Is it possible to cure cholelithiasis without surgery? Causes causing an attack. Which doctor should I contact for gallstone disease?

Gallstone disease or calculous cholecystitis- a common lesion of the biliary system in adults. It consists in the formation of stones from the contents of bile in the bladder, and because of them, the patency of the bile duct is impaired.

Gallstone disease is found in half of people over 70 years of age. This disease is associated with poor nutrition, low mobility, pathological metabolism substances at endocrine diseases and obesity, chronic inflammatory diseases of the liver, intestines and gall bladder, previous injuries to the abdomen and spine.

Signs of cholelithiasis do not appear immediately, but years later, when the disease reaches the clinical stage. Before this, it is asymptomatic. May be discovered by accident duodenal intubation and bile analysis.

Main symptoms

The main symptoms of gallstone disease appear acute attacks. During the interictal period they may be absent or have insignificant severity.

Pain is an obligatory symptom; it occurs in paroxysms and is called “hepatic colic.” The character is sharp, cramping or stabbing. Localized in the hypochondrium on the right. Give to right shoulder blade, collarbone, arm, upper jaw. Sometimes they disguise themselves as an attack of angina, shifting to the middle chest, accompanied by palpitations. During a prolonged attack, after a few hours it is clearly located in the area of ​​the gallbladder.

The pain is caused by a reflex spastic contraction of the biliary tract in response to irritation from the inside by a moving stone. The second option is overstretching of the gallbladder due to excess bile due to impaired outflow.

During the interictal period, cholestasis (stagnation of bile) occurs in the small ducts of the liver. The liver capsule is overstretched and tense. The pain becomes constant, aching, dull, and occupies the entire right hypochondrium.

The pain is accompanied by nausea and vomiting. The symptom of vomiting is more associated with irritation of the pancreas. The more expressed she is, the more interested she is. Sometimes it is permanent. Vomit contains bile.

Symptoms indicating complete blockage of the bile duct are yellow discoloration of the sclera of the eyes and skin. This is due to the entry of bilirubin into the blood through damaged gallbladder walls and dilated vessels.

At the same time, there is not enough stercobilin in the intestines, so the stool becomes light-colored. And urine becomes dark due to increased urobilin.

With a long course of the disease, you can consider the symptoms of cholesterol metabolism disorders: xanthelasmas (small rashes in the form of flat grains) of yellow color on the eyelids, on the skin of the hands, shoulders.

Symptoms of cholelithiasis accompanied by inflammation (calculous cholecystitis) give an increase in temperature from low to 39 degrees and signs of intoxication: headache, weakness, dizziness, loss of appetite.

Insufficient flow of bile into the intestines disrupts the digestion process and causes diarrhea, followed by constipation, and bloating.

A patient suffering from cholelithiasis is distinguished by a character trait: he is irritable, uncooperative, subject to mood swings, decisions often change and depend on his well-being, and it is difficult to work with him in a team.

Upon examination, the doctor discovers a dry tongue covered with a yellow coating. Yellowed sclera and skin. During palpation of the abdomen in the right hypochondrium, one can feel a tense edge of the liver, an enlarged gallbladder, and sharp pain when pressing at the point of projection of the bladder. The skin over the bladder area is highly sensitive to touch. This is where tight and tense muscles are identified. abdominal wall.

Causes of exacerbation and consequences

Patients associate symptoms of exacerbation with poor diet, alcohol intake, heavy physical activity, and nervous tension.

The transition of pain from cramping to constant intense pain indicates inflammation of the gallbladder (cholecystitis) or bile duct (cholangitis). Movement brings new pain, so patients prefer to lie on their right side and not move. The temperature rises to a significant level.

Prolonged intense pain with temperature and changes in the blood may indicate phlegmon of the gallbladder wall (a bag of pus is formed), because the stone not only disrupts the outflow of bile, but also compresses blood vessels. As a result, the wall becomes thinner. When a rupture occurs, symptoms of peritonitis appear: a flat “board-shaped” tense abdomen, sunken cheeks, severe intoxication in the form of impaired consciousness, a drop in blood pressure. This condition is life-threatening.

For education fistula tracts Between the gallbladder and the small intestine, severe diarrhea may occur due to the stone’s spontaneous breakthrough through the wall. This symptom is caused by an abundant bypass flow of bile.

There are cases when large stones broke through the wall of the gallbladder, entered the intestine through the fistula, then moved with the contents to the junction of the small intestine with the large intestine (ileocecal angle) and blocked the sphincter located here. In this case, symptoms of intestinal obstruction appear: pain around the navel, impaired passage of gases and feces.

A rare disease that cannot be fully called the result of gallstone disease is gallbladder cancer. It occurs in one in a hundred patients. It is not entirely clear what comes first here: cancer or stones.

Examination methods

Install correct diagnosis The results of the examination help:

• general blood test (leukocytosis and accelerated ESR);
• biochemical liver tests (transaminases, alkaline phosphatase, bilirubin, cholesterol);
• visual identification of stones ultrasound examination(ultrasound) or x-ray;
• Magnetic resonance and computed tomography serve as additional, more accurate diagnostic methods.

If cholelithiasis is suspected, all symptoms must be compared with heart disease, lower lobe pneumonia, and acute intercostal neuralgia. This is the doctor's job. You should not try to make a diagnosis on your own. This only prolongs the time required for treatment.

Cholelithiasis- this is a pathological condition that is accompanied by the formation of stones in the area of ​​the gallbladder or bile ducts. GSD is extremely dangerous because there is a high probability of complications and death. The disease mainly develops in females, but it can also occur in males. In order to better understand this pathology and correctly evaluate it, it is necessary to pay attention to the causes and signs of formation, diagnosis and what the treatment should be, whether it can be carried out with folk remedies.

What are the causes of the disease?

When the quantitative ratio of bile components is disturbed, the formation of solid formations (flakes) is noted, which, as cholelithiasis occurs, will grow and merge into stones. Most often, pathology manifests itself under conditions of problematic cholesterol metabolism, namely its excess ratio in bile. In turn, excess cholesterol develops under the influence of a whole list of factors. For example, this can occur with obesity and the use of a significant amount of foods containing cholesterol.

The reasons may well be a decrease in the ratio of bile acids that penetrate into the bile. Also, a factor in the development of the disease may be a decrease in the number of phospholipids, which normally prevent cholesterol and bilirubin from transforming into a solid state and settling. Another reason is stagnant algorithms in the bile circulation system. It is strongly recommended to pay attention to the following:

• stagnation of the component can be characterized by a mechanical and functional nature, depending on the cause of development;
• in the mechanical form, there is an exception to the optimal outflow of bile from the organ. This can be influenced by such reasons as neoplasms, adhesions, kinks, changes in the size of internal organs and lymph nodes;
• functional algorithms are associated with destabilization of the motility of the gallbladder and biliary tract, for example, dyskinesia.

Towards the emergence pathological condition can lead to infectious lesions and inflammatory processes in the organs of the biliary system. We should not forget about reasons such as allergic reactions And autoimmune changes. In order to understand cholelithiasis even better, it is necessary to familiarize yourself with the classification and what the main symptoms are.

Briefly about the stages

In accordance with the modern classification, the disease is divided into three successive stages. First of all we're talking about about the initial stage of the preclinical course, which is not characterized by any signs. It can be identified by the biochemical composition of bile.

Next comes the stage of stone formation, namely the so-called latent stone carriage. The stage is also not associated with any symptoms, but with instrumental diagnostics it is possible to identify stones in the area of ​​the gallbladder. Then specialists identify the development of a condition such as acute or chronic calculous cholecystitis. Classification of cholelithiasis by some specialists is carried out up to the fourth stage, namely until the stage when complications develop. Signs of pathology deserve special attention, and therefore it is necessary to pay special attention to them.

Symptoms of gallstone disease

A characteristic symptom of pain should be considered biliary or hepatic colic. We are talking about an obvious sharp pain under the right rib area. It can be cutting or piercing in nature. A few hours after the development of painful symptoms, they finally begin to concentrate at the location of the gallbladder. There may be different irradiations of this pain: to the shoulder blades, neck, right shoulder.

