Causes of cholelithiasis. Gallbladder: stones. cholelithiasis. Calculous cholecystitis. How are stones formed?

Symptoms today cholelithiasis can be detected by almost every person, regardless of age and lifestyle. Moreover, this pathology began to “get younger” and manifest itself much more often than before. If previously it was most often found in people over 40 years of age, now it can be found even in young boys and girls. There can be many reasons for this.

What is the disease?

Before considering the symptoms of gallstone disease, it is necessary to find out the mechanism of its development. The pathology can be chronic or acute. It develops gradually. Characterized by the appearance of small or large stones in the bile ducts and bladder. This process is quite long.

The formation of stones begins when the bile thickens. Granules appear in it, on which molecules of undigested calcium and cholesterol settle. It should be noted that stones can be multiple or single. In addition, they have different sizes. When they begin to move, an acute attack occurs, which is accompanied by very strong pain syndrome.

Signs of gallstone disease may not appear immediately, that is, the pathology develops over time. In addition, large elements can “sit” in the ducts for quite a long time and not move anywhere. Although this also causes a lot of problems. It should be noted that this disease is very common, and the number of cases is constantly growing.

It must be said that there are several types of stones:

• pigmented;
• cholesterol;
• limestone;
• pigment-cholesterol;
• complex stones consisting of the three above components.

Causes of pathology

Before looking at the symptoms of gallstone disease, it is necessary to understand why it happens in the first place. So, among the reasons contributing to the development of pathology, the following can be identified:

• age (after 40 years, the body’s nervous and humoral systems begin to act differently on internal organs, less effectively);
• heavy weight (especially if a person eats too fatty, spicy foods, rich in cholesterol);
• metabolic disorders in the body;
• poor nutrition;
• unsuitable climate and poor ecology;
• infection of the biliary tract (cholesterol precipitates in them, which then accumulates, gets compacted and turns into stones);
• insufficient amount of acids that can dissolve lipids;
• any other pathologies of internal organs (physiological, infectious or inflammatory).

Signs of pathology

The symptoms of gallstone disease are not specific, so it is quite difficult to recognize it at first. Only a doctor can make an accurate diagnosis. However, the disease manifests itself as follows:

There are other signs of gallstone disease: allergic reactions, increased fatigue, sleep disturbance and lack of appetite, lethargy. It must be said that they can appear individually or simultaneously.

Diagnosis of the disease

Symptoms of gallstone disease in adults cannot provide a complete picture, which is necessary to prescribe adequate treatment. Naturally, you will have to visit an experienced doctor who will carry out the entire range of diagnostic measures. They help determine the size of the stones, the degree of development of the pathology, and its type.

Various tools, both technical and clinical, are used for diagnosis. In the second case, the doctor palpates the gallbladder and ducts, during which the patient may feel discomfort and pain. In addition, colic may be accompanied by the passage of very small stones, which also indicates the presence of the disease.

When making a diagnosis, the symptoms of gallstone disease in adults and children (if there are such cases) are taken into account. In addition, the patient will need to undergo the following procedures:

• ultrasound examination of internal organs;
• blood and urine analysis (for the content of duodenal elements, cholesterol levels, bilirubin, fat metabolism indicators and alpha-amylase activity);
• a thorough analysis of the patient’s medical history and family history;
• stool analysis (in it you can often see which elements of food are not digested);
• examination of the inner surface of the stomach, duodenum and esophagus (esophagogastroduodenoscopy);
• cholangiopancreatography (examination of the bile ducts from the inside using a duodenofibroscope);
• CT scan internal organs;

It is necessary to take into account the non-specificity of symptoms, so the diagnosis must be made as accurately as possible. Otherwise, the doctor may simply treat the wrong disease, which will lead to unpredictable consequences.

Features of the course of an acute attack and first aid

This pathology can develop gradually, but the time will come when it will make itself felt. Therefore, you must know how to relieve an attack of gallstone disease. It must be said that a person feels worst at the moment when solid particles begin to move through the ducts and clog them. In this case it appears strong pain and other symptoms. In this case, most often the attack occurs at night. It usually lasts up to 6 hours. If you have an attack of gallstone disease, you should definitely know what to do. So, you will have to take the following measures:

1. A heating pad or warm compress. As a last resort, it is necessary to organize a warm bath to reduce pain and alleviate the condition.
2. Now you need to take any painkiller that can relieve spasms (“Atropine”, “Papaverine”, “No-shpu”).
3. It is imperative to call an ambulance and hospitalize the victim. Moreover, you need to go to the hospital if the pathology worsens. It is in the hospital that all necessary diagnostics can be carried out and surgical intervention can be performed (if absolutely necessary).
4. Along with painkillers, it is necessary to take anti-inflammatory and antibacterial medications.

It must be said that timely measures can significantly alleviate the patient’s condition. Now you know how to relieve an attack of gallstone disease. However, this does not mean that the pathology does not need to be treated.

Features of pathology treatment

Now you can figure out how to cope with this problem using traditional, non-traditional and radical methods. Let's start with the first ones. Treatment of gallstone disease should be comprehensive. That is, it is not enough to simply remove stones from the ducts and bladder. It is necessary to carry out drug therapy for a long time, follow a certain diet, and follow doctor’s orders.

Specialists use various drugs for gallstone disease:

1. To eliminate pain, intramuscular and intravenous analgesics (Talamonal, analgin solution) are used. IN extreme cases Narcotic substances may be used: morphine, Promedol.
2. To eliminate spasms in the ducts, you need to use the drugs “Papaverine” or “No-spa”, and under the skin. To improve bile circulation, you can use special drugs (“Cholenzim”). However, try not to use stronger medications, as this can lead to an acute attack that will end in surgery.
3. Treatment of cholelithiasis is accompanied by the passage of solid elements. Warm teas and heating pads are usually used for this.
4. If the pathology has already entered the chronic stage, try to periodically undergo courses of treatment prescribed by your doctor. For example, drugs such as “Liobil” and others are taken.

