home Audience 1 What causes cholelithiasis? Gallstone disease - symptoms and treatment. Do's and Don'ts

What causes cholelithiasis? Gallstone disease - symptoms and treatment. Do's and Don'ts

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

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

Let me explain: you have had the consequence removed - the stones and the bubble in which they are formed, and the disease - metabolic disorder - has not gone away, you continue to live with her. Now stones can form in the bile ducts, which is much more dangerous. And proper balanced nutrition, which we usually call a diet, will gradually normalize metabolism and you will get rid of cholelithiasis forever.

Moreover, if in the presence of a gallbladder, the bile in it became concentrated, which gave it the opportunity to exhibit disinfectant properties and kill pathogenic microbes, now it enters directly into the duodenum- constantly, having no place to accumulate. This bile cannot help digest large amounts of food, since there is no reservoir where it accumulated - the bladder has been removed.

It is for this reason that it is recommended fractional meals 5-6 times throughout the day and give up irrational consumption of fatty foods. Yes, fat is needed, but in small quantities. You also need to drink a lot of water - at least 1.5 liters, which will dilute the bile. And adhere to the list of permitted and prohibited foods for cholelithiasis (you remember - the disease has not gone away!), which is given above.

I hope that the article was useful for you and helped you understand such a complex phenomenon as cholelithiasis, its symptoms and causes, surgical treatment and nutrition for the formation of gallstones.

Be healthy! We eat rationally and correctly!

The number and size of gallstones are very diverse: sometimes it is one large stone, but more often there are multiple stones, numbering in the tens, sometimes in the hundreds. They vary in size from chicken eggs to millet grains and smaller. Stones can have different chemical compositions. Cholesterol, lime and bile pigments participate in their formation. Consequently, metabolic disorders in the body, bile stagnation and infection play an important role in the process of stone formation. When bile stagnates, its concentration increases, creating conditions for the crystallization of cholesterol contained in it and removed from the body with it. It has been scientifically established that excessive and irregular nutrition, as well as insufficient mobility, contribute to the creation of conditions for the formation of gallstones. The most common causes of biliary colic (the main manifestation of cholelithiasis) are the consumption of alcohol, spicy fatty foods, and excessive physical activity.

A common metabolic disease in which, due to disruption of the processes of bile formation and bile excretion, stones form in the gall bladder. Small stones (microliths) sometimes also form in the intrahepatic bile ducts, especially in elderly men and patients with cirrhosis of the liver. Once in the gallbladder, microliths can serve as a basis for the deposition of cholesterol on them and the formation of large cholesterol stones. In addition to cholesterol stones, there are pigment (bilirubin), calcareous, mixed and combined types of stones. Stone-carrying is possible without clinical manifestations; It is often discovered by chance at autopsy. Gallstones occur at any age, and the older the patient, the higher the incidence of the disease. In women, cholelithiasis and stone carriage are observed several times more often than in men.

Gallstone disease is often accompanied by chronic cholecystitis. With multiple stones, bedsores form in the gallbladder, which can lead to ulceration and perforation of its walls.

Classification

In cholelithiasis there are stages: physico-chemical (changes in bile), latent (asymptomatic stone carriage), clinical (calculous cholecystitis, biliary colic).
The following clinical forms of cholelithiasis are distinguished: asymptomatic stone carriers, calculous cholecystitis, biliary colic.
Gallstone disease can be complicated or uncomplicated.

The main manifestation of cholelithiasis is biliary, or hepatic, colic, which is manifested by attacks of very severe pain in the right hypochondrium. At the same time, they spread and radiate to the right shoulder, arm, collarbone and scapula or to the lower back on the right side of the body. The most severe pain occurs when blockage of the common bile duct occurs suddenly.

An attack of biliary colic is accompanied by nausea and repeated vomiting with an admixture of bile in the vomit, which does not alleviate the condition of the patients. Sometimes reflex pain appears in the heart area. Biliary colic usually occurs with an increase in body temperature, which lasts from several hours to 1 day.

Between attacks, patients feel practically healthy, sometimes they feel dull pain, a feeling of heaviness in the right hypochondrium, and nausea. There may be a decrease in appetite and dyspeptic disorders.

With prolonged blockage of the common bile duct, bile from the liver is absorbed into the blood, jaundice occurs, which requires appropriate treatment in a hospital setting.
The most reliable confirmation of the diagnosis of cholelithiasis is the results of an X-ray examination with the introduction of a radiopaque liquid into the bile ducts.

In the clinical manifestations of cholelithiasis, functional disorders of the extrahepatic biliary tract are of significant importance, both in the early period before the formation of stones, and in the presence of such. Gallstone disease is a fairly common disease, especially in women, accompanied by a number of complications and sequential processes.
The size and number of gallstones vary in different cases. The most voluminous are single, solitary stones (monoliths), and the weight of the stone can reach 25-30 g; gallstones usually have a round, ovoid shape, common bile duct stones resemble the end of a cigar, and intrahepatic duct stones can be branched. Small stones, almost grains of sand, can number several thousand in one patient.