In the vast majority of cases, pain occurs:

• after eating hot, spicy, fried and fatty foods;
• with alcohol abuse;
• in case of development of stressful situations;
• subject to heavy physical activity or, for example, long work in an inclined position.

Concomitant manifestations should be considered, in particular, nausea (it develops up to the urge to vomit, which does not bring any relief to the patient at all). Vomiting is formed as a reflex response to the fact that the peripapillary region of the duodenum is irritated. If the inflammatory algorithm has captured the tissue structures of the pancreas, vomiting may be frequent, mixed with bile, and even indomitable.

Depending on how severe the intoxication turns out to be, an increase in temperature indicators from low-grade fever to obvious fever. If the entire bile duct is blocked by a stone and the sphincter of Oddi is obstructed, obstructive formation of jaundice and a change in the color of the stool will be diagnosed. Before starting a rehabilitation course, as with the formation of calculous cholecystitis, it is strongly recommended to clarify the diagnosis. This will help you decide whether therapy with folk remedies is acceptable and what complications there may be.

Diagnostic features

Speaking about the diagnosis of cholelithiasis, pay attention to the fact that the process begins with a consultation with a gastroenterologist. Next, a physical examination and general blood test are performed. In addition, a mandatory step should be considered biochemical research blood, cholecystography. While the most informative technique is ultrasound of the peritoneum. This examination identifies with high accuracy the presence of stones, changes in the shape of the bladder walls and other changes.

It will be possible to clarify the diagnosis through MRI and CT of the biliary tract. In addition, scintiography of the biliary system and ERCP can be considered an informative examination technique. It is after this that it will be possible to say with confidence that this happens to a person and what the treatment should be, whether it can be provided by folk remedies.

How to treat cholelithiasis?

Identification of stones in the area of ​​the gallbladder without the presence of complications from cholelithiasis, as a rule, does not require specific treatment, and therefore they resort to the so-called wait-and-see approach. It is strongly recommended to pay attention to the following:

1. if calculous cholecystitis develops in acute or chronic form, then removal of the gallbladder is necessary. This happens because it is he who is the source of the formation of stones;
2. surgical intervention (cholecystotomy) may be abdominal or laparoscopic. This will depend solely on the general condition of the body, changes in the area of ​​the bladder walls and surrounding tissues, the size of the stones;
3. cholecystectomy from minimal access can always be converted to open surgery on the peritoneum. Most often they resort to this precisely in case of any technical need, for example, if there are complications.

Techniques are used aimed at dissolving stones using medicines. For this purpose, ursodeoxycholic and chenodeoxycholic acid are used. However, this kind of therapy does not entail an absolute cure for gallstone disease. In addition, over time, the formation of new stones is possible. In the following way destruction of stones should be considered shock wave lithotripsy, which is used only in the presence of a single stone. This may also be relevant for patients who do not suffer acute form inflammatory process in the area of ​​the gallbladder or its ducts.

Such tactics are possible only as a supplement to the main rehabilitation course at the stage of remission. As a rule, in this case, a person no longer has questions about how to relieve an attack, what the symptoms and treatment are, whether treatment is possible without surgery and whether a special diet should be introduced.

What you need to know about complications?

The most common complication in in this case should be considered an inflammatory process in the area of ​​the gallbladder. The form of this condition can be identified as acute or chronic. In addition, a person may have obstruction of the biliary tract with stones or one stone. Obstruction of the lumen biliary tract in the area of ​​the pancreas can provoke a pathology such as acute. One more a common complication Cholelithiasis should be considered an inflammatory process in the area of ​​the bile ducts, namely cholangitis.

Nuances of prognosis and prevention

Prevention of the disease will consist of eliminating factors that contribute to increased cholesterolemia and bilirubinemia, stagnant processes associated with bile. Balanced diet, stabilization of body weight, active image lives with constant physical activity make it possible to eliminate metabolic disorders. Besides, timely diagnosis and treatment of diseases of the biliary system (dyskinesia, obstruction, inflammatory diseases) will make it possible to reduce the likelihood of developing bile stagnation and sediment formation in the specified area. I would like to note that:

• It is recommended to pay special attention to cholesterol metabolism and the state of the described system to all those who have a hereditary predisposition to the formation of stones;
• If stones develop in the area of ​​the gallbladder, adherence to a certain diet will be an excellent prevention. The diet in this case implies the exclusion of fatty and fried items from the menu, which will apply to baked goods, pastry creams and much more;
• stabilization of body weight indicators and consumption of the optimal amount of fluid should be considered a prerequisite;
• to reduce the likelihood of stones moving from the gallbladder area along the ducts, work that involves prolonged stay in an inclined position is not recommended (this is typical for many diseases);
• It is not recommended to use folk remedies on your own, only after prior consultation with your doctor.

The prognosis for the formation of cholelithiasis will directly depend on the rate of formation of stones, their size and degree of mobility. In the vast majority of cases, the presence of stones in the specified authority entails complications. Provided successful and highly qualified removal of the gallbladder, a cure is guaranteed without obvious consequences for the life of the patient.

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1.Can cancer be prevented?
The occurrence of a disease such as cancer depends on many factors. No person can ensure complete safety for himself. But significantly reduce the chances of occurrence malignant tumor everyone can.

2.How does smoking affect the development of cancer?
Absolutely, categorically forbid yourself from smoking. Everyone is already tired of this truth. But quitting smoking reduces the risk of developing all types of cancer. Smoking is associated with 30% of deaths from oncological diseases. In Russia, lung tumors kill more people than tumors of all other organs.
Eliminating tobacco from your life is the best prevention. Even if you smoke not a pack a day, but only half a day, the risk of lung cancer is already reduced by 27%, as the American Medical Association found.

3.Does it affect excess weight on the development of cancer?
Look at the scales more often! Extra pounds will affect more than just your waist. The American Institute for Cancer Research has found that obesity promotes the development of tumors of the esophagus, kidneys and gallbladder. The fact is that adipose tissue serves not only to preserve energy reserves, it also has a secretory function: fat produces proteins that affect the development of a chronic inflammatory process in the body. And oncological diseases appear against the background of inflammation. In Russia, WHO associates 26% of all cancer cases with obesity.

4.Do exercise help reduce the risk of cancer?
Spend at least half an hour a week training. Sport is on the same level as proper nutrition when it comes to cancer prevention. In the United States, a third of all deaths are attributed to the fact that patients did not follow any diet or pay attention to physical exercise. The American Cancer Society recommends exercising 150 minutes a week at a moderate pace or half as much but at a vigorous pace. However, a study published in the journal Nutrition and Cancer in 2010 shows that even 30 minutes can reduce the risk of breast cancer (which affects one in eight women worldwide) by 35%.

5.How does alcohol affect cancer cells?
Less alcohol! Alcohol has been blamed for causing tumors of the mouth, larynx, liver, rectum and mammary glands. Ethyl alcohol breaks down in the body to acetaldehyde, which then, under the action of enzymes, turns into acetic acid. Acetaldehyde is a strong carcinogen. Alcohol is especially harmful for women, as it stimulates the production of estrogens - hormones that affect the growth of breast tissue. Excess estrogen leads to the formation of breast tumors, which means that every extra sip of alcohol increases the risk of getting sick.

6.Which cabbage helps fight cancer?
Love broccoli. Vegetables not only contribute to a healthy diet, but they also help fight cancer. This is also why recommendations for healthy eating contain the rule: half daily ration should be vegetables and fruits. Particularly useful are cruciferous vegetables, which contain glucosinolates - substances that, when processed, acquire anti-cancer properties. These vegetables include cabbage: regular cabbage, Brussels sprouts and broccoli.

7. Red meat affects which organ cancer?
The more vegetables you eat, the less red meat you put on your plate. Research has confirmed that people who eat more than 500g of red meat per week have a higher risk of developing colorectal cancer.

