Chronic calculous cholecystitis is a disease in which stones form in the cavity of the gallbladder, which subsequently cause inflammation of the walls of the bladder.

Cholelithiasis It is a common disease and occurs in 10-15% of the adult population. In women, this disease occurs 2-3 times more often than in men. Cholecystitis is an ancient human disease. The first gallstones were discovered during the study of Egyptian mummies.

Anatomy and physiology of the gallbladder

The gallbladder is a hollow, pear-shaped organ. The gallbladder is projected approximately in the middle of the right hypochondrium.

The length of the gallbladder is from 5 to 14 centimeters, and the capacity is 30-70 milliliters. The bladder has a bottom, body and neck.

The wall of the gallbladder consists of mucous, muscular, and connective tissue membranes. The mucosa consists of epithelium and various glandular cells. The muscularis propria consists of smooth muscle fibers. At the cervix, the mucous and muscular membranes form a sphincter, which prevents the release of bile at inappropriate times.

The bladder neck continues into the cystic duct, which then merges with the common hepatic duct to form the common bile duct.
The gallbladder is located on the lower surface of the liver so that the wide end of the bladder (bottom) extends somewhat beyond the lower edge of the liver.

The function of the gallbladder is the accumulation, concentration of bile and release of bile as needed.
The liver produces bile and when it is not needed, the bile accumulates in the gallbladder.
Once bile enters the bladder, it is concentrated by absorption of excess water and microelements by the epithelium of the bladder.

Bile secretion occurs after eating. The muscle layer of the bladder contracts, increasing the pressure in the gallbladder to 200-300 mm. water column. Under the influence of pressure, the sphincter relaxes, and bile enters the cystic duct. The bile then enters the common bile duct, which opens into the duodenum.

The role of bile in digestion

Bile in the duodenum creates the necessary conditions for the activity of enzymes found in pancreatic juice. Bile dissolves fats, which promotes further absorption of these fats. Bile is involved in the absorption of vitamins D, E, K, A in the small intestine. Bile also stimulates the secretion of pancreatic juice.

Causes of development of chronic calculous cholecystitis

The main reason for the appearance of calculous cholecystitis is the formation of stones.
There are many factors that lead to the formation of gallstones. These factors are divided into: unchangeable (those that cannot be influenced) and those that can be changed.

Constant factors:

• Floor. Most often, women get sick due to taking contraceptives, childbirth (estrogens, which are increased during pregnancy, increase the absorption of cholesterol from the intestines and its abundant excretion in the bile).
• Age. People aged 50 to 60 years are more likely to suffer from cholecystitis.
• Genetic factors. These include family predisposition and various congenital anomalies of the gallbladder.
• Ethnic factor. The largest number of cases of cholecystitis is observed among Indians living in the southwestern United States and among the Japanese.

Factors that can be influenced.

• Nutrition . Increased consumption of animal fats and sweets, as well as hunger and rapid weight loss can cause cholecystitis.
• Obesity. The amount of cholesterol in the blood and bile increases, which leads to the formation of stones
• Diseases of the gastrointestinal tract. Crohn's disease, resection (removal) of part of the small intestine
• Medications. Estrogens, contraceptives, diuretics (diuretics) - increase the risk of cholecystitis.
• Physical inactivity (immobile, sedentary lifestyle)
• Decreased muscle tone of the gallbladder

How are stones formed?

Stones can be made from cholesterol, from bile pigments, or mixed.
The process of formation of cholesterol stones can be divided into 2 phases:

First phase– violation of the ratio of cholesterol and solvents (bile acids, phospholipids) in bile.
In this phase, the amount of cholesterol increases and the amount of bile acids decreases.

Increased cholesterol occurs due to disruption of various enzymes.
- decreased hydroxylase activity (affects cholesterol reduction)
- decreased acetyl transferase activity (converts cholesterol into other substances)
- increased breakdown of fats from the fat layer of the body (increases the amount of cholesterol in the blood).

The decrease in fatty acids occurs for the following reasons.
- Disorders of fatty acid synthesis in the liver
- Increased secretion of bile acids from the body (impaired absorption of fatty acids in the intestine)
- Impaired intrahepatic circulation

Second phase – bile saturated with cholesterol forms bile stasis (stagnation of bile in the bladder), then the process of crystallization occurs - forming crystals of cholesterol monohydrate. These crystals stick together and form stones of varying sizes and composition.
Stones consisting of cholesterol can be single or multiple, usually round or oval in shape. The color of these stones is yellow-green. The sizes of the stones vary from 1 millimeter to 3-4 centimeters.

Bile stones are formed due to an increase in the amount of unbound, water-insoluble bilirubin. These stones are composed of various polymers of bilirubin and calcium salts.
Pigment stones are usually small in size, up to 10 millimeters. Usually there are several pieces in a bubble. These stones are black or gray.

Most often (80-82% of cases) mixed stones are found. They consist of cholesterol, bilirubin and calcium salts. The stones are always multiple in number and yellow-brown in color.

Symptoms of gallstone disease

In 70-80% of cases, chronic calculous cholecystitis develops asymptomatically over several years. The discovery of stones in the gall bladder in these cases occurs by accident - during an ultrasound done for other diseases.

Symptoms appear only if the stone moves along the cystic canal, which leads to its blockage and inflammation.

Depending on the stage of cholelithiasis, the symptoms presented in the next section of the article are also highlighted.

Clinical stages of cholelithiasis

1. Stage of violation of the physicochemical properties of bile.
At this stage there are no clinical symptoms. The diagnosis can only be made by examining bile. Cholesterol “snowflakes” (crystals) are found in bile. Biochemical analysis of bile shows an increase in cholesterol concentration and a decrease in the amount of bile acids.

2. Latent stage.
At this stage, the patient does not have any complaints. There are already stones in the gallbladder. The diagnosis can be made using ultrasound.

3. Stage of onset of symptoms of the disease.
- Biliary colic is a very severe, paroxysmal and acute pain that lasts from 2 to 6 hours, sometimes more. Attacks of pain usually appear in the evening or at night.

The pain is in the right hypochondrium and spreads to the right shoulder blade and right cervical region. Pain most often appears after a rich, fatty meal or after heavy physical activity.

Products that may cause pain after consumption:

• Cream
• Alcohol
• Cakes
• Carbonated drinks

Other symptoms of the disease:

• Increased sweating
• Chills
• Increase in body temperature to 38 degrees Celsius
• Vomiting of bile that does not bring relief

4. Stage of development of complications

At this stage, complications develop such as:
Acute cholecystitis– this disease requires immediate surgical intervention.

Hydrocele of the gallbladder. The cystic duct is blocked by a stone or narrowed to the point of complete blockage of the duct. The release of bile from the bladder stops. Bile from the bladder is absorbed through the walls, and a serous-mucosal secretion is released into its lumen.
Gradually accumulating, the secretion stretches the walls of the gallbladder, sometimes to enormous sizes.

Perforation or rupture of the gallbladder leads to the development of biliary peritonitis (inflammation of the peritoneum).

Liver abscess. Limited accumulation of pus in the liver. An abscess forms after a section of the liver is destroyed. Symptoms: high temperature up to 40 degrees, intoxication, enlarged liver.
This disease can only be treated surgically.

Gallbladder cancer. Chronic calculous cholecystitis greatly increases the risk of cancer.

Diagnosis of cholelithiasis

In case of the above mentioned symptoms, you should consult a gastroenterologist or therapist.

Conversation with a doctor
The doctor will ask you about your complaints. Reveals the causes of the disease. He will dwell in particular detail on nutrition (after taking what foods do you feel unwell?). Next, he will enter all the data into the medical record and then begin the examination.

Inspection
The examination always begins with a visual examination of the patient. If the patient complains of severe pain at the time of examination, then his face will express suffering.

The patient will be in a supine position with legs bent and brought to the stomach. This is a forced position (reduces pain). I would also like to note a very important sign: when the patient turns onto his left side, the pain intensifies.

Palpation (palpation of the abdomen)
On superficial palpation, flatulence (bloating) of the abdomen is determined. Increased sensitivity in the right hypochondrium is also determined. Possible muscle tension in the abdominal area.

With deep palpation, an enlarged gallbladder can be determined (normally, the gallbladder cannot be palpated). Also, with deep palpation, specific symptoms are determined.
1. Murphy's symptom - the appearance of pain during inspiration at the moment of palpating the right hypochondrium.

2. Ortner’s symptom – the appearance of pain in the right hypochondrium when tapping (percussion) on the right costal arch.

Ultrasound of the liver and gallbladder
Ultrasonography clearly identifies the presence of stones in the gall bladder.

