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Cholelithiasis. Treatment with folk remedies. How to treat gallstone disease without surgery

It is important to identify the symptoms of gallstone disease in the early stages in order to begin treating this disease as quickly as possible and try to cope with it. This disease is associated with the formation of stones in gallbladder and bile ducts. If there are no complications, then conservative methods are used in treatment, but if it is not possible to remove stones using conventional methods, then it is necessary to resort to surgical intervention.

What causes cholelithiasis?

The symptoms of cholelithiasis are described in detail in this article. But first, it’s worth deciding what may be causing it. The causes of cholelithiasis are usually associated with impaired metabolism. This leads to the formation of stones in the gall bladder and bile ducts.

The process goes as follows. Due to impaired metabolism in the human body, the composition and properties of bile can change dramatically. As a result, the bile thickens and stagnates, and the acids present in it precipitate. From here, dense formations are formed that turn into stones. They contain bilirubin, cholesterol, salts and proteins.

The size and number of stones that can form in the gallbladder varies greatly. From one to several dozen and from grains of sand in size to large objects the size of a walnut.

Very often, cholelithiasis is accompanied by inflammation of the gallbladder. This disease is called cholecystitis. There are also disturbances in the flow of bile into the digestive tract, which leads to biliary dyskinesia.

Possible complications

When complications arise, the stone can completely block the flow of bile to the neck of the gallbladder. As a result, so-called obstructive jaundice rapidly develops. This is already a disease that can lead to death if it is not treated in time.

Possible complications also include perforation of the gallbladder or peritonitis. In the latter case inflammatory process extends to the peritoneum. It can happen and it’s already fraught toxic shock and even multiple organ failure. Most of these diseases are fatal in extreme cases.

It is worth noting that there are a number of factors that influence the development of this disease and increase the risk of its formation. Women of advanced age who have impaired tone and motility, concomitant diseases of the liver, intestines, pancreas, and the presence of chronic diseases are more often susceptible to cholelithiasis. infectious diseases. And also those people who lead sedentary lifestyle life, do not monitor their diet, are prone to obesity, dieting. The disease often occurs in pregnant women.

Symptoms of the disease

One of the main dangers of this disease is that in the early stages it is practically asymptomatic. And it happens when, even with the development of the disease, the appearance of stones in the gall bladder, no painful sensations arise. This is what is called asymptomatic stone carriage. In this case, the disease can be detected only as a result of an x-ray examination.

But there are also obvious symptoms of gallstone disease. These include attacks of severe pain in the right hypochondrium, vomiting, unpleasant bitterness in the mouth, and nausea. Often the disease is accompanied by inflammatory changes in the gallbladder itself and the ducts leading to it.

The movement of stones on them can lead to severe attacks biliary colic, which are also called hepatic. With colic, pain also occurs in the right hypochondrium, from there the pain radiates to the shoulder or shoulder blade. Another striking symptom of cholelithiasis is that pain occurs after eating. It is during these periods that they may be accompanied by nausea and even profuse vomiting.

Diagnostic methods

Only highly qualified specialists can diagnose cholelithiasis. First of all, these are gastroenterologists, and surgeons will help cope with the disease.

In a clinic with good technical equipment and diagnostic equipment, you are guaranteed to receive correct diagnosis. To accurately determine your disease, you will need to undergo an ultrasound examination. This method is the main one in diagnosing cholelithiasis. During an ultrasound of the abdominal organs, it will be possible to accurately determine whether stones are present in the gall bladder, as well as accurately determine their size and quantity, evaluate their shape, determine the size of the gall bladder itself, the deformation of its walls, and the condition in which the bile ducts are located.

Another effective method - CT scan with contrast. This will allow your doctor to identify the key signs of inflammation of the gallbladder, assess its functionality, and notice if

Experts also advise that you definitely undergo general and biochemical blood tests. This will make it possible to identify other signs of inflammation, if any. Deep and full diagnostic studies help establish concomitant diseases, determine individual characteristics patients. Only in this case will the doctor be able to prescribe the optimal and effective course of treatment.

Fighting the disease

Treatment without surgery for gallstone disease is considered the most preferred treatment method. True, it cannot always be used. For example, if the disease continues for a long time, irreversible inflammatory processes in the body begin.

However, there is an opinion that conservative therapy with this method is still ineffective. Due to the fact that stones remain in the gallbladder for quite a long time, and there are often no symptoms in the early stages of the disease. As a result, this can lead to complications and the development of an inflammatory process. Therefore, as soon as the diagnosis is confirmed, you need to immediately resort to treatment without surgery for cholelithiasis in order to try to cope with the disease without surgery.

The methods involve removing stones; in the worst case, the disease can lead to the removal of the entire gallbladder.

Only your attending physician can determine the method of your treatment. He will appreciate your overall physical state, as well as the degree of operational risk. There are several effective methods these days.

For example, litholytic therapy is often used. It consists in dissolving the stones that are in the gall bladder with all kinds of medications. This may be ursodeoxycholic acid or chenodeoxycholic acid. This method shows high efficiency in the treatment of patients whose stones mainly consist of cholesterol.

But this doesn't happen often. As a rule, stones have a mixed composition, in which one or another element rarely predominates. It contains proteins, all kinds of salts and bilirubin in more or less equal shares. So litholysis, which occurs without surgery, is possible in the treatment of only a fifth of patients who suffer from cholelithiasis.

In extreme cases, when inflammation has already begun to develop, it is necessary to resort to the surgical method. It always applies when conservative methods show their ineffectiveness. In this case, the surgeon performs an operation to remove the gallbladder. Nowadays, clinics use two methods - standard operation and laparoscopic.

Clear signs

The most a clear sign This disease is an attack of cholelithiasis. It is worth noting that at the very beginning only small stones are formed, so the inflammatory process, as a rule, does not occur. Manifestations of an attack in the early stages include hepatic colic, when unpleasant and painful sensations occur in the area of the right hypochondrium. In some cases, the pain may completely cover the entire right side.

Also, some patients experience chills, a low temperature may rise, and slight bloating may occur.

This attack lasts about half an hour, after which the acute pain subsides, but remains aching. Only after two or three hours the pain will go away fully. Characteristic attacks can occur at intervals of a quarter of an hour.

