home Audience 2 Stones in the gallbladder, what to do. A. Chemical methods. Traditional medicine methods

Stones in the gallbladder, what to do. A. Chemical methods. Traditional medicine methods

Gallstone – These are small, hard granules that form in the gallbladder, simply put, gallstones. Very often the disease is asymptomatic, but it is dangerous because it can lead to the development of cholecystitis.

The size of the stones can be as small as the head of a needle or as large as Walnut. Until now, doctors do not entirely understand the main reason for the formation of gallstones, but it is known for sure that excess cholesterol in bile plays an important role in this disease.

Symptoms of gallstones

If a stone blocks the channel that transports bile from the gallbladder to the stomach, the patient experiences an attack of acute pain (colic) in the abdominal area. The following symptoms may also occur:

nausea;
vomit;
bloating;
belching;
sweating

Although, as we have already said, in most cases the symptoms of this disease do not manifest themselves in any way and a person with gallstones can live for many years without knowing about their presence.

There are several ways to diagnose gallstones:

blood test;
radiography;
ultrasound;
CT scanning.

Treatment of gallstones

Asymptomatic gallstones do not require treatment. The presence of stones, which are accompanied by periodic painful attacks, require immediate treatment. Most often, the patient is offered surgery to remove the gallbladder itself. The operation is called cholecystectomy. After the gallbladder is removed, bile passes directly from the liver to the intestines. There is a relatively new type of operation called laparoscopic cholecystectomy. This type of surgery reduces the patient's hospital stay and speeds up the recovery process, but it is not recommended for people who have had abdominal surgery in the past. During this operation, the doctor makes 4 incisions in the abdominal cavity and inserts a laparoscope (a special rigid endoscope designed for abdominal surgery) and a catheter with a miniature video camera. The video camera allows you to see the gallbladder and everything internal organs which are located next door. Also applicable non-surgical methods stone removal:

crushing stones using shock wave therapy;
drug dissolution of gallstones (it must be taken into account that this may take at least several months).

Prevention of gallstones

Almost any disease can be prevented if you carefully monitor your health. To prevent the formation of bile stones, doctors advise:

if cholesterol levels are high, consume foods that contain less cholesterol and a large amount of starch and fiber;
if you are overweight, combine proper nutrition and physical activity to lose weight without harm to the body;
refrain from smoking, which can lead to gallstones; women who have previously had gallstones should avoid birth control pills with estrogen, since this hormone can cause gallstones.

37 comments to the article “Treatment of gallstones without surgery”

Thank you very much! Herbal treatment also takes about 24 months. The result is not always predictable. What do you know about this?

Unfortunately, herbal treatment is almost not studied in medical universities. But properly selected fees will definitely not make things worse. Therefore, such treatment of gallstones without surgery can only be welcomed. It is better to be treated in a comprehensive manner, and if surgery is really necessary, do not delay it.

Good day! What can you say about laser stone removal?

Hello! Can you tell me??? 3 days ago my aunt had her gallbladder with a bunch of stones removed. She was admitted to the operating table after the yellow disease had passed for 12 days. He is still in intensive care. Jaundice does not subside (they want to refer it for plasmapheresis)
What could cause this and what should we expect??? The doctor speaks in incomprehensible terms and very quickly, I don’t have time to remember………..

Most likely, some kind of stone blocked the bile ducts, which is why jaundice developed. But these are just my assumptions.

But then I know absolutely for sure. The duty of the attending physician is to convey information to relatives in a form ACCESSIBLE to them. At the beginning of the conversation, ask the doctor to explain your aunt's condition to you slowly and in simple words. As a last resort, you can address this question to the head of the department or to the chief of medicine (deputy chief physician for medical work).

Good afternoon
After the attack, an ultrasound examination revealed a 13mm stone in the gall bladder,
They advised to just cut it out, although it was said that you can live with the stone for another 20 years, please advise in an accessible form what to eat and whether it is worth rushing to have the operation. Thank you in advance.

You can try to dissolve a 13 mm stone. If it doesn't bother you, then you can probably wait to have surgery, although you should discuss this with your surgeons.

I have already written before about nutrition in the presence of gallstones. Read the article itself and the comments to it.

Good afternoon.
After giving birth, I began to experience regular bouts of wild pain. After my long complaints, I was sent for an ultrasound, and it turned out that there were at least 6 stones of 0.6 cm and inflammation of the gallbladder. I was not prescribed any medications because I am breastfeeding, the only thing was Nimesil to drink during an attack. I read the summary and realized that it’s better not to drink this. Do you know any remedies (folk or homeopathic) to relieve pain during an attack? Thank you.

