Gallstone disease is the formation of hard stones in the gallbladder and ducts from bile components. Sometimes the signs of the disease are so minor that not all patients are able to describe what symptoms cause gallstones

Treatment without surgery is carried out using chenodeoxycholic and ursodeoxycholic acid, as well as effective folk remedies.
Cholecystectomy is performed only in advanced stages.

Reasons

Gallstone disease occurs as a result of stagnation of bile in the bile ducts.
The reason for this is the incorrect composition of bile.
It consists of cholesterol, acids and lecithin.

With the correct ratio of these components, cholesterol dissolves in bile and enters the duodenum through the biliary tract.

If the composition of bile is incorrect, compounds of cholesterol crystals with calcium salts appear.
As a result, deposits occur in the gallbladder.

There are several factors that contribute to the development of gallstones:

• obesity,
• incomplete emptying of the gallbladder (the remaining bile remaining in it gradually loses its density until deposits form),
• increased concentrations of bilirubin in the bile (a yellow dye that is formed as a result of the physiological breakdown of old or damaged red blood cells or infection of the ducts leading from the liver),
• diabetes mellitus type 2,
• sudden weight loss and starvation,
• hypertriglyceridemia (that is, an increased concentration of triglycerides in the blood serum, which leads to impaired bile composition),

Diet errors:

1. Excessive amounts of sweets, sugar, honey and jam in the diet.
2. Excessive amounts of animal fats and cholesterol in the diet.
3. Insufficient amount of fiber in the diet.
4. Irregular meals.

Symptoms

Even small stones can block the exit of bile into the bile duct and then attacks of severe pain appear. This is the so-called biliary colic, which is the most common symptom of cholelithiasis. The disease is three times more common in women than in men.

Charcot's triad is a characteristic set of symptoms associated with inflammation of the biliary tract.

These include:

1. Epigastric pain radiating to the right shoulder. Most often they appear after eating, especially after fatty and heavy foods, last from several tens of minutes to several hours, and then disappear.
2. Sometimes the pain is very acute and may be accompanied by nausea and vomiting, a feeling of anxiety,.
3. Fever and chills.
4. Jaundice.
5. If a stone blocks the bile duct, pain may occur after almost every meal.

Diagnosis of deposits in the bile ducts can be carried out in several ways.
Many times, the disease is discovered by chance during another study, for example, during an ultrasound during pregnancy.

To identify stones, they use, first of all, a blood test and an ultrasound of the abdomen.
A blood test to diagnose gallbladder deposits involves looking at liver enzymes to look for signs of liver dysfunction.
Elevated liver enzymes may indicate blockage of the bile ducts by stones.

First of all, avoid fried, fatty foods (meat and fish), smoked foods, eggs, fatty sour cream, mayonnaise, legumes, fried potatoes, chips, mushrooms, fried onions.

Avoid margarine, refined sugar, chocolate, whipped cream, puff pastry and cakes, wheat bread, coffee, alcohol, carbonated drinks, canned food and preservatives.

Eat 4-5 small meals a day and drink at least 2.5 liters of water. The menu may include vegetable soups, lean grilled or boiled meat, lean poultry without skin and lean fish (perch, pike perch, pike).

Add low-fat cottage cheese to the menu.
For dessert, eat boiled fruits, fruit purees, juices and fruit salads. Drink fennel tea, apple, grape or orange juice.

Reducing the amount of fat in the diet reduces the absorption of fat-soluble vitamins, so foods should be included in the diet:

• rich in beta-carotene (chard, broccoli, carrots, peppers, green lettuce, green onions, spinach, apricots, peaches, plums, cherries),
• vitamin D (fatty sea fish: salmon, mackerel, sardine, herring),
• vitamin E (green parsley, spinach, lettuce, asparagus, nectarines, wheat bran, vegetable oils)
• vitamin K (spinach, lettuce, Brussels sprouts, green tea, cabbage, ).

The following oils can be used in the diet: rapeseed, olive, sunflower, soybean and corn. Butter can be consumed in limited quantities.

Your diet should include foods rich in vitamin C.
It stimulates it to produce antibodies that facilitate the treatment of inflammation.
It contains parsley, red pepper, green pepper, Brussels sprouts, broccoli, cauliflower, spinach, black currants, strawberries, wild strawberries, kiwi, lemon, grapefruit, oranges.