This pain during an attack of gallstone disease occurs due to stones formed in the gallbladder. How larger size stones, the more severe the pain.

In the later stages, complications of this disease are accompanied by symptoms such as prolonged and acute pain, pallor, rapid breathing, increased sweating. In this case, it is necessary to take tests for cholelithiasis.

Preventive measures

Most effective prevention cholelithiasis is diet. It is necessary to eat properly to avoid this disease, but it is worth recognizing that often people do not think about such a danger at all and do not take care of their own gallbladder. After all, it is in it that bile is accumulated and stored for a long time - a liquid that helps our body absorb and digest fats.

At the same time, the gallbladder, unlike the liver, heart or kidneys, is not a vital and necessary organ, but when problems arise with it, it can significantly worsen your life.

At the same time, it must be emphasized that diet is not the main cause of the disease. It is impossible to recover from it only by starting to eat right. There are many more factors, most of them we have already mentioned in this article.

Diets and maintaining adequate weight are only a preventive measure that will help reduce the risk of cholelithiasis.

Healthy eating

So, the main recommendations for gallstone disease are related to the need to eat a healthy and balanced diet. A diet that is low in fat and cholesterol and moderate in calories and high in fiber will help. It will allow you to maintain the required weight.

Gallstone disease in the ICD (International Classification of Diseases) has code K80. It is officially recognized throughout the world. Everywhere it is given increased attention, because if it develops, a person suffers strong physical suffering In extreme cases, death can occur.

a large number of fresh vegetables and fruits;
it is best to focus on poultry, fish and lean meat;
consume large quantities of low-fat dairy products;
give preference whole grains- this could be brown rice, whole grain bread, bran or oats.

There are several medical studies that have helped determine which food products can either completely prevent the development of gallstone disease or reduce the likelihood of its occurrence to a minimum. It was found that the risk of stone formation in the bile ducts significantly reduces regular use caffeinated coffee. This applies to both men and women.

Moderate alcohol consumption also contributes to this. There is also research showing that women who eat a serving of peanuts a day can reduce their risk of gallbladder removal by 20% compared to women who rarely or never eat peanuts or peanut butter.

At the same time, scientists insist that modern industrial foods rich in fats and carbohydrates often lead to the development of this disease. During severe attacks pain due to gallstone disease, the body may try to remove bile while the stones are blocking its outflow. When you start eating excessively fatty foods, the gallbladder contracts much faster.

You need to remember that changing your diet will not completely rid you of this disease, but it can significantly alleviate the symptoms and will also be an effective prevention.

What to do if you have cholelithiasis is described in detail in this article. It is important to try to completely exclude fast food, fried foods, whole milk and most dairy products (ice cream, cheese, butter), red fatty meat, confectionery factory-made (donuts, cookies, pies, waffles).

Low-calorie diets are also very dangerous. If you have overweight, strive to reduce it gradually. No more than one kilogram per week. After all, only balanced diet and uniform loads help cope with stones in the gall bladder and ducts. If the diet is ineffective, consult a doctor immediately.

Contraindications

We have already looked at the basis of the diet for gallstone disease, what is possible with this disease. Now let's discuss in more detail the foods that should be avoided.

First of all, these are eggs. It is best to completely exclude them from the diet. They are very high level cholesterol. In addition, eggs belong to the group of strong allergens. This also makes the product a serious cause of irritation for the gallbladder.

You should not eat fatty fried meat, pork, red meat, or sausages. It must be replaced with poultry meat. It is worth giving up fatty fish and replacing it with lean fish. Just remember to be sure to remove the skin and fat from the chicken or turkey to prevent gallbladder irritation.

Avoid any fried foods. This is not only meat, potatoes and pies, but also fast food. Do not eat food prepared with margarine vegetable oil and animal fats. All this can only worsen the disease. Alternatively, use ghee or red palm oil.

You can't eat refined foods. This White bread, white rice, refined sugar. All this increases the percentage of cholesterol in bile.

Avoid dairy products. The danger is posed by milk itself, as well as yogurt, cheeses, sour cream, cream, and ice cream. They contain a lot of animal fat, which provokes complications of gallstone disease. IN as a last resort, buy low-fat dairy products. Whole cow's milk can be replaced with almond. This way you can supply the body with the necessary calcium to maintain normal bones and teeth.

Don't eat processed foods. They usually contain trans fats. In the store, of course, you can find manufacturers who do not use such additives, but to do this you need to carefully study the composition on the packaging. If there is any doubt, just refuse of this product. First of all, this applies to potato chips, donuts, cookies, and various desserts.

Recipes for cholelithiasis

In addition to effective medicines and drugs, there are a large number folk recipes, which will help, if not cope, then certainly minimize the consequences of cholelithiasis, will serve as a good means of prevention.

Considering that these are all folk remedies, be sure to consult with your doctor before you start taking them. Many people advise drinking a decoction of it twice a day, morning and evening. medicinal herbs, which must include wormwood and horsetail. One teaspoon of this mixture will be enough for one cup of water.

Another tip is juices for cholelithiasis. Radish juice is considered the most effective. One glass of this drink a day for two to three months will help you forget about problems with your gallbladder. By the way, you can mix it with red beet juice.

And in ancient times, cholelithiasis was often fought with the help of lemon juice and olive oil.

Gallstone disease, which is also commonly defined as cholelithiasis or cholelithiasis, is a disease in which stones form in the gallbladder or bile ducts. Gallstone disease, the symptoms of which are observed in patients, as shown by the results of medical practice, is ineffective in treatment using conservative therapy and various types techniques, therefore the only way to cure the disease is surgery.

general description

Gallstone disease is a fairly common diagnosis, and the peculiarity is that susceptibility to it, as well as the causes that provoke its development, are quite difficult to track. The fact is that in most people, cholelithiasis occurs latently, that is, in a latent form without any special manifestations. In structure various diseases, which affect the digestive organs, cholelithiasis occupies significant place precisely because of its own prevalence.

