How does gallstone disease manifest itself? Gallstone disease (cholelithiasis) causes, diagnosis and treatment. Symptoms and signs: an attack of pain, what to do

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

The second name of the disease is calculous cholecystitis. Since cholelithiasis affects the organ of the digestive tract (gall bladder), it is usually treated.

Features of gallstones

Calculi are the main manifestation of gallstone disease. They are made up of calcium, cholesterol, and bilirubin, and come in a variety of sizes. With a small value, we are talking about the so-called "sand" in the gallbladder, but if the formations are large, they are considered full-fledged stones (calculi).

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

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

Stones in the gallbladder can be either single or multiple. There may be dozens, or even hundreds. However, it should be remembered that the presence of even one calculus can cause serious harm to health. Moreover, dangerous complications are often the result of small rather than large gallstones.

Reasons for the formation of stones

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

Hypercholesterolemia may result from:

obesity;
abuse of fatty foods containing a large amount;
reducing the amount of specific acids entering the bile;
reducing the amount of phospholipids that prevent hardening and settling and cholesterol;
stasis of bile.

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

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

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

Classification

Gallstone disease is divided into several stages:

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

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

Types of gallstones

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

Cholesterol. Cholesterol is one of the components of bile, but when it is overabundant, calculi can form. This substance enters the human body with food, and is evenly distributed throughout its cells, contributing to its full functioning. If there is a violation of the process of assimilation of cholesterol, it begins to accumulate in the bile, forming stones. Cholesterol stones are round or oval in shape and can be 1 to 1.5 centimeters in diameter. Their location often becomes the bottom of the gallbladder.
Bilirubin. Bilirubin is a breakdown product of hemoglobin. Stones that form with its excess in the body are also called pigment stones. Bilirubin calculi are smaller in size than cholesterol calculi, but they may be larger in number. At the same time, they affect not only the bottom of the gallbladder, but are also able to be localized in the biliary tract.

Gallbladder stones can have varying degrees of calcium saturation. It depends on it how clearly it will be possible to see the neoplasm on the screen of the ultrasound machine or on the x-ray. In addition, the choice of therapeutic technique also depends on the degree of saturation of stones with calcium. If the stone is calcified, then it will be much more difficult to deal with it with medications.

Depending on the size of the gallstones are:

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

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

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

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

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

Symptoms and signs of gallstone disease

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

The patient may not be aware of the presence of the disease for a long time, that is, be a latent stone carrier. When the neoplasms reach a fairly large size, the first alarming signs of the pathological process in the gallbladder appear. They may appear in different ways.

The first symptoms of gallstone disease that occur even before the onset of pain in the right hypochondrium include:

feeling of heaviness in the abdomen after eating;
bouts of nausea;
slight yellowing of the skin (mechanical jaundice).

Such a clinical picture occurs due to a violation of the outflow of bile. Under the influence of such a failure, deviations occur in the work of the organs of the digestive tract.

The most common symptoms and signs of GSD include:

, which signal the development of biliary colic. The duration of the attack can last from 10 minutes to several hours, while the pain can be acute, unbearable, and give to the right shoulder, other parts of the abdomen or back. If the attack does not go away within 5-6 hours, the patient may develop serious complications.
An increase in body temperature, indicating the development of an acute disease, which is a frequent companion of cholelithiasis. Intense inflammation of the gallbladder leads to an active release of toxic substances into the blood. If there are frequent attacks of pain after biliary colic, and they are accompanied by fever, this indicates the development of acute cholecystitis. If the temperature rises are temporary, and the thermometer reaches 38 ° C, this may indicate the occurrence of cholangitis. But, nevertheless, temperature is not an obligatory sign of cholelithiasis.
development of jaundice. This anomaly occurs due to prolonged stagnant processes due to a violation of the outflow of bile. First of all, the eye sclera turn yellow, and only then - the skin. In people with fair skin, this symptom is more noticeable than in swarthy patients. Often, along with yellowing of the skin and whites of the eyes, patients change color and urine. It acquires a dark shade, which is associated with the release of a large amount of bilirubin by the kidneys. With calculous cholecystitis, jaundice is only an indirect, but not an obligatory symptom. In addition, it can become a consequence of other diseases - cirrhosis, hepatitis, etc.
An acute response of the body to the intake of fats. Under the influence of bile, lipids are broken down and absorbed into the blood. If stones are located near the neck or bile duct with cholelithiasis, they simply block the path of bile. As a result, it cannot circulate normally in the intestines. Such an anomaly causes diarrhea, nausea, flatulence, dull pain in the abdomen. But these symptoms are not specific manifestations of cholelithiasis, since they occur in most diseases of the gastrointestinal tract. Fatty food intolerance can occur at different stages in the development of gallstone disease. However, even a large calculus, if it is at the bottom of the diseased organ, is not an obstacle to the outflow of bile. Therefore, fatty foods will be digested and absorbed quite normally.