The main components of stones are cholesterol, pigments (bilirubin and its oxidation products) and lime salts. All these substances can be combined in various proportions. Of the organic substances, they contain a special colloidal substance of a protein nature, which forms the skeleton of the stone, and of the inorganic substances, in addition to lime salts (carbon dioxide and phosphoric acid), iron, copper, magnesium, aluminum and sulfur were found in gallstones. For practical purposes, it is enough to distinguish three types of stones based on their chemical composition: cholesterol, mixed and pigment.

Cholesterol, radial stones consist almost exclusively (up to 98%) of cholesterol; they are white, sometimes slightly yellowish, round or oval in shape, ranging in size from a pea to a large cherry.
Mixed stones, cholesterol-pigment-calcareous, multiple, faceted, occur in tens, hundreds, even thousands. These are the most common, most common stones. In the section, you can clearly see a layered structure with a central core, which is a soft black substance consisting of cholesterol. In the center of mixed stones, fragments of epithelium and foreign bodies (blood clot, dried roundworm, etc.) are sometimes found, around which stones falling out of the bile are layered.
Pure pigment stones are of two types: a) observed in cholelithiasis, possibly with a plant diet, and b) observed in hemolytic jaundice. These pure pigment stones are usually multiple, black in color, and turn green in the air; they are found in the bile ducts and gallbladder.

Causes of cholelithiasis (gallbladder stones)

The development of gallstone disease is a complex process associated with metabolic disorders, infection and stagnation of bile. Undoubtedly, heredity also plays a role. Metabolic disorders contribute to disruption of bile eicolloidity. The stability of the bile colloidal system, its surface activity and solubility depend on the composition and correct ratio of bile ingredients, primarily bile acids and cholesterol (the so-called cholate-cholesterol index). An increase in the concentration of cholesterol or bilirubin in bile can contribute to their loss from solution. The prerequisites for increasing the concentration of cholesterol and decreasing the content of cholates in bile are created when bile stagnates. Infection promotes stone formation by inhibiting the synthesis of bile acids by liver cells. All these mechanisms, closely related to each other, lead to the development of the disease, which is facilitated by neuro-endocrine and metabolic disorders. Hence, the more frequent development of gallstone disease among people with obesity, poor lifestyle, its frequent association with other metabolic diseases (atherosclerosis, diabetes), as well as the frequent occurrence of the disease during repeated pregnancy.

Of great importance in the formation of gallstones is, apparently, the abnormal composition of bile produced by the liver (dyscholia), which contributes to the loss of difficultly soluble components of bile, as well as a violation of general metabolism with an overload of blood with cholesterol (hypercholesterolemia) and other products of slow metabolism. Infection leading to disruption of the integrity of the epithelium of the gallbladder mucosa with its desquamation, foreign bodies inside the gallbladder, which easily cause deposition of lime and other components of bile, are rather only secondary, more rare factors of stone formation. Excessive secretion of bilirubin by bile during massive hemolysis is also important.

Impaired liver activity and changes in metabolism are based on unfavorable environmental influences in the form of excessive poor nutrition and lack of physical work. Neuroendocrine factors affecting the function of the liver cell and tissue metabolism, as well as the emptying of the gallbladder, are also of great importance.
Gallstone disease is often combined with obesity, gout, the presence of kidney stones, sand in the urine, atherosclerosis, hypertension, diabetes, i.e., it is observed in numerous conditions occurring with: hypercholesterolemia.

The disease most often manifests itself between the ages of 30 and 55 years, and in women it is 4-5 times more common than in men. Gallstones in inflammation of the gallbladder and hemolytic jaundice can be observed at an earlier age. Gallstone disease, of course, often manifests itself clinically for the first time during pregnancy or in the postpartum period: pregnancy is accompanied under normal conditions by physiological hypercholesterolemia and increased function of liver cells, which creates the best conditions for fetal development and milk production by the mammary gland. Particularly significant disturbances in metabolic and vegetative processes can be expected when the physiological rhythm of the reproductive function is disrupted due to repeated abortions or premature births without subsequent lactation, etc., when a delay in emptying of the gallbladder is possible due to altered activity of the nervous system. Family cases of cholelithiasis, especially frequent in mother and daughter, are most often explained by the influence of the same environmental conditions mentioned above.

It has long been known that foods rich in cholesterol (fatty fish or meat, caviar, brains, butter, sour cream, eggs) contribute to the formation of stones, of course, if oxidative-enzymatic processes are disrupted.

Recent experimental studies have also discovered the effect of vitamin A deficiency on the integrity of the epithelium of the gallbladder mucosa; Its desquamation contributes to the precipitation of salt and other precipitation.

Currently, great importance in the loss of cholesterol in bile is attributed, as indicated, to the abnormal chemical composition of bile, in particular, the lack of bile (as well as fatty) acids, which can be seen as a dysfunction of the liver cell itself.