In any case, you cannot choose medications on your own, as you can only harm yourself. It is better to consult a specialist and undergo a thorough examination.

Features of treatment with folk remedies

Naturally, drug therapy is not a panacea and does not always help. Self-prepared substances can also enhance the effect. For example, treatment of gallstone disease folk remedies will significantly increase your chances of getting rid of the pathology, but you should not use them without the consent of your doctor. So, the following recipes may be useful:

1. Red beet juice. Long-term use of this drink will help you quickly deal with stones. Moreover, they will dissolve completely painlessly. You can use not only juice, but also beet broth. To do this, the vegetable needs to be cooked for a long time. Please note that not all people like this drink.
2. Treatment of cholelithiasis, folk remedies, in particular, can be done using mixtures of different plants, each of which has its own specific action. For example, the following remedy can relieve pain, cleanse internal organs, and improve their blood supply: the roots of calamus, valerian and buckthorn, wild rosemary, mint, hawthorn, chamomile, lily of the valley and rose hips mixed in equal quantities. Before this, all plants should be chopped. The maximum amount of each herb is 5 grams. Next, pour the mixture with 1.5 liters of water and put on fire. The liquid should boil for no more than five minutes. Also, give the product time to sit (about 6 hours). You need to take it several times a day, 100 ml. It is necessary to drink the remedy until complete recovery.
3. In order to eliminate stagnation of bile in the ducts, use a decoction of wild strawberry berries and leaves. Take it three times a day, a glass.
4. Regular dill is also considered useful. To prepare the decoction you will need two large spoons of seeds and 2 cups of boiling water. Next, the mixture must be put on fire. It should boil for no more than 12 minutes. Try to drink half a glass of the product daily. Moreover, the liquid should be warm. It will take you several weeks to heal.
5. Chicory root infusion will help you effectively dissolve stones and remove them from the body. To prepare the drink, take 60 grams of crushed raw materials and pour 200 ml of boiling water over it. The decoction should sit for at least 20 minutes. Next, take the drink in small portions throughout the day. It is best if the broth is fresh each time.
6. Black radish juice and honey will help you cleanse your gallbladder and dissolve stones. Try to drink 1 tablespoon of the mixture on an empty stomach in the morning. After this you can eat only after a quarter of an hour. Please note that this procedure is long and takes at least six months.

In addition, try to improve bile secretion. To do this, take carrot and cabbage juice every day.

Indications for surgery and types of operations

There are cases when it is impossible to use medications or folk recipes they simply don't help. In addition, acute attacks require surgical intervention. In this case, surgical removal of stones is performed. There are certain indications for intervention:

There are also contraindications to surgery: serious condition patient, any oncological diseases other organs, strong inflammatory processes in the body, as well as individual characteristics.

Gallstones are removed in several ways:

1. Traditional (laparotomy). To do this, the doctor must open the anterior abdominal wall and remove the bladder along with all its contents. Such an operation is performed if the stones are too large or the organ will no longer perform its assigned function.
2. Laparoscopic. To do this, you do not need to cut the peritoneum. Specialists simply make small holes in the area of ​​the bubble and remove the stones through them. At the same time, recovery after such an operation occurs much faster, and there are practically no scars left on the skin. That is, this type of intervention is used most often.

If you have gallstone disease, the operation can be performed without a scalpel. For example, now in medicine they use specialized technical means that are capable of crushing the formed elements. This method is called shock wave lithotripsy. This procedure is not possible everywhere. After the procedure, small stones are simply dissolved with the help of medications and removed from the body.

Nutritional Features

For more effective treatment the patient is prescribed diet No. 5. For gallstone disease, it is considered optimal. So, the caloric intake with this diet is about 2800 kcal daily. If the patient is obese, then these indicators can be reduced to 2300 kcal. You need to eat at least 5 times a day in small portions.

You need to drink clean water, and as much as possible (from two liters per day). Try not to drink carbonated water; alcohol is prohibited. The best thing tea will do, juices and herbal infusions. Products for cholelithiasis must be fresh and safe. It is forbidden to eat fatty, fried, smoked, spicy foods, chocolate, canned food, sausages and semi-finished products, fish and meat broths. Also, try to avoid using garlic, pepper, lard, onion, sorrel and excessive amounts of salt while cooking.

Allowed products are: bran bread, vegetables and fruits, low-fat dairy products, lean meat and fish. Moreover, the latter should be baked in the oven or steamed. Eat porridge and boiled eggs (no more than 1 per day). Use sunflower instead olive oil. If you are experiencing a period of exacerbation, then the products should be ground.

You cannot prescribe a diet for yourself. Try to consult with an experienced specialist in this field, as well as your doctor. If you don’t know what you can cook for gallstone disease, the recipes presented in this article will be very useful to you.

So, take 300 g of potatoes, 25 g of carrots, 19 g of butter, 350 g of water, 7 g of parsley and 25 g of onions. All vegetables must be boiled. Gradually add oil and parsley to the “soup”. It is advisable to chop the carrots and potatoes.

Carrot and potato puree is healthy and very tasty during illness. All vegetables must be boiled and crushed (grinded). Next, add a little milk and a little salt to the mixture. Now the puree can be brought to a boil and served.

A very useful vegetable in such a situation is eggplant. It can be stewed in sour cream sauce. To prepare this dish, take 230 g of eggplant, herbs, a little butter and salt. For the sauce you will need 50 g of water, 50 g of sour cream, a little butter and flour. We cook the eggplant last. The sauce is made like this: fry the flour in a heated frying pan, add oil and water. Boil the mixture for about 20 minutes. Lastly, sour cream is added. Now peel and cut the eggplant, salt it and leave for a few minutes to remove the bitterness. Next, place the pieces in a frying pan and simmer a little over low heat. Lastly, add the sauce to the eggplant and leave the dish to simmer for another 5 minutes. Bon appetit!