Surgical treatment

1. Laparoscopic surgery. This is currently the most modern method of removing deposits from the gallbladder. Through 3 or 4 incisions in the skin of the abdomen, about 1 cm long, the surgeon inserts a camera and instruments into the abdominal cavity. Watching the progress of the operation on the monitor, these instruments remove the entire bladder along with the stones. Advantages: The biggest advantage of this method is the rapid restoration of health and the ability to leave the hospital two days after the operation. Small wounds on the abdomen heal quickly, they are less painful, and, what is important for many women, they are less noticeable. You can return to work 2 weeks after surgery. Disadvantages: This method is not suitable for people who are obese or have acute inflammation of the gallbladder.
2. Classic operation For people who cannot perform the operation using the laparoscopic method, surgery using the classical method is recommended. Under general anesthesia, an incision is made under the right arch of the rib vault about 10 cm long. Through it, the organ filled with deposits is cut out and removed. Advantages: Unlike the laparoscopic method, the classical operation used for acute inflammatory processes of the biliary tract and complications of the disease. Disadvantages: Long period of wound healing, and long recovery period. After a classic operation, the time to return to work increases to 4 and sometimes 6 weeks.
3. Stone crushing (lithotripsy) How else to treat such a painful condition as gallstones symptoms Treatment without surgery with a laser is called lithotripsy. This method consists of crushing gallstones using a shock wave (for example, ultrasound). Its effectiveness depends on the number and size of the stones , so it can only be used in every fourth patient. Advantages: It is an alternative for people who do not want or cannot undergo surgery. The procedure is painless and relatively safe. Disadvantages: This method is less effective than surgical treatment, and relapses of the disease occur in half of the cases.

Pharmacological treatment

If its intensity is strong, opioids are used: pethidine or pentazocine.
Drugs with antispasmodic effects are used simultaneously, including papaverine and drotaverine.

In the treatment of patients who, due to contraindications, cannot be treated surgically, ursodeoxycholic acid can be used.
It dissolves cholesterol deposits.

However, you should know that the diameter of the stones decreases by 1 mm per month of pharmacological treatment.
Treatment is long-term (12-24 months), and its effectiveness is 50-70%.

Ursodeoxycholic acid cannot be used if the diameter of the deposits exceeds 15 mm, also in the case of dye-based stones, obese patients, with liver disease and during pregnancy.

Natural Treatments

Removal of deposits from the gallbladder most often occurs surgically. However, you can try natural treatments.

Try to drink herbal teas from juniper fruits and St. John's wort. They stimulate the dissolution of stones in the gallbladder.
Gallstone disease can be treated with herbs.

Use the following recipe:

1. – 20 g.
2. Chamomile flowers – 20 g.
3. Mint leaves – 20 g.

Mix the herbs, add 1 spoon of the mixture and pour a glass of boiling water. Leave covered for 3 minutes, strain and drink the warm infusion half a glass several times a day.

Apples contain malic acid and limonoids, phytochemicals known for their antioxidant and medicinal properties. Malic acid can help you with gallstones.

To prepare a medicinal mixture, you need to squeeze the juice out of 3-4 apples and add a tablespoon of apple cider vinegar to it. The liquid should be taken several times a day for 10 days.

Pear with honey
Not only apple, but also pear, reduces deposits and lowers cholesterol levels. From these fruits you can prepare a drink that dissolves deposits.

To do this you need 4 pears, several glasses of boiled water and a tablespoon of honey for taste.

Cut the pears into slices and place in a mixer, add water and then honey. Beat everything until smooth. The mixture must be taken several times a day, at least 4 times a week.

Mint stimulates the gastrointestinal tract and improves digestion. Regulates bile flow and protects against bile formation. In addition, it relieves unpleasant symptoms of gallstone disease.

The mint infusion recipe is very simple. Place a handful of fresh mint leaves in a saucepan and add half a liter of water. Cook for 10 minutes. Then strain the liquid. Drink the decoction three times a day for several days.

Lemon with olive oil
Mix two tablespoons of lemon juice with a spoon of olive oil. Drink the mixture in a course of 40 days. Then take a break and repeat the course of treatment after a few weeks.

