One gallstone. Why is a gallstone dangerous? Gallstones. Percutaneous cholelitholysis

Quantity and size gallstones very diverse: sometimes it is one large stone, but more often it is multiple stones, numbering in tens, sometimes hundreds. They vary in size from chicken eggs to millet grains and smaller. Stones can have different chemical compositions. Cholesterol, lime and bile pigments participate in their formation. Consequently, metabolic disorders in the body, bile stagnation and infection play an important role in the process of stone formation. When bile stagnates, its concentration increases, creating conditions for the crystallization of cholesterol contained in it and removed from the body with it. It has been scientifically established that excessive and irregular nutrition, as well as insufficient mobility, contribute to the creation of conditions for the formation of gallstones. The most common causes of biliary colic (the main manifestation of gallstone disease) are the consumption of alcohol, spicy fatty foods, excessive physical exercise.

A common metabolic disease in which, due to disruption of the processes of bile formation and bile excretion, stones form in the gall bladder. Small stones (microliths) sometimes also form in the intrahepatic bile ducts, especially in elderly men and patients with cirrhosis of the liver. Once in the gallbladder, microliths can serve as a basis for the deposition of cholesterol on them and the formation of large cholesterol stones. In addition to cholesterol stones, there are pigment (bilirubin), calcareous, mixed and combined types of stones. Stone-carrying is possible without clinical manifestations; It is often discovered by chance at autopsy. Gallstones occur at any age, and the older the patient, the higher the incidence of the disease. Among women cholelithiasis and stone-carrying are observed several times more often than in men.

Gallstone disease is often accompanied by chronic cholecystitis. With multiple stones, bedsores form in the gallbladder, which can lead to ulceration and perforation of its walls.

Classification

• In cholelithiasis there are stages: physico-chemical (changes in bile), latent (asymptomatic stone carriage), clinical (calculous cholecystitis, biliary colic).
• The following clinical forms of cholelithiasis are distinguished: asymptomatic stone carriers, calculous cholecystitis, biliary colic.
• Gallstone disease can be complicated or uncomplicated.

The main manifestation of cholelithiasis is biliary, or hepatic, colic, which manifests itself in attacks very severe pain in the right hypochondrium. At the same time, they spread and radiate to the right shoulder, arm, collarbone and scapula or to the lower back on the right side of the body. The most severe pain occurs when blockage of the common bile duct occurs suddenly.

An attack of biliary colic is accompanied by nausea and repeated vomiting with an admixture of bile in the vomit, which does not alleviate the condition of the patients. Sometimes reflex pain appears in the heart area. Biliary colic usually occurs with an increase in body temperature, which lasts from several hours to 1 day.

Between attacks, patients feel practically healthy, sometimes feeling dull pain, feeling of heaviness in the right hypochondrium, nausea. There may be a decrease in appetite and dyspeptic disorders.

With prolonged blockage of the common bile duct, bile from the liver is absorbed into the blood, jaundice occurs, which requires appropriate treatment in a hospital setting.
The most reliable confirmation of the diagnosis of cholelithiasis is the results of an X-ray examination with the introduction of a radiopaque liquid into the bile ducts.

In the clinical manifestations of cholelithiasis, functional disorders of the extrahepatic biliary tract are of significant importance, both in the early period before the formation of stones, and in the presence of such. Gallstone disease is a fairly common disease, especially in women, accompanied by a number of complications and sequential processes.
The size and number of gallstones vary in different cases. The most voluminous are single, solitary stones (monoliths), and the weight of the stone can reach 25-30 g; gallstones usually have a round, ovoid shape, common bile duct stones resemble the end of a cigar, and intrahepatic duct stones can be branched. Small stones, almost grains of sand, can number several thousand in one patient.

The main components of stones are cholesterol, pigments (bilirubin and its oxidation products) and lime salts. All these substances can be combined in various proportions. Of the organic substances, they contain a special colloidal substance of a protein nature, which forms the skeleton of the stone, and of the inorganic substances, in addition to lime salts (carbon dioxide and phosphoric acid), iron, copper, magnesium, aluminum and sulfur were found in gallstones. For practical purposes, it is enough to distinguish three types of stones based on their chemical composition: cholesterol, mixed and pigment.

1. Cholesterol, radial stones consist almost exclusively (up to 98%) of cholesterol; they are white, sometimes slightly yellowish, round or oval in shape, ranging in size from a pea to a large cherry.
2. Mixed stones, cholesterol-pigment-calcareous, multiple, faceted, occur in tens, hundreds, even thousands. These are the most common, most common stones. In the section, you can clearly see a layered structure with a central core, which is a soft black substance consisting of cholesterol. In the center of mixed stones, fragments of epithelium are sometimes found, foreign bodies(blood clot, dried roundworm, etc.), around which stones falling out of the bile are layered.
3. Pure pigment stones are of two types: a) observed in cholelithiasis, possibly with a plant diet, and b) observed in hemolytic jaundice. These pure pigment stones are usually multiple, black in color, and turn green in the air; they meet in bile ducts and in the gallbladder.

Causes of cholelithiasis (gallbladder stones)

The development of gallstone disease is a complex process associated with metabolic disorders, infection and stagnation of bile. Undoubtedly, heredity also plays a role. Metabolic disorders contribute to disruption of bile eicolloidity. The stability of the bile colloidal system, its surface activity and solubility depend on the composition and correct ratio bile ingredients, primarily bile acids and cholesterol (the so-called cholate-cholesterol index). An increase in the concentration of cholesterol or bilirubin in bile can contribute to their loss from solution. The prerequisites for increasing the concentration of cholesterol and decreasing the content of cholates in bile are created when bile stagnates. Infection promotes stone formation by inhibiting the synthesis of bile acids by liver cells. All these mechanisms, closely related to each other, lead to the development of the disease, which is facilitated by neuro-endocrine and metabolic disorders. From here more frequent development cholelithiasis among obese people, poor lifestyle, its frequent association with other metabolic diseases (atherosclerosis, diabetes), as well as the frequent occurrence of the disease during re-pregnancy.

Great importance in the formation of gallstones, it appears that there is an abnormal composition of the bile produced by the liver (dyscholia), which contributes to the loss of difficultly soluble constituents of bile, as well as a violation of general metabolism with an overload of blood with cholesterol (hypercholesterolemia) and other products of slow metabolism. Infection leading to disruption of the integrity of the epithelium of the gallbladder mucosa with its desquamation, foreign bodies inside the gallbladder, which easily cause deposition of lime and other components of bile, are rather only secondary, more rare factors of stone formation. Excessive secretion of bilirubin by bile during massive hemolysis is also important.

Unfavorable influences underlie liver dysfunction and metabolic changes external environment in the form of excessive malnutrition, lack of physical work. Neuroendocrine factors affecting the function of the liver cell and tissue metabolism, as well as the emptying of the gallbladder, are also of great importance.
Gallstone disease is often combined with obesity, gout, the presence of kidney stones, sand in the urine, atherosclerosis, hypertension, diabetes, i.e., it is observed in numerous conditions occurring with: hypercholesterolemia.