8.Which of the proposed remedies protect against skin cancer?
Stock up on sunscreen! Women aged 18–36 are especially susceptible to melanoma, the most dangerous form of skin cancer. In Russia, in just 10 years, the incidence of melanoma has increased by 26%, world statistics show an even greater increase. Both tanning equipment and Sun rays. The danger can be minimized with a simple tube of sunscreen. A 2010 study in the Journal of Clinical Oncology confirmed that people who regularly apply a special cream have half the incidence of melanoma than those who neglect such cosmetics.
You need to choose a cream with a protection factor of SPF 15, apply it even in winter and even in cloudy weather (the procedure should turn into the same habit as brushing your teeth), and also not expose it to the sun's rays from 10 a.m. to 4 p.m.

9. Do you think stress affects the development of cancer?
Stress itself does not cause cancer, but it weakens the entire body and creates conditions for the development of this disease. Research has shown that constant worry changes the activity of immune cells responsible for turning on the “fight and flight” mechanism. As a result, a large amount of cortisol, monocytes and neutrophils, which are responsible for inflammatory processes, constantly circulate in the blood. And as already mentioned, chronic inflammatory processes can lead to the formation of cancer cells.

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Typically, cholelithiasis is diagnosed by a surgeon or therapist when a patient comes to him with characteristic symptoms. Sometimes the first specialist is also the doctor who performs ultrasound or radiography ( accidental discovery of stone carriers).

During the initial examination of the patient, the doctor usually pays attention to following symptoms, which could go unnoticed by the patient himself:

• Murphy's sign. Pain occurs if the doctor puts light pressure on the gallbladder area and asks the patient to take a deep breath. Due to the increase in the volume of the abdominal cavity, the gallbladder is pressed against the fingers. The symptom usually indicates the presence of an inflammatory process.
• Ortner's sign. Pain in the projection of the gallbladder appears when a finger is gently tapped on the right costal arch.
• Shchetkin-Blumberg symptom. This symptom is detected if, after gradually pressing the hand on the abdomen and abruptly releasing the pressure, the patient suddenly experiences pain. This usually indicates an inflammatory process affecting the peritoneum. In case of cholelithiasis, it can be regarded as a sign of cholecystitis or some inflammatory complications of the disease.
• Skin hyperesthesia. Hyperesthesia is called increased sensitivity skin, which is determined by touching or stroking. Sometimes it is a sharp feeling of discomfort, and sometimes it is moderate pain. Hyperesthesia in cholelithiasis is usually a consequence of the inflammatory process. It is found in the right hypochondrium, shoulder and shoulder blade on the right.
• Xanthelasmas. This is the name given to small yellowish spots or bumps that sometimes appear in the upper eyelid area. Education data indicates increased level cholesterol in the blood and are actually its deposits in the skin.
• Dry coated tongue detected during examination of the oral cavity.
• Low blood pressure ( hypotension) sometimes detected during a prolonged attack of cholelithiasis. Hypotension is more often found in elderly patients.

In general, in the process of diagnosing cholelithiasis, the following research methods can be prescribed:

• lab tests;
• ultrasonography;
• radiography;

Blood tests for gallstone disease

In case of cholelithiasis, in general and biochemical blood tests, you should pay attention to the following indicators:

• Leukocyte level. Leukocytes are white blood cells that perform many different functions in the body. One of the main ones is the fight against pathogenic microbes and development of the inflammatory process. Increased white blood cell level ( 10 – 15 billion per 1 liter) is usually observed with concomitant cholecystitis and a number of complications of the disease.
• Erythrocyte sedimentation rate ( ESR). ESR usually increases during inflammatory processes, and its level directly depends on the extent of inflammation. As a rule, ESR above 20 mm/hour occurs with various complications of cholelithiasis. During pregnancy, this indicator is not informative, since the ESR will be high in a healthy woman.
• Bilirubin. High level bilirubin in the absence of stones can be regarded as a predisposition to their formation in the future. In case of disturbances in the outflow of bile, already during the clinical stage of the disease, the level of associated ( direct) bilirubin. The norm is up to 4.5 µmol/l.
• Alkaline phosphatase. This enzyme is present in many human tissues, but its greatest concentration is found in the cells of the liver and bile ducts. When they are damaged, the enzyme enters the bloodstream large quantities, and its concentration increases during analysis. The norm is 20 – 140 IU/l. In pregnant women, the rate of this enzyme is higher, so it is not as indicative of gallstone disease.
• Cholesterol. Determining cholesterol levels can help detect the disease in the early stages, when stones are just forming. Normally, the content of this substance in the blood is 3.6 – 7.8 mmol/l, but it is recommended to maintain its level to 5 mmol/l.
• Triglycerides. Triglyceride levels indirectly reflect the risk of stone formation. The norm varies depending on gender and age and averages 0.5 – 3.3 mmol/l in an adult.
• Gamma-glutamyl transpeptidase ( GGT). This enzyme is found in high concentrations in the kidneys and liver. An increase in this indicator in combination with other symptoms often indicates a blockage of the bile duct with a stone. The norm is 5 – 61 IU/l and varies depending on the analysis technique ( in various laboratories), as well as the gender and age of the patient.
• Liver transaminases. ALT ( alanine aminotransferase) and AST ( aspartate aminotransferase) are found in liver cells and can increase when these cells are destroyed. In the diagnosis of cholelithiasis, this is important for monitoring complications affecting the liver ( reactive hepatitis). The norm is for AST 10 – 38 IU/l, and for ALT – 7 – 41 IU/l. AST levels can also rise in other pathologies that do not affect liver function ( for example, with myocardial infarction).
• Alpha amylase. This enzyme is found mainly in pancreatic cells. The norm is 28 – 100 U/l. When diagnosing cholelithiasis, this enzyme is important to monitor some complications ( pancreatitis).

Blood for general analysis is usually taken from a finger, and for biochemical analysis - from a vein. Before donating blood for analysis, it is advisable not to eat, smoke, or drink alcohol ( in 24 – 48 hours) and do not perform heavy physical exercise. All these factors can varying degrees influence the results of the analysis and somewhat distort the true picture in the conclusion. Deviations in these cases can be up to 10–15%.

Also, for an in-depth diagnosis of the causes of cholelithiasis, a bile analysis can be performed. Bile is collected using a special procedure - probing. The resulting samples can be sent to a laboratory, where the bile is tested for cholesterol, lecithin and bile acids. As a result, a special lithogenicity index can be calculated. If its indicator is above 1, then the process of stone formation is underway ( even if the stones themselves are not there yet). Thus, it is the biochemical analysis of bile that makes it possible to recognize the disease at the pre-disease stage. Unfortunately, this procedure is rarely performed due to its relatively high cost and relative complexity.

Ultrasonography ( Ultrasound) for cholelithiasis

Typically, an ultrasound is prescribed when dull pain or heaviness appears in the right hypochondrium, as well as after biliary colic to confirm the diagnosis. Ultrasound is often performed for preventive purposes if the patient, according to the doctor, is predisposed to various diseases of the abdominal organs.

Ultrasound can be used to determine following features diseases:

• the presence of stones even in the absence of symptoms;
• number of gallstones;
• sizes of stones;
• location of stones in the bladder cavity;
• the size of the organ itself;
• thickness of the walls of the organ;
• the presence of stones in the bile ducts or intrahepatic ducts;
• helps identify some complications.

The simplest and most common of the methods using X-rays is survey radiography of the abdominal cavity. The patient is in a standing or lying position ( depending on his general condition). The image represents the entire abdominal cavity, in which, depending on the configured radiation characteristics, an image of certain tissues can be obtained. The picture itself is obtained quickly on modern devices. On older models it may take some time.

In case of cholelithiasis, plain radiography of the abdominal cavity can detect an intense inflammatory process in the area of ​​the gallbladder and the stones themselves. In the early stages of the disease, small stones that form may not be detected by x-ray. This is explained by their low density ( X-ray negative stones), which is close to the density of the surrounding tissues. Also, radiography will not detect small stones.