Gallstone disease is a serious disease.
But the above methods can help get rid of this problem and alleviate unpleasant ailments. In treatment, use recipes from traditional medicine.
If the symptoms of the disease do not go away, you should visit a doctor.

In this article we will try to understand the causes of gallstones, the first symptoms, risk factors and the possibility of treatment without surgery. We will also touch on the topic of nutrition and try to draw conclusions regarding the operation.

How do gallstones actually form?

First of all, you need to remember that gallstone disease is this is a disease associated with metabolic disorders. This problem occurs in people with lipid metabolism disorders and cholesterol metabolism disorders. Bile takes part in the breakdown of fats and brings them to a very fine state. If, for example, a person excludes fats from his diet, then the bile will concentrate, which will subsequently lead to the crystallization of stones. The thing is that cholesterol and bilirubin cannot be filtered by the kidneys, so they are excreted exclusively through bile. Under unfavorable conditions, they are able to settle and form crystals. After which these crystals begin to turn into real stones, which are dangerous due to blockage of the ducts. If they form, the resulting symptoms are very difficult to immediately distinguish from other diseases. If the ducts are blocked, then bile stops being excreted, which will inevitably lead to inflammation of the gallbladder.

If you are not sure about the presence of gallstones, then you should go for an ultrasound diagnosis, which will show an accurate result.

Symptoms of gallstone disease:

• Pain in the right hypochondrium radiating to the neck, arm or jaw
• Nausea and bitterness in the mouth
• Constipation, flatulence, loose stools, heartburn
• Yellowing of the skin and eye sclera

These stones can reach large sizes (about the size of a quail egg); when the size of the stone reaches 4-5 mm, it becomes larger than the size of the duct and the channel becomes clogged.
Large stones cannot be dissolved using therapeutic methods., so in such cases you need to undergo surgery. Most often this results from neglect of one’s health and failure to consult a doctor in a timely manner.

What causes stones to appear?

• Cholesterol and fatty foods
• Constant fasting or irregular eating
• Sedentary lifestyle
• Metabolic disorders
• Diseases of the liver and digestive organs
• Diseases of the gallbladder
• Frequent drinking and nervous stress

The danger of stones in the body

The biggest danger is the development of all kinds of complications. If your stones continue to grow, they can form a bedsore on the surface of the bladder, a fistula, and even effusion into the intestines, which can lead to detrimental consequences, and even intestinal obstruction. The stones themselves pose a great threat not only to the gallstones, they can endanger other organs, including the pancreas.

Treatment without surgery

It all starts with nutrition, so try to take it extremely seriously from now on. You need to normalize lipid metabolism, lower cholesterol levels and cleanse the blood. To begin with, start following a low cholesterol diet/nutrition. Also, do not forget about the correct consumption of fats:

• Eat mostly butter fats in the morning
• For lunch, fish oil (omega 3-6)
• Consume high-quality vegetable fats in the evening

Adjust your weight and completely give up smoking and alcohol, exercise regularly and play sports or just walk.

Nutrition tips

Is it necessary to have surgery if there are stones in the gall bladder?

If you have 1-2 small stones, there are no problems with the gallstones (no blockages), there are no complications from the pancreas, there is no reflux of bile, bitterness or disruption of the stomach, then you can take your time with the operation. You can try to make yourself a proper diet or try to dissolve gallstones. But if you have pain and eating disorders, then you need to have surgery.

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The gallbladder is an organ that stores bile produced by the liver. The latter is necessary for digesting food. If necessary, it is released into the duodenum. Bile is a complex substance containing large amounts of bilirubin and cholesterol.

Gallstones are formed due to stagnation of bile, during which cholesterol is retained in the bladder and precipitates. This process is called the process of formation of “sand” - microscopic stones. If the “sand” is not eliminated, the stones adhere to each other, forming stones. Stones in the gall ducts and in the gallbladder itself take a long time to form. This takes 5-20 years.

Gallstones may not manifest themselves for a long time, but it is still not recommended to start the disease: the stone can injure the wall of the gallbladder and the inflammation will spread to neighboring organs (patients often also suffer from gastritis, ulcers, pancreatitis). We will look at what to do if gallstones occur and how to treat this problem without surgery in this article.

How are gallstones formed?