Unfortunately, in folk and homeopathic remedies I'm not very good at understanding... 🙁

Good afternoon doctor! Tell me, my grandmother has gallstones of 12 and 7 mm, she was sent for surgery. She is 79 years old! Is it dangerous to have surgery on her at this age, what are the risks? Or is it worth using other methods of treating stones? Thank you in advance.

Usually in old age There are many concomitant diseases due to which the patient may not be able to tolerate planned surgery. For such an operation you need a positive opinion from a therapist and an anesthesiologist (who gives anesthesia). As a rule, at this age patients undergo surgery very rarely.

However, when it comes to life and death, patients are operated on anyway (surgery for life-saving reasons). Despite the high risk of dying during surgery, refusing surgery will also lead to death.

This general provisions. In your case, you should discuss this issue with surgeons, as well as with a therapist and anesthesiologist. Need to weigh possible risks and the benefits of the operation.

My wife has a 9 mm stone, tomorrow is the 3rd day in the hospital, in the morning there is a meeting with the doctor, and in the evening we need to make a decision: surgery or does it make sense to dissolve it??

To correctly decide on an operation, doctors take into account not only the size and number of stones, but everything in general: the composition of the stones, the presence of cholecystitis, the dynamics of the disease, the results of previous treatment, the age and concomitant diseases of the patient, his desire and much more.

2Vladimir:
Sorry, I’m not a doctor, but I’ve encountered this problem myself. I have a 1.6 cm stone, and the first thing they said was to remove the gallbladder. After meetings with many doctors, it turned out that the function of the gallbladder was not impaired, there was no dyskinesia of the tract... After three months of a strict diet, the attacks stopped, although before that they were repeated monthly, fine sand began to come out. It is important to understand whether the stones have a destructive effect on the walls of the gallbladder, on its function and on the bile ducts in general - this helps to understand whether you still have time to search alternative paths treatment...

2Emergency doctor: I hope I was not wrong in my statement... sorry for taking the initiative... and thanks for the article!

Svetlana, I wrote the same thing, but in different words. I will say more - often surgeons first offer surgery as a quick and reliable means solve the problem in one fell swoop. In addition, they receive additional payments for high operational activity (number of operations per 1 bed). That's why surgeons don't really want to treat people conservatively.

😯 sorry again, and thank you again - it was after your article that I became motivated to look for other opportunities.

I have been sick for a year and a half - a gallstone, 1 cm, easily dislodged. Dull pain often, there was one severe colic. The pancreas worries me too. I decided to have the operation. Questions. What is the prevention of stone formation in the future? Since I was young (now 45), kidney stones have also formed, some were cut out, now again a large stone + small ones in the kidneys. Is there something wrong with your metabolism? Why do I have so many stones? No excess weight active image life, family there.

Alina, it looks like you have a high tendency to form stones. I have already written about preventing the formation of gallstones. As for the kidneys, nutrition there also depends on the type of stones, in some cases they can even be dissolved.

Good day. My wife, a month after giving birth, had severe pain, an ambulance took her to the hospital, they said that there were stones in the gall bladder and she needed to have an operation. The operation was refused. Two weeks later the pain recurred, the skin and eyes turned yellow. After the examination they said that the stone was in the duct. Two days later they did a probing (to remove the stone from the duct), but there was no stone. Please tell me, can such pain be not due to stones? What research can be done to ensure the accuracy of the diagnosis?
Thank you in advance.

Research: main - ultrasound. Other studies are only prescribed by a doctor, for example, cholangiography (x-ray with contrast).

Hello, Doctor. About 3 years ago, the first attack of colic occurred, lasting about 15 minutes. Then the emergency doctor said that it was the stomach. That's what I thought all these 3 years. Of course, youth, etc. There was no talk of any diet. The attacks recurred every 2-3 months. and their duration increased. Then one friend advised me to drink an infusion of oatmeal in the morning - and I never had any attacks, despite the fact that I ate the same as before (fried food, pork, etc...). Then, apparently considering myself recovered, I stopped drinking the “potion.” Recently I was at a picnic, where I ate very, very poorly - as a result, an attack that only stopped under a drip in the hospital after 6 hours. An examination showed stones in the gall bladder, multiple 5-7 mm, slightly thickened walls. I went to the surgeon, sat with him for about 5 minutes, and without asking much, he said to operate. Of course, I asked what this would entail, to which he said - everything will be OK.