Signs of the presence of stones on ultrasound:
1. Presence of hard structures in the gallbladder
2. Mobility (movement) of stones
3. Ultrasonographic hypoechoic (visible in the picture as a white space) trace below the stone
4. Thickening of the gallbladder walls more than 4 millimeters

Abdominal x-ray
Stones containing calcium salts are clearly visible

Cholecystography– a study using contrast to better visualize the gallbladder.

CT scan– carried out in the diagnosis of cholecystitis and other diseases

Endoscopic cholangiopancreatography- used to determine the location of the stone in the common bile duct.

The course of chronic calculous cholecystitis
The asymptomatic form of cholecystitis lasts a long time. From the moment gallstones are identified, within 5-6 years, only 10-20% of patients begin to develop symptoms (complaints).
The appearance of any complications indicates an unfavorable course of the disease. In addition, many complications can only be treated surgically.

Treatment of cholelithiasis

Stages of treatment:
1. Prevent stone movement and related complications
2. Litholytic (crushing stones) therapy
3. Treatment of metabolic (metabolic) disorders

In the asymptomatic stage of chronic cholecystitis, the main treatment method is diet.

Diet for gallstone disease

Meals should be divided, in small portions 5-6 times a day. The food temperature should be - if cold dishes are not lower than 15 degrees, and if hot dishes are not higher than 62 degrees Celsius.

Prohibited products:

Alcoholic drinks
- legumes, in any form of preparation
- dairy products with high fat content (cream, full-fat milk)
- any fried foods
- meat from fatty varieties (goose, duck, pork, lamb), lard
- fatty fish, salted, smoked fish, caviar
- any types of canned food
- mushrooms
- fresh bread (especially hot bread), croutons
- spices, herbs, salinities, pickled foods
- coffee, chocolate, cocoa, strong tea
- salty, hard and fatty types of cheese

Cheeses can be consumed, but low-fat

Vegetables should be consumed boiled or baked (potatoes, carrots). You can eat finely chopped cabbage, ripe cucumbers, and tomatoes. Use green onions, parsley as an addition to dishes

Meat from low-fat varieties (beef, veal, rabbit), as well as (chicken and turkey without skin). Meat should be consumed boiled or baked. It is also recommended to use chopped meat (cutlets)

Vermicelli and pasta are allowed

Sweet ripe fruits and berries, as well as various jams and preserves

Drinks: not strong tea, not sour juices, various mousses, compotes

Butter (30 grams) for dishes

Low-fat types of fish are allowed (pike perch, cod, pike, bream, perch, hake). It is recommended to use fish boiled, in the form of cutlets, aspic

You can use whole milk. You can also add milk to various cereals.
Non-sour cottage cheese and non-sour low-fat yoghurts are allowed

Effective treatment of cholecystitis when symptoms are present is possible only in a hospital setting!

Drug treatment of biliary colic (pain symptom)

Typically, treatment begins with M-anticholinergics (to reduce spasms) - atropine (0.1% -1 milliliter intramuscularly) or Platifilin - 2% -1 milliliter intramuscularly

If anticholinergics do not help, antispasmodics are used:
Papaverine 2% - 2 milliliters intramuscularly or Drotaverine (Noshpa) 2% -2 milliliters.

Baralgin 5 milliliters intramuscularly or Pentalgin also 5 milliliters are used as painkillers.
In case of very severe pain, use Promedol 2% - 1 ml.

Conditions under which the effect of treatment will be maximum:
1. stones containing cholesterol
2. smaller in size than 5 millimeters
3. the age of the stones is no more than 3 years
4. no obesity
They use drugs such as Ursofalk or Ursosan - 8-13 mg per kilogram of body weight per day.
The course of treatment should be continued for 6 months to 2 years.

Direct stone breaking method
The method is based on direct injection of a strong stone dissolver into the gallbladder.

Extracorporeal shock wave lithotripsy- crushing stones using the energy of shock waves created outside the human body.

This method is carried out using various devices that produce different types of waves. For example, waves created by a laser, an electromagnetic device, or a device that produces ultrasound.

Any of the devices is installed in the projection of the gallbladder, then waves from various sources affect the stones and they are crushed into small crystals.

These crystals are then freely released along with bile into the duodenum.
This method is used when the stones are no larger than 1 centimeter and when the gallbladder is still functioning.
In other cases, if symptoms of cholecystitis are present, surgery to remove the gallbladder is recommended.

Surgical removal of the gallbladder

There are two main types of cholecystectomy (removal of the gallbladder):
1. Standard cholecystectomy
2. Laparoscopic cholecystectomy

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

The laparoscopic method is based on the use of a laparoscope apparatus. This device consists of several parts:
- video cameras with high magnification ability
- different types of tools
Advantages of method 2 over the first:
1. Laparoscopic surgery does not require large incisions. The incisions are made in several places and are very small.
2. The seams are cosmetic, so they are practically invisible
3. Performance is restored 3 times faster
4. The number of complications is ten times less

Prevention of gallstone disease

Primary prevention is to prevent the formation of stones. The main method of prevention is exercise, diet, avoiding alcohol consumption, avoiding smoking, and losing weight if you are overweight.

Secondary prevention consists of preventing complications. The main method of prevention is the effective treatment of chronic cholecystitis described above.

Why is gallstone disease dangerous?

Gallstone disease or calculous cholecystitis is the formation of stones in the gall bladder. This often causes severe inflammation and leads to serious symptoms. First of all, the disease manifests itself in severe pain, impaired flow of bile from the gallbladder, and digestive disorders. Treatment of cholelithiasis is usually classified as surgical. This is explained by the fact that the inflammatory process caused by the movement of stones poses a serious threat to the health and life of patients. That is why the problem is usually solved in the fastest way - removing the gallbladder along with the stones.

Gallstone disease is dangerous primarily due to the following complications:

• Gallbladder perforation. Perforation is a rupture of the gallbladder. It can be caused by the movement of stones or too strong contraction ( spasm) smooth muscles of the organ. In this case, the contents of the organ enter the abdominal cavity. Even if there was no pus inside, the bile itself can cause serious irritation and inflammation of the peritoneum. The inflammatory process spreads to the intestinal loops and other neighboring organs. Most often, the cavity of the gallbladder contains opportunistic microbes. In the abdominal cavity, they multiply rapidly, realizing their pathogenic potential and leading to the development of peritonitis.
• Empyema of the gallbladder. Empyema is an accumulation of pus in a natural cavity of the body. With calculous cholecystitis, the stone often gets stuck at the level of the bladder neck. At first, this leads to dropsy - the accumulation of mucous secretion in the cavity of the organ. The pressure inside increases, the walls stretch, but can contract spastically. This leads to severe pain - biliary colic. If such a blocked gallbladder becomes infected, the mucus turns into pus and empyema occurs. Typically, the causative agents are bacteria from the genera Escherichia, Klebsiella, Streptococcus, Proteus, Pseudomonas, and less commonly Clostridium and some other microorganisms. They can enter through the bloodstream or ascend through the bile duct from the intestines. With the accumulation of pus, the patient's condition worsens greatly. Temperature rises, headaches intensify ( due to the absorption of breakdown products into the blood). Without urgent surgery, the gallbladder ruptures and its contents enter the abdominal cavity, causing purulent peritonitis. At this stage ( after the breakup) the disease often ends in the death of the patient, despite the efforts of doctors.
• Reactive hepatitis. The inflammatory process from the gallbladder can spread to the liver, causing its inflammation. The liver also suffers from deterioration of local blood flow. Typically, this problem ( unlike viral hepatitis) goes away quite quickly after removal of the gallbladder, the main center of inflammation.
• Acute cholangitis. This complication involves blockage and inflammation of the bile duct. In this case, the outflow of bile is disrupted by a stone stuck in the duct. Since the bile ducts connect to the pancreatic ducts, pancreatitis can develop in parallel. Acute cholangitis occurs with a strong increase in temperature, chills, jaundice, and severe pain in the right hypochondrium.
• Acute pancreatitis. Usually occurs due to lack of bile ( which does not come out of a clogged bladder) or blockage of the common duct. Pancreatic juice contains a large number of strong digestive enzymes. Their stagnation can cause necrosis ( death) the gland itself. This form of acute pancreatitis poses a serious threat to the patient's life.
• Biliary fistulas. If gallstones do not cause severe pain, the patient can ignore them for a long time. However, the inflammatory process in the wall of the organ ( directly around the stone) is still developing. Gradually, the wall is destroyed and “soldered” to neighboring anatomical structures. Over time, a fistula may form, connecting the gallbladder to other hollow organs. Such organs can be the duodenum ( more often), stomach, small intestine, large intestine. There are also possible variants of fistulas between the bile ducts and these organs. If the stones themselves do not bother the patient, then fistulas can cause accumulation of air in the gallbladder, disruption of the outflow of bile ( and intolerance to fatty foods), jaundice, vomiting bile.
• Paravesical abscess. This complication is characterized by the accumulation of pus near the gallbladder. Usually the abscess is delimited from the rest of the abdominal cavity by adhesions that arise against the background of the inflammatory process. From above, the abscess is limited by the lower edge of the liver. The complication is dangerous due to the spread of infection with the development of peritonitis and liver dysfunction.
• Scar strictures. Strictures are places of narrowing in the bile duct that prevent the normal flow of bile. In gallstone disease, this complication can occur as a result of inflammation ( the body responds with excessive formation of connective tissue - scars) or as a consequence of an intervention to remove stones. Either way, strictures can persist even after recovery and seriously affect the body's ability to digest and absorb fatty foods. In addition, if stones are removed without removing the gallbladder, strictures can cause bile stagnation. In general, people with such narrowing of the duct are more likely to have relapses ( repeated inflammation of the gallbladder).
• Secondary biliary cirrhosis. This complication can occur if stones in the gall bladder interfere with the flow of bile for a long time. The fact is that bile enters the gallbladder from the liver. Its overflow causes stagnation of bile in the ducts in the liver itself. It can eventually lead to the death of hepatocytes ( normal liver cells) and their replacement by connective tissue, which does not perform the necessary functions. This phenomenon is called cirrhosis. The consequence is serious blood clotting disorders, disturbances in the absorption of fat-soluble vitamins ( A, D, E, K), accumulation of fluid in the abdominal cavity ( ascites), severe intoxication ( poisoning) organism.