The gallbladder is a small sac that holds 50-80 ml of bile, a fluid that the body needs to digest fats and maintain normal microflora. If bile stagnates, its components begin to precipitate and crystallize. This is how stones are formed, which increase in size and quantity over the years.

Moreover, one of the most common causes of illness are considered:

1. Severe inflammation in the gallbladder.
2. The contractility of the gallbladder decreases, which causes stagnation of bile.
3. When bile contains large amounts of calcium, cholesterol, bile pigment, it is water-insoluble bilirubin.
4. Most often, in women, the disease is provoked by obesity, a large number of births, and the use of hormones - estrogens.
5. Heredity. The formation of gallstones is caused by a genetic factor. If parents suffered from an illness, their child also has a risk of developing pathology.
6. Drug treatment – ​​Cyclosporine, Clofibrate, Octreotide.
7. Diet. Fasting or long intervals between meals can cause gallstones. Limiting your fluid intake is not recommended.
8. Gallstones can occur due to hemolytic anemia, Caroli syndrome,.
9. As a consequence of an operation in which the lower part of the intestine is removed.
10. Alcohol. Abuse of it provokes stagnation in the bladder. Bilirubin crystallizes and stones appear.

As you know, bile consists of various components, therefore stones may differ in composition. The following types of stones are distinguished:

1. Cholesterol - have a round shape and a small diameter (approximately 16-18 mm);
2. Calcareous – contain a lot of calcium and are quite rare;
3. Mixed - characterized by a layered structure, in some cases consisting of a pigmented center and a cholesterol shell.

In addition, bilirubin stones, which are small in size and localized both in the bag and in the ducts, can form in the gallbladder. However, most often the stones are mixed. On average, their sizes range from 0.1 mm to 5 cm.

Symptoms of gallstones

The clinical picture of symptoms when gallstones appear is quite varied. Symptoms depend on the composition, quantity and location of stones. Most patients with single large stones located directly in the gallbladder are often not even aware of their disease. This condition is called the hidden (latent) form of cholelithiasis.

As for specific signs, then gallstones make themselves felt with such symptoms:

• (projection of the liver and biliary tract) – intensity from mild discomfort to hepatic colic;
• dyspeptic syndrome - manifestations of digestive disorders - nausea, unstable stool;
• an increase in body temperature is a consequence of the addition of a secondary bacterial infection.
• if the stone descends along the bile duct, then the pain is localized in the groin and radiates to the femoral part.

In 70% of people, this disease does not cause any discomfort at all; a person begins to feel discomfort only when the stones have already grown and blocked the bile duct and the typical manifestation is biliary colic, which is an attack of acute pain when the bile duct is periodically blocked by a stone. This attack of acute pain, that is, colic, can last from 10 minutes to 5 hours

Diagnostics

Diagnosis is carried out by a gastroenterologist. The diagnosis is established using the patient's complaints and some additional studies.

First, the patient undergoes an ultrasound of the abdominal organs. – the main and most effective method for diagnosing cholelithiasis. Detects the presence of stones in the gallbladder, thickening of the walls of the gallbladder, its deformation, and dilation of the bile ducts. Its main advantages are non-invasiveness (non-traumatic), safety, accessibility and the possibility of repeated use.

If the situation is more serious, then doctors resort to cholecystocholangiography (x-ray examination with the introduction of a contrast agent).

Consequences

The course of gallstone disease can be complicated by the following conditions:

• phlegmon of the gallbladder wall;
• biliary fistulas;
• Mirizzi syndrome (compression of the common bile duct);
• gallbladder perforation;
• biliary pancreatitis;
• spicy and ;
• hydrocele of the gallbladder;
• intestinal obstruction;
• gallbladder cancer;
• acute purulent inflammation (empyema) and gangrene of the gallbladder.

In general, the presence of a stone in the bladder is not dangerous as long as it does not block the bile duct. Small stones usually pass on their own, and if their size is comparable to the diameter of the duct (about 0.5 cm), then pain occurs with passage - colic. The grain of sand “slipped” further into the small intestine - the pain disappears. If the pebble is so large that it gets stuck, then this situation requires immediate medical intervention.