Infections and bile stasis are of known importance in gallstone disease. Of the diseases suffered, special attention was paid to typhoid fever, since it is known that the typhoid bacillus can affect the bile ducts, excreted in bile.

Stagnation of bile is promoted, in addition to a sedentary lifestyle, by excessive obesity, pregnancy, clothing that compresses the liver or restricts the movement of the diaphragm, prolapse of the abdominal organs, mainly the right kidney and liver; in this case, bending of the bile ducts, especially the cystic ducts, located in the lig may occur. hepato-duodenal. When the mucous membrane of the duodenum swells and ulcerative processes in it become scarred, the mouth of the common bile duct may be compressed, which leads to stagnation of bile. Catarrhs that arise as a result of a gross violation of the diet sometimes contribute to stagnation of bile and infection of the biliary tract. Usually, however, in addition to the mechanical factor, the effect of the above-mentioned hepatic-metabolic factor is also noted.

The greatest importance in the origin of cholelithiasis should be given to disruption of the nervous regulation of various aspects of the activity of the liver and biliary tract, including the gallbladder, with their complex innervation device. The formation of bile, its entry into the gallbladder and its release into the duodenum is finely regulated by autonomic nerves, as well as higher nervous activity, which is evidenced by the great importance of conditioned reflex connections for normal bile secretion.

At the same time, the receptor fields of the biliary tract, even with functional disorders of the biliary function, give rise to pathological signaling to the cerebral cortex. Thus, in the pathogenesis of cholelithiasis, it is possible to establish individual links that are also characteristic of other cortico-visceral diseases.

Metabolic-endocrine disorders play only a secondary role, subordinate to functional changes in nervous regulation. With initial damage to adjacent organs and infectious causes, disruption of the hepatobiliary system, leading to cholelithiasis, also occurs through the neuroreflex pathway.

Certain signs of cholelithiasis, especially the signs accompanying biliary colic, characteristic of gallstone dyspepsia, etc., owe their intensity and diversity primarily to the abundant innervation of the gallbladder and bile ducts and are, undoubtedly, mainly neuroreflex in nature.

Symptoms, signs of cholelithiasis (gallbladder stones)

The clinical picture of cholelithiasis is extremely varied and difficult to describe briefly. Uncomplicated gallstone disease is manifested by gallstone dyspepsia and biliary, or hepatic, colic.

Complications of gallstone disease

Biliary colic.
Cholecystitis.
Acute pancreatitis.
Gallbladder fistula, mechanical intestinal obstruction.
Obstructive jaundice.
Cholangitis and septicemia or liver abscess.
Perforation and peritonitis.

Gallstone disease is characterized by a chronic course, leading to disability of patients and even threatening their lives during certain periods of the disease in the presence of certain complications, especially as a result of blockage of the bile ducts, intestinal obstruction and phlegmonous cholecystitis. Often the disease takes a hidden (latent) course, and stones are discovered only at the autopsy of patients who died from another cause.

Of the complications of cholelithiasis, almost as numerous as, for example, complications of peptic ulcer of the stomach and duodenum, blockage of the bile ducts and their infection are described first of all separately, although very often the phenomena of blockage and infection are combined.

During their movement, stones can get stuck at various points along the path of bile movement, causing special characteristic clinical symptoms. Most often, we observe blockage of the cystic and common bile duct.

A typical manifestation of the disease is an attack of biliary, or hepatic, colic. The pain occurs suddenly, but is sometimes preceded by nausea. Colic usually begins at night, usually 3-4 hours after an evening meal, especially fatty foods, or drinking alcohol; accompanied by a rise in temperature (sometimes with chills), tension in the abdominal muscles, stool retention, bradycardia, vomiting, and bloating. Temporary anuria is possible, and in the presence of coronary disease - resumption of anginal attacks. There are a large number of cholesterol crystals in the duodenal contents, sometimes small stones are found. In some cases, stones can be detected in feces 2-3 days after the attack. In some cases, colic recurs frequently, in others - rarely, occurring in the form of gallstone dyspepsia.

With biliary colic, complications are possible, of which the most dangerous are blockage of the neck of the gallbladder by a stone; as a result of the stone laying an artificial path into the intestine (fistula), severe infection of the biliary apparatus occurs with the development of ulcers, biliary peritonitis and sepsis. Gallstone disease favors the development of malignant neoplasms of the biliary system.

Diagnosis and differential diagnosis of cholelithiasis (gallbladder stones)

The diagnosis of cholelithiasis is made on the basis of patient complaints, medical history and course of the disease. In the anamnesis, it is especially important to indicate the dependence of complaints on fatty and floury foods, their connection with pregnancy, obesity of patients (in the past), the presence of cases of cholelithiasis in the family (the patient’s mother, sisters) under the same external living conditions.