If we talk about the general symptoms of cholelithiasis, then it can be quite diverse. Abdominal pains of different intensity and nature, digestive disorders, nausea, sometimes with bouts of vomiting are possible. But since the clinic of the disease is characteristic of many pathologies of the gastrointestinal tract, experienced doctors always prescribe an ultrasound of the gallbladder to understand the cause of the patient's ailment.

Diagnostics

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

On palpation of the abdomen, there is tension and soreness of the skin in the muscles of the abdominal wall in the immediate vicinity of the diseased gallbladder. In addition, the doctor notes that the patient has yellowish spots on the skin, which occur due to a violation of lipid metabolism, yellowing of the eye sclera and skin.

But a physical examination is not the main diagnostic procedure. This is a preliminary examination, which gives the doctor the basis for referring the patient to certain studies. In particular:

. In the presence of an inflammatory process in the gallbladder, a moderate increase in ESR and a pronounced leukocytosis will be noticed in the test results.
. When deciphering the data, the doctor notes an increased level of cholesterol and bilirubin against the background of abnormal activity of alkaline phosphatase.
Cholecystography. This diagnostic technique helps to accurately examine the state of the gallbladder. During the procedure, an increase in the organ and the appearance of lime inclusions on its walls are revealed. With the help of cholecystography, calcareous stones located inside the diseased organ are detected.
Ultrasound of the abdominal cavity is the most informative diagnostic technique for suspected development of gallstone disease. In addition to identifying neoplasms, specialists note deformation of the gallbladder wall. Negative changes in the motility of the diseased organ are also recorded. Well visible on ultrasound and signs characteristic of cholecystitis.

A thorough examination of the state of the gallbladder is also possible with an MRI or CT scan. No less informative diagnostic technique, during which violations in the circulation of bile are detected, is scintigraphy. The method of retrograde endoscopic cholangiopancreatography is also widely used.

Complications

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

So, the edges of the stones can injure the walls of the bladder, causing the development of inflammatory processes in them. In especially severe cases, neoplasms clog the entrance and exit from the gallbladder, thereby making it difficult for the outflow of bile. With such deviations, stagnant processes begin to occur, entailing the development of inflammation. This process can take from several hours to several days, but sooner or later it will definitely make itself felt. The extent of the lesion and the intensity of the pathological phenomenon may be different.

So, the formation of a small edema of the gallbladder wall, or its destruction is possible. The consequence of this dangerous process is the rupture of the diseased organ. Such a complication of cholelithiasis directly threatens the patient's life.

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

If the inflammation is too intense, and pathogens release too many toxins into the blood, TTS can appear immediately. Under such circumstances, even immediate resuscitation measures are not a guarantee that the patient will exit the dangerous state and prevent death.