Disease prevention

It is necessary to treat the presented pathology, but it is best to prevent it. That is, you are obliged to follow all the necessary preventive measures that will help you avoid the disease. Otherwise, treatment will take a long and painful time.

For example, try to maintain an optimal body weight. Obesity only contributes to the emergence of this pathology and other health problems. Therefore, force yourself to move, do morning exercises, do gymnastics or some other active look sports Walk more, hike, run, bike, swim.

A very effective way of prevention is a balanced and proper diet. You should not overload your gastrointestinal tract, so do not overeat, try to give up unhealthy foods, dishes and habits. For example, stop smoking, drinking alcohol, and eating at fast food establishments. Eliminate spicy, fatty, smoked and canned foods from the menu. Limit your consumption of sweets, baked goods, lard, fatty fish and other heavy foods. After all, what is not digested in the stomach turns into harmful sediment, from which stones are subsequently formed. If you don't know how to properly calculate your diet, consult a nutritionist. He will build you a nutritional system that will allow you to get rid of the threat of disease and bring your body into shape.

If you want to lose weight, then you need to do it very carefully so that the functioning of the body's systems is not disrupted. There is no need to lose weight suddenly and quickly. This can only do harm.

However, if the disease does appear, it is urgent to stop its development. That is, try not to delay treatment after detecting the first symptoms and correct diagnosis.

Regarding questions about stone removal, you should consult your doctor. If necessary, you can get advice from other specialists in this field. You should not self-medicate, as the consequences can be very serious. It is better to combine all traditional and non-traditional methods of eliminating the disease under the supervision of a doctor. Be healthy!

Gallstone disease or, as it is also called, cholecystitis, is a disease associated with a disturbance in the exchange of bilirubin and cholesterol. As a result, calculus (stones) form in the gallbladder or its ducts. An attack of cholelithiasis is one of the most popular diseases after diabetes mellitus and cardiovascular pathology.

Gallbladder cholecystitis occurs more often in people in economically disadvantaged developed countries, whose work involves a sedentary lifestyle and stressful situations. However, in Lately, cholelithiasis is common in children.

Formation of gallstones

An attack of cholelithiasis occurs as a result of the accumulation of bile in the bladder area. The movement of bile along the biliary tract is ensured by the work of the liver, common bile duct, gallbladder, duodenum and pancreas. This allows bile to enter the intestines in a timely manner during the digestion process and accumulate in the bladder on an empty stomach.

The reasons for the formation of stones are changes in the composition and stagnation of bile, the onset of inflammatory processes, and motor-tonic disorders of bile excretion. Signs of gallstone disease are the development of cholesterol (up to 80–90% of all gallstones), mixed and pigment stones. As a result of the appearance of cholesterol stones, bile becomes oversaturated with cholesterol, it precipitates, and the formation of cholesterol crystals occurs. If the motility of the gallbladder is impaired, the crystals are no longer able to be removed from the intestines, they remain in it and begin to grow.

Bilirubin (pigment) stones occur during the accelerated breakdown of red blood cells during hemolytic anemia. Mixed stones are a combination of both forms. They contain cholesterol, bilirubin and calcium. Most often, such cholelithiasis, the symptoms of which will be described below, occurs due to inflammatory processes in the bile ducts and gallbladder.

Causes of gallstone disease

The reasons for the appearance of stones in women and men are approximately similar. Among the main ones we should highlight:

• inflammation of the biliary tract (cholecystitis). Infection plays a role in the formation of stones. Bacteria can convert water-soluble bilirubin into insoluble bilirubin, which can precipitate;
• cholecystitis occurs as a result of disruption of the endocrine system: diabetes, hypothyroidism (insufficient secretion of thyroid hormones), disruption of estrogen metabolism in a number of gynecological diseases in women, pregnancy and taking contraception. As a result, disruption of the contractile function of the gallbladder and stagnation of bile begins;
• disorders of cholesterol metabolism: obesity, gout, atherosclerosis. If cholecystitis begins, ideal conditions for the formation of stones;
• hyperbilirubinemia - an increase in the level of bilirubin with an increase in its content in bile - hemolytic anemia;
• The reasons for the formation of stones may lie in hereditary predisposition;
• In women, gallstones are formed as a result of frequent dieting, improper and irregular nutrition;
• excessive consumption of food rich in animal fats and cholesterol. This leads to a shift in the acidic side of the bile reaction, resulting in cholecystitis and the formation of stones.

Symptoms of gallstone disease

Gallstone disease is often found in children, so it is necessary to know not only the causes of its occurrence, but also the first symptoms. A long-term illness may not be accompanied by any symptoms and may turn out to be a real finding on ultrasound examination. Symptoms begin to appear when stones migrate and infection begins in the gallbladder and ducts. Symptoms of the disease may directly depend on the location of the stones, the activity of inflammation, their size, as well as damage to other digestive organs.

When stones leave the gallbladder and move through the bile ducts, an attack of biliary colic occurs. If the diet for gallstone disease is not followed, this can provoke the movement of stones. The pain is sudden, as if cholecystitis had begun, in the upper half of the abdomen, in the area of ​​the right hypochondrium, radiating to right shoulder and right shoulder blade. Often, the pain is accompanied by nausea, vomiting that cannot bring relief, and dry mouth. The skin may become itchy.

If treatment is not started in a timely manner, yellowing of the skin and sclera occurs, feces become discolored, and urine, on the contrary, acquires a dark tint. The duration of a painful attack can last from several minutes to several hours, the pain goes away on its own or after taking a painkiller.

Symptoms of biliary colic or cholecystitis may not always have standard manifestations; they often resemble other diseases: liver abscess, right-sided pneumonia, acute appendicitis, especially in the case of its atypical position, renal colic– for acute pancreatitis and urolithiasis. May manifest itself as cholecystitis, in the form of pain in heart. In order to make an accurate diagnosis in this case, it is recommended to immediately consult a general practitioner.