Then I decided to look through the Internet and changed my mind. God forbid you become one of those 10% who then begin chronic diarrhea. This is the end - the person is not allowed to travel abroad. And also all sorts of syndromes... Please tell me what examinations I need to do now (in other words, what should I tell the therapist) to find out if it is possible to get rid of them without gall bladder surgery? The stones don't seem to be big. There is a lot of information about Ziflan on the Internet. What do you think if you've heard of it? In general, what dangers can there be when expelling gallstones? Thanks in advance, I'm really looking forward to your answer.

Periodically suffering from attacks of hepatic colic, it was necessary not to wait, but only then to be examined and treated.

The scope of the examination depends on the capabilities of the clinic, but since you have already been examined in the hospital, it is unlikely that the clinic will be able to offer anything better.

I haven’t used Ziflan, consult your surgeon and therapist. Judging by the description, the drug is not bad.

There is usually only one danger when expelling stones from the gallbladder - blockage of the ducts, which requires surgery. But if you dissolve the stones slowly, there shouldn't be any problems.

Good afternoon.
I visited your site and couldn’t help but write to you. I would like to express my respect and gratitude to you in advance for not ignoring requests to you and responding to them. I hope that you will answer me too.

The fact is that I am 23 years old, an ultrasound recently showed that I have 4 stones in my gall bladder. 0.8 cm each. But they practically do not make themselves felt. I wanted to ask: during pregnancy (my husband and I are planning a child in the near future), is there a danger in this situation for me or for the child if these stones are not removed? Let me explain: I heard that if a woman has gallstones and she is pregnant, then there is a possibility of termination of pregnancy. Since the fruit puts pressure on the bladder, the stones, in turn, also make themselves felt. And in this case it is necessary to terminate the pregnancy.

I would really like to know the answer: I need to remove them so that there are no problems during pregnancy, or I can calmly plan for a child and not “touch” the stones.

Thank you in advance, best regards, Katya

Dear Katerina, unfortunately, your question is from the field of obstetrics and gynecology. I have little understanding of this. You should contact an antenatal clinic. They should know, because there are many women with gallstones. Although, of course, before pregnancy you should, if possible, get rid of health problems.

Thank you very much for your answer

Good afternoon, thank you for your clear presentation 🙄

I am confused by the different locations of the gallbladder in the diagrams and drawings: my gall bladder looks like what you show - the bottom of the bladder is higher than the neck of the bladder.

But in many pictures I see that the location is different - the bottom of the bubble is at the bottom, so the difference in location is 45%!!! As I understand it, the location of the bubble is not described and is not taken into account when making a diagnosis. Does this matter and which position of the gallbladder is more “correct”?

Thank you!!!

The size, shape and location of the gallbladder are variable, so where exactly the bottom is is not important. The main thing is not the form, but the content. 🙂

Thank you!
It just seems to me that this matters when determining the likelihood of stones getting into the bile ducts (in a horizontal position this will be more likely) and also matters when prescribing choleretic and antispasmodics. Maybe I'm being too wise 🙄

If the stones “want” to get into the channels, they will get there in any case. After all, during the day you not only walk, but also lie and bend. In addition, the liver is not fixedly fixed, but is connected by ligaments to a movable diaphragm. And the gallbladder is able to contract thanks to the muscle layer in the wall.

Hello!!!
My name is Elena. A 1.2 cm stone was found in my gall bladder.
I am a disabled person of the 1st group, I suffer from myopathy. I'm afraid to have surgery. I don't know what to do. I haven't done any tests yet. I don’t even know what I can do. What advice could you give me?

First, you need to contact your physician and surgeon about non-surgical treatment. If you have enough money and the stones begin to dissolve, get treatment. If not, you need to think about surgery.

Gallstones are a sign cholelithiasis. It is usually detected by ultrasound and may come as a surprise to the patient, because small stones do not cause severe attacks pain, and a person may not be aware of their existence. Of course, if the stone large sizes closes the duct, it causes an attack similar to hepatic colic, and the patient already learns about it on the surgical table. Let’s find out in detail how stones appear and what their varieties are.

Gallstones in the gallbladder can be of different sizes, in different quantities, differ in their composition and color, as well as in location.