The disease most often manifests itself between the ages of 30 and 55 years, and in women it is 4-5 times more common than in men. Gallstones in inflammation of the gallbladder and hemolytic jaundice can be observed at an earlier age. Gallstone disease, of course, often manifests itself clinically for the first time during pregnancy or in the postpartum period: pregnancy is accompanied under normal conditions by physiological hypercholesterolemia and increased function of liver cells, which creates the best conditions for fetal development and milk production by the mammary gland. Particularly significant disturbances in metabolic and vegetative processes can be expected when the physiological rhythm of the reproductive function is disrupted during repeated abortions or premature birth without subsequent lactation, etc., when there is a possibility of delayed emptying of the gallbladder due to altered activity nervous system. Family cases of cholelithiasis, especially frequent in mother and daughter, are most often explained by the influence of the same environmental conditions mentioned above.

It has long been known that foods rich in cholesterol (fatty fish or meat, caviar, brains, butter, sour cream, eggs) contribute to the formation of stones, of course, if oxidative-enzymatic processes are disrupted.

Recent experimental studies have also discovered the effect of vitamin A deficiency on the integrity of the epithelium of the gallbladder mucosa; Its desquamation contributes to the precipitation of salt and other precipitation.

Currently, great importance in the loss of cholesterol in bile is attributed, as indicated, to the abnormal chemical composition of bile, in particular, the lack of bile (as well as fatty) acids, which can be seen as a dysfunction of the liver cell itself.

Infections and bile stasis are of known importance in gallstone disease. Of the diseases suffered, special attention was paid to typhoid fever, since it is known that the typhoid bacillus can affect the bile ducts, being excreted in the bile.

Stagnation of bile is promoted, in addition to a sedentary lifestyle, by excessive obesity, pregnancy, clothing that compresses the liver or restricts the movement of the diaphragm, prolapse of the abdominal organs, mainly the right kidney and liver; in this case, bending of the bile ducts, especially the cystic ducts, located in the lig may occur. hepato-duodenal. When the mucous membrane of the duodenum swells and ulcerative processes in it become scarred, the mouth of the common bile duct may be compressed, which leads to stagnation of bile. Catarrhs ​​that arise as a result of a gross violation of the diet sometimes contribute to stagnation of bile and infection of the biliary tract. Usually, however, in addition to the mechanical factor, the effect of the above-mentioned hepatic-metabolic factor is also noted.

The greatest importance in the origin of cholelithiasis should be given to disruption of the nervous regulation of various aspects of the activity of the liver and biliary tract, including the gallbladder, with their complex innervation device. The formation of bile, its entry into the gallbladder and its release into the duodenum is finely regulated by autonomic nerves, as well as higher nervous activity, which is evidenced by the great importance of conditioned reflex connections for normal bile secretion.

At the same time, the receptor fields of the biliary tract, even with functional disorders of the biliary function, give rise to pathological signaling to the cerebral cortex. Thus, in the pathogenesis of cholelithiasis, it is possible to establish individual links that are also characteristic of other cortico-visceral diseases.

Metabolic-endocrine disorders play only a secondary role, subordinate to functional changes in nervous regulation. With initial damage to adjacent organs and infectious causes, disruption of the hepatobiliary system, leading to cholelithiasis, also occurs through the neuroreflex pathway.

Certain signs of cholelithiasis, especially the signs accompanying biliary colic, characteristic of gallstone dyspepsia, etc., owe their intensity and diversity primarily to the abundant innervation of the gallbladder and bile ducts and are, undoubtedly, mainly neuroreflex in nature.

Symptoms, signs of cholelithiasis (gallbladder stones)

The clinical picture of cholelithiasis is extremely varied and difficult to brief description. Uncomplicated gallstone disease is manifested by gallstone dyspepsia and biliary, or hepatic, colic.

Complications of gallstone disease

Complications of gallstone disease

• Biliary colic.
• Cholecystitis.
• Acute pancreatitis.
• Gallbladder fistula, mechanical intestinal obstruction.
• Obstructive jaundice.
• Cholangitis and septicemia or liver abscess.
• Perforation and peritonitis.

Gallstone disease is characterized chronic course, leading to disability of patients and even threatening their lives during certain periods of the disease in the presence of certain complications, especially as a result of blockage of the bile ducts, intestinal obstruction and phlegmonous cholecystitis. Often the disease takes a hidden (latent) course, and stones are discovered only at the autopsy of patients who died from another cause.

Of the complications of gallstone disease, almost as numerous as, for example, complications peptic ulcer stomach and duodenum, the blockage of the bile ducts and their infection are described first of all separately, although very often the phenomena of blockage and infection are combined.

During their movement, stones can get stuck at various points along the path of bile movement, causing special characteristic clinical symptoms. Most often, we observe blockage of the cystic and common bile duct.

A typical manifestation of the disease is an attack of biliary, or hepatic, colic. The pain occurs suddenly, but is sometimes preceded by nausea. Colic usually begins at night, usually 3-4 hours after an evening meal, especially fatty foods, or drinking alcohol; accompanied by a rise in temperature (sometimes with chills), tension in the abdominal muscles, stool retention, bradycardia, vomiting, and bloating. Temporary anuria is possible, and in the presence of coronary disease - resumption of anginal attacks. There are a large number of cholesterol crystals in the duodenal contents, sometimes small stones are found. In some cases, stones can be detected in feces 2-3 days after the attack. In some cases, colic recurs frequently, in others - rarely, occurring in the form of gallstone dyspepsia.

With biliary colic, complications are possible, of which the most dangerous are blockage of the neck of the gallbladder by a stone; as a result of the stone laying an artificial path into the intestine (fistula), severe infection of the biliary apparatus occurs with the development of ulcers, biliary peritonitis and sepsis. Gallstone disease favors the development malignant neoplasms biliary system.

Diagnosis and differential diagnosis of cholelithiasis (gallbladder stones)

The diagnosis of cholelithiasis is made on the basis of patient complaints, medical history and course of the disease. In the anamnesis, it is especially important to indicate the dependence of complaints on fatty and floury foods, their connection with pregnancy, obesity of patients (in the past), the presence of cases of cholelithiasis in the family (the patient’s mother, sisters) under the same external living conditions.

When examining patients, the possibility of cholelithiasis is indicated by the presence of at least mild jaundice, skin pigmentation (liver spots, chloasma), cholesterol deposition in the skin (cholesterol nodes - xanthelasmas - in the thickness of the eyelids near the nose). Often, patients have overdeveloped subcutaneous fat. However, cholelithiasis also affects people with normal and low weight, especially in connection with biliary tract infection. As a result of severe cholelithiasis and its complications, patients can suddenly lose weight and even acquire a cachectic appearance. The cholesterol level in the blood may fall below normal, although cholelithiasis is often accompanied by elevated blood cholesterol levels. Direct evidence of the presence of a stone can be provided by cholecystography, the results of which are positive with modern technology in 90% of patients; The detection of microliths in the duodenal contents is also important.