Treatment of cholelithiasis

There are two ways to treat cholelithiasis: conservative and surgical.

Drug treatment

Treatment of gallstone disease without surgery is effective if the size of the stones does not exceed 15 millimeters, while maintaining the patency of the cystic duct and the contractility of the gallbladder. It is true that treating cholecystitis with medication is prohibited if:

• the diameter of the stones is more than 2 centimeters;
• acute inflammatory diseases of the biliary tract and gallbladder;
• the reasons for the appearance of stones lie in existing diabetes mellitus, liver disease, chronic pancreatitis, peptic ulcer of the duodenum and stomach;
• if the reasons are obesity;
• inflammatory disease of the large and small intestine;
• pregnancy;
• “disabled” – non-functioning gallbladder;
• carbonate or pigment stones;
• gallbladder cancer;
• multiple stones occupying more than half the volume of the gallbladder.

Treatment methods with medications may be as follows. The use of ursodeoxycholic acid preparations, whose action is aimed at dissolving exclusively cholesterol stones. Take the drug for 6 to 24 months. However, after the stones dissolve, the probability of relapse is 50%. The duration of administration and dose of the drug is determined only by a doctor - a gastroenterologist or therapist. Conservative treatment allowed only under the supervision of a doctor.

Methods of shock wave cholelithotrepsia - treatment by crushing large stones into small fragments using shock waves, followed by the administration of bile acid preparations. The probability of re-formation of stones is 30%.

For a long time, cholelithiasis can be asymptomatic or without symptoms at all, which creates certain difficulties in identifying it. early stages. It leads to late diagnosis, at the stage of already formed gallstones, when to use conservative methods very problematic, and the only treatment option is surgery.

Surgery

The patient undergoes a planned operation before the first attack of biliary colic or immediately after it. This is associated with a high risk of complications.

After surgical treatment, you need to adhere to individual dietary regimen(small, frequent meals with the exclusion or limitation of individually intolerant foods, fatty, fried food). It is necessary to observe a regime of rest and work, physical education. Completely eliminate alcohol consumption. Provided there is stable remission, sanatorium-resort treatment is possible immediately after surgery.

Treatment with folk remedies

Treatment of cholelithiasis with folk remedies is possible with initial stage, which only a doctor can determine. Some of the recipes below are great for getting rid of gallstones.

Chaga treatment

Treatment of cholelithiasis with folk remedies is carried out using the birch chaga mushroom. The recipes for its preparation are simple - a small piece of chaga must be softened, pour warm water for 3–4 hours. After this, the mushroom should be grated or minced. The mushroom crushed in this way should be poured with hot water and allowed to brew for another two days, then strain. Take the infusion up to three times a day, one glass.

Sunflower root decoction

During treatment with folk remedies for cholelithiasis, a decoction of sunflower root helps well. To do this, peel the root, cutting off all thread-like processes, cut into small pieces and dry in the shade until completely dry. Next, take three liters of water and add a glass of dried roots. Boil the resulting mass for about 5 minutes.

After the broth has cooled, it should be placed in the refrigerator. The contents should not be thrown away, since after three days you can reuse the roots by filling them with three liters of water. And this time you need to boil for 10 minutes. Drink one liter of decoction every day for two months.

During treatment with sunflower roots, there may be a burning sensation in the joints, increased pressure, and flakes or sand may appear in the urine. In this case, treatment cannot be stopped; only a slight reduction in dosage is possible.

Dill infusion

A decoction of dill is considered a good remedy for the treatment of gallstones. Take two tablespoons of dill seeds, pour 0.5 liters of boiling water, then boil for 15 minutes over low heat or a water bath. This decoction should be taken 3 times a day, 0.5 cups, for three weeks.

Also effective in the treatment of gallstone disease is a decoction of horsetail, wheatgrass juice, decoction shepherd's purse, a collection of immortelle, yarrow and rhubarb root, as well as some other herbs.

Complications of gallstone disease

In case of infection, the development of acute cholecystitis, empyema (large accumulation of pus), cholangitis (inflammation of the bile ducts) occurs, which can cause peritonitis. The main symptoms are intense, sharp pain in the right hypochondrium, fever, chills, impaired consciousness, severe weakness. Choledocholithiasis (stones in the bile duct) with the formation of obstructive jaundice. After another attack of biliary colic, yellowness of the skin and sclera, itching of the skin, darkening of urine and discoloration of feces are formed.

With prolonged blockage of the cystic duct and the absence of infection, hydrocele of the gallbladder appears. Bile is absorbed from the bladder, but the mucous membrane continues to produce mucus. The bubble greatly increases in size. Attacks of biliary colic begin, then the pain decreases, leaving only heaviness in the right hypochondrium.

Against the background of prolonged cholelithiasis, gallbladder cancer often appears, and chronic and acute pancreatitis develops. With prolonged blockage of the intrahepatic bile ducts, secondary biliary cirrhosis develops. Large gallstones hardly migrate, but they can cause a fistula between the duodenum and the gallbladder. When a stone falls out of the bladder, it begins to migrate, which can lead to the development of intestinal obstruction.

Untimely operation to remove the gallbladder (cholecystectomy) becomes one of the main reasons for the formation of postcholecystectomy syndrome. Complications can pose a threat to a person’s life and require urgent hospitalization in a surgical hospital.

Prevention of gallstone disease

Even after successful surgical intervention, prevention of cholelithiasis will not be superfluous. Active rest, exercise in the gym, promote the rapid outflow of bile, thereby eliminating its stagnation. Overall weight should be normalized, as this reduces cholesterol hypersecretion.

Prevention of cholelithiasis in patients who must take estrogens, clofibrate, ceftriaxone, octreotide involves undergoing an ultrasound examination. This is necessary to determine changes in the gallbladder. If your blood cholesterol levels are high, you need to take statins.