They can dissolve, forming sand in the gallbladder, exit into the bile ducts (if they are small) or block them.

It is worth considering in more detail the classification of stones according to their chemical composition.

They can be:

cholesterol;
pigment or bilirubin;
limestone;
mixed.

Why does each type of stone occur, and what does it represent?

Cholesterol stones are stones that are 80% cholesterol deposits. These gallstones can be of different shapes (round, oval, flat), different sizes (from 1 mm to 4 cm). Typically they are yellow-green in color.

They arise as a result of crystallization of cholesterol against the background of a decrease in the level of bile acids and lecithin in the composition of bile. Most often, such a disorder is observed in liver disease, unhealthy diet (overeating or starvation), diabetes mellitus and endocrine disorders. With these diseases, the acidity level of bile decreases, resulting in its stagnation and the deposit of cholesterol in the bladder.

Bilirubin stones appear when there is a high concentration of bilirubin in the patient’s blood, as well as hemoglobin breakdown products. Usually there are many such stones, they are small, do not exceed 1 cm, and are dark green or black in color. Bilirubin stones appear due to infections, intoxication of the body, anemia, or consumption medicines.

Calcareous stones appear due to the deposition of calcium salts and crystallization of cholesterol in the gallbladder. Most often this happens due to inflammatory processes in the bladder or the action of bacteria.

Sometimes it is very difficult to determine which stone is in the gall bladder. In this case they talk about mixed type when cholesterol and bilirubin stones are covered with a layer of calcifications. They are found in large quantities in the gallbladder and are yellow-brown in color.

The type and, accordingly, the composition of the stones is very important when choosing a treatment method. The effectiveness of treatment depends on the correctness of the diagnosis.

How to find out about the presence of stones?

Heaviness symptoms of cholelithiasis depends on the stage of development of the disease.

Let's look at all the stages in more detail:

The first stage lasts several years. It is characterized by the fact that the liver begins to produce bile with a high content of cholesterol and low content of bile acids. In this case, there are no symptoms; you can find out about the onset of the disease only after examining the bile.
The second stage is characterized by the formation of stones as a result of changes in the composition of bile and its stagnation. Signs of gallstones may be absent if the stones are located directly in the bladder. If they begin to move into the neck of the bladder and clog the duct, in this case cholecystitis develops, resulting in various complications and painful sensations appear in the lower abdomen.
The third stage of cholelithiasis is considered if the patient develops complications in the form of different forms cholecystitis and cholangitis. The severity of symptoms in this case depends on the size of the stones, their location, and organ damage digestive system(liver, pancreas).

It is worth noting that the calculus can get into the neck of the bladder and thereby cause hepatic colic.

Large stones, for example cholesterol stones, can clog the duct and cannot be avoided without surgery. If the stones are small (up to 5 mm), they can freely pass through the duct and enter the intestine or return from the cervix back to the bladder.

If the stone remains in the bile duct, it causes complications in the form of cholangitis, acute or choledochitis. The bile becomes infected and inflammation of the organ develops, symptoms such as dull pain in the abdominal area in the upper right quadrant and jaundice appear.

Important! With calculous cholecystitis, stones are found in the bile duct in 80% of patients with a high concentration of bilirubin.

If, with cholelithiasis, colic appears on the right side of the abdomen, body temperature rises and yellowing is noted skin, then this indicates the presence of infection and cholangitis. With bacterial cholangitis, the infection can spread to the liver, pancreas and lead to severe consequences.

When a stone passes through the bile duct, the patient may develop a fever and jaundice, but such symptoms persist for several days, after which they disappear.

But it is worth noting that the signs of gallstones depend individually on each person. It happens that large stones do not cause discomfort to a person, while in others small stones cause severe attacks of pain.

Gallstones may cause symptoms such as pain varying intensity in the right hypochondrium, a bitter taste in the mouth, nausea or vomiting, and bloating.

Often the appearance of these symptoms is accompanied by stress, physical activity, or eating foods containing high amounts of cholesterol.

In children, cholelithiasis can manifest itself in the form of gall bladder or duct stones without complications, or it can be combined:

with acute there is an attack of colic;
with chronic cholecystitis.

The child has initial stage Cholelithiasis is marked by an inflammatory process in the bladder, and the composition of the bile changes, after which destructive changes occur in the walls of the organ and circulatory disorders.