Concerning differential diagnosis, then in various stages cholelithiasis has to bear in mind a number of diseases. In case of gallstone dyspepsia, it is necessary to exclude first of all a gastric and duodenal ulcer, chronic appendicitis, colitis and many other causes of gastric and intestinal dyspepsia. The erased signs of gallstone dyspepsia, described in detail above, make it possible to clinically clarify the diagnosis.

Hepatic colic must be differentiated from a number of diseases.

1. With renal colic, pain is localized lower, in lumbar region, and radiate to the groin, genitals and leg; dysuria, anuria, blood in the urine, and sometimes sandy discharge are often observed; vomiting is less persistent and feverish reactions are less common. We must not forget that both colics can occur at the same time.
2. In case of food poisoning, manifestations begin suddenly with profuse food vomiting, often diarrhea, in the form of an outbreak of a number of diseases; there is no characteristic dyspepsia in the anamnesis.
3. At acute appendicitis pain and tension in the abdominal wall (muscular protection) are localized below the navel, the pulse is more frequent, etc.
4. Duodenal ulcers and periduodenitis, due to the anatomical proximity to the gallbladder, are especially often mixed with biliary colic. Helps establish a diagnosis detailed analysis pain syndrome, pain points and X-ray examination.
5. Myocardial infarction can give a similar picture, especially since pain during a heart attack can be localized only in the right upper quadrant of the abdomen (“status gastralgicus” due to acute congestive liver). The issue is resolved by the patient's medical history, electrocardiographic changes, etc. Angina pectoris and even myocardial infarction can be caused by biliary colic. Nitroglycerin, according to some authors, also alleviates an attack of cholelithiasis.
6. Acute hemorrhagic pancreatitis is more pronounced general phenomena(see description of this form).
7. Intestinal colic is characterized periodic pain with rumbling and sometimes accompanied by diarrhea.
8. Mesenteric lymphadenitis (usually tuberculous) when located in the right upper quadrant is sometimes accompanied by pericholecystitis and periduodenitis without affecting the gallbladder itself, but is often mistakenly recognized as chronic cholecystitis.
9. Tabetic crises produce less intense pain, vomiting is more profuse, the temperature is not elevated, and there are neurological signs of tabes dorsalis.
10. With lead colic, the pain is localized in the middle of the abdomen, is diffuse, and calms down with deep pressure; the stomach is usually retracted and tense; arterial pressure increased; the gums have a typical lead border.

As stated above, biliary colic is almost always caused by stones, but in rare cases it can be caused by an roundworm or echinococcus vesicle stuck in the ducts. Analysis of stool and the presence of other symptoms of ascarid infestation or hydatid disease help establish the diagnosis.

An enlarged gallbladder with dropsy can be mixed with hydronephrosis, a pancreatic cyst; the gallbladder is characterized by respiratory mobility and lateral displacement; anterior hydatid cyst of the liver is differentiated from hydrocele by other signs characteristic of hydatid disease.

It is necessary to differentiate febrile cholecystitis, obstructive stone jaundice, cholangitis pseudomalarial fever, secondary biliary cirrhosis of the liver, gallstone ileus, etc. from other diseases that may resemble the corresponding complication of cholelithiasis.

Prognosis and working ability of cholelithiasis (gallbladder stones)

The prognosis of cholelithiasis is difficult to formulate in general form, the course of the disease is so varied. In most cases, the disease occurs with periodically recurring painful attacks and dyspepsia and, with the right regimen, is not prone to progression and does not significantly shorten life expectancy. This is the course of gallstone disease in most sanatorium-resort patients. In patients in the therapeutic departments of hospitals, a more persistent course with complications is usually observed; finally, patients in surgical departments experience the most serious complications gallstone disease, giving a relatively high mortality rate.

With frequent exacerbations of cholelithiasis and severe inflammatory phenomena (fever, leukocytosis), which are not inferior to treatment, patients are completely unable to work or their ability to work is limited. In milder cases of cholelithiasis with a predominance of spastic or dyskinetic phenomena in the area of ​​the gallbladder, without pronounced symptoms of cholecystitis, patients should be recognized as having limited ability to work in the presence of significant severity and persistence of nervous disorders and frequent, mainly non-infectious, subfebrile condition. They cannot perform work involving significant physical stress. With the development of severe complications of cholelithiasis, patients are completely disabled.

Prevention and treatment of cholelithiasis (gallbladder stones)

To relieve a painful attack, antispasmodics (drotaverine hydrochloride, papaverine hydrochloride) and analgesics (metamizole sodium, promedol) are administered intravenously or intramuscularly. If the attack still cannot be eliminated and the jaundice does not go away, you have to resort to surgical treatment. To remove stones, lithotripsy is used - crushing them using a shock wave.

Patients with cholelithiasis must strictly adhere to their diet and diet, and not abuse alcohol.

Patients with chronic diseases gallbladder and bile ducts with insufficient bile secretion and a tendency to constipation, a diet with a high content of magnesium, calcium, carotene, and vitamins B and A is recommended. If bile enters the intestines in insufficient quantities, then the consumption of animal fats should be limited. It is also recommended to consume more honey, fruits, berries, raisins, and dried apricots.

To prevent the development of the inflammatory process in the mucous membrane of the gallbladder, timely treatment of infectious diseases is necessary. In cases where cholelithiasis is combined with inflammation of the mucous membrane of the gallbladder (chronic cholecystitis), the disease is much more severe. Attacks of biliary colic occur more often, and most importantly, severe complications can develop (dropsy of the gallbladder, cholangitis, pancreatitis, etc.), the treatment of which is very difficult.

For the prevention of cholelithiasis, a general hygienic regime, sufficient physical activity and proper nutrition are important, as well as the fight against infections and dysfunction gastrointestinal tract, eliminating stagnation of bile, eliminating nervous shock. For people leading a sedentary lifestyle, it is especially important to avoid overeating, systematically take walks in the fresh air, and engage in light sports.

Treatment of cholelithiasis at different stages of its development varies. However, regardless of temporary urgent measures, patients, as a rule, must adhere to a general and dietary regimen for years and decades, periodically undergo spa treatment in order to counteract metabolic disorders, cholesterolemia, to increase the activity of liver cells, to strengthen the nervous regulation of bile-hepatic activity. Of great importance is the fight against stagnation of bile, infection of the gallbladder and bile ducts, ascending from the intestines or metastasizing from distant foci, as well as eliminating difficult experiences. It is necessary to recommend split meals (more often and little by little), as they are the best choleretic agent. The daily amount of drinking should be plentiful to increase secretion and dilute bile. It is important to eliminate all causes that contribute to bile stagnation (for example, a tight belt); with severe ptosis, it is necessary to wear a bandage. Constipation should be combated by prescribing diet, enemas and mild laxatives.

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

In case of cholelithiasis, it is usually necessary to limit patients both in terms of the total caloric intake of food and in relation to meat, fatty dishes, especially smoked foods, canned food, snacks, as well as alcoholic drinks. Egg yolks and brains, especially rich in cholesterol, should be excluded from food, and butter should be sharply limited . The diet should be predominantly vegetarian with a sufficient amount of vitamins, for example, vitamin A, the lack of which in the experiment leads to disruption of the integrity of the epithelium of the mucous membranes and, in particular, to the formation of gallstones. Much attention is paid to the culinary processing of food, and fried meat, strong sauces, broths, and some seasonings should be avoided. It is necessary to take into account not only the physicochemical properties of food, but also its individual tolerance.