Treatment of gallstone disease

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

Dissolution of gallstones with the help of special medications. In particular, chenodeoxycholic and ursodeoxycholic acid. This technique is effective only for single cholesterol calculi. If the patient has no contraindications, such therapy is prescribed for a course of one and a half years.
Extracorporeal shock wave lithotripsy is a conservative method for the treatment of cholelithiasis, which involves the use of a shock wave, which leads to the destruction of gallstones. Such a wave is created with the help of special medical devices. Such treatment of cholelithiasis is carried out only with small cholesterol calculi (up to 3 cm). The procedure practically does not cause pain and is quite easily tolerated by patients. Pieces of stones are excreted from the body during bowel movements.
Diet. This is one of the foundations of a successful recovery and removal of unpleasant symptoms. Throughout the course of diet therapy, it is necessary to follow the rules of fractional nutrition. Food should be taken 4-6 times a day in small portions. Fatty, spicy, fried, spicy dishes, smoked meats, pickles, carbonated and alcoholic drinks, chocolate are necessarily excluded from the diet. The patient should give up fatty meats and hot spices. A healthy diet for cholelithiasis is based on the use of dairy products and plant products. It is necessary to add wheat bran to the menu.

Cholecystectomy is the most popular surgical treatment for gallstones. It is carried out in 2 ways:

classic;
laparoscopic.

Only the surgeon can determine which type of operation is appropriate for each individual case. Cholecystectomy is mandatory for:

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

A mandatory operation is also necessary when:

peritonitis. Inflammation of the abdominal organs and tissues of the peritoneum itself is a dangerous condition that can lead to death. The pathological process can develop when the gallbladder ruptures and bile contaminated with pathogenic microorganisms enters the abdominal cavity. In this case, the operation is aimed not only at removing the affected organ, but also at thorough disinfection of adjacent organs. Delaying the operation can lead to death.
Stricture of bile ducts. The narrowing of the canal is called a stricture. An intense inflammatory process can lead to such violations. They lead to stagnation of bile and its accumulation in the tissues of the liver, although the gallbladder can be removed. During surgery, the efforts of the surgeon are aimed at eliminating strictures. The narrowed area can be widened, or the doctor can create a bypass for bile, through which it is excreted directly into the rectum. It is impossible to normalize the situation without surgical intervention.
Accumulation of purulent contents. When a bacterial infection attaches to the tissues of the gallbladder, pus accumulates in them. A collection of pus within the gallbladder itself is called an empyema. If the pathological contents are collected outside of it, without affecting the abdominal organs, in this case we are talking about the development of a paravesical abscess. Such anomalies lead to a sharp deterioration in the patient's condition. During the operation, the gallbladder is removed and the abscess is emptied, followed by careful treatment with antiseptics to prevent peritonitis.
Biliary fistulas are pathological openings located between the gallbladder (less commonly, its ducts) and adjacent hollow organs. For such a deviation, any specific clinical picture is uncharacteristic, but it can significantly disrupt the outflow of bile, leading to its stagnation. In addition, they can cause the development of other diseases and digestive disorders. During the operation, pathological openings are closed, which helps to prevent unwanted complications.

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

But for older people with diseases of the cardiovascular system, kidneys or other organs, surgery can only do harm. In this case, doctors try to avoid such treatment tactics.

As you can see, the choice of therapeutic technique for GSD depends on many factors. To say exactly whether there is a need for an operation can only be done by the attending physician after all the necessary diagnostic measures have been taken.

Diet for gallstone disease

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

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

dried bread made from flour of the 2nd grade;
low-fat cheeses;
boiled, steamed or baked vegetables;
finely chopped white cabbage (in limited quantities);
baked or boiled lean meat;
different types of cereals;
vermicelli and pasta (within reasonable limits);
jams and preserves;
sweet fruits and berries;
weak tea;
sweet homemade juices;
mousse;
dried fruit compote;
butter, which must be added to various dishes in an amount of not more than 30 g per day;
low-fat varieties of fish (perch, pike, hake, etc.);
whole milk. It can be consumed both in its pure form and used for making cereals.

Fat-free cottage cheese and natural low-fat yoghurts are also allowed (home-made is better).