Most children do not have such symptoms of gallstones, it all depends on the reaction of the autonomic nervous system. Some children experience pain similar to diseases of the gastrointestinal tract. But if stones from the gall bladder descend into the neck, then attacks of acute pain in the abdomen occur; in addition, the child begins to vomit and jaundice appears.

Important! If signs of hepatic colic appear, the child should be urgently taken to the hospital.

In children, the following trend is observed in the development of gallstone disease:

In the first year, inflammation and stone formation occur.
In the second year, the inflammatory process covers all layers of the walls of the gallbladder and recrystallization occurs in the stones.
Over the next few years, the gallbladder becomes infected and chronic cholangitis develops with all the accompanying complications.

To prevent such consequences in children, preventive measures must be taken. Why do stones appear in adults and children?

What causes stones to appear?

Gallbladder stones appear when there is a high concentration of calcium, cholesterol or bilirubin in the bile. What contributes to this?

Scientists have discovered why the composition of bile may change. The imbalance of substances is influenced by the use of hormonal drugs and certain medications, obesity, frequent childbirth (in women), heredity, diabetes mellitus, anemia, cirrhosis of the liver, and previous operations to remove parts of the digestive system (parts of the liver or intestines).

An attack of cholelithiasis occurs when eating improperly, eating too fatty or spicy foods.

What can affect the appearance of stones in children?

Gallstones in children can appear for the following reasons:

poor nutrition(consumption of fats, easily digestible carbohydrates and proteins), which leads to metabolic disorders;
heredity (congenital disorder of phospholipid metabolism and lipoprotein defect);
malformations of the bile ducts and bladder, which lead to stagnation of bile.

Against the background of the appearance of gallstones, children may develop inflammation and calculous cholecystitis. In this case, an attack of pain appears.

How to avoid the formation of stones, and how to treat if they are detected?

Prevention and treatment

For both adults and children, the best way to prevent blockage of the ducts and the development of complications in the form of various diseases is the prevention of stone formation.

To prevent cholelithiasis in children, it is necessary to provide the child with proper nutrition from birth. Breastfeeding is the best preventative against many diseases, including obesity and gallstone disease.

Basically, for prevention you need:

monitor your weight, if you are overweight, stick to a diet and exercise;
eat healthy foods that are low in cholesterol and calories;
for women it is recommended to avoid the use of hormonal drugs containing estrogen;
promptly treat disorders of the gastrointestinal tract, such as liver disease, intestinal dysbiosis.

Gallbladder stones are not dangerous to health. When small in size, they can dissolve and come out along with bile. But large stones can block the bile duct. In this case, an infection occurs, which contributes to the development of inflammation of the gallbladder and liver.

Stones are diagnosed by ultrasound or X-ray examination. If their presence is not accompanied by pain, then treatment is not necessary. When a painful attack occurs, surgical intervention is most often required.

For moderate pain and small stones, the doctor may prescribe medications to dissolve the stones. It is worth noting that treatment with medications is quite long, sometimes the drugs need to be used for several years. In order to prevent the formation of new stones in this case, it is necessary to eliminate the cause of their appearance.

It is possible with the help of choleretic drugs such as Ursofalk, Ursosan, Henochol, Henosan. As aid Lecithin is used.

But there are some conditions for application medicinal dissolution concretions, namely:

stone size up to 2 cm;
the gallbladder is no more than half full of stones;
patency of the bile ducts;
absence of inflammation and other complications such as cholecystitis and cholangitis;
absence of colic attack;
absence of liver diseases.

If one of the above restrictions is present, surgery to remove the gallbladder is necessary.

As an exception, stones that are larger than 2 cm can be crushed by ultrasonics and then dissolved.

You can also dissolve stones using a chemical method. In this case, a special liquid is injected into the gallbladder through a catheter to dissolve cholesterol. The procedure itself lasts from 4 to 16 hours. But it is worth noting that this method can only be used for cholesterol stones.

Important! All medications should be prescribed by a doctor after examining the gallbladder, duct and liver. Self-medication often leads to stone getting stuck in the duct, an attack of pain and subsequent surgery.

If there are a large number of stones, surgery to remove the gallbladder is performed using two methods using laparoscopy and open cholecystectomy.

Recently, doctors have been practicing a new method of removing stones while preserving the bladder using a laparoscope.

To remove a stone stuck in the duct, the method of endoscopic retrograde cholangiopancreatography is used.

During an attack of colic, when severe pain occurs, it is recommended to take a painkiller. Atropine, Papaverine, Ketonal, Analgin or Ketanov are suitable.