During periods of sharp exacerbations of the disease, a meager diet is prescribed: tea, rice and semolina porridge with water, jelly, white uneatable crackers. Only gradually add fruits (lemon, applesauce, compotes), cauliflower, other pureed vegetables, a little milk with tea or coffee, yogurt, low-fat broth or vegetable soup etc. From fats, fresh butter is allowed in the future in small quantities, with breadcrumbs or vegetable puree; Provencal oil is given as a medicine in tablespoons on an empty stomach. For years, patients should avoid those foods that cause them attacks of colic or dyspepsia, namely: pies, cakes with cream and butter dough in general, solyanka, pork, fatty fish, cold fatty snacks, especially with alcoholic drinks, etc. .

The regimen of patients with cholelithiasis should not, however, be limited only to a properly selected diet and rational eating habits; patients should avoid excitement, hypothermia, constipation, etc., in a word, all those irritations that, in their experience, with particular consistency lead to the return of colic, to a large extent, probably due to the zones of prolonged excitation created in the cerebral cortex. Reception medicines, strengthening the inhibitory process in higher nervous activity, distraction, similar other methods should be used in order to prevent another attack even when exposed to habitual provoking factors.

In the treatment of cholelithiasis, one of the first places is occupied by sanatorium-resort treatment, which is indicated after acute attacks(not earlier than 1-2 months) for the majority of patients with uncomplicated cholelithiasis without signs of a pronounced decline in nutrition. Patients are sent mainly to Zheleznovodsk, Essentuki, Borjomi, etc., or to sanatoriums at the patients’ place of residence for diet and physiotherapy. At spa treatment Complete rest, correct general regimen, nutrition, measured walks, local application of mud to the liver area, which relieves pain and accelerates the healing of residual inflammatory processes, and drinking mineral waters, have a beneficial effect. From mineral waters, hot hydrocarbonate-sulfate-sodium springs are used (for example, the Zheleznovodsk Slavyanovsky spring with water at a temperature of 55°), hydro-carbonate-sodium springs Borjomi, etc., which promote better separation of more liquid bile and the cure of gastrointestinal catarrhs, as well as better loosening the intestines and diverting blood from the liver. Mineral or salt-pine baths are also used, which have a beneficial effect on the nervous system.

Under the influence of climate, mineral waters, hydrotherapy procedures, local application dirt and, finally, an appropriate dietary regimen, the metabolism changes in a favorable direction, inflammatory phenomena subside, bile becomes less viscous and is easier to remove from the biliary tract and normal is restored to a large extent neural regulation activity of the hepatobiliary system.

Of the medications, bile acids (decholine) may be important, allowing for a normal ratio of bile acids and cholesterol and thereby counteracting stone formation; herbal preparations rich in anti-spasmodic, anti-inflammatory, laxative ingredients; preparations from plants with choleretic properties (holosas extract from rose hips, infusion of immortelle Helichrysum arenarium and many others), choleretic and laxative salts - magnesium sulfate, artificial Carlsbad salt, etc.

Treatment of biliary colic consists of vigorous application of heat to the liver area in the form of heating pads or compresses; if the patient cannot tolerate heat, ice is sometimes applied. Painkillers are prescribed: belladonna, morphine. Usually, vomiting does not allow giving medications orally, and most often it is necessary to inject 0.01 or 0.015 morphine under the skin, preferably with the addition of 0.5 or 1 mg of atropine, since morphine, apparently, can intensify spasms of the sphincter of Oddi and thereby increase the pressure in the bile ducts.

Novocaine also relieves colic ( intravenous administration 5 ml of 0.5% solution), papaverine. Many patients experience bloating during an attack; in these cases, warm enemas are prescribed; For persistent constipation, siphon enemas are used. Vomiting can be calmed by drinking hot black coffee or swallowing ice cubes.

For 5-6 days after the attack, it is necessary to monitor whether the stone is passed with stool. In preventing a seizure, rest, prohibition of bumpy driving, an appropriate diet with a limit on fatty and spicy foods, small meals with sufficient fluid intake and elimination of constipation are important.

For infection of the biliary tract, sulfazine and other sulfonamide drugs are used in an average dose, penicillin (200,000-400,000 units per day), methenamine, “non-surgical drainage” of the biliary tract in combination with agents that increase the body’s resistance and improve the condition of the liver: intravenous infusion of glucose, ascorbic acid, campolone, blood transfusion, etc.

At obstructive jaundice Prescribe the same drugs that improve the condition of the liver, and in addition, ox bile, parenteral vitamin K (against hemorrhagic diathesis).
Urgent surgical treatment is indicated for gangrenous cholecystitis, perforated peritonitis, intestinal obstruction due to stones (simultaneously with treatment with penicillin). Limited accumulations of pus in case of empyema of the gallbladder are subject to surgical intervention, subphrenic abscess, purulent cholecystitis, blockage of the common bile duct with a stone, hydrocele of the gallbladder, purulent cholangitis. More often, surgery is performed to remove the gallbladder (cholecystectomy) or to open and drain the gallbladder or common bile duct. After surgery, the correct general and dietary regimen is also necessary to avoid relapse of stone formation or inflammatory-dyskinetic phenomena, as well as sanatorium-resort treatment.

In some cases it should only be conservative, in others it must be surgical. Foods rich in cholesterol and fats (brains, eggs, fatty varieties meat), rich meat soups, spicy and fatty dishes, lard, smoked meats, canned food, baked goods, alcoholic drinks. Dairy products, fruit and vegetable juices, vegetables, vegetarian soups, boiled meat, fish and pasta, cereals, berries, butter and vegetable oil, preferably corn. Patients should be advised to eat moderately, regularly and often, with plenty of fluids, giving preference to mineral waters (Essentuki No. 20, Borzhom, etc.).

Prescribe various choleretic drugs. Carlsbad salt, magnesium sulfate, sodium sulfate, allohol, cholecin, cholenzyme, oxafenamide, holagol, flamin, cholelitin, etc. are very effective. For pain, antispastic and analgesic drugs are used: atropine, antispasmodic, belladonna, papaverine, platiphylline, etc. colic sometimes it is necessary to prescribe pantopon or morphine, always with atropine, since morphine drugs can cause spasm of the sphincter of Oddi. If you have symptoms " acute abdomen» The use of drugs is contraindicated.

In the presence of infection, antibiotics are used taking into account the sensitivity of the flora isolated from bile for 5-10 days; sulfa drugs.

Surgical treatment is carried out in cases of persistent disease, with frequent relapses of biliary colic that occur despite active treatment, with blockage of the gallbladder, perforation of the gallbladder, and the formation of biliary fistulas. Surgical treatment of cholelithiasis must be timely.