Thus, cholelithiasis requires a very serious attitude. In the absence of timely diagnosis and treatment, it can significantly harm the patient’s health, and sometimes even threaten his life. To increase the chances of a successful recovery, the first symptoms of calculous cholecystitis should not be ignored. Early consultation with a doctor often helps to detect stones when they have not yet reached significant size. In this case, the likelihood of complications is lower and you may not have to resort to surgical treatment to remove the gallbladder. However, if necessary, you still need to agree to the operation. Only the attending physician can adequately assess the situation and choose the most effective and safe method of treatment.

Is it possible to cure calculous cholecystitis without surgery?

Currently, surgery remains the most effective and justified method of treating calculous cholecystitis. When stones form in the gall bladder, as a rule, an inflammatory process develops, which not only disrupts the functioning of the organ, but also poses a threat to the body as a whole. Surgery to remove the gallbladder along with stones is the most appropriate treatment option. In the absence of complications, the risk to the patient remains minimal. The organ itself is usually removed endoscopically ( without incision of the anterior abdominal wall, through small holes).

The main advantages of surgical treatment of calculous cholecystitis are:

• Radical solution to the problem. Removing the gallbladder guarantees the cessation of pain ( biliary colic), since colic appears due to contractions of the muscles of this organ. In addition, there is no threat of relapse ( repeated exacerbations) cholelithiasis. Bile will no longer be able to accumulate in the bladder, stagnate and form stones. It will flow directly from the liver to the duodenum.
• Patient safety. Nowadays, endoscopic removal of the gallbladder ( cholecystectomy) is a routine operation. The risk of complications during surgery is minimal. If all rules of asepsis and antisepsis are observed, postoperative complications are also unlikely. The patient recovers quickly and can be discharged ( in consultation with the attending physician) just a few days after the operation. After a few months, he can lead a very normal lifestyle, apart from a special diet.
• Possibility of treating complications. Many patients turn to the doctor too late, when complications of calculous cholecystitis begin to appear. Then surgical treatment is simply necessary to remove pus, examine neighboring organs, and adequately assess the risk to life.

However, the operation also has its disadvantages. Many patients are simply afraid of anesthesia and surgery. In addition, any operation is stressful. There is a risk ( albeit minimal) postoperative complications, due to which the patient has to stay in the hospital for several weeks. The main disadvantage of cholecystectomy is the removal of the organ itself. After this operation, bile no longer accumulates in the liver. It continuously enters the duodenum in small quantities. The body loses the ability to regulate the flow of bile in certain portions. Because of this, you have to follow a diet without fatty foods for the rest of your life ( There is not enough bile to emulsify fats).

Nowadays, there are several methods of non-surgical treatment of calculous cholecystitis. This is not about symptomatic treatment ( relieving muscle spasms, eliminating pain syndrome), namely about getting rid of stones inside the gallbladder. The main advantage of these methods is the preservation of the organ itself. If the result is successful, the gallbladder is freed from stones and continues to perform its functions of accumulating and dispensing bile.

There are three main methods of non-surgical treatment of calculous cholecystitis:

• Drug dissolution of stones. This method is perhaps the safest for the patient. The patient must take drugs based on ursodeoxycholic acid for a long time. It helps dissolve stones containing bile acids. The problem is that even to dissolve small stones, you need to take the medicine regularly for several months. If we are talking about larger stones, the course may take 1–2 years. However, there is no guarantee that the stones will dissolve completely. Depending on the individual characteristics of metabolism, they may contain impurities that will not dissolve. As a result, the stones will decrease in size and the symptoms of the disease will disappear. However, this effect will be temporary.
• Ultrasonic stone crushing. These days, crushing stones using ultrasonic waves is a fairly common practice. The procedure is safe for the patient and easy to perform. The problem is that the stones are crushed into sharp fragments, which still cannot leave the gallbladder without injuring it. In addition, the problem of bile stagnation is not solved radically, and after a while ( usually several years) stones may form again.
• Laser stone removal. It is used quite rarely due to its high cost and relatively low efficiency. The stones also undergo a kind of crushing and fall apart. However, even these parts can injure the mucous membrane of the organ. In addition, the risk of relapse is high ( re-formation of stones). Then the procedure will have to be repeated.

Thus, non-surgical treatment of calculous cholecystitis exists. However, it is used mainly for small stones, as well as for the treatment of patients for whom it is dangerous to operate ( due to concomitant diseases). In addition, none of the non-surgical methods of stone removal are recommended for acute cases. Concomitant inflammation requires surgical treatment of the area with examination of neighboring organs. This will avoid complications. If intense inflammation has already begun, crushing the stones alone will not solve the problem. Therefore, all non-surgical methods are used mainly for the treatment of patients with stones ( chronic course of the disease).

When is surgery needed for gallstone disease?

Gallstone disease or calculous cholecystitis in the vast majority of cases at a certain stage of the disease requires surgical treatment. This is explained by the fact that stones that form in the gallbladder are usually detected only during severe inflammation. This process is called acute cholecystitis. The patient experiences severe pain in the right hypochondrium ( colic), which worsen after eating. Your temperature may also rise. In the acute stage, there is a possibility of serious complications, so they try to solve the problem radically and quickly. This solution is cholecystectomy - surgery to remove the gallbladder.

Cholecystectomy involves complete removal of the bladder along with the stones it contains. In an uncomplicated course of the disease, it guarantees a solution to the problem, since the bile formed in the liver will no longer accumulate and stagnate. The pigments simply will not be able to form stones again.

There are quite a few indications for cholecystectomy. They are divided into absolute and relative. Absolute indications are those without which serious complications can develop. Thus, if surgery is not performed when there is an absolute indication, the patient's life will be at risk. In this regard, doctors in such situations always try to convince the patient of the need for surgical intervention. There are no other treatments or they will take too long, increasing the risk of complications.

The absolute indications for cholecystectomy for cholelithiasis are:

• A large number of stones. If there are stones in the gall bladder ( regardless of their number and size) occupy more than 33% of the organ volume, cholecystectomy should be performed. It is almost impossible to crush or dissolve such a large number of stones. At the same time, the organ does not work, since the walls are greatly stretched, contract poorly, stones periodically clog the cervical area and interfere with the outflow of bile.
• Frequent colic. Attacks of pain due to gallstone disease can be very intense. They are relieved with antispasmodic drugs. However, frequent colic indicates that drug treatment is not successful. In this case, it is better to resort to removing the gallbladder, regardless of how many stones there are and what size they are.
• Stones in the bile duct. When the bile ducts are blocked by a stone from the gallbladder, the patient's condition greatly worsens. The outflow of bile stops completely, the pain intensifies, obstructive jaundice develops ( due to the free fraction of bilirubin).
• Biliary pancreatitis. Pancreatitis is inflammation of the pancreas. This organ shares an excretory duct with the gallbladder. In some cases, with calculous cholecystitis, the outflow of pancreatic juice is disrupted. Tissue destruction during pancreatitis threatens the patient's life, so the problem must be urgently solved through surgery.