Industrialized countries have statistics on this matter of about 15% incidence, and it can be noted that the prevalence directly depends on the age and gender of the patients. In particular, men suffer from this disease half as often as women. Every fifth of women aged 40 years or more experiences cholelithiasis, while men of the same age experience it in every tenth case. Up to 50 years of age, cholelithiasis is observed in about 11%, from 50 to 69 – up to 23%, from 70 years and more – up to 50%.

Let us dwell directly on the features of the course of the disease. The movement of bile, carried out by it along the biliary tract, occurs due to the coordination of the functions of the gallbladder, liver, pancreas, bile duct and duodenum. Due to this, in turn, bile enters the intestines in a timely manner during the digestion process; in addition, it accumulates in the gallbladder. When bile stagnates and its composition changes, the process of stone formation begins, which is also facilitated by inflammatory processes in combination with motor-tonic disorders of bile secretion (that is, dyskinesia).

There are gallstones cholesterol (the vast majority, about 90% of the variants of gallstones), as well as stones pigment And mixed . Thus, due to the oversaturation of bile with cholesterol, the formation of cholesterol stones, its precipitation, and the formation of crystals occur. A disruption in the gallbladder of the motility leads to the fact that these crystals are not removed into the intestines, which ultimately leads to their gradual growth. Pigment stones (they are also called bilirubin stones) are formed during increased decay, which occurs during actual hemolytic anemia. As for mixed stones, they are a unique combination based on the processes of both forms. Such stones contain cholesterol, bilirubin and calcium, the process of their formation itself occurs as a result inflammatory diseases affecting the bile ducts and, in fact, the gallbladder.

As for the reasons that contribute to the formation of gallstones, the following are among them:

unbalanced diet (in particular, if we are talking about the predominance of animal fats in it with simultaneous damage to vegetable fats);
hormonal disorders(with weakening of the functions characteristic of the thyroid gland);
sedentary lifestyle;
disorders associated with fat metabolism, which intersect with weight gain;
inflammation and other types of abnormalities that occur in the gallbladder;
various types of liver damage;
spinal injuries;
pregnancy;
starvation;
heredity;
spinal injuries;
diseases of the small intestine, etc.

The factors that provoke the development of the disease we are considering are the following:

helminthiases;
(arising from alcohol consumption);
biliary tract infections (chronic);
chronic hemolysis;
demographic aspects (relevance of the disease for residents of rural areas, as well as the Far East);
elderly age.

Gallstone disease: classification

Based on the characteristics of the disease accepted today, the following classification is distinguished in accordance with the stages relevant to it:

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. Special clinical manifestations at this stage no, detection of the disease at the initial stage is possible, for which a biochemical analysis of bile is used to determine the characteristics of its composition;
formation of stones – stage, which is also defined as latent stone carriage. In this case, there are no symptoms of cholelithiasis, but the use instrumental methods diagnostics allows you to determine the presence of stones in the gallbladder;
clinical manifestations - stage, the symptoms of which indicate the development of acute or chronic form calculous.

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

Gallstone disease: symptoms

Manifestations characteristic of cholelithiasis are determined based on the specific location and size of the stones formed. Based on the degree of severity relevant for inflammatory processes, as well as on the basis of functional disorders, the severity of the manifestations of the disease, as well as the features of its course, are subject to change.

In cholelithiasis, there is a particularly pronounced pain symptom(bilious or) is an acute pain that suddenly occurs in the right hypochondrium. It can be piercing or cutting in nature. After a few hours, the final concentration of pain is concentrated within the projection of the gallbladder. It is also possible for pain to radiate to the right shoulder, neck, right shoulder blade or in the back. In some cases, the pain radiates to the heart, which provokes the appearance.

Pain mainly occurs due to the consumption of spicy, fatty, fried or spicy foods and alcohol, against the background severe stress or significant physical activity. Also, prolonged stay in an inclined position during work can provoke pain. Calls pain syndrome a spasm that forms in the area of the muscles and ducts of the gallbladder, which is a reflex response to the irritation experienced by the wall due to stones.

In addition, the cause of spasm is overstretching of the bladder, formed by excess bile, which occurs as a result of obstruction (blockage) that occurs in the biliary tract. For global if there is a blockage in the bile duct characteristic manifestations There is an expansion of the bile ducts of the liver, as well as an increase in the volume of the organ, resulting in a corresponding pain reaction of the pain capsule. The pain in this case is constant, often in the right hypochondrium there is a characteristic feeling of heaviness.

Nausea is also identified as accompanying symptoms, which may be accompanied in some cases by vomiting without proper relief after it. It is noteworthy that vomiting is also a reflex response to irritation. In this case, the capture of pancreatic tissue by the inflammatory process is a factor leading to increased vomiting, which in this case has indomitable character and is accompanied by the release of bile with vomit.

Based on the severity of intoxication, an elevated temperature may be observed, fluctuating in subfebrile levels, but in some cases reaching severe fever. Blockage of the bile duct by a stone in combination with sphincter obstruction leads to discoloration of stool and jaundice.

Late diagnosis of the disease often indicates the presence of empyema (accumulation of pus) in the wall of the gallbladder, which arose due to the closure of the bile ducts by a calculus. Vesicoduodenal fistulas and biliary fistulas may also develop.

Diagnosis of cholelithiasis

Identification of symptoms characteristic of hepatic colic requires consultation with a specialist. The physical examination carried out by him means identifying symptoms characteristic of the presence of stones in the gallbladder (Murphy, Ortner, Zakharyin). In addition, a certain tension and soreness of the skin in the muscle area is revealed. abdominal wall within 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 disorder in the body's lipid metabolism), yellowness of the skin and sclera is noted.

The test results determine the presence of signs indicating nonspecific inflammation at the stage of clinical exacerbation, which in particular consist of a moderate increase and leukocytosis. When hypercholesterolemia is determined, as well as hyperbilirubinemia and increased activity, characteristic of alkaline phosphatase.

Cholecystography, used as a method for diagnosing cholelithiasis, determines the enlargement of the gallbladder, as well as the presence of calcareous inclusions in the walls. In addition, in this case, the stones with lime 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. When examining the abdominal cavity in this case, accuracy is ensured regarding the identification of the presence of certain echo-proof formations in the form of stones in combination with pathological deformations to which the walls of the bladder are exposed during the disease, as well as with changes that are relevant in its motility. Signs indicating cholecystitis are also clearly visible on ultrasound.