The following X-ray studies can also be used in the diagnosis of cholelithiasis:

• Oral cholecystography. This method involves injecting a special contrast agent into the body ( Yodognost, bilitrast, cholevid, etc.). The patient drinks several tablets at night, the contrast is absorbed in the intestines, enters the liver and is excreted in the bile. After about 12 hours, a picture is taken. Due to the presence of contrast in the bile, the contours of the gallbladder and bile ducts become clearly visible on the x-ray. If stones are found, the procedure can be continued. The patient takes medications that stimulate the flow of bile. By emptying the gallbladder, even small stones become more visible. This procedure may not give the expected results if you have liver problems ( Bile is poorly formed) or the duct is blocked by a stone ( then the contrast will not be distributed normally).
• Intravenous cholangiocholecystography. Can be performed if oral cholecystography does not give the desired result. Contrast agents are injected into the bloodstream by drip ( 0.5 – 0.9 ml/kg patient’s body weight). After this, after 20 - 30 minutes, the contrast is distributed through the bile ducts, and after 1.5 - 2 hours - through the gallbladder. The stones in the pictures look like “zones of brightening”, since they are not filled with contrast.
• Retrograde cholangiopancreatography. This research method is more complex, since the contrast is injected directly into the bile ducts. The patient is hospitalized and prepared for the procedure ( Can’t eat, requires sedatives), after which the doctor inserts a special tube through the mouth into the duodenum ( fiberscope). Its end leads directly to major papilla, where contrast is injected. After this, an x-ray is taken, which clearly shows the bile ducts. Due to the complexity of retrograde cholangiopancreatography, it is not prescribed to all patients. This method may be needed if choledocholithiasis is suspected ( the presence of stones directly in the bile ducts).

X-rays using contrast are contraindicated in patients with the following disorders:

• severe diseases of the liver and kidneys, accompanied by dysfunction of these organs;
• individual iodine intolerance ( since most radiopaque agents contain iodine);
• severe heart failure;
• some thyroid diseases;
• blood protein level is below 65 g/l;
• albumin level ( type of blood protein) below 50%;
• bilirubin level is more than 40 µmol/l.

Laparoscopy for cholelithiasis

Laparoscopy is the most informative method, since the doctor sees the problem with his own eyes during the procedure. He can assess the condition of tissues, condition neighboring organs, determine the likelihood of various complications. However, due to existing risks ( infection of the abdominal cavity during the procedure, complications of anesthesia, etc.) diagnostic laparoscopy prescribed only when other research methods have not provided enough information.

Treatment of cholelithiasis

At the stage of biliary colic, the patient is most often treated by a surgeon. It determines whether immediate surgery makes sense or whether the patient should be observed in a hospital for some time. If there are complications ( especially inflammatory processes in the abdominal cavity) surgery is the best option, since the risk serious consequences increases for the patient.

In general, all measures for the treatment of cholelithiasis can be divided into the following areas:

• Preventive measures. This usually includes a special diet and certain medications. The goal of prophylaxis is to prevent serious complications. For example, with stone-carrying disease, the patient may completely refuse specific therapeutic measures ( nothing bothers him), but will follow preventive measures to prevent inflammation and exacerbations.
• Medication ( conservative) treatment. This direction involves treatment with pharmacological drugs- tablets, injections and other means. It is usually aimed at eliminating the symptoms of the disease. Various drugs can be prescribed for infectious complications, biliary colic and other cases. In general, this does not solve the problem, but only eliminates the manifestations of the disease, since the gallstones themselves remain in the gall bladder.
• Surgical treatment. In this case, we are talking about removing the gallbladder in one way or another during a surgical operation. This method is the most reliable, as it eliminates the root cause of the disease. However, there are risks of surgical and postoperative complications. In addition, patients may have various contraindications to surgery.
• Radical non-surgical treatment. There are a number of methods that can remove stones without surgery involving tissue dissection. In this case, we are talking about chemical dissolution of stones or their crushing using special equipment. These methods are not applicable to all patients with cholelithiasis.

Hospitalization of the patient is not required in all cases. Most often, the patient is taken to the hospital only to clarify the diagnosis. Even after suffering biliary colic, some patients refuse hospitalization. However, there are a number of conditions in which the patient must be admitted to the hospital for more intensive treatment.

Emergency physicians usually use the following criteria for admitting a patient:

• repeated frequent attacks of biliary colic;
• acute pancreatitis due to cholelithiasis;
• gangrenous and others dangerous forms cholecystitis;
• first attack of cholelithiasis ( to confirm the diagnosis);
• pregnancy;
• concomitant serious diseases.

Which doctor treats cholelithiasis?

The following doctors may be involved in the treatment of patients with gallstone disease:

• Family doctor or therapist– may suspect or independently diagnose a disease and consult the patient for a long time.
• Surgeon– carries out surgical treatment if necessary. It may also be used to assess the risk of various complications.
• Physiotherapist– sometimes used for preventive measures or non-surgical treatment.
• Endoscopist– conducts FEGDS and some other diagnostic studies that require skills in working with an endoscope.
• Pediatrician– is necessarily involved when gallstones are detected in children.
• Gynecologist– can advise women who have been diagnosed with cholelithiasis during pregnancy.

What to do in case of an attack of cholelithiasis?

As first aid for biliary colic, it is recommended to resort to the following measures:

• The patient should be placed on his right side with his knees bent. If this position does not bring him relief, then he can take any position in which the pain eases. You just shouldn't move a lot ( some patients become very agitated and begin to suddenly change positions or walk).
• You can apply a warm heating pad to your right side. Heat can relieve spasm of smooth muscles, and the pain will gradually ease. If the pain does not subside after 20–30 minutes, you should immediately consult a doctor. It is not recommended to use heat for longer, as this may worsen the patient's condition. If an attack of pain appears for the first time, and the patient is not sure that it is caused by gallstones, then it is better not to apply heat until the diagnosis is clarified.
• The patient's collar is opened, a belt or other items of clothing that may interfere with normal blood circulation are removed.

For biliary colic, the following remedies will be most effective for relieving pain:

• Atropine. As first aid, 1 ml of solution with a concentration of 0.1% is administered. If necessary, the dose can be repeated after 15 – 20 minutes. The drug relieves spasm of smooth muscles, and the pain gradually decreases.
• Eufillin. The dose is selected individually. It is usually administered intramuscularly as a solution in the absence of atropine. It can also relieve spasm of smooth muscles.
• Promedol. It is a narcotic pain reliever, which is often combined with atropine for colic. The usual dose for an adult is 1 ml of a solution with a concentration of 1 - 2%.
• Morphine. Can also be entered into severe cases for pain relief in combination with atropine. Typically, 1 ml of a one percent solution is used.
• Papaverine. Can be used both in tablets and in injections. This is an antispasmodic that quickly eliminates spasm of smooth muscles. For biliary colic, an intramuscular injection is usually given, 1 - 2 ml of a 2% solution.
• Omnopon. It is a combination drug containing a narcotic pain reliever ( morphine), antispasmodic ( papaverine) and a number of other components.

It should be noted that painkillers and antispasmodics during an attack of cholelithiasis are best administered in the form of injections. Patients may vomit ( sometimes multiple), which will negate the effect of the pills.

Surgery for gallstone disease

The operation itself for cholelithiasis is called cholecystectomy. It involves dissecting the tissue of the anterior abdominal wall and removing the entire gallbladder along with stones. The bile duct is ligated, and in the future bile will flow directly from the liver into the duodenum. If necessary, the bile ducts can also be operated on ( for example, if a stone is stuck in one of them).

In general, cholecystectomy is considered a routine operation, during which complications are rare. This is explained by the high prevalence of cholelithiasis and the extensive experience of doctors. Currently, there are several ways to remove the gallbladder. Each of them has its own advantages and disadvantages.