Forecast and prevention in cholelithiasis

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

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

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

If we talk about the prevention of biliary colic when a disease is detected, then patients must follow a strict diet. They should carefully monitor their weight and consume a sufficient amount of fluid (1.5 - 2 liters per day). To avoid the risk of movement of calculi through the bile ducts, patients should avoid performing work that requires a long stay in an inclined position.

The prognosis for the development of cholelithiasis for all patients is different, since they directly depend on the rate of formation of stones, their size and mobility. In most cases, the presence of stones in the gallbladder leads to a number of adverse and severe complications. But if surgical intervention is carried out in a timely manner, the dangerous consequences of the disease can be completely prevented!

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

general description

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

Industrialized countries have statistics on this score of about 15% incidence, while it can be noted that the prevalence directly depends on the age and sex of patients. In particular, men suffer from this disease twice as rarely as, respectively, women. Every fifth of women aged 40 and over is faced with gallstone disease, while men of the same age experience it in every tenth case. Up to 50 years, gallstone disease is observed in about 11%, from 50 to 69 - up to 23%, from 70 years and more - up to 50%.

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

Gallstones are cholesterol (the vast majority, about 90% of the variants of gallstones), as well as stones pigmented and mixed . So, due to a supersaturation of bile with cholesterol, the formation of cholesterol stones, its precipitation, and the formation of crystals occur. Violation in the gallbladder of the motility leads to the fact that these crystals do not enter the intestine, which ultimately leads to their gradual growth. Pigment stones (also called bilirubin stones) are formed by increased breakdown, which occurs with topical hemolytic anemia. As for mixed stones, they are a kind of combination based on the processes of both forms. Such stones contain cholesterol, bilirubin and calcium, the very process of their formation occurs as a result of inflammatory diseases affecting the biliary tract and, in fact, the gallbladder.

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

unbalanced diet (in particular, when it comes to the predominance of animal fats in it with simultaneous damage to vegetable fats);
hormonal disorders (with a weakening of the functions characteristic of the thyroid gland);
sedentary lifestyle;
disorders associated with fat metabolism, which intersects with an increase in body weight;
inflammation and other abnormalities that occur in the gallbladder;
various kinds of liver damage;
spinal injuries;
pregnancy;
starvation;
heredity;
spinal injuries;
diseases of the small intestine, etc.

As factors provoking the development of the disease we are considering, the following are distinguished:

helminthiases;
(due to the use of alcohol);
biliary tract infections (in chronic form);
chronic hemolysis;
demographic aspects (relevance of the disease for residents of rural areas, as well as the Far East);
elderly age.

Gallstone disease: classification

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

physico-chemical (initial) stage - or, as it is also called, the pre-stone stage. It is characterized by changes occurring in the composition of bile. There are no special clinical manifestations at this stage, the detection of the disease at the initial stage is possible, for which a biochemical analysis of bile is used for the features of its composition;
formation of stones stage, which is also defined as latent lithology. In this case, there are no symptoms of cholelithiasis, however, the use of instrumental diagnostic methods makes it possible to determine the presence of stones in the gallbladder;
clinical manifestations - stage, the symptoms of which indicate the development of an acute or chronic form of calculus.

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

Gallstone disease: symptoms

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

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

Mostly pain occurs due to the use of spicy, fatty, fried or spicy foods and alcohol, against the background of severe stress or significant physical exertion. Also, pain can be provoked by a long stay in an inclined position during work. Causes pain spasm, which is formed in the area of the muscles and ducts of the gallbladder, which is a reflex response to the acting irritation experienced by the wall due to stones.

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

As concomitant symptoms, nausea is also distinguished, which in some cases may be accompanied by vomiting without proper relief after it. It is noteworthy that vomiting is also a reflex response to the stimulus. At the same time, the capture of pancreatic tissues by the inflammatory process is a factor leading to an increase in vomiting, which in this case has an indomitable character and is accompanied by the release of bile with vomit.