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 form in the gall ducts and in the gallbladder itself long time. 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 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 caused by obesity, big amount childbirth, taking 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, due to 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 unexpressed 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 (approximately 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 gallstones 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 drink questionable cocktails from strictly prohibited choleretic herbs and vegetable oil, which some recommend traditional healers, and make an appointment with a gastroenterologist.

For conservative treatment 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.

• fat 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 contraction of the bladder, and thereby prevent the accumulation of bile in it.

For existing gallstones, there are several options for patient management.

If stones were discovered by chance and do not bother the patient, most experts are inclined to believe that no active measures should be taken. therapeutic actions. The patient is explained the basic principles of his eating behavior and diet, which will slow down the process of formation of new stones or their increase, and will also reduce the likelihood of biliary colic - the main clinical manifestation of cholelithiasis.

The general principle of diet therapy is frequent divided meals (up to 5-6 times a day), at the same hours, taking into account individual food tolerance. Eating large amounts of food in the evening and at night is contraindicated. The energy value of food is 2500-2900 kcal/day, the content of proteins, fats, carbohydrates and vitamins in it must be balanced.

It is important to reduce (even eliminate) the proportion of animal fats in the diet and increase plant fats. The latter are more easily emulsified by bile, which facilitates the process of digestion and absorption of fats into small intestine. Besides, vegetable fat stimulates metabolism in liver cells (hepatocytes), increasing the volume of bile they produce and reducing its lithogenicity.

Among products containing animal protein, preference should be given low-fat varieties meat (beef, poultry, rabbit, fish).

Increasing the consumption of plant fiber (bran, vegetables (pumpkin, beets, various types of cabbage, watermelons, etc.) and fruits (apricot, plum, persimmon, etc.).

Sufficient (at least 2 liters) fluid intake, especially alkaline mineral water(without gas), also recommended for patients with cholelithiasis.

Products whose consumption should be sharply limited and even excluded include spicy foods, seasonings, fried, fatty, smoked foods, dough products, especially rich ones, meat and fish broths, carbonated and cold drinks, nuts, creams. Products containing large amounts of cholesterol (liver, brains, egg yolks, lamb and beef fats, etc.) are also contraindicated.

In most cases of “silent” cholelithiasis, compliance with the above recommendations allows you to avoid attacks of biliary colic.

What to do if an attack of biliary colic nevertheless develops?

Don't panic, remember, colic can disappear without special treatment
Increasing physical activity and changing body position, as a rule, does not reduce the intensity of pain or eliminate it
A hot heating pad, although it can reduce pain and even eliminate an attack, should not be applied to the right hypochondrium in order to avoid the development of serious complications; you can limit yourself to a warm (down) scarf
You should call a doctor ( ambulance) and before the arrival of doctors, you can try to eliminate the attack by taking drugs that eliminate spasms: drotaverine (known to many as no-shpa) orally or intramuscularly or papaverine 2 ml intramuscularly; If the patient has previously been given atropine or platyphylline and there have been no adverse effects, one of them can be administered intramuscularly (in a separate syringe) along with drotaverine or papaverine.
In most cases, it is not advisable to use analgesics on your own (analgin 50% - 2 ml, baralgin - 5 ml) for patients with biliary colic, since, while reducing pain, they only erase clinical picture, creating a picture of imaginary well-being. These drugs can be prescribed by a doctor, who will then be able to monitor the patient’s condition.
Patients with cholelithiasis (regardless of whether there are clinical manifestations or not) should not therapeutic purpose carry out the so-called “blind” duodenal intubation, or dubage, since this procedure can provoke or worsen biliary colic.

In the last few decades in clinical practice non-surgical (chemical and physical) methods for treating cholelithiasis have been introduced.

A. Chemical methods:

oral administration of bile acid preparations (litholytic therapy);
direct contact dissolution of stones using special means, introduced into the lumen of the gallbladder using drainages and catheters.
B. Physical methods:

destruction of stones due to powerful targeted ultrasound from a source located outside the patient’s body (extracorporeal lithotripsy);
destruction of stones by direct pulse action of laser or ultrasonic radiation from a source located inside human body(intracorporeal lithotripsy);
endoscopic instrumental (special loops) fragmentation of stones located in the common bile duct.
Litholytic therapy is based on the use of drugs that reduce the lithogenic properties of bile by reducing its cholesterol content and increasing bile acids.

A prerequisite for the effectiveness of such treatment is a functioning gallbladder, complete or more than half emptying after eating.

Chenodeoxycholic acid is prescribed at a rate of 12-15 mg per kg of patient weight per day. Ursodeoxycholic acid is prescribed at a rate of 10-12 mg per kg of patient weight per day. All daily dose Take in the evening with 150-200 ml of liquid. Litofalk is prescribed in a dose similar to Ursofalk. The duration of treatment (depending on the size and number of stones) can range from one to three months to one year or even more. While taking chenodeoxycholic acid, more often than ursodeoxycholic acid, the patient may experience loose stools, including diarrhea. There may be a transient increase in specific enzymes that reflect liver damage (transaminases), which, however, in the vast majority of cases does not require discontinuation. During treatment with bile acid preparations, patients should periodically (once every 1-2 months) undergo an ultrasound examination and, once every 6-9 months, an x-ray examination of the gallbladder with contrasting of the bile ducts with an agent taken orally.

If stones measuring 5 mm or less have not dissolved within 6 months, or stones larger than 5 mm have not dissolved within 9 months (according to the results of oral cholecystography!), treatment with bile acid preparations may be discontinued due to its ineffectiveness.

Chemical dissolution of stones with bile acids is contraindicated in patients with severe liver damage (cirrhosis, chronic hepatitis), frequent attacks biliary colic over the past few years, which are difficult to treat with drugs that eliminate spasms, pregnancy or a woman’s desire to have a child during the treatment period, severe obesity, disruption of the digestion process and absorption of food of various nature. Even with careful selection of patients for litholytic therapy, its effectiveness rarely exceeds 60-70%. After stopping treatment, a recurrence of cholelithiasis is very likely, primarily in patients who have not adjusted their regimen and diet.

Direct contact dissolution of cholesterol gallstones is carried out by percutaneous (under the control of computed tomography) puncture of the gallbladder (cholecystotomy) with the introduction of special solutions into its lumen through a special cannula, the composition of which is determined by the type of stones.

Extracorporeal lithotripsy with ultrasonic shock waves is a physical method for removing stones and has almost the same indications as litholytic therapy with bile acids. In this case, a larger (up to 25 mm) size of stones is allowed, but they must be single (no more than three). The presence of a calculus in the common bile duct, and the severe general condition of the patient, sclerotic changes in the gallbladder and extrahepatic bile ducts are contraindications to this type of therapy. Usually one, two, or much less often three sessions of extracorporeal lithotripsy are performed. This method effective in 30-50% of cases. After successful fragmentation of large stones, the fragments should be dissolved using chenodeoxycholic and/or ursodeoxycholic acid.

Endoscopic instrumental fragmentation of stones is carried out in a specialized surgical department if a stone from the gallbladder enters the common bile duct and causes its blockage (Fig. 3). In many cases, this endoscopic manipulation, performed using a duodenoscope, allows one to avoid abdominal surgery.