Unlike absolute indications, relative indications suggest that there are other treatment methods in addition to surgery. For example, in the chronic course of cholelithiasis, stones may not bother the patient for a long time. He does not have colic or jaundice, as happens in acute cases of the disease. However, doctors believe that the disease may worsen in the future. The patient will be offered to undergo surgery as planned, but this will be a relative indication, since at the time of the operation he has practically no complaints and no inflammatory process.

Special mention should be made of surgical treatment of complications of acute cholecystitis. In this case we are talking about the spread of the inflammatory process. Problems with the gallbladder also affect the functioning of neighboring organs. In such situations, the operation will include not only the removal of the gallbladder with stones, but also the solution of the problems resulting from this.

Surgical treatment may also be required for the following complications of gallstone disease:

• Peritonitis. Peritonitis is an inflammation of the peritoneum, the lining that covers most of the abdominal organs. This complication occurs when the inflammatory process spreads from the gallbladder or perforation ( gap) of this organ. Bile, and often a large number of microbes, enters the abdominal cavity, where intense inflammation begins. The operation is necessary not only to remove the gallbladder, but also to thoroughly disinfect the abdominal cavity as a whole. Surgical intervention cannot be postponed, since peritonitis can lead to the death of the patient.
• Strictures of the bile ducts. Strictures are narrowings of the canal. Such narrowings can form as a result of the inflammatory process. They impede the flow of bile and cause stagnation in the liver, although the gallbladder itself can be removed. Surgery is necessary to relieve strictures. As a rule, the narrowed area is expanded or a bypass path is made for bile from the liver to the duodenum. There is no effective solution to this problem other than surgery.
• Accumulation of pus. Purulent complications of cholelithiasis occur when an infection enters the gallbladder. If pus accumulates inside an organ, gradually filling it, this complication is called empyema. If pus accumulates near the gallbladder, but does not spread throughout the abdominal cavity, they speak of a paravesical abscess. With these complications, the patient's condition deteriorates significantly. There is a high risk of spreading the infection. The operation includes removal of the gallbladder, emptying of the purulent cavity and its thorough disinfection to prevent peritonitis.
• Biliary fistulas. Biliary fistulas are pathological openings between the gallbladder ( less often through the biliary tract) and adjacent hollow organs. Fistulas may not cause acute symptoms, but they disrupt the natural process of bile flow, digestion, and also predispose to other diseases. The operation is performed to close pathological holes.

In addition to the stage of the disease, its form and the presence of complications, concomitant diseases and age play an important role in the choice of treatment. In some cases, patients are contraindicated for drug treatment ( intolerance to pharmacological drugs). Then surgical treatment will be a reasonable solution to the problem. Elderly patients with chronic diseases ( heart failure, kidney failure, etc.) may simply not be able to endure the operation, so in such cases, surgical treatment, on the contrary, is tried to be avoided. Thus, the treatment strategy for gallstone disease may vary in different situations. Only the attending physician can clearly determine whether a patient needs surgery after a full examination.

How to treat cholelithiasis with folk remedies?

In the treatment of cholelithiasis, folk remedies are ineffective. The fact is that with this disease, stones begin to form in the gallbladder ( usually crystals containing bilirubin). It is almost impossible to dissolve these stones using traditional methods. To split or crush them, powerful pharmacological drugs or ultrasonic waves are used, respectively. However, folk remedies play a role in the treatment of patients with gallstone disease.

Possible effects of medicinal plants for gallstone disease are:

• Smooth muscle relaxation. Some medicinal plants relax the muscular sphincter of the gallbladder and the smooth muscles of its walls. Thanks to this, attacks of pain are relieved ( usually caused by spasm).
• Decreased bilirubin levels. Increased levels of bilirubin in bile ( especially with prolonged stagnation) may promote stone formation.
• Outflow of bile. Due to the relaxation of the sphincter of the gallbladder, bile flows out. It does not stagnate, and crystals and stones do not have time to form in the bubble.

Thus, the effect of using folk remedies will be predominantly preventive. Patients with liver problems or other factors that predispose them to gallstones will benefit from periodic treatment. This will slow down the formation of stones and prevent the problem before it occurs.

To prevent gallstone disease, you can use the following folk remedies:

• Radish juice. Black radish juice is diluted with honey in equal proportions. You can also cut a cavity in the radish and pour honey into it for 10–15 hours. After this, the mixture of juice and honey is consumed 1 tablespoon 1 - 2 times a day.
• Barberry leaves. Green barberry leaves are thoroughly washed with running water and filled with alcohol. For 20 g of crushed leaves, 100 ml of alcohol is needed. Infusion lasts 5 – 7 hours. After this, drink 1 teaspoon of the tincture 3-4 times a day. The course lasts 1 – 2 months. After six months it can be repeated.
• Rowan infusion. 30 g of rowan berries are poured into 500 ml of boiling water. Leave for 1 – 2 hours ( until the temperature drops to room temperature). Then the infusion is taken half a glass 2 - 3 times a day.
• Mumiyo. Shilajit can be taken both to prevent the formation of stones and for cholelithiasis ( if the diameter of the stones does not exceed 5 - 7 mm). It is diluted in a ratio of 1 to 1000 ( 1 g mummy per 1 liter of warm water). Before meals, drink 1 glass of solution, three times a day. This product can be used for no more than 8 - 10 days in a row, after which you need to take a break of 5 - 7 days.
• Mint with celandine. Equal proportions of dry leaves of these herbs are consumed as an infusion. For 2 tablespoons of the mixture you need 1 liter of boiling water. Infusion lasts 4 – 5 hours. After this, the infusion is consumed 1 glass per day. Sediment ( grass) filtered before use. It is not recommended to store the infusion for more than 3 - 4 days.
• Snake knotweed. To prepare the decoction, you need to pour 2 tablespoons of dry crushed rhizomes into 1 liter of boiling water and cook for 10 - 15 minutes over low heat. 10 minutes after turning off the heat, strain the broth and let it cool ( usually 3 – 4 hours). The decoction is taken 2 tablespoons half an hour before meals, twice a day.

A common method of preventing gallstone disease is blind probing, which can be performed at home. This procedure is also used in medical institutions. Its purpose is to empty the gallbladder and prevent bile stagnation. People with gallstones ( detected by ultrasound examination) blind probing is contraindicated, as this will lead to stone entry into the bile duct and can seriously worsen the general condition.

To prevent bile stagnation using blind probing, you can use pharmacological drugs or some natural mineral waters. Water or medicine should be drunk on an empty stomach, after which the patient lies on the right side, placing it under the right hypochondrium ( to the area of ​​the liver and gallbladder) warm heating pad. You need to lie down for 1 – 2 hours. During this time, the sphincter will relax, the bile duct will expand, and bile will gradually flow into the intestines. The success of the procedure is indicated by dark stool with an unpleasant odor after a few hours. It is advisable to consult with your doctor about the methodology for conducting blind probing and its advisability in each specific case. After the procedure, you need to follow a low-fat diet for several days.

Thus, folk remedies can successfully prevent the formation of gallstones. In this case, regularity of treatment courses is important. It is also advisable to undergo preventive examinations with a doctor. This will help detect small stones ( using ultrasound) in case traditional methods do not help. After the formation of stones, the effectiveness of traditional medicine is greatly reduced.

What are the first signs of gallstone disease?

Gallstone disease can proceed secretly for a long time, without manifesting itself in any way. During this period, the patient’s body experiences stagnation of bile in the gallbladder and gradual formation of stones. Stones are formed from pigments contained in bile ( bilirubin and others), and resemble crystals. The longer the bile stagnates, the faster such crystals grow. At a certain stage, they begin to injure the inner lining of the organ, interfere with the normal contraction of its walls and prevent the normal outflow of bile. From this moment on, the patient begins to experience certain problems.