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

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

Diagnosis of gallstone disease

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

The results of the surrender determine the presence of signs indicating non-specific inflammation at the stage of clinical exacerbation, which in particular consist in the moderation of the increase and in leukocytosis. When hypercholesterolemia is determined, as well as hyperbilirubinemia and increased activity characteristic of alkaline phosphatase.

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

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

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

Treatment of gallstone disease

Patients with a diagnosis of cholelithiasis are assigned a general type of hygiene regimen, rational nutrition, as well as a systematic load in dosed volumes. Diet No. 5 is also shown with the exclusion of certain foods in it (fats in particular). It is recommended to eat meals "by the hour". In general, the absence of complications often excludes the use of specific treatment - in this case, first of all, the emphasis is on waiting tactics.

With the development of an acute or chronic form of calculous cholecystitis, the removal of the gallbladder is required, which in this case is the process of stone formation. The specificity of the surgical intervention is determined on the basis of the general condition of the body and the changes accompanying the pathological process, concentrated in the area of the walls of the bladder and the tissues surrounding it, and the size of the calculi is also taken into account.

If symptoms relevant to cholelithiasis occur, it is necessary to contact a gastroenterologist; in addition, a surgeon's consultation may be prescribed.

Gallstone disease is a pathology that occurs in every tenth adult. The disease is not common among children. The resulting stones are located in the gallbladder or in the ducts. They block the access of bile to the duodenum, and at a certain position they also compress the output duct of the pancreas. The necessary enzymes and bile do not enter the intestines.

Treatment of cholelithiasis is designed to eliminate the resulting obstacle and normalize the process of digestion.

Main directions

A treatment plan for cholelithiasis is developed after examination, consultations with a gastroenterologist and a surgeon. Methods are proposed different in each case. They depend on the stage of the disease, clinical manifestations, localization and type of stones.

Sick mode

Given the provoking factors for the development of cholelithiasis, one should refrain from hard physical work, try to avoid stressful conditions, engage in active movements (walking, physiotherapy exercises, swimming), and control weight.

Eating with the restriction of certain foods can prevent seizures, delay the increase in stones. A diet is prescribed in accordance with table number 5. It requires the abandonment of fatty foods (meat, fish, lard, sausage, butter), pickles and marinades, hot sauces, cream confectionery, carbonated drinks, alcohol and beer.

Recommended low-fat meat and fish, dairy products, cereals, fresh vegetables and fruits, rarely coffee, rosehip drink. A patient with cholelithiasis needs to eat at least five times a day, in reduced portions. Instead of fried and smoked dishes, use steam, boiled.

Drug therapy

Treatment of gallstone disease without surgery is the dream of every patient. Doctors understand this and try to apply possible drug therapy.

Choleretic agents cannot be used. They may worsen the condition. Herbal decoctions and tinctures are not recommended. They also promote the movement of stones and exacerbate symptoms.

Medical methods for the destruction of stones (litholysis) include the use of ursodeoxycholic acid preparations (Ursofalk, Ursosan). Dissolution is possible only in the case of their cholesterol nature. This requires the following conditions:

diameter not more than 1 cm;
localization only in the bubble;
complete patency of the duct;
preserved sufficient ability of the gallbladder to contract;
relatively "young" age of the stones.

The method is applicable if there are no other bowel diseases and with a normal weight of the patient.

The maximum dose of the drug is given in the evening, given that the liver is engaged in the synthesis of cholesterol at night. The course of treatment lasts up to two years. Control ultrasounds are done every six months. Treatment continues for another three months after receiving information about the dissolution.

The method of litholysis is indicated for the treatment of children, with an asymptomatic course of the disease, rare exacerbations. Of great importance in the treatment of children is the attention and endurance of parents.

It is believed that the effectiveness of the method is up to 50%, but every tenth patient re-forms stones within a five-year period.

At the same time, drugs that protect the liver, hepatoprotectors (Essentiale, Hepatofalk) are prescribed.