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

Treatment of cholelithiasis

Patients diagnosed with cholelithiasis are prescribed general type hygienic regime, rational nutrition, as well as systematic exercise in dosed volumes. Diet No. 5 is also indicated when certain foods are excluded (fats in particular). It is recommended to eat food “by the hour”. In general, the absence of complications often excludes the use specific treatment– in this case, first of all, the emphasis is on wait-and-see tactics.

With the development of acute or chronic forms of calculous cholecystitis, removal of the gallbladder is required, which in this case causes the process of stone formation. The specifics of the surgical intervention are determined based on the general condition of the body and the changes accompanying the pathological process, concentrated in the area of the walls of the bladder and the tissues surrounding it; the size of the stones is also taken into account.

If symptoms relevant to cholelithiasis occur, you should contact a gastroenterologist; in addition, a consultation with a surgeon may be scheduled.

A common pathology characterized by the formation of stones in the gallbladder or bile ducts is called. The formation of stones can be caused by the deposition of bile pigments, cholesterol, calcium salts, as well as lipid metabolism disorders. The disease is accompanied by pain in the right hypochondrium, biliary colic, and jaundice.

According to statistics, the disease occurs in approximately 13% of the adult population of the planet. The disease can develop in both men and women, but among representatives of the fair half of society it occurs twice as often.

The leading cause of pathology is the formation of stones due to lipid metabolism disorders. In addition, the occurrence of the disease may be due to:

unbalanced diet, abuse of fatty foods;
hormonal imbalance;
inactive lifestyle;
anomalies that occur in the gallbladder;
various liver lesions;
spinal injuries;
pregnancy;
fasting;
genetic predisposition;
presence of diabetes mellitus;
diseases of the small intestine.

Women are more susceptible to the disease. This is explained by the technique contraception, pregnancy and childbirth. Moreover, the disease is more often diagnosed in older people. The highest incidence is observed among the Japanese and Indians.

Symptoms of the disease

There are stones made from cholesterol, bile pigments and mixed ones.

An increase in unconjugated bilirubin is the cause of the formation of stones from bile pigments. They contain calcium salts and bilirubin.
As for pigmented stones, they are small in size, often up to 10 mm and black or grayish in color.
The composition of cholesterol stones: insoluble cholesterol and various impurities. There are both single and multiple. They are black or grey.
Mixed stones are most common. They contain: cholesterol, calcium salts and bilirubin. They are yellowish-brown and always multiple.

Symptoms of the pathology do not appear immediately in more than 60% of cases. Gallstone disease can be asymptomatic for several years.

Gallstones are detected in the gallbladder, usually by accident, during ultrasound examination. Symptoms can only appear if stones move through the cystic canal, which provokes blockage and the development of an inflammatory process.

Signs to watch out for

Since the pathology practically does not manifest itself over a long period, it is important to respond in a timely manner to signs that may indicate the presence of stones in the gallbladder. Often, we don’t particularly react to the appearance of heaviness in the stomach; we attribute it to a heavy dinner. Do not underestimate this sensation, as it can signal urolithiasis.

In addition, the first manifestations of pathology include: discomfort and pain after a meal, nausea, heartburn, vomiting, diarrhea or constipation, yellowness of the sclera and skin.

A lot of time passes from the moment stones begin to form until the first manifestations of pathology. According to some studies, average duration asymptomatic illness - ten years. If there is a predisposition to stone formation, this period may be reduced to several years.

For some, the formation of stones, on the contrary, is very slow - they grow throughout life and this does not manifest itself at all. Such stones are often discovered after death.

Based on the first manifestations, pathologists can determine accurate diagnosis difficult. The appearance of nausea, vomiting and stool disturbances may accompany other gastrointestinal ailments. To clarify the diagnosis, an ultrasound examination of the abdominal cavity is prescribed. It is with its help that one can detect both an increase in the size of the gall bladder and the presence of stones in its cavity.

Stages

There are several stages of cholelithiasis: the stage of disturbance of the physico-chemical properties of bile, latent or hidden, and the stage of the appearance of symptoms of the disease.

The first stage practically does not manifest itself at all. The diagnosis is established only by examining bile. Crystals or “snowflakes” of cholesterol are found in it. When conducting biochemical analysis There is an increase in cholesterol content and a decrease in the concentration of bile acids.

The second stage also does not manifest itself in any way. But at this stage there are already stones in the gallbladder. The diagnosis can be made using ultrasound. Symptoms, in particular biliary colic, appear only on last stage. At this stage, there are complaints of severe, paroxysmal or acute pain. The duration of the painful syndrome is from two to six hours. The attack usually occurs in the evening.

The patient complains of pain in the right hypochondrium area, spreading to the right cervical region. Often, pain occurs after eating fatty, spicy foods, as well as after physical activity.

The appearance of pain can also be caused by the consumption of carbonated drinks, eggs, cream, alcoholic drinks, and cakes. In addition to pain in the right hypochondrium, there may be complaints of increased temperature, chills, and increased sweating.

Ignoring the symptoms of gallstone disease is fraught with the development of the last stage or stage of complications.

What are the complications of gallstone disease? Lack of therapy is fraught with the development serious illnesses: acute cholecystitis, hydrocele of the gallbladder, perforation or rupture of the gallbladder, hepatic abscess, cancer of the gallbladder, empyema, reactive hepatitis, acute cholangitis, biliary fistulas, paravesical abscess, cicatricial strictures, secondary biliary cirrhosis.

Help with an attack of biliary colic

If severe pain appears in the right hypochondrium, chills, fever, subtle bloating and arrhythmia, measures must be taken. The attack itself lasts, as a rule, half an hour, after which the pain becomes aching. After about three hours, the pain goes away.

The occurrence of an attack is provoked by stones that move along bile ducts into the intestines. It is the size of the stones that determines the intensity of the pain.

Often, to relieve pain, the administration of M-anticholinergic blockers (help eliminate spasms) is prescribed - Atropine 0.1% - 1 ml IM or Platifillin 2% - 1 ml IM.