Typically, gallstone disease first manifests itself as follows:

• Heaviness in the stomach. A subjective feeling of heaviness in the abdomen is one of the first manifestations of the disease. Most patients complain about it when visiting a doctor. Heaviness is localized in the epigastrium ( in the pit of the stomach, in the upper abdomen) or in the right hypochondrium. It can appear spontaneously, after physical activity, but most often after eating. This sensation is explained by stagnation of bile and enlargement of the gallbladder.
• Pain after eating. Sometimes the first symptom of the disease is pain in the right hypochondrium. In rare cases, this is biliary colic. It is a severe, sometimes unbearable pain that can radiate to the right shoulder or shoulder blade. However, most often the first attacks of pain are less intense. It is rather a feeling of heaviness and discomfort, which, when moving, can turn into stabbing or bursting pain. Discomfort occurs an hour to an hour and a half after eating. Painful attacks are especially common after consuming large amounts of fatty foods or alcohol.
• Nausea. Nausea, heartburn, and sometimes vomiting can also be the first manifestations of the disease. They also usually appear after eating. The connection of many symptoms with food intake is explained by the fact that the gallbladder normally secretes a certain amount of bile. It is needed for emulsification ( a kind of dissolution and assimilation) fats and activation of certain digestive enzymes. In patients with gallstones, bile is not secreted and food is digested less well. Therefore, nausea occurs. The reverse reflux of food into the stomach leads to belching, heartburn, gas accumulation, and sometimes vomiting.
• Changes in stool. As mentioned above, bile is necessary for the normal absorption of fatty foods. With uncontrolled bile secretion, prolonged constipation or diarrhea may occur. Sometimes they appear even before other symptoms typical of cholecystitis. In later stages, the stool may become discolored. This means that the stones have blocked the ducts, and practically no bile is released from the gallbladder.
• Jaundice. Yellowing of the skin and sclera of the eyes is rarely the first symptom of gallstone disease. Usually it is observed after digestive problems and pain. Jaundice is caused by stagnation of bile not only at the level of the gallbladder, but also in the ducts inside the liver ( where is bile formed?). Due to liver dysfunction, a substance called bilirubin accumulates in the blood, which is normally excreted in bile. Bilirubin enters the skin, and its excess gives it a characteristic yellowish tint.

From the moment stones begin to form until the first signs of illness, quite a long time usually passes. According to some studies, the asymptomatic period lasts on average 10–12 years. If there is a predisposition to the formation of stones, it can be reduced to several years. In some patients, stones form slowly and grow throughout life, but do not reach the stage of clinical manifestations. Such stones are sometimes discovered at autopsy after the death of a patient for other reasons.

It is usually difficult to make a correct diagnosis based on the first symptoms and manifestations of gallstone disease. Nausea, vomiting and digestive disorders can also occur with disorders in other organs of the digestive system. To clarify the diagnosis, an ultrasound is prescribed ( ultrasonography) abdominal cavity. It allows you to detect a characteristic enlargement of the gallbladder, as well as the presence of stones in its cavity.

Is it possible to treat calculous cholecystitis at home?

Where calculous cholecystitis will be treated depends entirely on the patient’s condition. Patients with acute forms of the disease are usually subject to hospitalization, but there may be other indications. At home, cholelithiasis can be treated with medication if it is chronic. In other words, a patient with gallstones does not need urgent hospitalization unless he has severe pain, fever, or other signs of inflammation. However, sooner or later the question arises of surgically eliminating the problem. Then, of course, you need to go to the hospital.


In general, it is recommended to hospitalize a patient in the following cases:

• Acute forms of the disease. In the acute course of calculous cholecystitis, a serious inflammatory process develops. Without proper care for the patient, the course of the disease can become very complicated. In particular, we are talking about the accumulation of pus, the formation of an abscess or the development of peritonitis ( inflammation of the peritoneum). In the acute course of the disease, hospitalization cannot be delayed, since the above-mentioned complications can develop within 1 to 2 days after the first symptoms.
• First signs of illness. It is recommended to admit patients to the hospital who exhibit symptoms and signs of calculous cholecystitis for the first time. There they will do all the necessary research within a few days. They will help you figure out exactly what form of the disease the patient has, what his condition is, and whether there is a question of urgent surgical intervention.
• Accompanying illnesses. Cholecystitis can develop in parallel with other health problems. For example, in patients with chronic heart failure, diabetes mellitus or other chronic diseases, it can cause exacerbation and serious deterioration of the condition. To closely monitor the course of the disease, it is recommended to admit the patient to the hospital. There, if necessary, he will be quickly provided with any help.
• Patients with social problems. Hospitalization is recommended for all patients who cannot be provided with urgent care at home. For example, a patient with chronic cholelithiasis lives very far from the hospital. In the event of an exacerbation, it will be impossible to quickly provide qualified assistance ( Usually we are talking about surgery). During transportation, serious complications may develop. A similar situation arises with older people who have no one to care for them at home. In these cases, it makes sense to operate even on a non-acute process. This will prevent exacerbation of the disease in the future.
• Pregnant women. Calculous cholecystitis in pregnant women is associated with a higher risk for both mother and fetus. In order to provide assistance in time, it is recommended to hospitalize the patient.
• Patient's wish. Any patient with chronic cholelithiasis can voluntarily go to the hospital for surgical removal of gallstones. This is much more profitable than operating on an acute process. Firstly, the risk of complications during surgery and in the postoperative period is reduced. Secondly, the patient chooses the time himself ( vacation, planned sick leave, etc.). Thirdly, it deliberately eliminates the risk of recurrent complications of the disease in the future. The prognosis for such planned operations is much better. Doctors have more time to thoroughly examine the patient before treatment.

Thus, hospitalization at a certain stage of the disease is necessary for almost all patients with cholelithiasis. Not everyone has it associated with surgery. Sometimes this is a preventative course of treatment or diagnostic procedures performed to monitor the progress of the disease. The duration of hospitalization depends on its goals. Examination of a patient with gallstones discovered for the first time usually takes 1–2 days. Prophylactic drug treatment or surgery depends on the presence of complications. Hospitalization can last from several days to several weeks.

At home, the disease can be treated under the following conditions:

• chronic course of cholelithiasis ( no acute symptoms);
• finally formulated diagnosis;
• strict adherence to the specialist’s instructions ( regarding prevention and treatment);
• the need for long-term drug treatment ( for example, non-surgical stone dissolution can last 6 – 18 months);
• possibility of caring for the patient at home.

Thus, the possibility of treatment at home depends on many different factors. The advisability of hospitalization in each specific case is determined by the attending physician.

Is it possible to exercise if you have gallstone disease?

Gallstone disease or calculous cholecystitis is a fairly serious disease, the treatment of which must be taken very seriously. The formation of gallstones may not cause noticeable symptoms at first. Therefore, some patients, even after accidentally discovering a problem ( during a preventive ultrasound examination) continue to lead their usual lives, neglecting the regime prescribed by the doctor. In some cases, this can lead to accelerated progression of the disease and deterioration of the patient's condition.

One of the important conditions of the preventive regimen is limiting physical activity. This is necessary after the discovery of stones, during the acute stage of the disease, as well as during treatment. At the same time, we are talking not only about professional athletes, whose training requires every effort, but also about everyday physical activity. At each stage of the disease, they can affect the development of events differently.

The main reasons for limiting physical activity are:

• Accelerated formation of bilirubin. Bilirubin is a natural product of metabolism ( metabolism). This substance is formed during the breakdown of hemoglobin, the main component of red blood cells. The more physical activity a person performs, the faster red blood cells break down and the more hemoglobin enters the blood. As a result, the level of bilirubin also rises. This is especially dangerous for people who have stagnation of bile or a predisposition to the formation of stones. Bile with a high concentration of bilirubin accumulates in the gallbladder, which gradually crystallizes and forms stones. Thus, people who already have cholestasis ( bile stagnation), but stones have not yet formed, heavy physical activity is not recommended for preventive purposes.
• Movement of stones. If the stones have already formed, then severe loads can cause them to move. Most often, stones are located in the bottom of the gallbladder. There they can cause a moderate inflammatory process, but do not interfere with the outflow of bile. As a result of physical activity, intra-abdominal pressure rises. This also affects the gallbladder to some extent. It is compressed, and the stones can begin to move, moving towards the neck of the organ. There the stone gets stuck at the level of the sphincter or in the bile duct. As a result, a serious inflammatory process develops, and the disease becomes acute.
• Progression of symptoms. If the patient already has digestive disorders, pain in the right hypochondrium or other symptoms of cholelithiasis, then physical activity can provoke an exacerbation. For example, pain due to inflammation can develop into biliary colic. If the symptoms are caused by the movement of stones and blockage of the bile duct, they will not go away when you stop exercising. Thus, there is a chance that even a single exercise session ( running, jumping, lifting weights, etc.) can lead to emergency hospitalization and surgery. However, we are talking about people who already suffer from a chronic form of the disease, but do not comply with the regimen prescribed by the doctor.
• Risk of complications of gallstone disease. Calculous cholecystitis is almost always accompanied by an inflammatory process. Initially, it is caused by mechanical trauma to the mucous membrane. However, many patients also develop an infectious process. As a result, pus may form and accumulate in the bladder cavity. If, under such conditions, intra-abdominal pressure rises sharply or the patient makes a sharp, unsuccessful turn, the swollen gallbladder may burst. The infection will spread throughout the abdominal cavity and peritonitis will begin. Thus, playing sports and physical activity in general can contribute to the development of serious complications.
• Risk of postoperative complications. Often acute cholecystitis must be treated surgically. There are two main types of operations - open, when an incision is made in the abdominal wall, and endoscopic, when removal occurs through small holes. In both cases, after surgery, any physical activity is contraindicated for some time. With open surgery, healing takes longer, more stitches are required, and the risk of stitch dehiscence is higher. With endoscopic removal of the gallbladder, the patient recovers faster. As a rule, full exercise is allowed only 4–6 months after surgery, provided that the doctor does not see other contraindications for this.