Based on the method of removing the gallbladder, surgical methods can be divided as follows:

• Endoscopic removal ( minimally invasive). Endoscopic removal of the gallbladder is now considered in the best possible way treatment of gallstone disease. It involves making four small holes in the anterior wall of the abdominal cavity, through which special instruments are inserted ( a small camera, a special electric scalpel, etc.). A small amount is injected into the abdominal cavity carbon dioxide so that the stomach inflates and the doctor has room to maneuver. After this, the gallbladder is removed and pulled out through one of the holes. The main advantage of the laparoscopic method is minimal trauma. Within just a few days, patients can practically full life. There is no risk of suture dehiscence, postoperative complications are quite rare. The main disadvantage of this method is the doctor’s limited field of activity. Laparoscopic removal of the gallbladder is not recommended for various complications ( purulent complications, fistulas, etc.).
• Laparotomy. In this case, a dissection of the anterior abdominal wall is performed, which provides the surgeon with wide access to the gallbladder area. The incision is made parallel to the costal arch ( askance), at the edge of the muscle abdominals on the right or along the midline of the abdomen. The type of incision usually depends on the intended extent of the operation. In the presence of various complications, a midline incision will be preferable, which will give the surgeon greater access. Laparotomy for cholelithiasis is currently not used so often. After surgery, incisions take longer to heal, and the risk of postoperative complications is higher. As a rule, laparotomy is necessary in the presence of fistulas, ulcers and other complications of cholelithiasis, which require a more scrupulous approach. For uncomplicated cholelithiasis, they try to use laparoscopic methods, and laparotomy is used only in the absence of necessary equipment or specialists.

The need for surgical removal of stones in asymptomatic stone carriers is highly controversial. In this case, surgery may seem like an unjustified risk. However, most often in patients with stone-carrying stones, sooner or later biliary colic still occurs, and the question of surgery arises. Removal of the gallbladder during an asymptomatic course allows for a planned operation, in which the risk is significantly lower than with an urgent one ( the patient is gradually prepared for surgery).

In general, there are the following indications for surgical treatment of cholelithiasis:

• planned removal for stone-carrying cases ( at the request of the patient);
• a large number of small stones, since they can cause acute pancreatitis;
• patients with diabetes mellitus ( after proper preparation), since in them complications of the disease develop quickly and pose a great danger;
• signs of calcification of the gallbladder walls ( the risk of developing cancer is believed to be high over time);
• purulent complications ( empyema, peritonitis, etc.);
• biliary fistulas and a number of other complications.

Medicines for cholelithiasis

In most cases symptomatic drug treatment may be prescribed by a general practitioner. Symptoms represent certain disturbances in the body's functioning that can be corrected. Drug treatment is prescribed already at the stone-carrying stage in order to improve the patient’s condition and, if possible, prevent the disease from progressing to the next stage.

In general, the following groups of drugs can be used for cholelithiasis:

• Painkillers ( analgesics). The need for their use usually arises during severe biliary colic. During this period, patients may be prescribed narcotic painkillers ( usually once). Analgesics are also used at the postoperative stage.
• Antispasmodics. This group medications cause relaxation of smooth muscles. They are usually also prescribed during an exacerbation of the disease.
• Pancreatic enzymes. This group of drugs contains enzymes that are responsible for the breakdown of nutrients. The need for them may arise with concomitant pancreatitis or some other digestive disorders.
• Antipyretics ( antipyretics). These drugs are usually prescribed for concomitant acute cholecystitis or cholangitis, when the temperature can rise to 38 degrees or more. The most commonly used are non-steroidal anti-inflammatory drugs, which combine anti-inflammatory and analgesic effects.
• Sedatives ( sedatives). Need for sedatives may occur when pain occurs, as many patients become restless.
• Antiemetics. Often, cholelithiasis causes repeated bouts of vomiting. To improve the patient's condition, vomiting is stopped with medication.
• Antidiarrheals or laxatives. Drugs of these groups are taken as needed for corresponding stool disorders.
• Hepatoprotectors ( liver protection products). This group of products improves liver function and protects its cells from toxic influences. The formation of bile and its outflow are also normalized. Hepatoprotectors are prescribed for concomitant hepatitis or for its prevention.
• Antibiotics. Antibacterial drugs are prescribed to some patients with acute cholecystitis to reduce the chance infectious complications. For preventive purposes, antibiotic therapy can be prescribed in the postoperative period ( usually within 2 – 3 days).

Treatment of gallstone disease without surgery

Dissolving gallstones is called oral litholytic therapy. It implies a long 1 – 2 years) a course of treatment with special drugs that promote the gradual dissolution of stones. The most effective drugs are those based on ursodeoxycholic and chenodeoxycholic acid. These medications reduce the reabsorption of cholesterol in the intestines ( more bile is excreted in feces), reduce the production of bile, promote the gradual transformation of stones back into bile components. The method is optimal because it does not cause serious side effects and does not involve serious risks for the patient ( like during surgery). However, oral litholytic therapy is not suitable for all patients. In practice, doctors prescribe such treatment to only 13–15% of patients with cholelithiasis.

Successful conservative treatment is possible only if the following conditions are met:

• Treatment is started for patients whose disease is still at an early stage ( stone-carrying);
• the chemical composition of the stones should be cholesterol, not pigment;
• the patient has no signs of complications of the disease ( Rare colic is acceptable);
• stones must be single and not exceed 1.5 cm in diameter;
• the gallbladder should not be atonic or disabled ( his muscles contract normally, bile is secreted);
• stones should not contain a lot of calcium ( calcification is determined by the degree of darkness on the x-ray; treatment is prescribed when the attenuation coefficient on CT is less than 70 arbitrary units on the Hounsfield scale).

The treatment regimen for oral litholytic therapy is as follows ( choose one of the possible options):

• Chenodeoxycholic acid- 1 per day ( In the evening) 15 mg per 1 kg of body weight ( that is, the dose for a person weighing 70 kg is 1050 mg, respectively).
• Ursodeoxycholic acid– also 1 time per day in the evening, 10 mg per 1 kg of body weight.
• A combination of chenodeoxycholic and ursodeoxycholic acids. Taken in the evening before bed in equal doses - 7 - 8 mg per 1 kg of body weight each.

Oral litholytic therapy is not prescribed to patients who have the following contraindications:

• women during pregnancy;
• excess weight ( obesity);
• cirrhosis, acute and chronic hepatitis;
• frequent exacerbations of cholelithiasis ( colic);
• serious digestive disorders ( prolonged diarrhea);
• inflammatory complications of cholelithiasis ( acute cholecystitis);
• severe disruption of the gallbladder ( a “disconnected” bladder that does not contract and does not secrete bile well even without blockage of the ducts);
• the presence of a stomach or duodenal ulcer ( especially during exacerbations);
• some tumors of the gastrointestinal tract;
• multiple stones, which in total occupy more than half the volume of the bladder;
• large stones with a diameter of more than 15 mm;
• pigment stones and stones with high calcium content.

Compared to dissolving gallstones, their crushing has more disadvantages and is used less frequently. This method is called shock wave lithotripsy. Stones are crushed using directed ultrasonic waves. The main problem with this is that fragments of crushed stones can clog the bile ducts. Also, this method does not reduce the likelihood of relapse ( for this purpose, after crushing, ursodeoxycholic acid is prescribed) and does not exclude the possibility of some complications ( gallbladder carcinoma, etc.).

Shock wave lithotripsy is used for the following indications:

• the presence of one or more stones, provided that the sum of their diameters does not exceed 3 cm;
• cholesterol stones;
• the gallbladder functions normally, there are no associated complications;
• the smooth muscles of the gallbladder ensure its contraction by at least 50% ( important for removing fragments).

There is also a third non-surgical treatment option. This is the introduction of special dissolving drugs directly into the gallbladder ( usually through the bile ducts). However, due to the complexity of the procedure and the lack of visible benefits ( there is also high risk relapse and contraindications are almost the same) this method of treatment is used extremely rarely. In most cases, doctors absolutely rightly try to convince the patient of the advisability of endoscopic cholecystectomy. Non-surgical treatment methods are often used when there are serious contraindications to surgical treatment.

Treatment of cholelithiasis with folk remedies

However, traditional medicine can provide significant assistance to patients in combating the manifestations of the disease. For example, some medicinal plants reduce the level of bilirubin in the blood ( reduce jaundice), others relax the smooth muscles in the walls of the organ, reducing pain. There are also plants with moderate anti-inflammatory and antibacterial activity, which reduce the likelihood of complications.