Gallstones: treatment without surgery

Detection of stones in the gall bladder does not always imply mandatory surgical intervention; in most cases, treatment without surgery is indicated. But uncontrolled self-medication at home is fraught with blockage of the bile ducts and an emergency end to the operating table of the surgeon on duty.

Therefore, it is better not to consume dubious cocktails made from strictly prohibited choleretic herbs and vegetable oil, which are recommended by some traditional healers, but to make an appointment with a gastroenterologist.

For conservative treatment of cholelithiasis The following medications are prescribed:

1. Drugs that help normalize the composition of bile (ursofalk, lyobil);
2. Enzyme preparations that improve digestive processes, in particular the processes of lipid digestion (Creon).
3. For pain caused by contraction of the gallbladder, patients are recommended to use various muscle relaxants (plataphylline, drotaverine, no-spa, metacin, pirencipin).
4. Stimulators of bile acid secretion (phenobarbital, zixorine).

Modern conservative treatment, which allows preserving the organ and its ducts, includes three main methods: dissolving stones with drugs, crushing stones using ultrasound or laser, and percutaneous cholelitholysis (invasive method).

Dissolution of stones (litholytic therapy)

Dissolving gallstones with medications helps cure gallstones without surgery. The main drugs used to dissolve gallstones are ursodeoxycholic acid (Ursosan) and chenodeoxycholic acid (Chenofalk).

Litholytic therapy indicated in the following cases:

1. The stones are small in size (from 5 to 15 mm) and fill no more than 1/2 of the gallbladder.
2. The contractile function of the gallbladder is normal, the patency of the bile ducts is good.
3. The stones are of cholesterol nature. The chemical composition of stones can be determined using duodenal intubation or oral cholecystography.

Ursosan and Henofalk reduce the level of substances in bile that promote the formation of stones (cholesterol) and increase the level of substances that dissolve stones (bile acids). Litholytic therapy is effective only in the presence of small cholesterol stones, in the early stages of the disease. The dose and duration of medication is determined by the doctor based on ultrasound data.

Stone crushing (extracorporeal lithotripsy)

Extracorporeal shock wave lithotripsy (pulverization) is a technique based on the generation of a shock wave, leading to crushing the stone into many grains of sand. Currently, this procedure is used as a preparatory step before oral litholytic therapy.

Contraindications are:

1. Bleeding disorders;
2. Chronic inflammatory diseases of the gastrointestinal tract (cholecystitis, pancreatitis, ulcers).

TO side effects Ultrasound lithotripsy includes:

1. Risk of bile duct blockage;
2. Damage to the walls of the gallbladder by stone fragments as a result of vibration.

Indications for ESWL are the absence of obstruction of the bile ducts, single and multiple cholesterol stones with a diameter of no more than 3 cm.

Percutaneous transhepatic cholelitholysis

It is rarely used because it is an invasive method. A catheter is inserted into the gallbladder through the skin and liver tissue, through which 5-10 ml of a mixture of special drugs is injected dropwise. The procedure must be repeated; in 3-4 weeks, up to 90% of the stones can be dissolved.

You can dissolve not only cholesterol, but also other types of gallstones. The number and size of stones do not matter. Unlike the previous two, this method can be used not only in individuals with asymptomatic cholelithiasis, but also in patients with severe clinical manifestations of the disease.

Surgery to remove gallstones

However, it is worth understanding that surgical treatment cannot be avoided if:

• frequent biliary colic;
• “disabled” (lost contractility) bladder;
• large stones;
• frequent exacerbations of cholecystitis;
• complications.

In most cases, surgery to remove stones from the gallbladder is recommended for patients whose disease is accompanied by frequent relapses, attacks of severe pain, large stones, high body temperature, and various complications.

Surgical treatment can be laparoscopic and open (cholecystolithotomy, cholecystectomy, papillosphincterotomy, cholecystostomy). The surgical option is determined for each patient individually.

Nutrition

Usually, a diet is prescribed as soon as the first signs of gallstones appear. It is specially designed for such patients, it is called therapeutic diet No. 5, and you must adhere to it constantly.

• fatty meat;
• various smoked meats;
• margarine;
• spicy seasonings;
• hard-boiled eggs;
• strong coffee;
• canned meat and fish;
• pickled products;
• broths: meat, fish and mushroom;
• fresh bread and yeast baked goods;
• carbonated drinks;
• alcohol.