When examining patients, the possibility of cholelithiasis is indicated by the presence of at least mild jaundice, skin pigmentation (liver spots, chloasma), cholesterol deposition in the skin (cholesterol nodes - xanthelasmas - in the thickness of the eyelids near the nose). Often, patients have overdeveloped subcutaneous fat. However, cholelithiasis also affects people with normal and low weight, especially in connection with biliary tract infection. As a result of severe cholelithiasis and its complications, patients can suddenly lose weight and even acquire a cachectic appearance. The cholesterol level in the blood may fall below normal, although cholelithiasis is often accompanied by elevated blood cholesterol levels. Direct evidence of the presence of a stone can be provided by cholecystography, the results of which are positive with modern technology in 90% of patients; The detection of microliths in the duodenal contents is also important.

As for the differential diagnosis, in the various stages of cholelithiasis one has to keep in mind a number of diseases. In case of gallstone dyspepsia, it is necessary to exclude first of all gastric and duodenal ulcers, chronic appendicitis, colitis and many other causes of gastric and intestinal dyspepsia. The erased signs of gallstone dyspepsia, described in detail above, make it possible to clinically clarify the diagnosis.

Hepatic colic must be differentiated from a number of diseases.

As stated above, biliary colic is almost always caused by stones, but in rare cases it can be caused by an roundworm or echinococcus vesicle stuck in the ducts. Analysis of stool and the presence of other symptoms of ascarid infestation or hydatid disease help establish the diagnosis.

An enlarged gallbladder with dropsy can be mixed with hydronephrosis, a pancreatic cyst; the gallbladder is characterized by respiratory mobility and lateral displacement; anterior hydatid cyst of the liver is differentiated from hydrocele by other signs characteristic of hydatid disease.

It is necessary to differentiate febrile cholecystitis, obstructive stone jaundice, cholangitis pseudomalarial fever, secondary biliary cirrhosis of the liver, gallstone ileus, etc. from other diseases that may resemble the corresponding complication of cholelithiasis.

Prognosis and working ability of cholelithiasis (gallbladder stones)

The prognosis of cholelithiasis is difficult to formulate in a general form, the course of the disease is so varied. In most cases, the disease occurs with periodically recurring painful attacks and dyspepsia and, with the right regimen, is not prone to progression and does not significantly shorten life expectancy. This is the course of gallstone disease in most sanatorium-resort patients. In patients in the therapeutic departments of hospitals, a more persistent course with complications is usually observed; finally, patients in surgical departments experience the most serious complications of cholelithiasis, resulting in a relatively high mortality rate.

With frequent exacerbations of cholelithiasis and severe inflammatory phenomena (fever, leukocytosis), which are not inferior to treatment, patients are completely unable to work or their ability to work is limited. In milder cases of cholelithiasis with a predominance of spastic or dyskinetic phenomena in the area of the gallbladder, without pronounced symptoms of cholecystitis, patients should be recognized as having limited ability to work in the presence of significant severity and persistence of nervous disorders and frequent, mainly non-infectious, subfebrile condition. They cannot perform work involving significant physical stress. With the development of severe complications of cholelithiasis, patients are completely disabled.

Prevention and treatment of cholelithiasis (gallbladder stones)

To relieve a painful attack, antispasmodics (drotaverine hydrochloride, papaverine hydrochloride) and analgesics (metamizole sodium, promedol) are administered intravenously or intramuscularly. If the attack still cannot be eliminated and the jaundice does not go away, you have to resort to surgical treatment. To remove stones, lithotripsy is used - crushing them using a shock wave.

Patients with cholelithiasis must strictly adhere to their diet and diet, and not abuse alcohol.

For patients with chronic diseases of the gallbladder and biliary tract with insufficient bile secretion and a tendency to constipation, a diet with a high content of magnesium, calcium, carotene, and vitamins B and A is recommended. If bile enters the intestines in insufficient quantities, then the consumption of animal fats should be limited. It is also recommended to consume more honey, fruits, berries, raisins, and dried apricots.

To prevent the development of the inflammatory process in the mucous membrane of the gallbladder, timely treatment of infectious diseases is necessary. In cases where cholelithiasis is combined with inflammation of the mucous membrane of the gallbladder (chronic cholecystitis), the disease is much more severe. Attacks of biliary colic occur more often, and most importantly, severe complications can develop (dropsy of the gallbladder, cholangitis, pancreatitis, etc.), the treatment of which is very difficult.

To prevent cholelithiasis, a general hygienic regimen, sufficient physical activity and proper nutrition are important, as well as the fight against infections, dysfunctions of the gastrointestinal tract, elimination of bile stagnation, and elimination of nervous shock. For people leading a sedentary lifestyle, it is especially important to avoid overeating, systematically take walks in the fresh air, and engage in light sports.

Treatment of cholelithiasis at different stages of its development varies. However, regardless of temporary urgent measures, patients, as a rule, must adhere to a general and dietary regimen for years and decades, periodically undergo spa treatment in order to counteract metabolic disorders, cholesterolemia, to increase the activity of liver cells, to strengthen the nervous regulation of bile-hepatic activity. Of great importance is the fight against stagnation of bile, infection of the gallbladder and bile ducts, ascending from the intestines or metastasizing from distant foci, as well as eliminating difficult experiences. It is necessary to recommend split meals (more often and little by little), as it is the best choleretic agent. The daily amount of drinking should be plentiful to increase secretion and dilute bile. It is important to eliminate all causes that contribute to bile stagnation (for example, a tight belt); with severe ptosis, it is necessary to wear a bandage. Constipation should be combated by prescribing diet, enemas and mild laxatives.