The following folk remedies can be used in the treatment of cholelithiasis:

• Cabbage juice. Juice is squeezed out of well-washed white cabbage leaves, which patients take 0.5 cups twice a day. It is recommended to drink the juice warm before meals.
• Rowan juice. The juice is obtained from ripe rowan fruits. It is drunk slightly chilled ( about 15 degrees) before meals, 25–50 ml. It is believed that this reduces the inflammatory process in cholecystitis.
• Oat infusion. 0.5 kg of washed oats is poured into 1 liter of boiling water. Leave the mixture for about 1 hour, stirring occasionally. After this, filter the infusion and drink half a glass of water three times a day. This remedy normalizes the production and outflow of bile in diseases of the biliary tract and gallbladder.
• Beetroot decoction. Ripe medium-sized beets are peeled and cut into thin slices, being careful not to lose the juice. The slices are poured with a small amount of water ( until complete immersion) and cook over low heat. Gradually the broth thickens. The resulting syrup is cooled and drunk 30-40 ml three times a day.
• Budra infusion. 5 g of ivy budra is poured into 200 ml of boiling water and left in a dark place for at least 1 hour. Then the infusion is filtered through a bandage or gauze. The resulting liquid is drunk 50 ml before each meal ( 3 – 4 times a day).

There are also some non-herbal remedies that can be used successfully to assist in the treatment of gallstones. For example, after removing stones ( by fragmentation or dissolution when the gallbladder is preserved) Morshyn brine and mineral waters similar in properties can be very useful. Ropa is successfully used for blind probing to enhance the flow of bile. This is useful after prolonged stagnation, and also allows you to take bile samples for biochemical and microbiological research.

Diet for gallstone disease

For cholelithiasis at all stages, it is recommended to follow dietary table No. 5 according to Pevzner. It is designed to ensure sufficient supply of all necessary nutrients to the body, without putting excess stress on the liver and gallbladder.

Diet No. 5 is based on the following principles:

• Food is taken 4 – 5 times during the day. The portions should be approximately equal in volume.
• In between meals ( on an empty stomach) recommended to drink warm water. A sufficient amount of liquid dilutes the bile somewhat. The total volume should be at least 2 liters per day.
• Most dishes must be steamed; boiled meat is allowed. Any fried foods or fatty baked foods should be excluded.
• Products that can cause flatulence are not recommended ( bloating).
• You should limit your salt intake, both in its pure form and when preparing various dishes ( in total up to 10 g per day).
• Maintain approximately equal proportions between liquid and semi-liquid foods.
• Food should be warm when consumed ( room temperature or warmer), but not hot. Excessively hot or cold food can provoke spasm of the gallbladder muscles with the appearance of acute pain.

Examples of permitted and prohibited foods according to diet No. 5 according to Pevzner

Prevention of gallstone disease

• maintaining normal body weight;
• rational use of hormonal drugs ( mostly estrogens);
• sufficient physical activity ( sports, walks, etc.);
• exclusion of fatty foods, alcohol;
• diet;
• drinking enough liquid;
• limiting heavy physical activity and sudden movements at the stone-bearing stage;
• periodic consultations with a specialist and ultrasound if necessary ( especially for stone-carrying patients);
• removal of the gallbladder at the stone-carrying stage ( to prevent exacerbations and complications in the future);
• timely consultation with a doctor in case of visible changes in the patient’s condition;
• ursodeoxycholic acid 250 mg/day ( drug prophylaxis for patients who have lithogenic bile).

Is it possible to exercise if you have gallstones?

Permitted and prohibited sports at different stages of cholelithiasis are as follows:

• At the stone-carrying stage, if the stones are small, you can practice swimming, jogging and other moderate exercise. Active movements will partly prevent the enlargement of stones. However, if the stones are large enough, you should not abuse even moderate loads.
• During severe symptoms of the disease, exercise can provoke biliary colic, so it is recommended to exclude almost any kind of sports. The very change in body position in space can cause the displacement of stones and spasm of smooth muscles.
• In the postoperative period, the load should also be limited, since the anterior wall of the abdominal cavity was injured. During endoscopic stone removal, trauma is minimal, but there is a risk that internal bleeding may develop. If during the operation the abdominal wall was cut, then the risk of suture divergence is high. After endoscopic surgery It is recommended to abstain from active sports for at least 6 – 8 weeks. After laparotomy, this period may drag on for several months. In each specific case, the rehabilitation period should be discussed with the attending physician.

In general, we can say that healthy person Various sports are the prevention of cholelithiasis. In the absence of concomitant disorders in the body, movement improves the flow of bile and reduces the likelihood of stone formation. The most suitable for such prevention are swimming, jogging, and cycling. In the presence of stones, the most dangerous sports will be weightlifting, powerlifting, artistic gymnastics, and contact sports. In these cases, there is a high risk of extreme loads, impacts to the gallbladder area, and a rapid change in body position in space is also characteristic. All this can provoke an attack of cholelithiasis.

How much water can you drink if you have gallstones?

Healthy people have normal water intake ( at least 1.5 - 2 liters of liquid) can be regarded as the prevention of cholelithiasis. It has been noted that a lack of fluid can make the bile more concentrated, causing sediment to begin to form. It is especially important to consume sufficient fluids for those people who have been diagnosed with lithogenic bile secretion ( even before the stone formation stage). For them it is direct preventive measure, delaying the onset of gallstone disease itself.

The average water consumption rate for an adult is ( including those with cholelithiasis) should be about 2 liters. However, it should be taken into account various factors. Intense physical activity is associated with additional fluid loss. In summer, in hot weather, the rate of water consumption also increases ( up to approximately 3 l).

There may be any restrictions on fluid intake in the postoperative period. Water passes through the gastrointestinal tract, partly stimulating its contractions. Immediately after surgery, this may create a risk of complications. In each individual case, the amount of fluid allowed after surgery must be clarified with the surgeon. After laparoscopic removal of the gallbladder, there may be no restrictions, but after surgical treatment of some complications, restrictions, on the contrary, can be quite strict.

Is it possible to drink alcohol if you have cholelithiasis?

At the stone-bearing stage, when obvious symptoms the disease does not exist yet, but the patient already knows about his problem; drinking alcohol is also not recommended. The risk of complications in this case is lower, but it still exists. However, we are not just talking about strong alcoholic drinks. Beer, for example, can cause flatulence ( gas accumulations). Increased pressure in the abdominal cavity sometimes causes displacement of stones and biliary colic. In addition, drinking large amounts of beer disrupts the functioning of enzyme systems, can cause bowel problems and increases the risk of infectious complications ( cholecystitis).

Another important factor that excludes alcohol intake is its incompatibility with many medicines that patients take. In acute cholecystitis, these are antibiotics, the effect of which is weakened in combination with ethyl alcohol and may even be toxic.

If the patient suffers from cholelithiasis with periodic exacerbations ( chronic cholecystitis), then periodic consumption of alcohol, firstly, will cause increased frequency and intensification of pain. Secondly, such patients develop complications such as carcinoma more quickly ( cancer) gallbladder and cirrhosis of the liver.

Gallstones and their connection with dietary errors

Bile produced by the liver is a colloidal solution in which cholesterol, bilirubin, bile acids and salts are suspended. If, due to errors in nutrition or for some other reason, the balance of the components of bile is disturbed, then they fall out in the form of sediment, forming stones of various compositions and sizes. That is, gallstone disease (GSD) develops. Most often, stones have a cholesterol composition, since with poor nutrition, this is the substance that the liver produces the most.

By poor nutrition we mean such a regime when a person eats rarely (with breaks of 5 hours or more between meals), when he likes to eat in large portions, often has fried dishes on the menu, prefers fatty meats and smoked meats, is fond of baked goods, high-calorie confectionery and various snacks. Such foods are themselves high in cholesterol and require the liver to produce large amounts of bile in order to break down the excess fats. And with irregular nutrition and overeating, bile is produced unevenly, often stagnating in the gallbladder and ducts. All these problems with bile secretion lead to the formation of stones, which settle in the gallbladder and provoke calculous cholecystitis, often ending in cholecystectomy.