Blockage of the common bile duct with the development of jaundice or pancreatitis (along with a violation of the outflow of bile, a violation of the outflow of pancreatic juice is also possible, since its duct flows into the area of ​​the mouth of the common bile duct).

Fig.3. Blockage of the common bile duct by a stone.

Prevention

Means of preventing gallstone disease include eliminating risk factors (see above), and primarily excess body weight, adherence to a diet and regimen that will reduce the likelihood of stone formation (in fairness, it should be mentioned that the preventive value of dietary measures is not recognized by all specialists) .

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How to Dissolve and Remove Gallbladder Stones Naturally

But if stones block the bile ducts, it requires treatment. People who have excess weight, or those who try to lose it quickly are more likely to develop gallstones.

Sometimes, these can be quite painful sensations that appear constantly or pass away from time to time. When gallstones block the bile duct, you may experience pain, fever and chills, and the skin or whites of your eyes may turn yellow. In this case, consult a doctor immediately. Having stones in the bile ducts increases the risk of swelling of the pancreas (pancreatitis).

Most effective procedure Ultrasound is used to identify gallstones. If the ultrasound does not detect the presence of gallstones, and the doctor believes that they are causing the symptoms, he may order a scan of the gallbladder.

Most people have gallstones, but this fact remains unknown until symptoms begin to appear. The first attacks of gallstones cause mild pain; your doctor may prescribe a pain reliever and observe the symptoms.

Radiation diagnostics of pathology of the gallbladder and biliary tract

If you have a severe or repeated attack, gallstones may need to be removed.

Calculous cholecystitis - what is it? Symptoms, causes, treatment of calculous cholecystitis

During this procedure, the doctor makes a small incision in the abdomen and removes the gallstone.

Gallstones. What is the danger?

In this case, bile flows directly from the liver to the intestines. If a stone blocks the channel that transports bile from the gallbladder to the stomach, the patient experiences an attack of acute pain (colic) in the abdominal area.

Asymptomatic gallstones do not require treatment. The presence of stones, which are accompanied by periodic painful attacks, require immediate treatment.

Prevention of gallstones

After the gallbladder is removed, bile passes directly from the liver to the intestines. The video camera allows you to see the gallbladder and all internal organs that are nearby.

In the body of the pancreas in the duct, a calculus (two closely located) of irregular shape measuring 8 and ... was visualized, not expanded.

Good afternoon Ultrasound conclusion: Calculous cholecystitis, Gall bladder enlarged in size 100+50 mm. The wall is thickened to 5.5 mm with areas with a double contour. There is a 25 mm stone in the neck. There is a suspension in the cavity of the bubble.

In the lumen there is anechoic bile and a 9 mm calculus. Surgeons advise removing the gallbladder. Is it really impossible to try to dissolve the stone with treatment?

Cholelithiasis (Greek, from chole - bile, and lithos - stone) is the formation of stones. In some cases, a complication may be the development of pancreatitis. The presence of stones in the bile ducts is called choledocholithiasis. Choledocholithiasis can be complicated by biliary colic, obstruction (blockage) of the bile ducts, the development of pancreatitis or cholangitis.

There are several ways to diagnose gallstones:

In conditions of insufficient emptying of the gallbladder and stagnation of bile, microlites are not excreted into the intestines and begin to grow. The typical location of cholesterol stones is in the bile ducts. Pigment stones are much less common - 10-20% of total number stones forming in the gall bladder.

Mixed stones are formed as a result of the accumulation of a significant amount of calcium bilirubinate and other calcium salts on the surface of pigmented or cholesterol stones. In the second stage of cholelithiasis, stones are detected in the gallbladder by X-ray or ultrasound examination, but the disease, as a rule, is asymptomatic.

Symptoms of gallstones

The cause of biliary colic is obstruction of the bile ducts by a stone that enters the cystic duct and prevents the outflow of bile from the gallbladder or liver.

Treatment of gallstones

1. Mild - characterized by rare attacks of biliary colic, which are easily relieved with medications.

Publications on the topic: Ultrasound of the abdominal cavity (for doctors)

In severe, complicated cases of cholelithiasis, surgical treatment is necessary - cholecystectomy (surgery to remove the gallbladder). When relieving an attack of biliary colic, antispasmodics are the main medicines choice.

If inflammatory processes are detected in the bile ducts - antibacterial therapy. Litholytic therapy consists of taking medications to destroy gallstones.

The gallbladder has clear, even contours. Unfortunately, the presence of gallstones may not become apparent for a long time. On X-ray examination You can detect gall bladder stones, which contain calcium.

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How to treat gallbladder stones?

The question of how to treat gall bladder stones can only be answered by a doctor, based on the results of the examination and tests. There are several methods to combat gallstones:

• Cholecystectomy involves complete removal of the affected organ, that is, the gallbladder;
• Taking bile salts to dissolve stones and then remove them;
• Exposure to ultrasonic waves.

Drug treatment of gall bladder stones may consist of taking antispasmodics to relieve colic, antibiotics, and drugs that help dissolve stones. Taking the latter often leads to various kinds of complications, therefore, throughout the entire course of treatment (and it can be about two years), you must be under the supervision of a doctor.

nmedicine.net

Causes of gallstones and symptoms of the disease

There are several possible reasons for the appearance of stones in the gallbladder. Middle-aged women are most susceptible to this process, which is characterized by hormonal changes in the female body.

Also at risk are girls taking hormonal drugs, pregnant women and those who follow a strict diet for weight loss.

Statistical data from past years stubbornly proved that only female representatives are exposed to this negative formation in the gallbladder, however modern statistics shows the opposite.

IN last years Stones have become often found in the gallbladder of representatives of the stronger half, which is facilitated by an unhealthy lifestyle, alcohol abuse, and obesity in men.

According to scientists, the formation and development of stones occurs under certain conditions. Most often this occurs as a result of oversaturation of the bile mass with calcium, as well as due to an increase in cholesterol levels in the human body.

In people suffering from liver cirrhosis, anemia and diabetes mellitus, the risks of developing stones are quite high, therefore, in the presence of these diseases, periodic examination by a specialist is recommended, which will prevent the formation of stones or identify a developed disease in the first stages of formation.

Stones developed in the gallbladder sometimes do not show symptoms, so some sick people find out about the presence of this formation quite by accident, undergoing an annual medical examination at the clinic or examination of other internal organs. However, in most cases, stones are still periodically accompanied by unpleasant and painful symptoms:

• paroxysmal pain that occurs in the upper abdomen, sometimes moving to the back and shoulder blades;
• there is a bitter taste in the mouth;
• may appear unpleasant nausea and even vomiting;
• there is frequent belching;
• heartburn;
• bloating;
• difficulty breathing associated with severe pain;
• frequent waking up at night due to sharp pain in the abdominal cavity.

These symptoms occur not only in the presence of developed stones in the gallbladder, but also in other diseases of the digestive system, so only an experienced doctor can determine an accurate diagnosis, based on a diagnostic examination.

Stones that remain in the gallbladder for a long time and are not treated in a timely manner gradually damage the mucous membrane of the organ, which contributes to the development of the inflammatory process, called “calculous cholecystitis” in medical practice.