If anticholinergic blockers are ineffective, they are used antispasmodics. In this case, intramuscular administration of Papaverine 2% - 2 ml or Drotaverine (No-shpy) 2% - 2 ml is prescribed.

Baralgin or Pentalgin 5 ml IM is prescribed as a pain reliever. If the pain is severe and cannot be relieved by anything, use Promedol 2% - 1 ml.

How to diagnose cholelithiasis?

In order to identify pathology, in addition to questioning, examination, palpation of the abdomen and blood sampling for general and biochemical blood tests, the following is prescribed:

ultrasound examination;
radiography;
cholecystography;
computed tomography;
endoscopic cholangiopancreatography.

Features of treatment

Treatment of pathology involves preventing the movement of stones, litholytic therapy (crushing stones), as well as normalization metabolic processes. The main direction of treatment for the asymptomatic stage of the disease is diet.

What should the diet be like? You need to eat food in small portions, at least five times a day. The temperature of cold dishes is 15 degrees (not lower), and hot dishes are not higher than 62 degrees Celsius.

Patients are prohibited from consuming: alcoholic beverages, legumes, fatty and spicy foods, dairy products (cream, full-fat milk, sour cream), fatty meats and fish, canned food, mushrooms, freshly baked bread, spices, coffee, chocolate, strong tea.

It is allowed to eat low-fat cheeses, dried bread, baked vegetables (potatoes, carrots), fresh vegetables (tomatoes, cucumbers, cabbage, green onions, parsley), low-fat varieties meat (veal, rabbit, beef, chicken) stewed or boiled, cereals, noodles, sweet ripe berries and fruits, compotes, low-fat yoghurts and low-fat cottage cheese.

Drug dissolution of stones

Drug therapy for the disease is effective in the following cases: if the stones consist of cholesterol, if they do not exceed five millimeters, if the patient is not obese and the age of the stones does not exceed three years. In order to dissolve the stones, the use of Ursofalk or Ursosan is prescribed - 8-13 mg per kilogram of body weight per day. The average duration of a therapeutic course is a year.

Surgery for gallstone disease

The operation is performed if stones big size and also in the case when drug therapy has not brought positive results. The main types of cholecystectomy (surgery to remove the gallbladder) include:

standard cholecystectomy;
laparoscopic cholecystectomy.

The first method has been used for a long time. It is based on abdominal surgery(with an open abdominal cavity). However, recently it has been used less and less. This is due to frequent postoperative complications.

The laparoscopic technique is based on the use of a special device – a laparoscope. This method is much more effective than the first. Laparoscopic cholecystectomy does not require large incisions. In addition, small scars remain after the operation. Another advantage of such an operation is fast recovery performance. And most importantly, complications after surgery are rare.

Useful information in the article "."

How to carry out prevention?

In order to prevent the development of this pathology, it is recommended to lead an active and healthy lifestyle, eat right, play sports, and stop drinking alcohol and smoking.

Gallstone disease is a pathology associated with impaired metabolism of fat-soluble substances such as bilirubin and cholesterol, resulting in the formation of one or more stones in the gallbladder or ducts leading from it. The disease can develop in children under one year of age, but is most often detected in the older generation - in more than 30% of people over 70 years of age. Women suffer 5 or more times more often than men, especially multiparous women.

Gallstone disease is the main evidence of metabolic disorders

Excess weight, eating animal fats and proteins, diseases of the hepato-biliary zone, as well as a sedentary lifestyle are the main risk factors for this disease. It is dangerous because calculi (stones) can create an obstruction in the path of bile, which can cause damage to many internal organs.

How are stones formed?

- an organ in the form of a small “bag” that can contract. Its main function is to store bile formed in the liver and remove excess water from it. When fatty foods enter the intestines, the bladder contracts and pushes bile (it is extremely necessary for processing fats) into the ducts, which bring it to the duodenum.

Stones begin to form in one of two cases:

when it is violated normal composition bile: this is due both to the nature of the food and to general diseases or infections of the liver or gallbladder itself;
if bile stagnates in its “storage” due to violations of its contractility or motility of the biliary tract.

There are three types in the gallbladder, each of them has its own mechanism of formation:

Cholesterol stones, which are found in almost 90% of all gallstones, are formed due to the oversaturation of bile with cholesterol.
Bilirubin (also known as pigment) stones most often occur when red blood cells break down in increased quantities, releasing hemoglobin, which turns into bilirubin.
Mixed stones contain cholesterol, and calcium, which gives the stone hardness and X-ray contrast properties.

The process of stone formation is as follows. Under the influence of reception hormonal drugs, sudden weight loss, pregnancy, complete intravenous nutrition and other phenomena, a sediment of putty-like consistency appears at the bottom of the gallbladder - sludge. Excessive amounts of cholesterol, under the influence of certain substances contained in this sediment, fall into the lumen of the bladder in the form of solid crystals. Further, if the inflammation of the biliary tract or the nature of the food does not change, the crystals bind together, forming stones. The latter grow and become denser; Bilirubin and calcium may be deposited on them.

Why are stones formed?

The following are the main causes of cholelithiasis:

Inflammation of organs that produce, concentrate or excrete: cholecystitis, hepatitis, cholangitis.
Diseases endocrine organs: reduced function thyroid gland, diabetes mellitus, impaired estrogen metabolism.
Taking contraceptives.
Pregnancy.
Conditions leading to changes in cholesterol metabolism: obesity, atherosclerosis, consumption of large amounts of animal fats and proteins.
An increase in blood and bile levels does not direct bilirubin– with hemolytic anemia.
Starvation.
Hereditary predisposition.
Congenital anomalies in which the outflow of bile is obstructed: S-shaped gallbladder, stenosis of the common bile duct, duodenal diverticulum.

Primary and secondary processes stone formation.

Primary stone formation

It occurs only in the unaffected infectious process the gallbladder, where bile remains for a long time, becoming very concentrated.

Cholesterol, formed by cells liver, does not dissolve in water, so it enters the bile in the form of special colloidal particles - micelles. IN normal conditions the micelles do not disintegrate, but with an excess of estrogens, cholesterol precipitates. This is how cholesterol stones are formed.