Diet for gallstone disease

The diet for gallstone disease should exclude or limit high-calorie, fatty, cholesterol-rich foods, especially in the case of a hereditary predisposition to the formation of stones.

First of all, there should be frequent meals (4-6 times a day), in small portions, this leads to a decrease in stagnation of bile in the gallbladder. The diet should contain a large amount of dietary fiber from fruits and vegetables. You can add bran to the menu (15 grams two to three times a day). This helps reduce the lithogenicity (propensity to form stones) of bile.

If you suspect the onset of gallstone disease, it is recommended to immediately consult a doctor. Depending on the stage of the disease, you will be prescribed one of the treatment methods. In most cases, surgery can be avoided.

Cholelithiasis

What is Gallstone disease -

Gallstone disease (GSD) is a disease of the hepato-biliary system caused by a disorder of lipid and/or bilirubin metabolism, characterized by the formation of gallstones in the hepatic bile ducts (intrahepatic cholelithiasis), in the common bile duct (choledocholithiasis) or in the gallbladder (cholecystolithiasis). Most often, gallstones form in the gallbladder (GB).

Prevalence. GSD is a common pathology, although the true incidence is extremely difficult to characterize due to the latent course of the disease in a significant number of people. GSD occupies a significant place in the structure of diseases of the digestive system, which is associated with its widespread prevalence. In industrialized countries, the incidence of cholelithiasis is approximately 10-15%. The prevalence of the disease depends on gender and age. Women are affected twice as often as men. Over the age of 40, every fifth woman and every tenth man suffers from gallstone disease. At the age of up to 50 years, the incidence of cholelithiasis is 7-11%, in the group of people 50-69 years old - 11-23%, and among people over 70 years old - 33-50%.

Pathogenesis (what happens?) during Gallstone disease:

As is known, cholesterol (CH) is synthesized mainly in the liver under the control of HMGCoAreductase. During metabolism, cholesterol is returned to the hepatocyte as part of low-density lipoproteins (LDL) or chylomicron remnants (ChM) with the participation of ApoB, E (LDL) or ApoE (ChM remnants) receptors located on the cell membrane. The cholesterol released under the action of lysosomes is partially deposited in the form of esterified cholesterol, the rest is used for the synthesis of Bile Acids (BAs) or is excreted into bile. The reason for the hypersecretion of cholesterol is an increase in the number of ApoB, E or ApoE receptors (hereditary factor), HMGCoAreductase activity (obesity, hypertriglyceridemia), a decrease in 7ahydroxylase activity (hereditary, age factors), ACHAT activity (the effect of progesterone).

The most likely pathogenesis of cholelithiasis is hypersecretion of cholesterol against the background of normal production of bile acids, although there is evidence of a decrease in their secretion. The decrease in the FA pool is due to impaired FA synthesis, changes in the enterohepatic circulation (EGC), and increased removal of FA from the body. It is possible that changes in cholesterol metabolism underlie the decrease in FA synthesis. In case of cholelithiasis, the secretion of fatty acids remains normal even with a reduced pool of fatty acids due to the acceleration of the EGC. The main reason leading to an increase in the recirculation of bile acids and, secondarily, to a small pool of them, is dysfunction of the gallbladder.

Oversaturation of bile with cholesterol occurs when it is impossible to solubilize it. IN physiological conditions CS is solubilized by micelles and vesicles, which are fairly stable formations that play an important role in the transport of cholesterol in bile. The gallbladder simultaneously contains both micelles and vesicles. As a result of the processes of absorption and secretion of water in the gallbladder, a change in the concentration of lipids occurs, leading to certain physicochemical changes. As a result, there is a constant transition of vesicles into micelles and back. It has been established that with an excess of cholesterol or water, the transformation of mixed micelles into monolamellar vesicles, which become supersaturated with cholesterol (+ cholesterol) or lecithin (+ HgO), is possible. At a high cholesterol/phospholipid ratio (CS/PL > 1), bile is rich in vesicles, while at a low ratio (CS/PL< 1) смешанными мицеллами. Перенасыщенные ХС везикулы могут слипаться и агломерировать, образуя мультиламеллярные везикулы или липосомы, представляющие суспензию жидких кристаллов В норме в результате сокращения ЖП агломерировавшие частицы выбрасываются в duodenum. However, with a decrease in the contractile function of the gallbladder, solid cholesterol crystals are formed from vesicles oversaturated with cholesterol. The vesicle saturated with cholesterol is extremely stable. Striving for balance, it gets rid of excess cholesterol through its nucleation. Nucleation of CS crystals occurs only after the aggregation of vesicles forming liquid crystals. Further growth of the CS crystal occurs mainly due to CS monolamellar vesicles. Over time, the liposome, which has lost cholesterol but is rich in phospholipids (PL), turns into a micelle. This process occurs continuously

The pathophysiology of gallstone formation includes the following stages: saturation, crystallization, and stone growth. The most dangerous stage is the saturation of bile with cholesterol. As water is absorbed, the concentration of lipids in bile increases and a phase of supersaturation of the cholesterol monomer in liposomes is formed. The next step is the formation of a crystal of cholesterol monohydrate from its molecule in a supersaturated liposome, which determines the beginning of nucleation.

The most unstable phase of liquid crystals is when a transition to the micellar phase or to the phase of true microcrystals is possible. The closer to the upper limit in the triangular system (Admiranat Resin limit, indicating maximum solubilization of cholesterol and further transition to a state of bile supersaturation), the greater the likelihood of precipitation and the formation of microcrystals.

A change in the ratio of the concentrations of hydrophilic and hydrophobic FAs leads to a redistribution of phases in the triangular coordinate system. With an increase in the concentration of hydrophilic FAs (tauroursocholates, tauroursodeoxycholates), a gradual decrease in the micellar zone occurs due to an increase in the zone of liquid crystals. When the level of hydrophic FAs (taurochenodesoxycholates and taurocholates) in bile increases, an increase in the micellar zone is observed.