Food is prepared by boiling or baking, and you need to eat it often - 5-6 times a day. The diet for gallstones should contain a maximum of vegetables and vegetable oils. Vegetables, due to vegetable protein, stimulate the breakdown of excess cholesterol, and vegetable oils improve intestinal motility, promote bladder contraction, and thereby prevent the accumulation of bile in it.

Every tenth inhabitant of our planet is diagnosed with gallstones. They differ in size. Sometimes there is only one stone in the bubble, but most often there are several of them, and of different shapes. This pathology is usually discovered during the next preventive examination. In this case, the question arises: “Gallstone in the gall bladder - should it be removed or not?” It is not possible to give a definite answer to this. The pathology may not manifest itself for a long time, but it is not recommended to start it. The stone can injure the walls of the organ, and inflammation can spread to other areas. In this article we will talk in more detail about the causes of this pathology and the treatment methods offered by modern medicine.

General information

The gallbladder is a small reservoir of liquid contents that is located next to the liver. The latter continuously produces bile. It constantly accumulates in the bladder, which, when emptied, throws it into the duodenum. Bile promotes active digestion of food. It consists of quite complex chemicals, as well as cholesterol and bilirubin. Over a long period of time, cholesterol gradually begins to precipitate and then be deposited on the so-called protein frameworks. This process entails the formation of microscopic stones, which over time can increase in size and merge with each other. In this case, we are usually talking about cholelithiasis.

The formation of a stone in the gallbladder is a fairly long process, taking from 5 to approximately 20 years. Experts distinguish the following types:

• Cholesterol. They are distinguished by their round shape and small diameter of up to 18 mm.
• Calcareous. They contain a lot of calcium and are extremely rare.
• Mixed. Characterized by a layered structure.

The type of stones depends primarily on the person’s diet. For example, in Europe, 90% of all diagnosed gallstones are cholesterol in nature. In Japan, until 1945, calcareous forms predominated. However, over time and as the Japanese switched to a “Western” diet, the proportion of cholesterol stones began to increase.

It is noteworthy that on the African continent this kind of pathology is confirmed extremely rarely, which cannot be said about our country. On the territory of Russia, 12 out of 100 people are diagnosed annually, 600 thousand people; in the USA these figures are much higher. In America, about 1.2 million people undergo surgery every year.

Reasons

Under normal conditions, in absolutely healthy people, the bile in the bladder is in a liquid state and does not contribute to the formation of stones. However, experts name a number of factors that influence the change in its initial properties. As a result, stones are formed.

• Inflammation of the wall of the pouch.
• Metabolic disorders due to physical inactivity, stagnation of bile, ailments of an infectious nature.
• Hereditary predisposition.
• Liver diseases.
• Food. Due to the consumption of cholesterol-containing foods, the concentration of this substance gradually increases and stones form.
• Diet. Fasting often causes the development of gallstone disease.
• Changes at the hormonal level. An excess of female sex hormones is usually observed during pregnancy and the use of oral contraceptives.
• Age. The body of older people quite often cannot cope with the load on the liver, which entails the formation of pathology.
• Stress.
• Drinking alcoholic beverages.

What symptoms indicate a gallstone?

How to relieve an attack of pain? What medications should I take for this? Before understanding these issues, it is necessary to tell what signs indicate the formation of stones.

Many people with this pathology often do not even suspect it. Symptoms most often appear several years after the onset of its formation.

Biliary colic appears suddenly. The pain is constant in nature and is localized mainly in the area of ​​the right hypochondrium. The duration of the spasms can range from 15 minutes to approximately four hours. If after this time the pain does not go away, inflammation of the gallbladder can be suspected.

Patients also note the presence of a pronounced dyspeptic syndrome (problems with stool, nausea, bloating). Some people have a fever. This symptom most often indicates the addition of a secondary bacterial infection.

Survey plan

If you have been diagnosed with a gallstone, only a qualified specialist can tell you how to treat it and what to do next. If primary symptoms appear, it is recommended to consult a gastroenterologist. Diagnosis of this pathology involves a conversation with a doctor, studying the patient’s specific complaints, and collecting an anamnesis.