For the formation of pigment stones, not only the breakdown of red blood cells is needed - hemolysis, but also some bacteria. In addition to inflammation, they cause the transition of direct bilirubin to indirect bilirubin, which precipitates.

Primary calcium stones form only when the level of calcium in the blood is elevated, for example, with hyperfunction of the parathyroid glands.

Secondary stones

These stones form not only in the gallbladder, but also in the bile ducts affected by the inflammatory process. They are based on primary stones made of cholesterol or bilirubin, which have a small diameter and, as a result, do not exert gravitational pressure on the walls of the bile ducts. Calcium dissolved in the inflammatory fluid is deposited on such stones.

Thus, if the stones consist of more than just calcium, and an increased level of this electrolyte is not detected in the blood, then gallstones– secondary.

How does the disease manifest itself?

Warning! Symptoms of cholelithiasis do not appear when the first microcrystals of cholesterol or bilirubin fall out, but only after a few years, when the stone interferes with the normal outflow of bile.

Signs of the disease vary from biliary colic or inflammation of the gallbladder (if the stone either does not completely block the bile ducts or is located closer to the duodenum) to a dangerous disease - inflammation of the intrahepatic bile ducts.

Manifestations of biliary colic are pain under the right costal arch, which has the following characteristics:

The main symptom of the pathology is pain in the right hypochondrium

begins suddenly;
radiates under the right shoulder blade or in the back;
within the first hour the pain becomes very intense;
it remains the same for another 1-6 hours, then disappears within an hour;
accompanied by nausea and/or vomiting;
the temperature does not rise.

The same symptoms, only with elevated temperature, are accompanied by cholangitis and cholecystitis.

The danger of cholelithiasis

Warning! Gallstones can lead to conditions that can be life-threatening.

These are conditions such as:

obstructive jaundice;
inflammation of intrahepatic bile ducts;
liver abscess;
cirrhosis;
bile duct ruptures;
cancer developing from the bile ducts;
intestinal obstruction caused by a stone passing from the gallbladder into the intestine;
fistulas;
sepsis.

How is the diagnosis made?

Diagnosis of cholelithiasis is carried out by a gastroenterologist. It is based on:

complaints and examination of the patient;
Ultrasound: both sludge and almost all stones, even the smallest in diameter, are detected;
radiography: on plain radiograph calcium stones are visible;
magnetic resonance cholangiopancreatography – the most informative method diagnosis of gallstones;
retrograde cholangiopancreatography – endoscopic method, used for diagnosing stones in the bile ducts;
to determine liver disorders caused by a stone, laboratory tests are needed - “liver tests”;
In order to detect the cause of stone formation, it is necessary to determine the level of calcium, cholesterol, and parathyroid hormone in the blood.

Is this disease treatable? Of course, but quite often this is done surgically. In addition, there are other methods of combating pathology, namely the dissolution of stones with the help of medications and non-contact crushing with subsequent removal naturally. The latter methods are more gentle, but cannot be used in all cases. We talked in detail about all the existing methods of getting rid of gallstones in the article.

Gallstone disease (GSD) is a pathological process accompanied by the formation of stones in the gallbladder.

The second name of the disease is calculous cholecystitis. Since cholelithiasis affects the organ of the digestive tract (gallbladder), its treatment is usually carried out.

Features of gallstones

Stones are the main manifestation of gallstone disease. They are made up of calcium, cholesterol and bilirubin, and can come in different sizes. If the size is small, we are talking about the so-called “sand” in the gallbladder, but if the formations are large, they are considered full-fledged stones (calculi).

Such formations may increase in size over time. So, from a small grain of sand a stone of 1 cm or more in size can emerge. The stone may have different shapes- from round or oval to polyhedron outlines. The same applies to the density of stones. There are quite strong stones, but there are also very fragile ones that can crumble from one touch.

The surface of the stone can be smooth, spiky or porous (in cracks). These features are characteristic of all stones, regardless of their location. However, stones are often found in the gallbladder. This anomaly is called cholelithiasis, or gallbladder calculosis. Less commonly, stones are detected in the bile ducts. This disease is called choledocholithiasis.

Gallstones in the gallbladder can be either single or multiple. There can be dozens, and even hundreds of them. However, it should be remembered that the presence of even one stone can cause serious harm health. Moreover, dangerous complications often result from small rather than large gallstones.

Causes of stone formation

If for some reason the quantitative balance of the components that make up bile is disturbed, the formation of solid structures - flakes - occurs. As they grow, they merge to form stones. Often the disease develops under the influence of the accumulation of excessively large amounts of cholesterol in the bile. In this case, bile is called lithogenic.

Hypercholesterolemia can result from:

obesity;
abuse of fatty foods containing large amounts;
reducing the amount of specific acids entering the bile;
reducing the amount of phospholipids that prevent hardening and sedimentation and cholesterol;
stagnation of bile.

Bile stasis can be mechanical or functional. If we are talking about the mechanical nature of this deviation, then factors such as:

tumors;
adhesions;
kinks of the gallbladder;
enlargement of neighboring organs or lymph nodes;
scar formation;
inflammatory processes accompanied by swelling of the organ wall;
stricture

Functional failures are associated with impaired motility of the gallbladder itself. In particular, they occur in patients with hypokinetic. In addition, the development of cholelithiasis can be a consequence of disorders in the biliary system, infectious and allergic diseases, autoimmune pathologies, etc.

Classification

Gallstone disease is divided into several stages:

Physicochemical or pre-stone. This is the initial stage of the development of cholelithiasis. During its course, gradual changes occur in the composition of bile. There are no special clinical manifestations at this stage. Discover initial stage ZhKB is possible during biochemical research composition of bile.
The phase of latent (hidden) stone bearing. At this stage, stones in the gallbladder or its ducts are just beginning to form. The clinical picture is also not typical for this phase of the pathological process. It is possible to identify gallstone neoplasms only during instrumental diagnostic procedures.
The stage when the symptoms of the disease begin to appear brighter and more severe. In this case, we can talk about the development of acute calculous cholecystitis, or state the fact of its transition to a chronic form.