Dietary nutrition is very important in the treatment of gallstone disease. In acute attacks of biliary colic, a strict gentle regimen is necessary. Concomitant lesions of the gastrointestinal tract or other diseases (colitis, constipation, diabetes, gout) should be taken into account.

In case of cholelithiasis, it is usually necessary to limit patients both in terms of the total caloric intake of food and in relation to meat, fatty dishes, especially smoked foods, canned food, snacks, as well as alcoholic drinks. Egg yolks and brains, especially rich in cholesterol, should be excluded from food, and butter should be sharply limited . The diet should be predominantly vegetarian with a sufficient amount of vitamins, for example, vitamin A, the lack of which in the experiment leads to disruption of the integrity of the epithelium of the mucous membranes and, in particular, to the formation of gallstones. Much attention is paid to the culinary processing of food, and fried meat, strong sauces, broths, and some seasonings should be avoided. It is necessary to take into account not only the physicochemical properties of food, but also its individual tolerance.

During periods of sharp exacerbations of the disease, a meager diet is prescribed: tea, rice and semolina porridge with water, jelly, white uneatable crackers. Only gradually add fruits (lemon, applesauce, compotes), cauliflower, other pureed vegetables, a little milk with tea or coffee, curdled milk, low-fat broth or vegetable soup, etc. From fats, small amounts of fresh butter are allowed in the future , with breadcrumbs or vegetable puree; Provencal oil is given as a medicine in tablespoons on an empty stomach. For years, patients should avoid those foods that cause them attacks of colic or dyspepsia, namely: pies, cakes with cream and butter dough in general, solyanka, pork, fatty fish, cold fatty snacks, especially with alcoholic drinks, etc. .

The regimen of patients with cholelithiasis should not, however, be limited only to a properly selected diet and rational eating habits; patients should avoid excitement, hypothermia, constipation, etc., in a word, all those irritations that, in their experience, with particular consistency lead to the return of colic, to a large extent, probably due to the zones of prolonged excitation created in the cerebral cortex. Taking medications that strengthen the inhibitory process in higher nervous activity, distraction, and similar other methods should be used in order to prevent another attack, even when exposed to habitual provoking factors.

In the treatment of cholelithiasis, one of the first places is occupied by sanatorium-resort treatment, which is indicated after acute attacks have passed (not earlier than 1-2 months) for the majority of patients with uncomplicated cholelithiasis without signs of a pronounced decline in nutrition. Patients are sent mainly to Zheleznovodsk, Essentuki, Borjomi, etc., or to sanatoriums at the patients’ place of residence for diet and physiotherapy. During sanatorium-resort treatment, complete rest, proper general regimen, nutrition, measured walks, local application of mud to the liver area, which relieves pain and accelerates the healing of residual inflammatory processes, and drinking mineral waters, are beneficial. From mineral waters, hot hydrocarbonate-sulfate-sodium springs are used (for example, the Zheleznovodsk Slavyanovsky spring with water at a temperature of 55°), hydro-carbonate-sodium springs Borjomi, etc., which promote better separation of more liquid bile and the cure of gastrointestinal catarrhs, as well as better loosening the intestines and diverting blood from the liver. Mineral or salt-pine baths are also used, which have a beneficial effect on the nervous system.

Under the influence of climate, mineral waters, hydrotherapy procedures, local application of mud and, finally, an appropriate dietary regimen, metabolism changes in a favorable direction, inflammatory phenomena subside, bile becomes less viscous and is easier to remove from the biliary tract, and normal nervous regulation is largely restored activity of the hepatobiliary system.

Of the medications, bile acids (decholine) may be important, allowing for a normal ratio of bile acids and cholesterol and thereby counteracting stone formation; herbal preparations rich in anti-spasmodic, anti-inflammatory, laxative ingredients; preparations from plants with choleretic properties (holosas extract from rose hips, infusion of immortelle Helichrysum arenarium and many others), choleretic and laxative salts - magnesium sulfate, artificial Carlsbad salt, etc.

Treatment of biliary colic consists of vigorous application of heat to the liver area in the form of heating pads or compresses; if the patient cannot tolerate heat, ice is sometimes applied. Painkillers are prescribed: belladonna, morphine. Usually, vomiting does not allow giving medications orally, and most often it is necessary to inject 0.01 or 0.015 morphine under the skin, preferably with the addition of 0.5 or 1 mg of atropine, since morphine, apparently, can intensify spasms of the sphincter of Oddi and thereby increase the pressure in the bile ducts.

Novocaine (intravenous administration of 5 ml of 0.5% solution) and papaverine also relieve colic. Many patients experience bloating during an attack; in these cases, warm enemas are prescribed; For persistent constipation, siphon enemas are used. Vomiting can be calmed by drinking hot black coffee or swallowing ice cubes.