If gallstones are suspected, instrumental diagnostic methods are mandatory. It is usually not possible to examine the pathology using the most ordinary radiograph. Patients are recommended cholecystography, which uses x-rays along with a contrast agent.

Ultrasound examination is considered an even more accessible diagnostic method. It allows you to identify stones, determine their size and shape, as well as mobility.

What to do if a pathology is detected?

If a gallstone has been diagnosed, treatment methods should be comprehensive. Modern medicine, depending on the nature of the pathology and the severity of the inflammatory process, offers several approaches to therapy:

• Diet (principles of proper nutrition).
• Lifestyle correction (normalization of sleep and rest patterns, physical activity).
• Conservative therapy.
• Non-operative stone removal.
• Surgical intervention (if, for example, the gallstone is 32 mm).

What to do first? All patients, without exception, with this diagnosis are recommended to reconsider their usual lifestyle. It is necessary to give up all bad habits (smoking, alcohol abuse) and try to adhere to a healthy lifestyle. Patients should increase physical activity to enhance fat burning in the body and eliminate cholesterol. For these purposes, it is not at all necessary to go to the gym and do serious exercises. It is quite enough to take a walk after work, attend yoga or exercise classes.

Let's talk about nutrition

Bile and cholesterol are intrinsically linked. This is because an excess of these substances can trigger the formation of gallstones. 80% of cholesterol is constantly produced by the liver. The remainder comes with food. Cholesterol is extremely important for the synthesis of sex hormones, normal digestion and absorption of vitamins. However, its excess leads to heart attacks. By controlling cholesterol levels with diet, you can avoid the occurrence of pathologies such as gallstones.

The diet for this disease is based on reducing the intake of animal fats and excessively high-calorie foods. As practice shows, vegetarians practically do not have to face such a problem. Patients with this diagnosis are advised to avoid foods of animal origin that are high in fat (pork, rich broths, fried meats, etc.). Smoked meats, canned foods, and lard are also prohibited. The diet should be varied with vegetables and fruits; lean meat and fish are allowed in small quantities, as well as lactic acid products. The best breakfast is oatmeal in water with fresh berries or cottage cheese; for lunch you can bake chicken fillet with vegetables, and for dinner make a light vegetable salad with fish cutlets. Dishes are steamed or stewed.

It is recommended to take food in small portions, but often (4-5 times a day). All those who take a break between meals of more than 14 hours have an increased likelihood of developing this type of pathology. In addition, the risk group includes women who are constantly losing weight and those who like to refuse a full breakfast. Lack of regular nutrition leads to a deficiency of certain acids in the gastrointestinal tract. Excess cholesterol is not broken down and falls out, that is, a stone is formed in the gall bladder.

The diet involves a complete abstinence from alcohol and coffee. Just half a cup of this stimulating drink a day provokes unnecessary and even useless contraction of the bladder.

As for the fair sex, those ladies who daily include citrus fruits, grains and legumes in their diet are less at risk of developing pathology.

Conservative treatment

Diet alone is usually not enough to resolve gallstones. How to dissolve it medicinally? Therapeutic treatment should primarily be aimed at reducing unpleasant symptoms. Here we are talking about the so-called biliary colic. The severe pain that accompanies it is caused by intense muscle spasm in the area where the stone is located. In this case, a vicious circle is often observed. The spasm provokes severe pain discomfort. Pain, through a neuro-reflex effect on all surrounding tissues, only intensifies the spasm. In this case, therapy should pursue two goals simultaneously: relieving spasms and eliminating pain.

Experts prescribe various antispasmodic drugs to reduce the pain discomfort that accompanies gallstones. Only the doctor decides how to treat the pathology and what dosage of the drug to choose. As a rule, an attack is relieved by an injection of Papaverine or Dibazol. In acute attacks of biliary colic, intramuscular administration of No-shpa or Eufillin is recommended. Of course, any of these medications has its contraindications, so the choice of one or another drug is made only after examining the patient.

Antispasmodics are often administered simultaneously with painkillers. “Baralgin” is particularly effective.

If it is not possible to reduce the symptoms with the help of the above medications, stronger drugs are prescribed in combination (Tramal + Atropine).

Very often, due to nausea, the patient cannot take the medicine. In this type of situation, drugs are administered using an enema. As a rule, a combination of Eufillin, Analgin and belladonna is used.