Thus, sports are most often contraindicated in patients with cholecystitis. However, moderate physical activity is necessary in certain cases. For example, to prevent the formation of stones, you should do gymnastics and take short walks at a moderate pace. This promotes normal contractions of the gallbladder and prevents bile from stagnating. As a result, even if the patient has a predisposition to form stones, this process slows down.

• daily walks of 30–60 minutes at an average pace;
• gymnastic exercises without sudden movements and limiting the load on the abdominal muscles;
• swimming ( not for speed) without diving to great depths.

These types of loads are used to prevent the formation of stones, as well as restore muscle tone after surgery ( then they start after 1 – 2 months). If we are talking about professional sports with heavy loads ( weightlifting, sprinting, jumping, etc.), then they are contraindicated in all patients with cholelithiasis. After the operation, full-fledged training should begin no earlier than 4 to 6 months, when the incision sites have healed well and strong connective tissue has formed.

Is pregnancy dangerous if you have gallstones?

Gallstone disease in pregnant women is a fairly common occurrence in medical practice. On the one hand, this disease is typical for older women. However, it is during pregnancy that quite a few prerequisites arise for the appearance of gallstones. Most often it occurs in patients with a hereditary predisposition or chronic liver diseases. According to statistics, exacerbation of gallstone disease usually occurs in the third trimester of pregnancy.

The prevalence of this problem during pregnancy is explained as follows:

• Metabolic changes. As a result of hormonal changes, the metabolism in the body also changes. This can lead to accelerated stone formation.
• Motor changes. Normally, the gallbladder stores bile and contracts, releasing it in small portions. During pregnancy, the rhythm and strength of its contractions are disrupted ( dyskinesia). As a result, bile stagnation may develop, which contributes to the formation of stones.
• Increased intra-abdominal pressure. If a woman already had small gallstones, the growth of the fetus may cause them to move. This is especially true in the third trimester, when the growing fetus pushes the stomach, colon and gall bladder upward. These organs are compressed. As a result, the stones located near the bottom of the bubble ( at the top of it), can enter the bile duct and block it. This will lead to the development of acute cholecystitis.
• Sedentary lifestyle. Pregnant women often neglect walks or basic physical exercises, which also contribute to the normal functioning of the gallbladder. This leads to stagnation of bile and accelerated formation of stones.
• Changing your diet. Changing food preferences can affect the composition of the microflora in the intestines and worsen the motility of the bile ducts. If the woman had latent ( asymptomatic) form of cholelithiasis, the risk of exacerbation increases greatly.

Unlike other patients with this disease, pregnant women are at much greater risk. Any complication of the disease is fraught with problems not only for the mother’s body, but also for the developing fetus. Therefore, all cases of exacerbation of cholecystitis during pregnancy are regarded as urgent. Patients are hospitalized to confirm the diagnosis and thoroughly assess their general condition.

Exacerbation of gallstone disease during pregnancy is especially dangerous for the following reasons:

• high risk of rupture due to increased intra-abdominal pressure;
• high risk of infectious complications ( including purulent processes) due to weakened immunity;
• fetal intoxication due to an inflammatory process;
• Fetal nutritional disorders due to poor digestion ( food is digested worse, since bile does not enter the duodenum);
• limited treatment options ( not all drugs and treatment methods that are usually used for gallstone disease are suitable for pregnant women).

If you consult a doctor in a timely manner, serious complications can usually be avoided. The functioning of the gallbladder and its diseases do not directly affect the reproductive system. Patients are usually hospitalized and, if necessary, undergo cholecystectomy - removal of the gallbladder. In this case, preference is given to minimally invasive ( endoscopic) methods. There are peculiarities in the surgical technique and methods of pain relief.

In the absence of complications of cholelithiasis, the prognosis for mother and child remains favorable. If the patient turned to a specialist too late, and the inflammatory process began to spread in the abdominal cavity, the question of removing the fetus by cesarean section may be raised. The prognosis is somewhat worse, since we are talking about a technically complex surgical intervention. It is necessary to remove the gallbladder, extract the fetus, and carefully examine the abdominal cavity to prevent the development of peritonitis.

What are the types of calculous cholecystitis?

Calculous cholecystitis does not occur in the same way in all patients. This disease is caused by the formation of stones in the gall bladder, which causes an inflammatory process. Depending on exactly how this process will proceed, as well as on the stage of the disease, several types of calculous cholecystitis are distinguished. Each of them not only has its own characteristics of course and manifestations, but also requires a special approach to treatment.

From the point of view of the main manifestations of the disease(clinical form)The following types of calculous cholecystitis are distinguished:

• Stone-carrying. This form is latent. The disease does not manifest itself in any way. The patient feels great, does not experience any pain in the right hypochondrium or digestive problems. However, the stones have already formed. They gradually increase in number and size. This will happen until the accumulated stones begin to disrupt the functioning of the organ. Then the disease will begin to manifest itself. Stone carriage can be detected during a preventive ultrasound examination. It is more difficult to notice stones on a plain X-ray of the abdomen. If stone-carrying stones are detected, there is no talk of emergency surgery. Doctors have time to try other treatments.
• Dyspeptic form. In this form, the disease manifests itself in a variety of digestive disorders. It can be difficult to suspect cholecystitis at first, since there is no typical pain in the right hypochondrium. Patients are bothered by heaviness in the stomach and epigastrium. Often after a heavy meal ( especially fatty foods and alcohol) there is belching with a bitter taste in the mouth. This is due to impaired bile secretion. Patients may also have problems with bowel movements. In this case, an ultrasound examination will help confirm the correct diagnosis.
• Biliary colic. In fact, biliary colic is not a form of gallstone disease. This is a common specific symptom. The problem is that in the acute stage of the disease, severe pain attacks occur frequently ( every day, and sometimes more often). The effect of antispasmodic drugs is temporary. Biliary colic is caused by painful contraction of the smooth muscles in the walls of the gallbladder. They are usually observed with large stones, overstretching of the organ, or stone entry into the bile duct.
• Chronic recurrent cholecystitis. The recurrent form of the disease is characterized by repeated attacks of cholecystitis. The attack is manifested by severe pain, colic, fever, characteristic changes in blood tests ( the level of leukocytes and the erythrocyte sedimentation rate - ESR - increases). Relapses occur when attempts at conservative treatment fail. Medicines temporarily reduce the inflammatory process, and some medical procedures can temporarily improve the flow of bile. But as long as there are stones in the cavity of the gallbladder, the risk of relapse remains high. Surgery ( cholecystectomy – removal of the gallbladder) solves this problem once and for all.
• Chronic residual cholecystitis. This form is not recognized by all specialists. It is sometimes talked about in cases where an attack of acute cholecystitis has passed. The patient's temperature dropped and his general condition returned to normal. However, the symptoms remained moderate pain in the right hypochondrium, which intensified with palpation ( palpating this area). Thus, we are not talking about complete recovery, but about the transition to a special form - residual ( residual) cholecystitis. As a rule, over time, the pain goes away or the disease worsens again, turning into acute cholecystitis.
• Angina form. It is a rare clinical form of calculous cholecystitis. Its difference from others is that pain from the right hypochondrium spreads to the heart area and provokes an attack of angina pectoris. Heart rhythm disturbances and other cardiovascular symptoms may also occur. This form is more common in patients with chronic coronary heart disease. Biliary colic in this case plays the role of a kind of “trigger mechanism”. The problem is that due to an attack of angina, doctors often do not immediately detect the main problem - calculous cholecystitis itself.
• Saint's syndrome. It is a very rare and poorly understood genetic disease. With it, the patient has a tendency to form stones in the gall bladder ( actually calculous cholecystitis), apparently due to the lack of certain enzymes. In parallel, diverticulosis of the colon and diaphragmatic hernia are observed. This combination of defects requires a special approach to treatment.

The form and stage of calculous cholecystitis are one of the most important criteria when prescribing treatment. At first, doctors usually try drug treatment. Most often, it turns out to be effective and allows you to fight symptoms and manifestations for a long time. Sometimes latent or mild forms are observed throughout the patient’s life. However, the very presence of stones always poses a threat of exacerbation. Then the optimal treatment will be cholecystectomy - complete surgical removal of the inflamed gallbladder along with stones.