Shock wave lithotripsy method

The method consists in an attempt to crush single calculi no more than 3 cm in diameter (or a group of three stones with a diameter of 1–1.5 cm) using ultrasound up to 3 mm, followed by the use of Ursofalk and independent exit into the duodenum. It has recently been abandoned due to the high percentage of relapses and complications (along with the stone, the wall of the gallbladder is subjected to physical impact). And there are no more than 15% of patients with such conditions.

There is a method of percutaneous lithiasis. Under general anesthesia, the patient's gallbladder is pierced and special substances are injected through the catheter that can dissolve stones. Such procedures must be carried out at least six. Indications are similar to the previous methods of treatment. The method is dangerous for the development of inflammation.

The listed methods of treatment are used for cholelithiasis in children and adults. Most doctors believe that if you are asymptomatic, you should not use medication at all.

Physiotherapy is indicated for a fading attack, in the interictal period. Electrophoresis is prescribed on the right hypochondrium with Papaverine, Magnesia, Platifillin, paraffin applications.

Surgical treatment

Surgical treatment of gallstone disease in some cases is the most effective way to get rid of the disease. With its help, complete recovery is achieved in up to 95% of patients. The best time for surgery, for children and adults, is the interictal period. Preoperative preparation is underway.

Currently, two types of surgical interventions are used:

Cholecystectomy or removal of the gallbladder filled with stones through a skin incision and opening the peritoneum.
Using a less traumatic laparoscopic method with a small skin incision or access through the vagina and colon, endoscopic devices are passed through the peritoneum to the liver, capture the bladder, cross, suture the narrowest point and bring the removed bladder out. Operations are carried out in specialized clinics.

After surgical removal of the gallbladder, the patient will have to constantly monitor the diet, drink mineral water.

Gallstone disease must be treated before it leads to complications.

Each of the methods has its own peculiarities of application and contraindications, ignoring which can lead to serious consequences for human health. The use of alternative methods of therapy is justified only for the relief of an attack, as well as the prevention of subsequent stone formation.

Radical treatment of the disease

Surgery for cholelithiasis is the gold standard for the treatment of this pathology. Its goal is to remove the container for calculi, avoiding the recurrence of biliary colic, as well as preventing the occurrence of obstructive jaundice, cholangiogenic sepsis, and biliary peritonitis. Performed in a planned manner, that is, even before the development of complications, the operation is safe - only 1 person out of 1000 has the risk of dying. The chance of a complete recovery after the operation is about 95%.

The indications for the operation are:

stone diameter more than 1 cm;
"disabled" gallbladder;
multiple stones;
patient with diabetes mellitus;
stones are formed by calcium salts, bilirubin or have a mixed origin;
stones (stone) are located in such a way that there is a high probability of blockage of the bile ducts;
the patient travels a lot;
the walls of the gallbladder containing stones are encrusted with calcium salts - the "porcelain" gallbladder.

Warning! Of course, the operation may not be performed for everyone - there are contraindications for the general condition.

In addition, the method as an independent method does not eliminate the cause of gallstone disease. After cholecystectomy (the so-called operation to remove the bladder), calculi can form in the ducts of the liver or the stump of the extrahepatic bile ducts. Nevertheless, only surgical treatment of pathology, subject to the subsequent diet, can permanently save a person from gallstones.

The operation can be performed in two ways - abdominal and laparoscopic.

Abdominal operation

This is a “big” operation in which a large incision is made on the front wall of the abdomen under general anesthesia. As a result of this access, surgeons can clearly examine and feel all the bile ducts, perform local ultrasound or x-rays with contrast to remove any existing stones. The method is indispensable for inflammatory and cicatricial processes in the area under the liver.

The disadvantages of this intervention are:

long recovery period after surgery;
greater chance of developing incisional hernias;
cosmetic defect;
more complications develop after surgery.

Laparoscopic method

The laparoscopy operation performed for cholelithiasis is an intervention under visual control using a fiber optic device connected to a monitor through several small incisions on the abdominal wall.