For 5-6 days after the attack, it is necessary to monitor whether the stone is passed with stool. In preventing a seizure, rest, prohibition of bumpy driving, an appropriate diet with a limit on fatty and spicy foods, small meals with sufficient fluid intake and elimination of constipation are important.

For infection of the biliary tract, sulfazine and other sulfonamide drugs are used in an average dose, penicillin (200,000-400,000 units per day), methenamine, “non-surgical drainage” of the biliary tract in combination with agents that increase the body’s resistance and improve the condition of the liver: intravenous infusion of glucose, ascorbic acid, campolone, blood transfusion, etc.

For obstructive jaundice, the same drugs that improve the condition of the liver are prescribed, and in addition, ox bile, parenteral vitamin K (against hemorrhagic diathesis).
Urgent surgical treatment is indicated for gangrenous cholecystitis, perforated peritonitis, intestinal obstruction due to stones (simultaneously with treatment with penicillin). Surgical intervention is subject to limited accumulations of pus in case of empyema of the gallbladder, subdiaphragmatic abscess, purulent cholecystitis, blockage of the common bile duct with a stone, hydrocele of the gallbladder, purulent cholangitis. More often, surgery is performed to remove the gallbladder (cholecystectomy) or to open and drain the gallbladder or common bile duct. After surgery, the correct general and dietary regimen is also necessary to avoid relapse of stone formation or inflammatory-dyskinetic phenomena, as well as sanatorium-resort treatment.

In some cases it should only be conservative, in others it must be surgical. From your diet, you should exclude foods rich in cholesterol and fats (brains, eggs, fatty meats), rich meat soups, spicy and fatty dishes, lard, smoked meats, canned food, rich foods, and alcoholic beverages. Allowed are dairy products, fruit and vegetable juices, vegetables, vegetarian soups, boiled meat, fish and pasta, cereals, berries, butter and vegetable oil, preferably corn. Patients should be advised to eat moderately, regularly and often, with plenty of fluids, giving preference to mineral waters (Essentuki No. 20, Borzhom, etc.).

Various choleretic drugs are prescribed. Carlsbad salt, magnesium sulfate, sodium sulfate, allohol, cholecin, cholenzyme, oxafenamide, holagol, flamin, cholelitin, etc. are very effective. For pain, antispastic and analgesic drugs are used: atropine, antispasmodic, belladonna, papaverine, platiphylline, etc. colic sometimes it is necessary to prescribe pantopon or morphine, always with atropine, since morphine drugs can cause spasm of the sphincter of Oddi. If there are symptoms of an “acute abdomen,” the use of drugs is contraindicated.

In the presence of infection, antibiotics are used taking into account the sensitivity of the flora isolated from bile for 5-10 days; sulfa drugs.

Surgical treatment is carried out in cases of persistent disease, with frequent relapses of biliary colic that occur despite active treatment, with blockage of the gallbladder, perforation of the gallbladder, and the formation of biliary fistulas. Surgical treatment of cholelithiasis must be timely.

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

Why do gallstones form?

Among the factors that provoke the process of formation of stones in the gall bladder, the leading and additional, accompanying factors are distinguished:

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

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

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

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

Forms of cholelithiasis and symptoms of gallstones

Among the clinical forms of cholelithiasis, the following are distinguished:

latent form or so-called stone carrier;
dyspeptic form of the disease;
painful form accompanied by attacks;
painful torpid form;
cancerous

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

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

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

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

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

Therapy for cholelithiasis: how to treat gallstones?

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

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

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

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

How to treat gallstones with additional methods? In addition to targeted actions and medications, auxiliary therapy is prescribed: drugs that stimulate the secretion of bile acids, enzymes for the digestive system, including those that destroy fats, medications to restore the balance in the composition of bile, as well as the lithotripsy method, both shock wave and medicinal, and litholysis method for crushing or dissolving stones. Crushed stones can pass out on their own along with the feces.

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

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

The most common surgical method of therapy is used in patients with acute cholecystitis, intractable to other types of treatment, in a condition that threatens the patient’s life. For destructive cholecystitis in acute form, surgery is performed in the first 24-48 hours after hospitalization. The choice of surgical intervention (cholicectomy, removal of the gallbladder, or decompression with removal of infected bile) depends both on the nature of the inflammatory process and disease, and on the physical condition of the patient.

Gallstone disease is also called cholelithiasis. The gallbladder or its ducts enter a pathological state in this disease due to the formation of stones in them. These are rocky deposits, popularly called stones. But, of course, it is wrong to compare them with natural stones. They did not come from outside, but formed independently and were deposited inside a person for several reasons. Cholelithiasis is dangerous and carries serious health problems, pain, complications, and gives rise to secondary pathologies. The sooner you pay attention to the symptoms and go to a doctor who diagnoses and begins treatment of the disease, the better it will be possible to avoid surgical intervention to remove stones and the consequences of their formation.