Oversaturation of bile with cholesterol has big influence on the functional state of the gastrointestinal tract. First of all, it leads to an increase in the absorption of cholesterol and electrolytes.

Active absorption of water, electrolytes, and lipids in the gallbladder occurs constantly, resulting in the maintenance of a certain concentration of bile. Diseases of the gallbladder lead to disruption of this important function. Absorption in the gallbladder wall is regulated by the interaction of intracellular (adenosine monophosphates, hormones, prostaglandins, etc.) and extracellular factors. One of the most important extracellular factors is the ratio of lipids in the GB cavity, especially FA/PL. It has been established that an increase in FA concentration causes a decrease in absorption in the GB wall as a result of the interaction of FA with ions. The consequence of this is the retention of NaCl and H20, since water absorption is a passive process associated with Na+ transport. As a result of an increase in the concentration of PL in bile, absorption in the wall of the gallbladder increases. The mechanism of the antagonistic (relative to FA) action of PL is explained by an increase in the size of micelles in supersaturated bile, which facilitates the penetration of FA into them. Strengthening absorption processes in the wall of the gallbladder leads to a further increase in the concentration of lipids in the bile. As a result of changes in the cholesterol content in the membrane of the cells of the gallbladder wall, a decrease in its contractile function occurs, which is of great importance, since a decrease in the volume of released bile can cause changes in the enterohepatic circulation of gallbladder and a decrease in their entry into the liver. Stagnation of bile in the gallbladder creates conditions for agglomeration of bile components and nucleation. It is believed that hypersecretion of cholesterol is an intrahepatic trigger for the hyperproduction of arachidonyl lecithin. When these PLs are hydrolyzed by phospholipase Kr, the gallbladder walls release arachidonic acid. An increase in its pool leads to the activation of a cascade reaction of prostanoid prostaglandin synthesis in the gallbladder wall, which stimulates the secretion of mucin. Mucinglycoprotein gel is necessary factor, which ensures the nucleation of CS crystals. The nucleating effect of mucin on CS crystals is based on its hydrophobic properties. The gel adheres tightly to the mucous membrane of the gallbladder, captures cholesterol microcrystals and adherent vesicles. The hydrophobic regions of the gel pores reduce the critical value of nucleation, weakening the connection of the cholesterol molecule with water. The gluing and agglomeration of vesicles occurs continuously in the gel until macroscopically visible liquid crystals are formed. As they increase, they become inactive and get stuck in the pores of the gel. The presence of a significant amount of mucin in the gallbladder leads to its dysfunction. Calcium ions play a cementing role in this process. It has been established that calcium precipitates from bile in the form of bicarbonates, phosphates and palmitates. IN the greatest number bicarbonates are determined in bile. They are formed at an alkaline pH, when the production of ions (Ca2+) exceeds the ability of bile to solubilize them.

An important function of the gallbladder is considered to be the binding of calcium ions. It occurs even at low FA concentrations and at the submicellar level. In addition to gastrointestinal hormones, chenodeoxycholic and especially ursodeoxycholic acids have a stimulating effect on the secretion of bicarbonates in bile. The mechanism of this action is not fully understood. Due to rapid acidification in the gallbladder, bicarbonates are neutralized. The release of hydrogen ions by the mucous membrane of the gallbladder leads to a decrease in the concentration of bicarbonates and calcium in the bile, respectively. In patients with cholelithiasis, the acidification function is impaired. It is possible that the increase in Ca concentration in bile and further precipitation are due to insufficient binding of its FA and impaired (decreased) acidification in the bile.

Consequently, the supersaturation of bile with cholesterol, the presence of vesicles rich in cholesterol, and a decrease in the contractile function of the gallbladder are of paramount importance for the nucleation process. However, the formation of stones does not always occur even in the presence of these factors. Moreover, in some cases there is an accumulation of cholesterol in the wall of the gallbladder (cholesterosis of the gallbladder), in others in the cavity of the gallbladder (calculi).

Protective mechanisms that prevent stone formation include:

• absorption of up to 50% of calcium contained in bile, which reduces its concentration;
• release of hydrogen ions by the mucous membrane of the gallbladder, leading to acidification of bile and prevention of calcium nucleation;
• secretion of water and electrolytes, which increases with inflammation, leads to a decrease in lipid concentrations;
• the presence of antinuclear factors that maintain the balance between the processes of nucleation and inhibition;
• it is possible that apoproteins (ApoA1, ApoAll, ApoB) in bile perform the same function as in blood serum, that is, they take part in the solubilization and directed transport of lipids, in particular cholesterol

Thus, the pathogenesis of cholelithiasis is multifactorial. At the same time, a necessary condition for the formation of stones is the simultaneous presence of factors such as supersaturation of bile with cholesterol (this process plays a leading role), as well as the beginning of nucleation and a decrease in the contractile function of the gallbladder

In cholelithiasis, there are two main types of stones: cholesterol and pigment.

Among various types In cholelithiasis, cholesterol stones predominate (70%), the incidence of pigment stones is less than 30%.

Pigment stones are more often defined as "black" and "brown". Black ones consist of polymers of insoluble salt, calcium hydrogen bilirubinate. Typically, supersaturation of bile occurs as a result of hydrolysis of unbound bilirubinates by endogenous (3-glucuronidase) in the gallbladder. Predisposing factors for the development of pigmented stones include infections of the biliary tract, old age, diet, fibrosis of the gallbladder, blood diseases, helminth infections. Brown stones are formed, as a rule, in the presence anaerobic infection.