In some sources you can see a four-stage gradation of gallstone disease. The last, fourth, phase of the disease is characterized as such, during which concomitant complications of the pathological process develop.

Types of gallstones

Stones localized in the gall bladder may have different chemical composition. According to this criterion, they are usually divided into:

Cholesterol. Cholesterol is one of the components of bile, but if there is an excess of it, stones can form. This substance enters the human body along with food and is evenly distributed throughout its cells, contributing to its full functioning. If there is a disruption in the absorption of cholesterol, it begins to accumulate in the bile, forming stones. Cholesterol stones are round or oval in shape and can reach 1 to 1.5 centimeters in diameter. Their location is often the bottom of the gallbladder.
Bilirubin. Bilirubin is a breakdown product of hemoglobin. Stones that form when there is an excess of it in the body are also called pigment stones. Bilirubin stones are smaller in size than cholesterol stones, but there may be more of them in number. Moreover, they affect not only the bottom of the gallbladder, but can also be localized in the biliary tract.

Gallstones can have varying degrees of calcium saturation. It determines how clearly the tumor can be seen on the screen of an ultrasound machine or on an x-ray. In addition, the choice of therapeutic technique also depends on the degree of calcium saturation of the stones. If the stone is calcified, it will be much more difficult to treat it with medications.

Depending on the size, gallstones are:

Small. The size of such neoplasms does not exceed 3 cm in diameter. For single stones localized in the area of the bottom of the gallbladder, no specific clinical symptoms do not appear in the patient.
Large. These are called stones whose diameter exceeds 3 cm. They interfere with the normal outflow of bile and can cause attacks of biliary colic or other unpleasant symptoms.

Not only the types, but also the size of stones can affect the choice of therapeutic tactics for cholelithiasis. Large stones, as a rule, are not subjected to medicinal dissolution. They are also not crushed using ultrasound, since such a therapeutic approach is unlikely to give the expected results.

In this case, cholecystectomy is performed - an operation to remove the gallbladder along with the stones located in it. If the stones are small, more gentle treatment methods are considered.

In some cases, doctors' attention may also be focused on the location of the tumors. Stones located in the area of the bottom of the gallbladder rarely bother the patient, since they are not characterized by any clinical picture.

If stones are localized in close proximity to the neck of the diseased organ, this can cause obstruction of the bile duct. In this case, the patient will be disturbed by unpleasant symptoms, manifested by pain in the right hypochondrium and disruption of the digestive process.

Symptoms and signs of gallstone disease

Gallstone disease is a pathological process that can be completely asymptomatic for a long time. Especially it concerns initial stages diseases when the stones are still too small, and therefore do not clog the bile ducts, and do not injure the wall of the bladder.

The patient may not realize the presence of the disease for a long time, that is, he may be a latent stone carrier. When the neoplasms reach quite large sizes, the first alarming signs of a pathological process in the gallbladder appear. They can manifest themselves in different ways.

The first symptoms of cholelithiasis, which occur even before the onset of pain in the right hypochondrium, include:

feeling of heaviness in the stomach after eating;
attacks of nausea;
slight yellowing of the skin (obstructive jaundice).

This clinical picture occurs due to a disruption in the process of bile outflow. Under the influence of such a malfunction, deviations in the functioning of the digestive tract occur.

The most common symptoms and signs of cholelithiasis include:

If we talk about the general symptoms of cholelithiasis, it can be quite diverse. Abdominal pain of varying intensity and nature, indigestion, nausea, and sometimes with bouts of vomiting are possible. But since the clinical picture of the disease is typical for many gastrointestinal pathologies, experienced doctors always prescribe an ultrasound of the gallbladder to understand the cause of the patient’s ailment.

Diagnostics

If symptoms characteristic of biliary colic occur, you should immediately consult a specialist. First of all, a physical examination and history taking are carried out, based on finding out exactly what symptoms the patient is suffering from.

When palpating the abdomen, tension and soreness of the skin in the muscles of the abdominal wall in the immediate vicinity of the diseased gallbladder are noted. In addition, the doctor notes that the patient has yellowish spots on the skin, which arise as a result of lipid metabolism disorders, yellowing of the eye sclera and skin.

But a physical examination is not the main diagnostic procedure. This is a preliminary examination that gives the doctor a basis for referring the patient for certain tests. In particular:

. If there is an inflammatory process in the gallbladder, the test results will show a moderate increase in ESR and pronounced leukocytosis.
. When deciphering the data, the doctor notes increased levels of cholesterol and bilirubin against the background of abnormal alkaline phosphatase activity.
Cholecystography. This diagnostic technique helps to study the condition of the gallbladder as accurately as possible. During the procedure, an enlargement of the organ and the appearance of calcareous inclusions on its walls are revealed. Using cholecystography, calcareous stones located inside the diseased organ are detected.
Ultrasound of the abdominal cavity is the most informative diagnostic technique for suspected development of gallstone disease. In addition to identifying neoplasms, specialists note deformation of the gallbladder wall. Negative changes in the motility of the diseased organ are also recorded. Signs characteristic of cholecystitis are also clearly visible on ultrasound.

A thorough study of the condition of the gallbladder is also possible using an MRI or CT scan. An equally informative diagnostic technique, during which disturbances in the circulation of bile are detected, is scintigraphy. The method of retrograde endoscopic cholangiopancreatography is also widely used.

Complications

The formation of stones in the gallbladder is fraught not only with impaired motility of the diseased organ. GSD can have an extremely negative impact on the functioning of other organs, especially those that are in close proximity to the gastrointestinal tract.

Thus, the edges of the stones can injure the walls of the bladder, causing the development of inflammatory processes in them. In particular severe cases neoplasms block the entrance and exit of the gall bladder, thereby complicating the outflow of bile. With such deviations, stagnant processes begin to occur, leading to the development of inflammation. This process can take from several hours to several days, but sooner or later it will definitely make itself felt. The extent of the lesion and the intensity of the pathological phenomenon may vary.

So, it is possible that a slight swelling of the gallbladder wall may form, or its destruction. The consequence of this dangerous process is rupture of the diseased organ. Such a complication of cholelithiasis directly threatens the patient’s life.