Particularly effective during an attack of colic combination drugs, such as Combispasm, Bellalgin, Spasmalgon. They have an analgesic effect and relieve muscle spasm

Sometimes the pain is so severe that only intramuscular injection medicines.

Stones can appear completely unexpectedly in any person, regardless of age. Only proper nutrition, active and healthy image life will be the best preventive measures for their education. If stones are detected, you should not immediately resort to surgical intervention, because cholesterol stones can be dissolved with medication and chemicals. Gallstones have different types and manifestations, therefore it is worth studying this issue fully in order to avoid mistakes during therapy.

Classmates

What are gallstones?

Gallstone disease (cholelithiasis) is considered one of the most common diseases. It is characterized by formation in the gallbladder hard stones, different sizes and shapes. More often, women suffer from the disease, as well as people who abuse fatty and protein foods.

The gallbladder is important organ involved in the digestion process. It accumulates bile produced by the liver, which is necessary for digesting food. It has narrow ducts that open into the small intestine and deliver bile to it for digestion fatty foods, cholesterol, bilirubin. It is from bile that rocky formations are formed that block the bile ducts.

What is gallstone disease

The disease is characterized by the formation of hard stones in the gallbladder or ducts. Pathology appears as a result of a disorder in cholesterol metabolism. Bile consists of bilirubin and cholesterol, and stones in the bladder are formed due to its stagnation. In this case, cholesterol is retained in the body and forms a dense sediment in the gallbladder, from which sand is formed.

Over time, if treatment is not started, the grains of sand stick together, forming solid conglomerates. The formation of such stones takes from 5 to 25 years, and the patient for a long time does not experience any discomfort.

The risk group for cholelithiasis includes older people, as well as patients taking medications that affect cholesterol metabolism. The development of the disease can be triggered by hereditary disposition, unhealthy diet (overeating and starvation), some gastrointestinal diseases, and metabolic disorders.

Watch the video about the effects of fasting on the gallbladder:

Symptoms of gallstones

The severity and degree of manifestation of symptoms depends on the size of the stones and their location. The longer the disease lasts, the more painful the symptoms. One of the most pronounced signs cholelithiasis is severe and sharp pain, called hepatic or biliary colic.

It is localized in the right hypochondrium, and a few hours after the onset of the attack, it covers the entire area of the gallbladder. The pain can radiate to the neck, back, under the shoulder blade and to the heart.

Main symptoms:

heartburn;
bitterness in the mouth;
belching;
pain under the ribs on the right;
general weakness.

The cause of the attack is often the consumption of fatty, spicy and fried foods, and alcohol. Pain can be caused by stress, physical overload, and spasm of the gallbladder caused by the movement of stones. Blockage bile ducts accompanied by constant nagging pain, feeling of heaviness in the right side.

Characteristic symptoms include severe nausea and vomiting, abnormal bowel movements, and bloating. In some cases, there is an increase in temperature, fever, and if the main bile duct is completely blocked, jaundice and white feces are observed.

Causes of stone formation

The gallbladder has a volume of no more than 70-80 ml, and the bile contained in it should not linger or accumulate. The process of its movement to the intestines must be continuous. With prolonged stagnation, cholesterol and bilirubin precipitate, where they crystallize. This process leads to the formation of stones of various sizes and shapes.

Causes of cholelithiasis (cholelithiasis):

obesity;
taking hormonal medications;
heredity;
alcohol abuse;
irregular meals, prolonged fasting;
taking medications that affect cholesterol metabolism (Octreotide, Cyclosporine);
inflammatory process in the gallbladder;
women have multiple births;
diabetes;
intestinal surgery;
increased level calcium in bile.

Often, cholelithiasis is caused by eating fatty and spicy foods, endocrine pathologies, and toxic liver damage.

Types of gallstones and what sizes they reach

There are several types of stones that differ in composition. It depends on constituent components bile.

Types of stones:

cholesterol;
limestone;
mixed;
bilirubin.

Cholesterol stones are round, smooth formations with a uniform structure. They can reach a size of about 15-20 mm in diameter, and the reason for their formation is metabolic disorders in obese people. They are localized exclusively in the gallbladder and appear in the absence of an inflammatory process.

Calcareous, composed of calcium, and the cause of their formation is considered to be inflammation of the gallbladder. Around bacteria or small particles of cholesterol, calcium salts accumulate, which quickly harden and form stones of various shapes and sizes.