Cholesterol stones usually contain more than 70% cholesterol monohydrate, an admixture of calcium salts, bile acids and pigments, proteins, fatty acids, phospholipids. Cholesterol stones are more common in patients in Northern Europe and America, which can be explained by the nature of nutrition, hereditary predisposition, and a number of endocrine diseases (diabetes mellitus, obesity). Predisposing factors in women may be excess estrogen levels, long-term use oral contraceptives, pregnancy. WITH high risk The formation of cholesterol stones is associated with old age, rapid weight loss, and poor nutrition.

Cholesterol stones are formed when bile is oversaturated with cholesterol due to reduced or insufficient secretion of bile acids and lecithin. Important points are an increase in the content of mucin, other pronucleators, calcium ions in bile, a decrease in antinuclear factors, and impaired motility of the gallbladder. In the formation of the stone core, an important role is played by the nucleation of cholesterol monohydrate crystals from biliary cholesterol phospholipid vesicles by aggregation of calcium salts of pigment or mucin.

Precipitation of calcium salts and pigment is the main pathophysiological mechanism for the formation of pigment stones. The leading link contributing to their formation is the precipitation of bilirubinate, phosphate and calcium carbonate in bile. It has been established that gallbladder mucin acts as a pronuclear factor.

There are three stages of cholelithiasis: physicochemical, latent (asymptomatic stone carriage), clinical (calculous cholecystitis).

In 2002, a classification of cholelithiasis was adopted, which distinguishes 4 stages:

• initial or prestone:
  • thick heterogeneous bile;
• stage of biliary sludge formation:
  • with the presence of microliths;
  • with the presence of putty-like bile;
  • combination of microliths with putty-like bile.
• formation of gallstones, differing:
  • by localization;
  • quantity;
  • composition;
  • clinical course.
  • chronic calculous cholecystitis.
• complications.

Symptoms of Gallstones:

At stage I There is a supersaturation of bile with cholesterol with a reduced content of bile acids and phospholipids (lithogenic bile). At this stage, patients have no clinical manifestations diseases. When examining bile, a low content of bile acids, phospholipids, a high concentration of cholesterol, violations of its micellar properties are revealed, and cholesterol “flakes”, crystals and their precipitates are detected. Stones in the gallbladder are not visualized during cholecystography and echohepatography. Heterogeneous bile is determined. The formation of biliary sludge (turbidity) with the presence of microlites or putty-like bile is observed. In some cases, their combination is determined. The first stage of the disease can last for many years.

It is known that cholesterol in bile, thanks to bile acids and phospholipids, remains in a dissolved state. With a decrease in cholesterol-holding factors, lower critical level favorable conditions are created for the precipitation of bile cholesterol. Typically, at high rates of bile acid secretion, bile is undersaturated with cholesterol, while at the same time, when the rate of bile acid secretion decreases, its concentration increases. Eating increases the secretion of bile acids. During the interdigestive period, especially after an overnight fast, an increase in cholesterol content is observed against the background of a decrease in the content of bile acids. It has been proven that at stage I of cholelithiasis the average rate of daily secretion of bile acids in patients is reduced.

The formation of lithogenic bile may be associated with increased secretion of cholesterol, which is often observed in obesity and hyperlipidemia. The prerequisites for changes in the physicochemical properties of bile are its stagnation, genetic predisposition, poor nutrition, metabolic disorders and regular hepatic-intestinal circulation of bile acids.

Stage II cholelithiasis(latent, asymptomatic stone carriage, formation of gallstones) is characterized by the same physicochemical changes in the composition of bile as in stage I, with the formation of stones in the gallbladder and bile ducts. The genesis of the formation of pigment stones consisting of calcium bilirubinate (brown stones, often localized in the bile ducts) or bilirubin and its components (black stones, usually formed in the gall bladder as a result of hemolysis, with cirrhotic changes in the liver, etc.) has been studied. not enough. Cholesterol stones, caused by an oversaturation of bile with cholesterol, are primarily formed in the gallbladder. When calcification of stones of any type is common, we speak of mixed stones. Infection (E. coli, Clostridium sp.) is important in stone formation, especially for the formation of brown pigmented stones. The bacterial enzyme (3glucuronidase) converts bilirubin glucuronide, soluble in water, into insoluble unconjugated bilirubin, which combines with calcium ion and precipitates. Brown stones are more often formed in patients with sclerosing cholangitis, with biliary invasions (opisthorchiasis, giardiasis, clonorchiasis, etc.). Less common are stones consisting of calcium carbonate and phosphorus.

The process of stone formation at this stage is associated not only with physicochemical changes in bile, but also with the addition of gall bladder mechanisms of their formation (stagnation of bile, damage to the mucous membrane, increased permeability of the bladder wall for bile acids, the presence of inflammation). Violations of the enterohepatic circulation of bile acids, etc. are important. At this stage, there are, as a rule, no clear clinical manifestations of the disease. The course of the disease depends on the location, number and composition of microliths.

The asymptomatic course of cholepistolithiasis can last for a long time, which is confirmed by the detection of “silent” gallstones during X-ray and ultrasound examination in 60-80% of patients. In 15% of patients with stones in the gallbladder, stones are simultaneously detected in the bile ducts. Often, clinical symptoms appear 5 years after the formation of stones, the cause of which is often the advancement of stones into the cystic duct with its blockage, leading to the development of cholecystitis. In this case, frequent but nonspecific complaints are dyspeptic disorders: heaviness in the epigastrium, belching, nausea, constipation. When palpating the abdomen, in some cases there is moderate pain in the area of ​​​​the projection of the bladder. The severity of clinical syndromes varies and depends on the activity of the process.

III stage of cholelithiasis stage of chronic calculous cholecystitis. A typical symptom of gallstone disease is biliary colic. Clinical manifestations depend on the location of gallstones, their size, quantity, nature of inflammation, functional state biliary system, damage to other digestive organs. Stones located in the body and at the bottom of the gallbladder (the “silent” zone) do not give obvious clinical manifestations until they enter the neck, cystic duct, or inflammation occurs. Every year, 12% of such patients may experience pain. The risk of cholelithiasis complications at this stage remains very low, and, therefore, prophylactic cholecystectomy is not indicated for such individuals. A stone that gets into the neck of the bladder obstructs its exit and thereby causes biliary (hepatic) colic.