It looks like the removal of the gallbladder on the monitor of the laparoscopic unit

The laparoscopic method has a lot of advantages over abdominal surgery: the wound does not hurt so much and not for so long, it does not restrict breathing; intestinal paresis is not expressed; not such a strong cosmetic defect. There are also negative sides to laparoscopic cholecystectomy - more contraindications to surgery. So, it cannot be performed not only with severe disorders of the heart, blood vessels and lungs, but also in cases of:

obesity;
peritonitis;
late pregnancy;
acute pancreatitis;
mechanical jaundice;
fistulas between internal organs and bile ducts;
gallbladder cancer;
adhesive process in the upper parts of the abdominal cavity;
acute cholecystitis, if more than 2 days have passed since the disease;
cicatricial changes in the hepatobiliary zone.

In 5% of cases, the difficulties of carrying out the intervention by the laparoscopic method are clarified only in the process. In this situation, you have to immediately switch to abdominal surgery.

Non-surgical treatment

Treatment of cholelithiasis can be carried out without surgery - using non-contact crushing of stones or dissolving them in a medical way.

Medical litholysis

Special bile acid preparations such as those found in human bile can be used to dissolve small stones. Such substances, taken in the form of tablets, reduce the absorption of cholesterol by the small intestine. As a result, less cholesterol enters the biliary tract, and due to the formation of liquid crystals with such acids, the cholesterol contained in the stones partially dissolves.

Bile acid preparations are effective not only for dissolving stones, but also for preventing their formation:

with abnormal biliary tract;
with obesity;
after a course of a diet with a reduced energy value;
after stomach surgery.

Bile acid preparations are contraindicated in:

disabled gallbladder;
pigment or carbonate stones;
if the stones occupy more than half of the volume of the bladder;
during pregnancy;
if diagnosed with carcinoma of the gallbladder.

Warning! Medications are used to dissolve only cholesterol stones smaller than 2 cm in diameter, which are visible not only on ultrasound, but also on plain radiography. They are prescribed only by a specialist gastroenterologist. The course of treatment is at least six months, but there is evidence that, even when completely dissolved, in half of the cases the stones recur.

Hardware dissolution of stones

Calculi with a small diameter (up to 2 cm) can be crushed by a shock wave or a laser beam directed at the gallbladder area, after which their fragments are removed naturally. Such operations are called "lithotripsy" (shock wave or laser) and are performed in a hospital. This is explained by the fact that after this procedure there is a high chance of complications associated with the wandering of small fragments of stones, which are treated only surgically.

Warning! Lithotripsy is performed only with normal contractility of the gallbladder, it cannot be performed with cholecystitis. The procedure itself is almost painless, but the removal of stone fragments is very unpleasant.

Treatment of gallstone disease with folk remedies sets itself 2 goals:

stop an attack of biliary colic;
prevent further stone formation.

In order to avoid further stone formation, it is recommended to use the following recipes:

Squeeze juice from cucumber, carrot and beet, mix it in equal proportions. Start by taking 1 glass of this juice, every month add another 200 ml per dose. Course - 6 months.
Drink 1 glass of freshly squeezed beetroot juice, which has been infused for 2-3 hours in the refrigerator, on an empty stomach.
1 tablespoon of immortelle flowers pour 200 ml of boiling water, boil for half an hour in a water bath, cool for 45 minutes. Take 100 ml twice a day.
Dry the watermelon peels in the oven, chop, pour water in a ratio of 1: 1, boil for half an hour. It is necessary to drink such a decoction of 200-600 ml per day, divided into 4-5 doses.

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Cholelithiasis(cholelithiasis, calculous cholecystitis, cholelithiasis) is a pathological condition characterized by the formation of calculi (stones) in the gallbladder or bile ducts. Most often, overweight women over 40 years of age get sick.