If the formation of stones in the biliary organ is not detected in a timely manner, serious complications may arise. If a stone suddenly leaves the gallbladder, blockage of the bile duct cannot be ruled out, which is especially likely in the presence of stones big size.

This process causes painful symptoms and is accompanied by sudden changes: chills or a feeling of intense heat occur, body temperature may rise, and the skin and whites of the eyes noticeably turn yellow.

If these signs are detected, the patient must be urgently taken to the inpatient department of a medical institution, since this process is quite dangerous for human life and health.

Diagnosis and treatment of gallstones

The most effective procedure is ultrasound examination, which determines the presence of gallstones or calculi. If the ultrasound results refute the specialist’s suspicions, the patient is sent to additional examination– gallbladder scan.

This procedure involves the intravenous injection of a special substance into the blood of the patient, which allows the specialist to observe blood circulation in the gallbladder, liver and intestines of the patient.

It is also possible to refer a blood test and undergo other diagnostic measures at the discretion of the treating doctor.

Treatment of this education in the gallbladder requires complex therapy using special medications. The most relevant are painkillers, antispasmodics, antibiotics and agents for dissolving formed stones, but such treatment can only be carried out in the presence of small stones.

If the doctor determines the need to crush the stones, the patient is prescribed lithotripsy. Surgical intervention It is performed only in the presence of complications, during exacerbations during the course of drug treatment and if the development of a serious inflammatory process in the gallbladder is detected.

Modern medicine makes it possible to eliminate formed stones without significant incisions; the operation is carried out with minor punctures in the abdominal cavity. This operation is easily tolerated by the patient and leaves virtually no scars on the human skin.

Some people, having learned about the presence of formed stones in the gallbladder, independently select treatment for this unpleasant illness using traditional medicine.

Of course, traditional methods of treatment often give positive results, eliminating the most serious human diseases, but in the case of identifying stones in the gall bladder, it is not recommended to use this practice.

The whole point is that by promoting the passage of stones from the organ with the use of medicinal choleretic herbs, it can lead to blockage of the bile ducts, which can have quite dangerous consequences that can even result in the death of a person.

Treatment of such a serious formation in the biliary organ should be carried out only under the supervision of the treating gastroenterologist in accordance with the prescription.

gastrosovet.ru

What indicates stones in the gallbladder

People whose diet is dominated by protein food, often feel a variety of symptoms accompanying the gallstone process. Their severity depends on the quantity, chemical composition, and also on the size of the stone. Often people with one or more small stones are not even aware of the pathology.

The most typical sign of cholelithiasis is heaviness under the ribs on the right side and a bitter taste in the mouth, especially noticeable in the morning.

When a calculus begins to move along the excretory tract or clogs the exit from the gallbladder, an attack of hepatic colic occurs. At this moment, pain is provoked by a spasm of the organ, which occurs due to significant compression on the inner surface of the walls of the bladder. Unpleasant sensations from the area of ​​the right hypochondrium can spread to the epigastric area (stomach), neck or arm.

Sick people experience other manifestations of gallstones:

• nausea, sometimes leading to vomiting;
• soreness on the right side;
• intestinal dysfunction (constipation, diarrhea, excessive gas formation).

Gallstone disease can cause fever, weakness and malaise. This symptom indicates that the gallstone process is complicated by a bacterial infection. And prolonged stagnation of bile, which occurs due to blockage of the ducts, affects the appearance of the sick person - his skin and the whites of his eyes acquire a jaundiced tint.

Causes of stone formation

U healthy person Bile is always liquid and does not form stones. Experts identify 3 main factors that provoke gall bladder stones.

Too much cholesterol

The most common cause of stone formation is a violation of the relationship between bile acids and cholesterol contained in liver secretions. It occurs due to the following factors:

• use oral contraceptives based on estrogen;
• abundance of protein foods and animal fats in the diet;
• liver dysfunction;
• excess weight.

Health problems associated with metabolic disorders and autoimmune diseases also lead to cholecystolithiasis.

Motor dysfunction of the gallbladder

With insufficient contractile activity, cholesterol flakes settle at the bottom of the organ. As a result, hard clots begin to form in the gallbladder. Poor outflow is often associated with an insufficiently active lifestyle, a dietary style in which there are long gaps between meals. In women, the triggering factor is pregnancy, when the gallbladder is compressed by the growing uterus.

Problems such as increased gas formation, dyskinesia of the bile ducts, and the presence of mechanical barriers to the path of bile also cause the formation of a calculus.

Infectious factor

An infection that enters the gallbladder from the intestines or brought by blood from diseased organs causes cholecystitis, cholangitis. It is believed that cholelithiasis and chronic inflammation– companion pathologies.

Stone sizes

Thick bile, stagnant in the natural reservoir, forms suspension and sand, which gradually turns into calculus. The longer it remains in the bile depot, the more large sizes acquires.

According to the chemical composition, stones are cholesterol, pigment, consisting of calcium deposits, or a combination.

One sick person has different types gallstones. Their sizes can be either very small or quite impressive. Surgeons know of cases where a calculus was removed during surgery, occupying the entire volume of the bladder. Often the organ is filled with many medium-sized stones.

The size of the stone and its chemical composition determine the advisability of conservative treatment. If the dense clot has not reached a size greater than the diameter of the lumen of the bile duct, it may pass on its own. If the stone grows too large, surgery will be required.

Complications of cholelithiasis

Stone disease almost never goes away without leaving a trace on human health - the pathology causes various complications. The most common of these is hepatic colic. It can occur when a stone blocks a duct and is accompanied by unbearable pain.

Colic often begins a more severe inflammatory disease - cholecystitis. Due to an obstruction that has stopped the flow of bile, a person feels constant pain, especially painful when moving. A high temperature is a sign that the patient has acute calculous cholecystitis. At laboratory analysis identify increased content blood leukocytes. A similar picture occurs with cholangitis, when the bile, ducts and liver become infected. If this disease is not treated in time, it can lead to sepsis or liver abscess.

Long-term stagnation of bile due to cholelithiasis provokes the accumulation of bilirubin pigment in it. This causes the sclera and human skin to turn yellow. In addition, the patient is bothered by severe itching.

Pancreatitis can develop if a stone blocks the common bile duct communicating with the pancreas. Its secretion, having no outlet, begins to destroy the tissue of the organ, which triggers inflammation. In severe cases, pancreatitis can lead to pancreatic necrosis, a condition incompatible with life. Timely therapy makes the patient feel better.

Complications of gallstone disease are very dangerous:

• rupture of the bile depot leading to peritonitis;
• throwing of large stones into the intestines, causing obstruction;
• tumor formation in the bladder against the background of constant irritation of its walls.

Diagnostics

To identify stones in the gall bladder, a person is referred for an ultrasound examination. It allows you to determine exactly where the formation is located, as well as the size and number of stones.

If there are difficulties in making a diagnosis, additional procedures are used:

• cholecystography - x-ray with the introduction of a contrast agent;
• cholangiography, combining endoscopy with X-ray method examinations;
• duodenal sounding.