The reasons for the formation of cholelithiasis can be obesity - when the liver produces excess cholesterol. Addiction to diets for quick weight loss is when the synthesis of bile acids that break down cholesterol is disrupted in the liver. At first, gallstones are very small, resemble grains of sand and do not bother the patient in any way, so they can only be detected by ultrasound, and once detected, one should immediately begin diet therapy in order to avoid surgery in the future.

Diet for cholelithiasis at the first asymptomatic stage

The course of cholelithiasis is conventionally divided into three stages. The first of them occurs almost unnoticed by humans. At this stage, under the influence of excess fats and “fast” carbohydrates entering the body with food, too much cholesterol becomes in the bile. At the same time, the content of bile acids that can break down its excess decreases, and there are also fewer phospholipids that help maintain cholesterol particles in suspension.

It is impossible to feel these changes in the composition of bile, but on an ultrasound of the gallbladder or during a biochemical analysis of its contents, “cholesterol flakes”, crystallizing grains of sand in the form of sediment (sludge), can be detected. At this stage, cholelithiasis can last for many years and not produce symptoms. But if for some diagnostic studies It was possible to establish it, the doctor will immediately recommend a therapeutic and prophylactic diet so that in the future it will not be necessary to treat inflammation, it will be possible to avoid stones and surgery to remove them.

The essence of diet therapy at this stage of cholelithiasis is fractional regular meals (at least 5 times a day in portions of 500-600 g) with a decrease in calorie intake (especially when overweight body), with a restriction on the menu for fatty and fried food, cholesterol-rich foods. It is imperative to regulate not only the amount of food and frequency of meals, but also the volume of water consumed per day - it should be at least two liters. A sufficient amount of water affects the composition of bile and its free secretion. IN daily menu the content of vegetables and fruits, nuts, and legumes should be increased, since plant proteins and fiber help reduce the concentration of cholesterol in bile. Mandatory moderate physical activity is recommended to avoid bile stagnation.

Nutrition that prevents exacerbation of cholelithiasis with formed stones

Most often, gallstone disease is detected in people at its second stage: bile begins to stagnate, the mucous membranes of the gallbladder are damaged and bile acids begin to leak through its walls, and stones form in the bladder. Usually they lie at the bottom and do not manifest themselves in any way, but sometimes they can enter the bile duct and cause inflammation, cholecystitis develops. If the stones are small in size, they are subsequently removed from the body, the functioning of the biliary system is improved again, however, the detected stones in the gallbladder require strict nutritional correction to avoid complications, obstruction of the bile duct and subsequent cholecystectomy.

First of all, bile stagnation should be eliminated. To do this, you need to sit at the dinner table at least 5 times a day, preferably at the same time, eat leisurely, chewing your food well. There are no restrictions on the composition of the diet at this stage of cholelithiasis, although it is recommended not to drink alcoholic beverages.

The diet for gallstones should be complete, but with a limitation of foods that affect cholesterol metabolism: hard-boiled and scrambled eggs, fried potatoes and meat, liver dishes, fatty varieties fish. It is recommended not to indulge in cereals and flour products, as they contribute to the oxidation of bile and the loss of cholesterol.

In order to establish the production of bile acids in the liver, the menu must contain complete proteins (lean meat, cottage cheese), vegetable oil, and easily digestible carbohydrates (sugar, honey, fruits). To prevent constipation, you need to eat at least 0.5 kg of fruits and vegetables every day, drink fresh juices (this is especially useful in the morning). In addition, green leafy vegetables, broccoli, avocado are good source magnesium, which improves the removal of cholesterol from the body. All these measures will help stop the development of cholelithiasis and avoid surgery.

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Treatment of cholelithiasis

Causes of gallstone disease

A disease in which stones form in the gallbladder and its ducts. The formation of stones most often occurs in the bladder itself and much less often in the ducts and bladder at the same time. This is a disease digestive system metabolic nature, characterized by the formation of stones in the hepatic bile ducts (intrahepatic cholelithiasis), in the common bile duct (choledocholithiasis) or in the gallbladder (cholecystolithiasis).

Gallstone disease is a fairly common disease, it is found in 20% of all autopsies in Europe, and after 40 years this figure reaches 25%, and after 70 years - 50%. This pathology is more common in women than in men.

In case of cholelithiasis, caused by a violation of the metabolism of cholesterol and bile acids, cholesterol stones are formed; In the event of a violation of the metabolism of bilirubin, pigment or bilirubin stones are formed, which consist mainly of calcium bilirubinate. Less commonly, stones form from calcium carbonate or phosphorus.

Classification of cholelithiasis

• gallstones with acute cholecystitis;
• gallstones with chronic cholecystitis;
• gallstones without cholecystitis (cholecystolithiasis);
• common bile duct stones with cholangitis;
• common bile duct stones with cholecystitis;
• common bile duct stones without cholangitis and cholecystitis.

Stages:

• I - physical and chemical;
• II - stage of latent stone bearing;
• III - stage of clinical manifestations (calculous cholecystitis).

The role of bile acids in the body is multifaceted. The most important properties of cholates:

• bactericidal effect (in bile, which contains a sufficient amount bile acids, no microorganisms) ;
• stimulation of intestinal peristalsis (in in case of reduction in the bile level of cholates, obstipation syndrome develops with prolonged constipation);
• emulsification of fats, in case of insufficiency they develop steatorrhea;
• stimulation fermentovir functions of the pancreas (in case of insufficient supply of enzymes to the intestines, exocrine pancreatic failure) ;
• stabilization of bile, due to insufficient content of bile cholates, cholesterol crystallization and stone formation occur;
• stimulation of choleresis.

During meals, the secretion of bile acids increases; bile is not sufficiently saturated with cholesterol. At night , when it happens cholesterol synthesis, its content in bile increases, and bile acids decrease, which stimulates the development of cholelithiasis. In some cases education lithogenic bile may be due to increased secretion of cholesterol, which is observed in obesity and metabolic syndrome. Genetic background also matters. poor nutrition, disorder of the hepatic-intestinal circulation of bile components.

Causes of gallstone disease:

• bile stagnation
• obesity
• metabolic disease
• infectious diseases
• pregnancy
• hormonal disorders
• sedentary lifestyle
• taking oral contraceptives

Symptoms of gallstone disease:

• pain in the right hypochondrium
• bitterness in the mouth
• nausea
• belching
• heartburn
• flatulence
• vomit
• jaundice (rare)

Stones that are contained at the bottom of the gallbladder (silent zone) do not create obvious clinical picture until they enter the neck, cystic duct, or inflammation occurs. A stone in the neck of the gallbladder occupies its outlet and thereby causes the development of biliary and hepatic colic. Cervical obstruction may be temporary if the stone returns to the gallbladder. A stone of 0.5 cm can pass into the duodenum and be excreted from the body in feces. However, remaining in the common bile duct, it causes mechanical or obstructive jaundice.

In this case, the bile is always infected and cholelithiasis is accompanied by inflammation of the mucous membranes of the biliary tract.

The main sign of stone migration is pain. It is more typical for exacerbation of chronic calculous cholecystitis. This is biliary (liver) colic. An attack of colic is provoked by fatty foods, spicy seasonings, salty and pickled foods, sudden physical activity, infections, negative emotions, and menstruation.

The pain often occurs suddenly, at night, is localized in the right upper quadrant of the abdomen, less often in the epigastric region, and is characterized by irradiation to the right scapula and subscapularis. Sometimes the pain radiates to the sacrum, the region of the heart, provoking an attack of angina. The pain is caused not so much by mechanical irritation of the mucous membrane and inflammation of the gallbladder, but by overstretching of its walls due to increased intravesical pressure and spastic contraction of the bladder sphincter. Less commonly, the pain can be dull, constant, periodic, and often accompanied by nausea and vomiting, which does not bring relief.