Nature has designed the human body in the wisest way. Everything in it is a single harmonious system, which, if it functions normally, does not cause problems or reasons to think about your health. But when a person feels pain, this is a signal of trouble, some kind of malfunction, which the body sends to the brain so that it takes actions that can get rid of the problem.

Important! Doctors call the main and first symptom of cholelithiasis pain, namely, sudden colic, which is localized in the right side under the ribs. But this is a sign of an emergency operational situation, when the stones have moved and created a pathogenic focus. It all begins, at the stage of small formations, with bitterness in the mouth, heaviness spreading throughout the abdomen, starting on the right, and a transient feeling of nausea.

Bitterness in the mouth is one of the first signs of cholelithiasis

For what reason do stones suddenly appear in a well-functioning, normally functioning body, and why do they accumulate in the gallbladder?

The main reason is a violation of metabolic processes. The metabolism of calcium, protein, bilirubin, cholesterol, and so on is disrupted. Participants in these metabolic processes that do not dissolve in bile accumulate in it. There they, fastened to each other, turn into a monolithic compound, which over time hardens under the pressure of more and more particles arriving and clinging to it.

Important! When microscopic particles form stones, they can reach truly enormous sizes, compared to the size of their container - the gallbladder - five centimeters.

Statistically, the formation of gallstones occurs in every seventh person, and women are twice as susceptible to this pathology as men. Their bodies contain more estrogens, which inhibit the release of bile hormones.

Estrogens are hormones that stimulate stagnation of bile in the gallbladder.

In addition to slow bile outflow, low mobility and a predominantly static lifestyle, in which all metabolic processes are inhibited, can provoke the growth of stones. Also, constant consumption of fatty foods creates cholesterol accumulations, greatly increasing the likelihood of stone formation.

Concretions are divided into four types, depending on the components.

On a note! While the formations are small (and they range from 0.1 mm), they lie quietly at the bottom of the gallbladder, and the owner does not even know about their existence.

If he (or she) is lucky, he will be able to feel bitterness, heaviness and nausea after eating at an early stage of stone formation, before they are overgrown with deposits, reach large sizes and begin to move through narrow ducts, causing unbearable pain.

Signs and diagnosis

So, when a stone or several from the gallbladder decides to come out (under the pressure of bile) out, it is sent along the only available path - the bile duct. The mouth of the duct is narrow, and the paradox is that a small stone that could pass through it without problems will remain at the bottom of the bubble until it grows to a certain size. Only then will its volume and weight begin to interfere with the bile contents, and it will try to “put pressure” on the calculus, expelling it out.

What happens to the duct when a solid object with a volume greater than the width of the passage gets into it? Of course, the duct will become clogged.

Pain when a stone comes out the patient experiences it for two reasons at once. The first is injury to the walls of the duct when large solid masses move through it.
Second - obstruction of bile flow due to blockage. Bile, which continuously flows from the liver into the “reservoir” of the gallbladder (it is produced in the liver), is forced to remain there, without having access to the intestines, in order to fulfill its function - to help in the digestive process - and be excreted from the body. Stretching of the walls of the bladder, which increases as bile accumulates in it, leads to very strong pain under the rib on the right, throughout the abdomen, even in the right arm, thigh, collarbone and right side of the back.
Pain in the right hypochondrium is a symptom of the acute phase of cholelithiasis
Nausea begins, not related to food intake, and develops into vomiting.
The skin may turn yellow.
The temperature is rising.
High body temperature is one of the symptoms of the acute phase of cholelithiasis

Among themselves, doctors call this situation a “rockfall.” If it has begun, the pain may still stop and return, but it will intensify and become more frequent until it becomes incessant.

Important! If the outflow of bile is completely blocked, without providing assistance to the patient, the pancreas will soon become inflamed (it will begin pancreatitis), the gallbladder itself (the name of the pathology is cholecystitis), and also forms obstructive jaundice with all the consequences.

Diagnostic methods

Until the patient suffers from pain in the form of colic, it is quite difficult to diagnose cholelithiasis by eye. After all, nausea and heaviness in the stomach are symptoms of many diseases, even those not related to the gastrointestinal tract. Bitterness in the mouth can also be caused by more than just a single pathology. Even colic on the right does not indicate one hundred percent of cholelithiasis. How can you find out about the presence of stones? Using ultrasound.

Attention! Primary stones, which are not visible on ultrasound, at the initial stage, can only be detected when bile is taken for biochemical analysis.

Ultrasound or fluoroscopy of the abdominal cavity (in case of early diagnosis, the last procedure is with the introduction of contrast) will give an excellent result and help detect even small stones.

And if for some reason these two types of studies are not available, today there is an alternative - a special study called choledochoscopy. On it, the doctor will see the stones with his own eyes, determine their size and location with an accuracy of a tenth of a millimeter, and also inform the patient how necessary it is to operate in order to remove the stones.

Choledochoscope - a device for conducting choledochoscopy

On a note! The opinion of surgeons regarding stones is clear - remove them in any case. Most doctors of therapeutic specialization believe that it is better not to touch stones in the bile, as long as they behave calmly.