Mixed stones occur as a result of increased inflammation in the liver and gallbladder. For cholesterol and pigment formations Calcium salts are layered, forming solid heterogeneous formations with a layered structure.

Bilirubin is formed regardless of the presence of inflammation, and the reason for this is a violation of the protein composition of the blood or congenital defects associated with increased breakdown of red blood cells. These stones are small in size and are often located in the bile ducts.

The least common are calcareous stones, and more often mixed ones, the size of which ranges from 0.5 mm to 5-6 cm.

Diagnosis of cholelithiasis

GSD is asymptomatic for a long time, and patients go to the doctor only with severe pain. Hepatic colic requires examination by a gastroenterologist to confirm the diagnosis. The doctor must prescribe general analysis blood and biochemistry.

On biochemical research, an increased level of bilirubin is clearly visible, and in general there is an increase in leukocytes and a rapid ESR (erythrocyte sedimentation rate).

Further diagnosis requires ultrasound of the gallbladder, which shows the presence of stones in the gallbladder and ducts in 90-95% of cases, as well as choledochoscopy. Visible on x-ray calcareous formations, and ultrasonography using an endoscope allows you to see gallstones in very overweight, obese patients.

ERPG (endoscopic retrograde cholangiopancreatography) effectively identifies stone formations in the bile ducts.

When is it better not to touch gallstones?

A surgeon will help get rid of large stones, but if the disease does not manifest itself in any way, then there is no need to treat it. The main thing that needs to be done is to follow a diet, lead a healthy lifestyle, and give up bad habits.

Small stones can be dissolved with the help of medications, but the treatment will take a very long time, and the effect is short-lived. In addition, the use of such drugs destroys liver cells and causes multiple complications.

If 1-2 small pebbles are found, they can be crushed using a shock wave. After which, the resulting fine sand leaves the body on its own. Under no circumstances should you use choleretic drugs (including during plant based). Uncontrolled movement of stones through the gallbladder can lead to dangerous complications.

Treatment methods

Drug treatment is used only at the initial stage of development of cholelithiasis.

In this case, the doctor prescribes the following medications:

The addition of a secondary infection requires the use of antibiotics, and to dissolve cholesterol stones, Ziflan and bile acid preparations are used. The latter contain different active substances and are divided into two groups: ursodeoxycholic (Ursosan, Ursofalk) and chenodeoxycholic (Chenosan, Henochol).

Taking such drugs requires compliance with certain conditions:

small size of stones (5-15 mm in diameter);
the gallbladder contracts on its own;
There are no stones in the bile ducts.

You will have to take these medications for a long time, more than 2 years, and they can cause many complications.

There is a rather interesting technique called contact dissolution. Its essence is that a special substance that dissolves stones (Propionate) is injected into the gallbladder and ducts. After such a procedure, the patient requires long-term maintenance therapy.

No less popular is spraying (shock wave therapy), which turns stones into small grains of sand. But this method of treatment can only be used if there are no stones in the ducts.

Find out in the video about a powerful remedy that helps remove stones from the gallbladder:

When is gallbladder removal surgery necessary?

Complete removal of the gallbladder is carried out with the development of acute calculous or chronic cholecystitis. In this case, an open abdominal surgery(classical cholecystectomy) or surgery using laparoscopy (laparoscopic cholecystectomy).

In some cases, it may be necessary surgical removal stones by laparoscopy, without removing the gallbladder. It is carried out in cases of frequent relapses and the presence of large stones.

Diet for gallstone disease

The first signs of the appearance of stones require a transition to strict dietary food. In this case, table No. 5 is assigned, and you will have to stick to it for life.

The following are completely excluded from the menu:

You should eat in small portions, at least 5-6 times a day, and food should be boiled or baked without butter or fat. The diet should contain a large amount of vegetables and vegetable oils.

Prevention

To prevent cholelithiasis, you need to eat right, normalize weight, exercise, or simply provide regular physical activity.

If cholelithiasis has already been diagnosed, in order to avoid repeated relapses, it is necessary to take litholytic drugs for six months, be wary of taking certain medications, and reset excess weight. Prolonged fasting and irregular diet can also trigger the formation of stones.

Conclusion

Cholelithiasis is more common in women, and its appearance can be triggered by poor nutrition, physical inactivity, heredity, and bad habits.
The disease can be asymptomatic for a long time, without causing any discomfort.
If hepatic colic occurs, you should immediately consult a doctor.
You cannot take herbal choleretic drugs when diagnosing cholelithiasis.
You cannot choose medications to dissolve stones on your own. This should be done by a specialist.