Causes

Stagnation of bile in the bladder and an increase in the concentration of salts in bile due to metabolic disorders lead to the formation of stones. To provoke the occurrence of pathology can:

Disease classification

Gallstone disease has the following stages of its development:

Initial (physico-chemical), pre-stone. There are changes in the composition of bile, there are no clinical manifestations of the disease. Pathology can be detected by passing a biochemical analysis of bile;
Stone formation. The stage also proceeds hidden (asymptomatically), the presence of calculi can be detected during instrumental examinations (ultrasound, CT);
Clinical manifestations. A form in which there are signs of acute or chronic calculous cholecystitis.

The nature of the stones:

Cholesterol stones consist only of cholesterol or it is the main component. Stones of large size, white, soft, easily crumble, layered in structure;
Pigmented (bilirubin) stones are small, brittle, black or brown;
Mixed calculi are formed from calcium, bilirubin and cholesterol, and can be of different sizes and structures.

Symptoms

At stages 1 and 2 of the formation of cholelithiasis, there are no symptoms, the first warning signs are heaviness in the right hypochondrium, bitterness in the mouth, nausea, and belching.

After the calculus exits the bladder into the bile ducts, the following symptoms occur:

In 1-3% of patients with stones in the bladder, acute calculous cholecystitis is formed.(stones block the channel), the symptoms are somewhat different from gallstone disease:

The pain syndrome takes on a constant, aching character, intensifies on inspiration;
Hyperthermia (fever) is observed immediately after the onset of the attack;
Vomiting can be repeated, does not cause relief.

In chronic cholecystitis, the following symptoms are observed:

There is nausea, discomfort in the epigastrium after eating;
Chronic diarrhea (for at least 3 months, daily liquid stools is 4-10 times).

Calculous cholecystitis in children

In children, cholelithiasis, as in adults, is characterized by the appearance of biliary colic, while the pain is localized in the right hypochondrium closer to the midline of the abdomen (a white line visually dividing the abdomen into 2 halves). During an attack, the child rushes about in bed or freezes, afraid to move, takes forced positions (pulls his knees to his stomach, lies on his side). The attack is repeated within 1-2 days.

A child with cholelithiasis also has dyspepsia - nausea, vomiting of bile, fever (up to 38-39), chills, bloating, yellowness of the sclera.

Diagnostics

The clinical diagnosis of cholelithiasis is made on the basis of the patient's complaints, after the appearance of biliary colic, the collection of anamnesis (hereditary factor, past and current diseases), examination of the patient (palpation of the abdomen, examination of the skin), according to the results of laboratory examinations.

Diagnostic research methods:

Treatment Methods

Gallstone disease is treated with drugs, but if there is no improvement, then surgical intervention is used.

Drug treatment

For the treatment of GSD use the following groups of drugs:

An exemplary dosage regimen:

Drotaverine 40 mg, adults 40–80 mg, three times a day, children from 3 to 6 years old 40–120 mg in 2–4 doses, 6–18 years old, 80–200 mg in 2–4 doses;
Kytril 1 mg, adults 1 mg 2 times a day or 2 mg once;
Remagel suspension 5 ml, consume 1-2 teaspoons, 4 times a day, 30 minutes after meals;
Venter 1 gr., 0.5-1 gr. 4 times a day or 1 gr., twice a day;
Ursofalk is prescribed at 10 mg / kg, once a day, for children and adults weighing less than 34 kg, a suspension of 1.25 ml per 5-7 kg is used.

Surgical and instrumental treatment

Diet

Proper nutrition with cholelithiasis ensures stable remission (asymptomatic course) during the course of the disease. With calculous cholecystitis, food is consumed in small portions, 5-6 times throughout the day, at a set time. It is necessary to include a significant amount of animal protein in the diet, it is better to consume dishes warm.

Approved Products:

Foods to be excluded from the diet:

Vegetables containing essential oils (turnip, onion, radish, garlic) and oxalic acid (sorrel and spinach);
With obesity, it limits the consumption of pasta, flour. confectionery;
Fatty meat (lamb, pork), lard;
Canned food;
Semi-finished products;
Margarine, mayonnaise;
Alcohol.