Drug therapy is also actively used to dissolve gallstones. How to display it in this case? The calculus can be literally dissolved with the help of ursodeoxycholic acids (Ursosan, Ursohol, Ursofalk) and chenodeoxycholic acids (Chenohol, Henofalk, Henodiol).

Who is this treatment suitable for? First of all, stones in the gallbladder should be of a cholesterol nature, their size should be no more than 15 mm, and the contractility of the bladder should be normal. The course of treatment usually lasts from 6 to approximately 24 months. During this time, patients are advised to avoid medications that promote stone formation and interfere with the normal absorption of drug components (for example, antacids).

Removing stones without surgery

For this, shock wave lithotripsy is used - a technique in which a specialist uses ultrasound or a laser to “break” a stone in the gall bladder. Surgery to remove a stone is not suitable for all patients. It is recommended only if the number of stones does not exceed three, they differ in cholesterol nature. Due to the fact that the procedure involves direct physical impact, it is not suitable for patients with bleeding disorders.

A total of no more than seven therapy sessions are required. The stones fragment to particles of about 3 mm, and then pass out on their own along with the bile. In practice, such treatment is usually combined with drug therapy. Common side effects include the following: development of the inflammatory process.

A laser can also be used to remove gallstones. Laser removal surgery is carried out on the same principle as ultrasound. However, with this procedure there is a fairly high probability of burning the mucous membrane. That is why its help is resorted to only in exceptional cases.

Surgical intervention

Surgery is highly effective for problems such as gallstones. The operation to remove an existing stone can be carried out in two ways:

• Open cholecystectomy. This is a classic procedure recommended for large stones. During the operation, the doctor makes an incision in the abdominal cavity, then removes the gallbladder and, if necessary, drains it. Drainage involves the installation of special plastic tubes for the outflow of blood, biological fluids and wound exudate. A couple of days after surgery, the tubes are removed.
• Laparoscopy is now actively used in many areas of medicine. One has to resort to its help in case of such pathology as a stone in the gall bladder. The operation to remove stones is characterized by its low-traumatic nature. Initially, the surgeon makes several punctures, through one of which carbon dioxide is supplied directly into the abdominal cavity itself. This is necessary so that the abdomen increases in size, and in the resulting space it is easier to carry out manipulations. After this, the laparoscope itself is inserted directly through the trocar. It is a tube with a camera at the end. An optical cable with a light source can be connected to it. This device allows you to view organs from the inside, since the image from the laparoscope is displayed on a computer screen. Micromanipulators are inserted through the remaining trocars to perform the operation itself.

Today, when choosing from the options proposed above, experts most often give preference to the second. Laparoscopy is recommended if the stone in the gall bladder is 2 cm. An operation of this kind has many advantages. These include the following: rapid recovery, absence of postoperative scars, minor blood loss.

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.

Gallstone disease refers to common diseases - 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– disturbance in the ratio of cholesterol and solvents (bile acids, phospholipids) in bile.
In this phase, there is an increase in the amount of cholesterol and a decrease in the amount of bile acids.

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 performed 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 becomes blocked by a stone or narrows 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 palpation of 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

X-ray of the abdomen
Stones containing calcium salts are clearly visible

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

Computed tomography– 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 spasm) - atropine (0.1% -1 milliliter intramuscularly) or Platyfilin - 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 (gallbladder removal):
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, pathogens 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 individual metabolic characteristics, 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 some time ( 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, do not contract well, 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 puts the patient's life at risk, 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 membrane 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. Gall 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 predisposing to gallstone disease 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 to 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 allow it to cool ( usually 3 – 4 hours). Take 2 tablespoons of the decoction 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 interfere with the normal outflow of bile. From this moment on, the patient begins to experience certain problems.

Typically, gallstone disease first appears 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.
• Stool changes. 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 ( ultrasound examination) 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.
• Concomitant diseases. 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 instructions of the specialist ( 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 cavity of the bladder. 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 suture dehiscence is higher. With endoscopic removal of the gallbladder, the patient recovers faster. As a rule, full exercise is allowed only 4 to 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 press;
• 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 gallstone disease?

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 get into 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 carefully 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 in this case worsens somewhat, 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 concerned about 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. Surgical treatment ( 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.