During an attack of pain, the abdomen is swollen, the anterior abdominal wall is tense, especially in the projection of the gallbladder. In older people, tension in the anterior abdominal wall and pain may not be present.

Characterized by sharp pain on palpation of the abdomen in the right hypochondrium. As the pain decreases, it is possible to palpate the painful liver and enlarged gall bladder.

How to treat cholelithiasis?

It is carried out both by medication and by surgery. Therapeutic and preventive measures for gallstone disease depend on the stage of the disease:

• Stages I and II are a therapeutic problem (as is chronic acalculous cholecystitis),
• Stage III requires surgery.

If there are no indications for surgical intervention, then specialists usually resort to conservative treatment. This treatment is based on the use of drugs based on ursodeoxycholic acid, with the help of which the stones dissolve. Treatment with medications also includes drugs that normalize the function of the bile ducts and duodenum, and drugs aimed at reducing inflammation in the mucosa and suppressing pathogenic flora.

In stage I, the patient is prescribed a general hygienic regime, systematic physical activity, rational fractional meals(diet No. 5), adequate correction is needed functional disorders digestive system.

Drug treatment should be aimed at stimulating the synthesis and secretion of bile acids (cholates) and inhibiting cholesterol synthesis. To achieve the first goal, phenobarbital and zigsorine are recommended. Usually, after this, the biochemical composition of bile improves: the cholate content increases, the cholesterol content decreases (the cholate-cholesterol index is normalized). Lyobil can be added to this complex.

In stage II, patients are shown drugs of ursodeoxycholic acid - ursofalk, ursosan. The drugs help break down stones and restore the physical and chemical composition of bile. This therapy is indicated for patients with serious concomitant pathology, those who surgery is at high risk (with ischemic heart disease, arterial hypertension, diabetes, chronic cor pulmonale, chronic obstructive pulmonary diseases, etc.).

In stage III, treatment is usually surgical. Open or, more often, laparoscopic cholecystectomy is used. Today, to remove stones from the bile ducts, the technique of endoscopic retrograde cholepancreatoscopy is used, during which, if necessary, sphincterotomy and stone extraction from the common bile duct are performed. If the stone cannot be removed, then this is done by percutaneous choledochotomy.

Indications for surgical intervention:

• absolute:
  • acute cholecystitis and other surgical complications;
  • frequent recurrent biliary colic;
  • non-functioning (“disabled”) gallbladder;
  • choledocholithiasis;
  • pancreatitis;
  • suspected gallbladder cancer;
• relative:
  • chronic calculous cholecystitis with symptoms;
  • contraindications to drug litholysis.

Contraindications for conservative treatment of cholelithiasis:

• complications of gallstone disease, including acute and chronic cholecystitis;
• the gallbladder is “disabled”;
• frequent relapses of biliary colic;
• pregnancy;
• severe obesity;
• concomitant diseases (peptic ulcer, chronic pancreatitis, diabetes mellitus, Crohn's disease, ulcerative colitis);
• chronic diarrhea;
• gallbladder cancer (suspected);
• pigmented or calcified stones;
• any common bile duct stones larger than 15 mm;
• multiple stones occupying more than 50% of the gallbladder lumen;
• inability to take medications for a long time (6-24 months).

Surgical treatment lasts 4-10 days (depending on the type of operation - open or
laparoscopic cholecystectomy), drug litholysis lasts on average 12-18 months.
Treatment effectiveness criteria:

• splitting of stones (in the case of drug litholysis or shock wave lithotripsy),
• elimination of symptoms of cholelithiasis (after cholecystectomy),
• no complications of cholelithiasis.

Another direction in the treatment of patients is shock wave lithotripsy. Shock wave therapy(cholelithotripsy) is performed when there are a small number of stones and a functioning gallbladder. The stones are crushed into small elements and excreted in the feces. The procedure is performed under general anesthesia or spinal anesthesia. However, 35% of patients after such an intervention develop transient biliary colic, and 2% develop pancreatitis. Before and after such therapy, therapy with ursodeoxycholic acid is also indicated. After successful lithotripsy, ursodeoxycholic acid is prescribed at a dose of 500-750 mg per day for a year. Without maintenance therapy with ursodoxycholic acid, 50% of patients experience recurrence of gallstones over the next 5 years.

Conservative treatment methods also include diet and physical therapy. Physiotherapy uses UHF, diathermy, and inductometry. However, these procedures can only be performed in the absence of symptoms of exacerbation.

What diseases can it be associated with?

Treatment of gallstone disease at home

A clinical examination is necessary once a year; after successful drug litholysis, ultrasound monitoring of gallstone recurrence is indicated once every 6 months; in case of relapse, re-treatment is indicated.

Treatment of cholelithiasis at home involves following all medical instructions. Particular attention should be paid to diet, eat often and in small portions, and avoid long periods fasting. Eliminate fatty, cholesterol-rich foods, eat more fruits, vegetables and foods rich in fiber. Drink a lot of juices mineral waters. Also recommended frequent visit baths

Moderate physical activity is required to prevent bile stagnation.

Sanatorium-resort treatment is indicated for stable remission - in Morshyn, Truskavets, Mirgorod, Kuyalnik and Transcarpathia.

What drugs are used to treat cholelithiasis?

• - 2 capsules 3 times a day for 2 weeks.
• - 120-240 mg in 2-3 doses.
• - 480 mg 2 times a day, duration of treatment - 5-14 days.
• - 250-500 mg at a time, interval between doses is 6 hours.
• - at a dose of 200 mg per day (50 mg in the morning and at lunch and 100 mg in the evening), the course of treatment is from 3 to 6 weeks.
• Zixorin - 300-500 mg per day (100 mg in the morning and 200-300 mg in the evening), course of treatment - 3-6 weeks.
• - 400-600 mg 3 times a day after eating, for 3-4 weeks.
• or - at a dose of 8-12 mg/kg; if cholesterol stones are no more than 15 mm and preserved contractile function gallbladder, then they are recommended to be consumed 2 times a day (for example, 500 mg in the morning and 250 mg in the evening); the course of treatment is 6-18-24 months.

Treatment of gallstone disease with traditional methods

Folk recipes treatment of cholelithiasis effectively prevent bile stagnation. Before using any of the recipes, you should consult with your doctor so as not to aggravate the disease.

Depending on the size and number of stones, drinking a variety of vegetable juices may help reduce them. It can be beetroot, cucumber, carrot or pumpkin juice. You need to drink half a glass 2-3 times a day.

• Lingonberry leaves: pour a glass of boiling water over 1 tablespoon of leaves, leave for 30 minutes and strain. Take 4 times a day, two tablespoons.
• Olive oil: take for 3 weeks 30 minutes before meals.
• Oats: pour 1 cup of oats with one liter of boiling water and cook over low heat until ¼ of the liquid has evaporated. Take this infusion 1 glass 3 times a day.
• Dill: 2 tbsp. pour dill seeds with 2 cups of boiling water, bring to a boil, leave for no more than 5 minutes and strain. Drink the infusion little by little throughout the day.
• Black radish juice with honey: mix juice and honey in equal proportions. Take 3 tablespoons once a day.

Herbs for gallstone disease ethnoscience recommends the following: horsetail, immortelle, mint, fennel, wormwood, meadow geranium, calamus. You can brew herbs either individually or mix several types.;

To clarify the diagnosis, use X-ray, ultrasonic, thermographic And laparoscopic research methods.

On a plain X-ray of the abdominal organs, it is sometimes possible to see a shadow of stones in the gall bladder or a shadow of an enlarged gall bladder, limited swelling of intestinal loops in the right half of the abdominal cavity, limited mobility right dome of the diaphragm. Application cholecystography or cholecystocholangiography in the acute phase of chronic cholecystitis is usually non-informative. More data is provided by sonography of the liver, biliary tract, and gallbladder.

Treatment of other diseases starting with the letter - g

The information is for educational purposes only. Do not self-medicate; For all questions regarding the definition of the disease and methods of its treatment, consult your doctor. EUROLAB is not responsible for the consequences caused by the use of information posted on the portal.