The gallbladder performs the functions of storing, concentrating and secreting bile. When bile stagnates, its components precipitate and turn into crystals, after which the gradual formation of stones occurs. This disease is most common among women over forty years of age. In men, the disease is less common. The reasons for the formation of gallstones are varied. What symptoms of gallstones serve as a signal of a progressive disease, we will tell you in this article.

The formation of gallstones is accompanied by a number of specific symptoms. Let's consider what symptoms are harbingers of cholelithiasis:

1. stabbing and paroxysmal pain under the right rib;
2. bitterness in the mouth;
3. jaundice;
4. nausea;
5. belching;
6. bloating;
7. changes in stool (constipation, diarrhea).

Increased temperature, chills, and fever are also symptoms of the development of the inflammatory process and cholecystitis of the gallbladder.

Causes of the disease

The most common causes of the disease are:

1. inflammatory process of the gallbladder;
2. the content of bile in increased amounts of cholesterol, bile pigment and calcium serves to convert bile into water-insoluble bilirubin;
3. genetic factor is one of the reasons for the formation of stones. The child is likely to develop gallstone disease if one of the parents has had it;
4. treatment with drugs such as octreotide, cyclosporine, clofibrate;
5. long intervals between meals and fasting foreshadow the formation of stones;
6. Crohn's disease, cirrhosis of the liver and Caroli syndrome can lead to the formation of gallstones;
7. when the lower part of the intestine is removed, stones form in the bile;
8. drinking alcohol in large quantities causes the formation of stagnation of bile, as a result of which bilirubin crystallizes and stones appear.

One of the main reasons for the appearance of cholelithiasis is the intake of large amounts of fatty foods with cholesterol. Due to impaired nutrition, obesity develops, which is a secondary risk factor for the development of the disease. In addition, incorrect functioning of internal organs and liver function failure can negatively affect bile and subsequently lead to the formation of stones.

Stones appear when the walls of the gallbladder contract poorly. The causes of poor bladder contraction may include problems such as flatulence and dyskinesia. Surgeries on the gallbladder can also affect its proper functioning. Another reason may be pregnancy, during which the gallbladder becomes stressed and its functioning is disrupted. Cysts, tumors, adhesions, swelling of the bladder walls, congenital defects - all of this can serve as a factor contributing to stone formation.

Infections that enter the bladder through the lymphatic or bloodstream may be one of the causes of cholelithiasis. Inflammation of the gallbladder and its canals is caused by any infection that gets into it. In the future, this leads to cholangitis and cholecystitis, and subsequently to the development of cholelithiasis. In medicine, stone formation is divided into two types:

• primary – the formation of stones occurs slowly and without any signs for a long time;
• secondary – the cause of stones is congestion in the gallbladder.

Bile contains various components and, therefore, the stones that form have a distinctive composition. Stones are classified into the following types:

1. round cholesterol stones with a diameter of 16-18 mm;
2. limestones containing large amounts of lime;
3. mixed stones - have a layered structure, and sometimes have a cholesterol shell and a pigmented center, ranging in size from 0.1 to 5 cm;
4. pigment stones - appear due to an increase in water-soluble bilirubin. They contain substances from calcium salts and bilirubin. In addition, there is a possibility that small bilirubin stones may appear in the bladder, which are located in the ducts and sac.

Diagnosis of cholelithiasis

If the above signs are detected, you should consult a physician or gastroenterologist. The doctor will draw up a general picture of the disease and determine the exact cause of its occurrence. When examining the patient, a general blood test for biochemistry, blood glucose levels, and an analysis of excrement are prescribed.

Another way to determine the disease is an ultrasound of the liver and gallbladder. An ultrasound shows an enlarged gallbladder and the presence of stones in it. The presence of stones can be detected by the following echo signs:

1. solids in the bladder;
2. movement of stones;
3. an increase in the thickness of the bladder wall by more than 4 mm;
4. white mark on the bottom of the stone.

An X-ray of the abdominal cavity clearly identifies stones consisting of calcium salts. Cholecystography is also performed using contrast to better view the gallbladder. To detect cholecystitis, computed tomography is prescribed. And to identify the location of the stone in the bladder, endoscopic cholangiopancreatography is required.

Asymptomatic cholecystitis is common and lasts a long time. This form of cholecystitis is called chronically calculous.

In addition, another type of cholelithiasis is microcholelithiasis, in which stones with a diameter of 0.1-0.2 cm are present in the gallbladder. Such microliths can be detected through endoscopic ultrasonography. The cause of microcholelithiasis is jaundice, postcholecystectomy syndrome.

The main task of differential diagnosis of cholelithiasis is to establish the reality of the disease, and not its similarity with any other diseases. Gallstone disease requires a scrupulous and serious approach, otherwise, if diagnosed untimely, it can cause harm to health, and in some cases, the consequences of cholelithiasis can put a person’s life at risk.

Treatment

Depending on the number and size of stones, the treatment method is determined. Treatment is divided into 2 types: surgical and conservative.

Non-surgical

If stones are detected in the bladder, in many cases drug treatment is carried out without surgery. In such cases, according to the indications and prescription of the doctor, the following drugs are prescribed:

In modern conditions, the following methods are used to treat the gallbladder and its ducts:

• dissolving stones with medications;
• invasive method (percutaneous cholelitholysis);
• crushing stones with ultrasound or laser.

Currently, drugs that actually dissolve stones are expensive and need to be taken for a long time without interruption. If you stop taking such drugs, the stones will form again, since the causes of the disease have not been eliminated. Dissolving stones with drugs is only 50% effective, for example, in patients with X-ray negative stones (not visible on X-rays). But if the stones are pigmented or X-ray positive, then it is difficult to achieve a positive result.

Surgical removal of an organ

There are two methods of cholecystectomy (organ removal):

1. standard;
2. laparoscopic.

The main method of removal is abdominal surgery (opening the abdominal cavity). This method is now rarely used, as complications subsequently arise after surgery. Laparoscopy is performed using a laparoscope apparatus, which consists of two parts:

The advantage of laparoscopy is the small incisions. After this procedure, the patient recovers quickly and there are practically no complications observed.

Indications for surgical removal of stones are:

• the volume of stones is over 33% relative to the gallbladder;
• frequent attacks in the form of colic that are not eliminated by medications;
• formation of blockage of the bile ducts.

Mandatory surgical treatment is resorted to for the following exacerbations:

1. inflammation of the abdominal cavity (peritonitis). Here, surgery is necessary to remove the gallbladder and disinfect the abdominal cavity;
2. narrowing of the bile ducts, which are formed during the inflammatory process. Due to the narrowing of the channels, the outflow of bile is difficult and stagnation begins;
3. accumulation of pus in the gallbladder. When pus accumulates inside an organ, empyema begins, and if pus accumulates next to the organ, then such a disease is called paravesical abscess;
4. the appearance of biliary fistulas - holes between adjacent organs and the gallbladder;
5. biliary ileus (cholelithiasis).

It should be noted that, despite the stage of the disease, when choosing treatment, it is necessary to take into account age and possible side effects. Sometimes, due to drug intolerance, contraindications to drug treatment may occur. Treatment for cholecystolithiasis is selected depending on the situation, and only the attending physician can determine the method of treatment after a thorough examination.

Use of traditional medicine

Cholecystolithiasis is also treated with folk remedies. To dissolve the stones, you need to take a glass of hot water with the juice of one lemon squeezed into it. When using this method of treatment, the stones begin to slowly dissolve. You need to use this product for a long time. In addition to this, you can take other juices from:

• Cucumber, beets, carrots;
• Juice of parsley, carrots, celery.

To treat this disease, other means are also used, for example, tincture of pine nuts or a mixture of Borjomi mineral water and raisins with holosas.

They help only if the gallstones are in small quantities and small in size, and the dissolution of large stones can cause rupture or blockage of the canals.

Nutrition

When the first signs of cholelithiasis are detected, the patient is recommended a special diet that must be followed continuously. This diet is called diet No. 5. Patients with gallstones should limit themselves to the following products: margarine, strong coffee, fatty meats, spicy seasonings, carbonated drinks, smoked products, canned meat and fish, alcohol, yeast baked goods, fresh bread, hard-boiled eggs, meat broths, fish, mushrooms, pickled foods.

Food for a patient with cholecystolithiasis is prepared by boiling or baking. You need to eat food 5-6 times a day. The diet should include as many vegetable oils and vegetables as possible. Vegetables absorb excess cholesterol.

Gallstones are formed due to metabolic problems in the body. They are the cause of cholelithiasis. Stones formed in the organ can be located anywhere - both in the bladder itself and in its ducts, and even in the liver, while their shape and size vary from very small (sand) to very large.