The list of laboratory tests includes the following:

• a series of biochemical and clinical tests (capillary and venous blood is taken);
• coprogram (stool analysis);
• general urine analysis.

Treatment options

Conservative therapy used today for gallstones is very effective and allows you to solve the problem without surgery. Treatment of cholelithiasis by dissolving stones with special preparations and crushing them with ultrasound allows you to save the organ.

Litholytic therapy

Doctors begin to treat a patient with this method when the stone is not too large. For this, experts prescribe drugs based on acids: ursodeoxycholic acid (Ursosan), chenodeoxycholic acid (Chenosan). They improve the quality of bile, reducing its cholesterol content and increasing the amount of fatty acids.

Such removal of gallstones without surgery makes sense in the following cases:

• the size of the stones does not exceed 15 mm;
• stones occupy no more than half the capacity of the gallbladder;
• cholesterol formations predominate;
• normal motor function of the organ and patency of the excretory canals are preserved;
• the patient has no contraindications to taking acids for a long period.

During treatment, it is recommended not to use drugs that provoke stone formation: cholestyramines, estrogens and antacids. Litholytic therapy with oral medications is contraindicated for people with diseases of the gastrointestinal tract and excretory system.

The duration of treatment is determined individually. The doctor, when prolonging or canceling medication, is guided by the results of control ultrasound examinations. As a rule, to dissolve gallstones, you need to use acids for a year and a half.

Application of extracorporeal lithotripsy

The method involves crushing stones with a shock wave. Small fragments are freely removed from the gallbladder. The procedure is often used in combination with litholytic therapy, then the crushed stones are completely dissolved with special preparations.

Lithotripsy is performed by contact and non-contact methods. In the first case, the source of the shock wave is brought through an endoscopic probe directly into the gallbladder close to the stone. With non-contact crushing, a device that generates a shock wave is directed to the location of the gallbladder projection.

Crushing stones is prohibited if the patient has problems with blood clotting, as well as chronic pathologies: stomach and duodenal ulcers, pancreatitis.

Percutaneous transhepatic cholelitholysis

The method of percutaneous transhepatic dissolution of gallstones is used less frequently than others, although it allows you to get rid of all types of stones. Cholelithiasis is carried out by introducing a catheter into the liver tissue, through which palmidrol, octaglin or methylhexyl ether is administered. Duration of treatment is 3-4 weeks. It is possible to dissolve stones in the gallbladder using this technique in 90% of cases.

Surgery

Surgery to remove the gallbladder is recommended when large stones are found in it. Surgical assistance is required for frequently recurring attacks of hepatic colic, or when complications arise. The operation can be performed by opening the abdominal cavity or laparoscopic method, in which the diseased organ can be removed through several miniature incisions.

Laparoscopy today is used much more often than cholecystectomy. This is due to the fact that minimally invasive intervention is tolerated much easier by patients, and the recovery period is also reduced.

Indications for surgical treatment are the following conditions:

• calcium and cholesterol deposits on the walls;
• chronic calculous cholecystitis;
• blockage of ducts with stones;
• repeated attacks of biliary colic;
• the occurrence of polyps in the organ;
• acute cholecystitis.

Consequences of cholecystectomy

Surgery to remove the gallbladder brings relief to a person who often experienced colic and other symptoms of pathology. But the cause of the stones is not eliminated, so after removal of the organ they can form again. To prevent this from happening, you should strictly adhere to all the doctor’s recommendations.

In addition, it is possible to develop the so-called postcholecystectomy syndrome, in which the operated person complains of the following symptoms:

• bitterness and dryness in the mouth;
• metallic taste of food;
• soreness and heaviness on the right side.

The absence of a bile storage organ can lead to its uncontrolled flow into the intestines. This causes new pathologies: duodenitis, colitis, esophagitis and others.

In the first six months to a year after removal, the body has not yet adapted to the new mode of operation without a bile accumulator. This provokes frequent intestinal dysfunctions: flatulence, diarrhea, constipation, and sometimes heaviness in the epigastrium occurs.

Diet

People who are aware of the symptoms of gallstones should special attention pay attention to diet. Need to eat in small portions at least every 2.5-3 hours. You should have dinner no later than 19:00, and before going to bed you should drink a glass of kefir or eat a small portion of fruit salad. It won't overload digestive system and at the same time will not allow the bile to stagnate.

There is a list of foods that are prohibited to eat if you have gallstone disease:

• alcoholic drinks (especially wine, beer);
• fried, smoked, marinades, canned food;
• strong meat and fish broths;
• legumes, vegetables with a spicy taste;
• seasonings and spices.

Nutritionists advise replacing animal fats with vegetable fats. Olive and flaxseed oils are especially beneficial for the gallbladder.

Prevent gallstone disease

Preventing stone formation is not just a doctor-recommended program, but a way of life. First of all, it is necessary to optimize nutrition:

• make sure that the break between meals is not too long;
• avoid the appearance of fatty foods and fried foods on the table;
• eat small portions.

It is very important to monitor your weight and prevent extra pounds. If your weight is already quite large, gradually get rid of the fat accumulated on your body.

Prevention of stone formation is directly related to sufficient physical activity and a rational regime of work and rest. Doctors advise avoiding stressful situations so as not to provoke spasms and congestion in the biliary system. By following these recommendations, you can keep your liver healthy and never know what the signs of gallstones are.

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

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

Symptoms of gallstones

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

• nausea;
• vomit;
• bloating;
• belching;
• sweating

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

There are several ways to diagnose gallstones:

• blood test;
• radiography;
• ultrasound;
• CT scanning.

Treatment of gallstones

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

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

Prevention of gallstones

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

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

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

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

What is gallstone disease

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

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

The risk group for cholelithiasis includes older people, as well as patients taking medications that affect cholesterol metabolism. Hereditary factors can trigger the development of the disease, poor nutrition(overeating and starvation), some gastrointestinal diseases, metabolic disorders.

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

Symptoms of gallstones

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

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

Main symptoms:

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

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

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

Causes of stone formation

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

Causes of cholelithiasis (cholelithiasis):

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

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

Types of gallstones and what sizes they reach

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

Types of stones:

• cholesterol;
• limestone;
• mixed;
• bilirubin.

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

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

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

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

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

Diagnosis of cholelithiasis

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

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

Further diagnosis requires ultrasound of the gallbladder, which shows the presence of stones in the gallbladder and ducts in 90-95% of cases, as well as choledochoscopy. Calcareous formations are clearly visible on x-rays, and ultrasonography using an endoscope allows you to see stones in the gall bladder in very overweight, obese patients.

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

When is it better not to touch gallstones?

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

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

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

Treatment methods

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

In this case, the doctor prescribes the following medications:

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

Taking such drugs requires compliance with certain conditions:

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

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

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

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

Find out in the video about powerful tool which helps remove stones from the gallbladder:

When is gallbladder removal surgery necessary?

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

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

Diet for gallstone disease

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

The following are completely excluded from the menu:

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

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

Prevention

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

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

Conclusion

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

Gastroenterologist, Hepatologist