Gastroenterologist, Hepatologist

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 egg to millet grain and less. Stones can have different chemical compositions. Cholesterol, lime and bile pigments participate in their formation. Therefore, in the process of stone formation important role metabolic disorders in the body, bile stagnation and infection play a role. 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. Most common reasons, causing the appearance 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 feeling dull pain, feeling of heaviness in the right hypochondrium, 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 clinical manifestations of cholelithiasis essential have functional disorders of extrahepatic biliary tract 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 various 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 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 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 substances. components bile, as well as a violation of general metabolism with blood overload 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, easily causing deposits lime and other components of bile are rather only secondary, rarer factors of stone formation. It has the same meaning over-allocation bilirubin bile with massive hemolysis.

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 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 mammary gland. Particularly significant disturbances in metabolic and vegetative processes can be expected when the physiological rhythm of the reproductive function is disrupted during repeated abortions or premature birth without subsequent lactation, etc., when there may be a delay in the emptying of the gallbladder 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 rich in cholesterol food (fatty fish or meat, caviar, brains, butter, sour cream, eggs) promotes the formation of stones, of course, when 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. From past diseases Special attention was given to typhoid fever, since it is known that 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 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 brief description. 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 chronic course, leading to disability of patients and even threatening their lives in certain periods diseases 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 gallstone disease, almost as numerous as, for example, complications peptic ulcer stomach and duodenum, first of all, blockage of the bile ducts and their infection are described 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, if present 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 with 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 malignant neoplasms 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 proof the presence of a stone can be determined 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.

Concerning differential diagnosis, then in various stages cholelithiasis has to take into account a number of diseases. In case of gallstone dyspepsia, it is necessary to exclude first of all a gastric and duodenal ulcer, 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, the cause of biliary colic is almost always stones, but in in rare cases it can be caused by an roundworm stuck in the ducts or an echinococcus bubble. 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 correct mode 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, in patients surgical departments are the most serious complications gallstone disease, giving a relatively high mortality rate.

At frequent exacerbations cholelithiasis and severe inflammatory phenomena (fever, leukocytosis), 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 if there is significant severity and persistence nervous disorders and frequent, mostly non-infectious, low-grade fever. 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 increased content magnesium, calcium, carotene, vitamins B, A. 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, it is necessary timely treatment infectious diseases. 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.

For the prevention of cholelithiasis, a general hygienic regime, sufficient physical activity and proper nutrition are important, as well as the fight against infections and dysfunction gastrointestinal tract, elimination of bile stagnation, elimination nervous shocks. 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, and periodically carry out 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.

Very important in the treatment of cholelithiasis has dietary nutrition. In acute attacks of biliary colic, a strict gentle regimen is necessary. Should be considered associated lesions gastrointestinal tract or other diseases (colitis, constipation, diabetes, gout).

In case of cholelithiasis, it is usually necessary to limit patients both in terms of the total calorie content of food and in relation to meat, fatty foods, especially smoked foods, canned food, snacks, as well as alcoholic drinks. Particularly cholesterol-rich foods should be excluded from food egg yolks and brains, sharply limit butter. 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 turns to 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 physicochemical characteristics food, but also individual tolerance to it.

During periods of sharp exacerbations of the disease, a meager diet is prescribed: tea, rice and semolina on water, jelly, white inconvenient 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, fresh butter is allowed in the future in small quantities, 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(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 dirt and, finally, an appropriate dietary regimen, the metabolism changes in a favorable direction, the inflammatory phenomena subside, the bile becomes less viscous and is easier to remove from the biliary tract, and the normal nervous regulation of the activity of the hepatobiliary system is largely restored.

Among medicines, bile acids (decholine) may be important, allowing normal ratio bile acids and cholesterol and thereby counteract stone formation; herbal preparations, rich in antispasmodic, 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, Campolon, blood transfusion, etc.

At obstructive jaundice Prescribe the same drugs that improve the condition of the liver, 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 Limited accumulations of pus are subject to 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 the operation, 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. Foods rich in cholesterol and fats (brains, eggs, fatty varieties meat), rich meat soups, spicy and fatty dishes, lard, smoked meats, canned food, baked goods, alcoholic drinks. 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 in moderation, regularly and often, with drinking 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 cholelithiasis should be timely.