The appearance of stones often causes irritation of the organ mucosa, resulting in the development of a disease such as.

Gallstones are formed in the gall bladder mainly from cholesterol crystals, but for the time being they do not bother a person - biliary colic is a consequence of blockage of one of the stones in the ducts.

Most often, women aged forty and older suffer from this pathology. Men, on the other hand, experience the disease 6–8 times less often, but why this happens is not fully understood.

Symptoms

For a long time, gallstones do not make themselves felt and people find out about their presence randomly during an examination or when they begin to move through the ducts and even block them.

The main signs of gallstones depend on the location of the stone - the manifestation of gallstones will be associated with the size and shape of the latter. The symptoms that all patients with gallstones experience are as follows:

• pain under the rib on the right side (paroxysmal, stabbing);
• nausea;
• bitter taste in the mouth;
• flatulence and other intestinal problems;
• belching air;
• development .

Sometimes symptoms such as fever and chills are also noted - this can occur when the stone begins to move through the ducts. However, most often, an increase in temperature indicates the addition of an infection and the development of cholecystitis, the symptoms of which are characteristic of the inflammatory process.

Predisposing factors that cause hepatic colic are stress and physical overexertion, eating spicy, fatty and fried foods, and excessive alcohol consumption.

The first symptoms of the disease are a deterioration in general well-being and pain, which, although localized under the ribs on the right side, radiates to other parts of the body. The pain develops due to the fact that the stone in the gallbladder, starting to come out, irritates and stretches the walls of the ducts. Or the pain syndrome may be caused by overstretching of the bladder due to the accumulation of bile in it.

Note that the symptoms in case of blockage of the ducts are as follows: the sclera and skin of a person become yellow, the person feels heaviness on the right side under the ribs, vomiting appears mixed with bile, which does not bring relief. This condition is extremely dangerous, as it can lead to seizures and a critical increase in temperature.

Usually the attack ends after the stone enters the small intestine. To improve the patient's condition, lay him on his right side and apply a heating pad. But sometimes the size of the stone is such that it cannot pass through the ducts and gets stuck in them - in this case, removal of stones from the gallbladder is carried out by surgical extraction.

Causes

Normally, stones should not form in a healthy body. However, there are predisposing factors that influence the disruption of metabolic processes and become the causes of the formation of stones in the gall bladder.

Excessive consumption of foods rich in cholesterol is the main cause of the development of cholelithiasis. From here comes the second predisposing factor - due to a disruption in the nutrition process. Also, a disturbance in the composition of bile with the formation of sediment in the form of solid particles, which subsequently form stones, can be caused by such reasons as disturbances in the liver, long-term use of oral contraceptives, and some pathologies of internal organs.

The formation of stones occurs against the background of a decrease in the ability of the gallbladder walls to contract, which, in turn, also depends on completely objective reasons. For example, the reasons for a decrease in contractile function are the presence of pathologies such as flatulence and others. If operations were performed on the organ, this can also cause a disruption in its performance.

Other reasons are physical inactivity and poor nutrition. And during pregnancy, there may be an additional load on the gallbladder, as a result of which its transport function is disrupted.

Mechanical obstacles to the outflow of bile also cause the appearance of stones. In particular, this can occur with various tumors, in the presence of adhesions and cysts, with severe swelling of the bladder walls, and even due to a congenital defect - a bend in the duct.

Gallstone disease can also be caused by reasons such as infections that enter the organ through the bloodstream or lymph flow from other systems of the body. Any infection that penetrates the gallbladder causes its inflammation, after which inflammation of its ducts develops. This leads to the development of cholecystitis and, against which cholelithiasis often develops.

Today, doctors distinguish two types of stone formation in this organ:

• primary, in which gallstones form over a long period of time and do not make themselves felt for a long time;
• secondary, when the formation of stones occurs due to the development of congestion in the gallbladder.

Features of treatment

The diagnosis of cholelithiasis is made based on examination data. Patients are advised to do this, but if it is difficult to determine the presence and location of stones using ultrasound, cholecystography or retrograde cholangiopancreatography is performed.

Treatment of pathology directly depends on the size and number of stones in the organ and their location. It can be either conservative or surgical. Timely conservative treatment makes it possible to preserve the integrity of the organ and ducts and consists of such procedures as:

• dissolution of stones by taking certain medications;
• crushing using ultrasound.

Also in some cases, percutaneous cholelitholysis and minimally invasive methods of stone removal are indicated. Sometimes treatment involves surgery - cholecystectomy. Diet for gallstones also plays an important role. Treatment with traditional methods has also proven itself well.

Drug treatment consists of treatment with drugs such as Henofalk and Ursosan - they allow you to dissolve stones and painlessly remove them from the body.

Drug treatment is indicated only in cases where the stones are small in size and when the functioning of the organ itself is not impaired. A method such as crushing gallstones using ultrasound or laser can be used when large stones need to be broken into small pieces that can independently move through the bile ducts into the intestines. It usually takes several sessions to destroy the stones, but this method is used in cases where a person has several large stones in the gallbladder that cannot be dissolved by taking medications.

Percutaneous cholelitholysis is rarely used and the procedure involves administering a substance that dissolves stones through a special catheter. Much more often, stones are removed from the gallbladder through small incisions (laparoscopy).

The most common operation for patients with cholelithiasis is cholecystectomy, which involves a large-scale operation to remove the organ. This procedure should be used in cases where other methods are unable to solve the problem, or when the entire organ is filled with large stones.

Treatment of this pathology is also associated with the need to adhere to a certain diet. The diet for gallstones includes the following recommendations:

• eat food up to six times a day in small portions;
• increase consumption of foods rich in magnesium;
• increase the amount of animal protein in your diet.

In addition, the diet for gallstones recommends completely avoiding foods such as sausages and smoked meats, pickles and preserves, legumes and butter, and also eliminating some vegetables (cucumbers, eggplants, radishes). It is not recommended to consume coffee, alcohol and organ meats.

The diet for gallstones allows you to eat fish and white meat, cereals (oatmeal and buckwheat are especially useful), cottage cheese and low-fat milk, fruits and vegetables that do not irritate the gastrointestinal mucosa, as well as drink mineral water and natural juices.

Traditional medicine methods

This disease is also treated with folk remedies. In particular, the dissolution of stones is carried out by drinking a glass of hot water with the juice of one lemon squeezed into it. In this case, slow dissolution occurs, so you need to use this recipe for a long time.

Other juice mixtures are also used for a long time:

• carrots, cucumbers and beets;
• carrots, celery and parsley juice.

There are other folk remedies to get rid of the disease. For example, you can treat an illness with raisins, which are mixed with holosas and Borjomi mineral water. Or tincture of pine nuts.

Note that folk remedies can remove those stones from the gallbladder that are small in size, provided that there are only a few of them. It is dangerous to “expel” large stones, as this can lead not only to blockage of the ducts, but also to their rupture.

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

The gallbladder is an 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 digesting fatty foods, cholesterol, and 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 does not experience discomfort for a long time.

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 of gallstone disease is severe and acute 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 of the bile ducts is accompanied by constant nagging pain and a 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 levels of 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. This depends on the constituent components of 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. Calcium salts are layered on cholesterol and pigment formations, 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 consult a doctor only when they experience severe pain. Hepatic colic requires examination by a gastroenterologist to confirm the diagnosis. The doctor is required to prescribe a general blood test and biochemistry.

On a biochemical study, an increased level of bilirubin is clearly visible, and on a general basis - 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. Calcareous formations are clearly visible on x-rays, and ultrasonography using an endoscope allows you to see stones in the gall bladder 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 herbal ones). 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, open abdominal surgery (classical cholecystectomy) or surgery using laparoscopy (laparoscopic cholecystectomy) can be used.

In some cases, surgical removal of stones by laparoscopy may be required 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 a strict diet. 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:

• any meat and fish broths;
• fried, fatty and salty;
• marinades, smoked meats, seasonings;
• eggs;
• rich pastries and fresh rye bread;
• strong tea and coffee;
• alcohol and soda;
• canned meat and fish.

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 lose excess weight. Prolonged fasting and irregular eating can also trigger the formation of stones.

Conclusion

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

Hepatologist, Gastroenterologist, Nutritionist

Svetlana Vladimirovna sees patients with liver and gastrointestinal diseases of varying severity. Thanks to her knowledge in nutrition, based on diagnostics, she carries out a full range of therapy for intra-abdominal organs.

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

Why do gallstones form?

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

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

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

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

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

Forms of cholelithiasis and symptoms of gallstones

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

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

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

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

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

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

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

Therapy for cholelithiasis: how to treat gallstones?

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

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

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

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

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

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

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

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