The spread of the inflammatory process to the abdominal organs is fraught with the development of peritonitis. A complication of this condition can be infectious-toxic shock or multiple organ failure. With its development, serious disruptions occur in the functioning of the heart, kidneys, blood vessels and even the brain.

If inflammation is too intense and pathogens release excessive amounts of toxins into the blood, ITS may appear immediately. Under such circumstances, even immediate resuscitation measures do not guarantee that the patient will recover from a dangerous condition and prevent death.

Treatment of cholelithiasis

Treatment of pathology can be conservative and surgical. As a rule, therapeutic techniques are used to begin with. These include:

Dissolution of gallstones using special medications. In particular, chenodeoxycholic and ursodeoxycholic acid. This technique is effective only for single cholesterol stones. If the patient has no contraindications, such therapy is prescribed for a course of one and a half years.
Extracorporeal shock wave lithotripsy – conservative method treatment of cholelithiasis, which involves the use of a shock wave, which leads to the destruction of gallstones. This wave is created using special medical devices. This treatment of cholelithiasis is carried out only for cholesterol stones of small sizes (up to 3 cm). The procedure causes virtually no pain and is quite easily tolerated by patients. Pieces of stones are eliminated from the body during bowel movements.
Diet. This is one of the foundations of successful recovery and removal unpleasant symptoms. Throughout the course of diet therapy, it is necessary to follow the rules of fractional nutrition. Food should be taken 4-6 times a day in small portions. Fatty, spicy, fried, spicy foods, smoked foods, pickles, carbonated and alcoholic drinks, chocolate. The patient should avoid fatty meats and spicy seasonings. Healthy eating for cholelithiasis is based on the consumption of dairy products and products plant origin. It is imperative to add wheat bran to the menu.

Particularly popular today surgery cholelithiasis - cholecystectomy. It is carried out in 2 ways:

classic;
laparoscopic.

Only a surgeon can determine what type of operation is appropriate to perform in each individual case. Cholecystectomy is mandatory if:

Numerous neoplasms in the gallbladder. In this case, the exact number and size of the stones do not play any role. If they occupy at least 33% of the area of the diseased organ, cholecystectomy is mandatory. It is not possible to crush or dissolve such a quantity of stones.
Frequent attacks of biliary colic. Pain with this deviation can be quite intense and frequent. They are relieved with the help of antispasmodic drugs, but sometimes such treatment does not bring relief. In this case, doctors resort to surgical intervention, regardless of the number of stones and their diameter.
Presence of stones in the bile ducts. Obstruction of the biliary tract poses a serious threat to the patient’s health and significantly worsens his well-being. The outflow of bile is disrupted, the pain syndrome becomes more intense and obstructive jaundice develops. In such a situation, surgery cannot be avoided.
Biliary pancreatitis. – an inflammatory process that develops and occurs in the tissues of the pancreas. The pancreas and gallbladder are connected by one bile duct, so a disruption in the functioning of one organ entails negative changes in the functioning of the other. In some cases, calculous cholecystitis leads to disruption of the outflow of pancreatic juice. Destruction of organ tissue can lead to serious complications, and directly threatens the patient's life. The problem must be solved exclusively surgically.

Mandatory surgery is also necessary for:

In addition to the stage of the pathology, the size and composition of the stones, the age of the patient and the presence of concomitant diseases play a large role in the choice of therapeutic technique. In case of intolerance to pharmacological agents, drug treatment of cholelithiasis is contraindicated for the patient. In this case, the only correct way out of this situation will be surgery.

But for older people with diseases of cardio-vascular system, kidneys or other organs, surgical intervention can only do harm. In this case, doctors try to avoid such treatment tactics.

As you can see, the choice therapeutic technique in cholelithiasis depends on many factors. Only the attending physician can say for sure whether there is a need for surgery after carrying out all the necessary diagnostic measures.

Diet for gallstone disease

Meals for cholelithiasis should be fractional. Food should be taken in small portions 4-6 times a day. The food temperature should not be less than 15 or more than 62 degrees Celsius. Prohibited products for cholelithiasis include:

alcohol;
legumes in any form;
fatty dairy and fermented milk products;
roast;
spicy;
salty;
smoked;
fatty fish and meats;
caviar;
sweets;
canned food;
mushrooms in any form;
hot fresh bread, toast, croutons;
spices, seasonings;
marinade;
coffee;
chocolate products;
cocoa;
strong black tea;
hard or salty cheese.

dried bread made from grade 2 flour;
low-fat cheeses;
boiled, steamed or baked vegetables;
finely chopped white cabbage(in limited quantities);
baked or boiled lean meat;
different types of cereals;
noodles and pasta (within reasonable limits);
jams and preserves;
sweet fruits and berries;
weak tea;
sweet homemade juices;
moussam;
dried fruit compote;
butter, which must be added to various dishes in an amount of no more than 30 g per day;
low-fat varieties of fish (pike perch, pike, hake, etc.);
whole milk. It can be used as pure form, and use it for making porridge.

Low-fat cottage cheese and natural low-fat yoghurts are also allowed (preferably homemade).

Prognosis and prevention for cholelithiasis

To prevent the development of gallstone disease, it is necessary, if possible, to avoid factors that can cause the development of hypercholesterolemia and bilirubinemia. It is also important to exclude stagnation in the gallbladder and its ducts. This is facilitated by:

balanced and nutritious nutrition;
physical activity;
careful monitoring of body weight, and, if necessary, its adjustment;
timely detection and complete cure diseases of the biliary system.

Especially close attention to bile circulation and cholesterol levels should be paid to people who have a genetic predisposition to gallstone disease.

If we talk about the prevention of biliary colic when the disease is detected, then patients need to follow a strict diet. They must carefully monitor their weight and drink enough fluid (1.5 - 2 liters per day). To avoid the risk of stones moving through the bile ducts, patients should avoid performing work that requires prolonged exposure to an inclined position.

The prognosis for the development of gallstone disease is different for all patients, since it directly depends on the rate of formation of stones, their size and mobility. In most cases, the presence of stones in the gallbladder leads to a number of unfavorable and severe complications. But if surgery is performed in a timely manner, dangerous consequences diseases are completely preventable!