No symptoms - no treatment? It's not quite like that. It is possible and necessary to treat stones. More precisely, stones cannot be treated, but they can be crushed, dissolved, or removed in a less invasive way than surgery.

How to rid a patient of stones

Surgeons believe that it makes no sense to rid the patient of stones using conservative methods. This takes a long time, is not always effective, is fraught with side effects, and most importantly, the stones are likely to grow again.

That is, in principle, two ways are proposed. If stones are found, but their size is small and they do not give symptoms, it is recommended to ignore their presence, while following a diet and monitoring their size in order to notice in time their increase, which threatens the patient’s health. This situation can last for years and even decades.

The second way, if a “rockfall” has begun, is to completely remove the entire gallbladder.

Is there life without a gallbladder? Today medicine answers: “yes,” but its representatives on this issue are divided into two camps. Many people believe that a modern person does not need a gallbladder. And although it is removed, along with the stones and ducts present there, in emergency situations, for example, when acute cholecystitis, which is about to develop into peritonitis, causing inflammation of the entire peritoneum, or with complete blockage and developing rapidly pancreatitis, you can live without a gallbladder.

Moreover, the patient’s life and health will remain full, subject to regular nutrition. No, you won’t need special diets or strict regimes.

Regular nutrition is the key to permanent removal of the gallbladder

On a note! Our primitive ancestors did not have refrigerators and supermarkets. They received food only when they hunted successfully, and this did not happen every day. And if they are full, accordingly, irregularly. But on the day of a successful hunt, they ate “for future use.” This is why the gallbladder was needed - to store bile in a “reservoir” until the moment when it is needed to digest food (fats and proteins).

Since today a person can easily afford not to eat “for future use,” bile can be released directly from the liver in small doses gradually, carrying out a continuous digestive process.

The second “camp” is categorically against removing the bladder without endangering the patient’s life. They believe that the gallbladder plays a vital role in the digestive process. It’s true, the organ accumulates bile and throws it in portions into the intestines and stomach to ensure the digestion process. Without a bladder, bile will flow directly, its concentration will be more liquid, food will be digested less efficiently, which will eventually lead to gastrointestinal diseases.

Treatment options

If we leave aside radical surgical methods, there are still several options to cope with stones.

Table. Non-surgical methods of treating cholelithiasis.

Way	Description
	Firstly, a well-functioning diet. The regime is strict, the diet is specific. No fats, spicy, smoked, fried, minimum protein foods. This is necessary so that the stones, if any, do not acquire new “details” and remain safe, lying at the bottom of the gallbladder.
	Secondly, medications that dissolve stones. Such means exist, and they, albeit slowly, do their job. "Ursofalk", chenodeoxycholic acid and other drugs, with the help of which, with a certain patience and luck, you can completely get rid of stones within a year. Yes, it is expensive and not always effective. The effect depends on many factors, not just the size and number of stones. Moreover, if patients maintain their previous lifestyle, stones will almost certainly form again after just a few years. And possible complications after long-term use of these drugs are damage to liver cells.
	The third way to destroy stones is a shock wave. If the formations are single and small, they can be crushed and removed from the body naturally in small parts. This procedure is the most commonly used today because it is minimally invasive, well tolerated, highly effective, and can even be performed on an outpatient basis.
	The method has a significant drawback - the stones are crushed using an ultrasonic device into fragments with sharp ends. At the exit, they can damage the shells. Therefore, after crushing, the above-mentioned drugs are prescribed to dissolve the corners and smooth out the shapes in order to reduce complications.
	This method can partially be classified as surgical, since in order for the laser beam to crush the stone in a directional manner, a puncture is made in the body. There is also a drawback here - the possibility of burns to the mucous membrane.

In all cases except the first, the stones will almost certainly grow back. And the patient, exhausted from the fight against stones, will sooner or later agree to an operation to excise the gallbladder.

On a note! In case of surgery to remove the gallbladder, it is best to choose laparoscopy. With it, the anterior abdominal wall is punctured (that is, the tissue is not cut), and through these punctures the gallbladder with all its contents is removed. There are practically no marks, healing proceeds quickly.

Prevention and complications

The development of cholelithiasis is fraught with a number of complications.

What's the best thing to do? Do not have stones, or have them, but they are small, and try to prevent them from growing to a size where they will have to be removed along with the blister. To do this, it is necessary to engage in the prevention of cholelithiasis.

Important! If you have small stones, you cannot take choleretic drugs in any form, not even just medications, but also herbal remedies. They will certainly cause migration of stones and complications. You should also not drink mineral water.
Maintaining personal hygiene is a measure to prevent cholelithiasis

In general, there is nothing terrible or difficult in following these preventive measures. This is the norm of life of a healthy person, which he must adhere to if he does not want to have not only gallstones, but also many other diseases. After all, maintaining health is not the highest price to pay in order not to one day be faced with a dilemma: to live with a gallbladder filled with stones or without it. read on our website.
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