fulfill all the points:

Check Status internal organs 1 time per year.
Do not drink alcohol often and in large quantities.
Refuse too fatty and fried foods.
Do not take medicines uncontrollably.
You can not drink choleretic herbs without the appointment of a specialist.
The daily ration should be fractional.
Avoid stress.
To live an active lifestyle.

If there are spasms in the right hypochondrium, radiating to the back, then this is a sure signal about problems with the gallbladder.

Do not self-medicate, but immediately contact a specialist. He will be able to determine the condition of the internal organs already with palpation. Ultrasound will confirm or refute cholelithiasis.

When confirming the diagnosis, treatment tactics may be different:

taking drugs that dissolve stones;
removal of an organ.

The second method of treatment is carried out only in case of detection of calcified stones, large in size.

Taking drugs does not give in this case positive result, a discomfort intensify over time, as the stones are constantly moving, causing an inflammatory process.

So, if you are worried about back pain, then the first thing you need to do is go not to an orthopedist, but to a gastroenterologist, it is possible that it was the gallbladder that caused this condition.

For diseases of the biliary tract characteristic features there will be spasms in the right hypochondrium and shoulder area, burning in the scapula area.

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Denial of responsibility

The information in the articles is for general information purposes only and should not be used for self-diagnosis of health problems or for medicinal purposes. This article is not a substitute for medical advice from a doctor (neurologist, internist). Please consult your doctor first to know the exact cause of your health problem.

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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 the 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 pure in terms of chemical composition stones. 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. Experts distinguish several different forms diseases. 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 clinical manifestations diseases. 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, tangible physical exertion, unpleasant emotions, changes in 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 vague 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 research also uses CT scan 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 in patients differently. different ages, on the 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 during the diagnostic process the development of inflammation in the biliary tract was detected, the course complex therapy turn on. 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, it is used sound wave. 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, the postoperative period lasts 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 are 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 Special attention pay 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 duodenum. At the same time, a person develops jaundice . The consequence of stagnation of bile in the liver is; also a complication of cholelithiasis can be inflammation of the biliary tract, provoking.

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.