Acute calculous cholecystitis most often occurs when a calculus enters the cystic duct. In this case, obstruction, stagnation and infection of bile, swelling and inflammation of the bladder wall occur. The disease is characterized by constant pain in the right hypochondrium with irradiation to the right shoulder, shoulder blade, back, and less often to the left half of the body. Pain often occurs at night or in the morning after an error in diet. Characterized by early fever excessive sweating, motionless position on the side with legs tucked to the stomach, Flatulence, nausea, vomiting. Upon objective examination, the abdomen weakly participates in the act of breathing, and its swelling is observed. The gallbladder is usually not palpable. Sometimes it is possible to identify a painful conglomerate consisting of the gallbladder and the omentum fused to it, an enlarged painful liver, positive symptom Murphy.

Chronic calculous cholecystitis is characterized by recurrent attacks of pain. There are cholelithiasis with chronic cholecystitis in the phases of exacerbation, fading exacerbation (incomplete remission) and remission. The presence of stones in the ducts is difficult. reduces the outflow of bile, causes various clinical syndromes the leading one is painful. The most typical exacerbation of chronic calculous cholecystitis is biliary (hepatic) colic. Hepatic colic is characterized by the following clinical signs:

• short-term pain in the right hypochondrium or epigastric region at intervals of about 1 hour or more;
• addition of fever with colic lasting more than 72 hours,
• positive symptoms of Murphy, Ortner, Mussi, Kera;
• bloating, excess gases, nausea, intolerance fatty foods.

Currently, the term “biliary pain” refers to a condition that occurs when the cystic duct is temporarily obstructed by a stone or sludge. Most often, biliary pain is localized in the epigastrium, has varying degrees of severity (pressing, cramping, pulling, etc.), begins suddenly, lasts from 1530 minutes to 34 hours (hepatic colic).

The appearance of pain in cholelithiasis is caused by mechanical irritation of the gallbladder wall or ducts by the calculus, overstretching of the organ wall due to increased intracavitary pressure, as well as spasm of the muscles of the bladder and ducts. Serotonin and norepinephrine are essential in the formation of pain. Thus, a decrease in serotonin levels leads to a decrease pain threshold and increased pain. Norepinephrine, in turn, mediates an increase in the activity of antinociceptive systems. The wall of the gallbladder is easily extensible, which is due to the presence of smooth muscle and elastic fibers in its middle shell. When acetylcholine stimulates muscarinic receptors on the surface of the muscle cell, smooth muscle contracts, which leads to the opening of sodium channels and the entry of Na+ into the cell. Depolarization of the cell leads to the opening of calcium channels and the entry of Ca2+ into the cell, which promotes myosin phosphorylation and muscle contraction, and consequently the occurrence muscle spasm and pain. The regulation of Ca2+ transport involves such mediators as acetylcholine, catecholamines (norepinephrine), serotonin, cholecystokinin, motilin, etc.

An attack of hepatic colic is provoked by fatty foods, spices, smoked foods, spicy seasonings, sudden physical overexertion, work in an inclined position, infection and negative emotions. Hepatic colic often occurs suddenly, often at night, and is localized in the right upper quadrant of the abdomen, less often in the epigastric region under the xiphoid process, with characteristic irradiation to the right scapula, shoulder and subscapular region. Sometimes the pain radiates to the lumbar region, to the region of the heart, provoking an attack of angina. The pain varies in intensity: from strong, cutting to relatively weak, aching. However, the pain syndrome is not always accompanied by typical attacks of biliary colic. The pain may be dull, constant or intermittent. Often, simultaneously with pain, nausea and vomiting appear, which does not bring relief. During a painful attack, the abdomen is swollen, the abdominal wall is tense in the area of ​​​​the gallbladder projection. With a decrease in pain, it is possible to palpate the enlarged, painful liver, and sometimes the gall bladder. Many patients exhibit typical symptoms: Mussy, Ortner, Kher, Murphy. Along with pain, patients note a feeling of heaviness in the epigastrium, flatulence, and unstable stool. An increase in body temperature is a fairly common and reliable sign of an inflammatory reaction associated with hepatic colic. Elevated temperature (up to 38 °C) is often a sign of purulent and destructive cholecystitis.

The skin, visible mucous membranes and sclera are often icteric. With a prolonged attack with purulent inflammation of the gallbladder, especially in elderly patients, signs of pulmonary heart and vascular insufficiency may appear. A dry, coated tongue is detected. During the interictal period, patients usually feel well, only in some cases there are constant dull pains in the right hypochondrium, dyspeptic complaints (a feeling of bitterness in the mouth, flatulence, etc.). On palpation, there is often pain in the right hypochondrium, epigastric region, and a slightly painful edge of a slightly enlarged liver. The gallbladder is usually not palpable.

IV stage of complications. With cholelithiasis, complications often develop that require surgical intervention. The most frequent complications are obstruction of the common bile or hepatic duct by a stone, blockage of the cystic duct with the development of hydrops or empyema of the gallbladder, perforation of the gallbladder with the development of bile peritonitis, the formation of a choledochoduodenal fistula, as well as progressive liver failure and necrosis of the pancreas. Long lasting obstructive jaundice often accompanied by cholangitis and contributes to the development of secondary biliary cirrhosis. Long-term calculous cholecystitis can cause the development of gallbladder cancer. In addition, complications of gallstone disease include biliary sludge (clot), a microscopic agglomeration of cholesterol crystals, mucin, calcium bilirubinate, and other pigment crystals; development of hydrocele of the gallbladder; emphysematous cholecystitis; phlegmon of the bladder wall; abscesses in the area of ​​the gallbladder bed, liver; biliary pancreatitis; intestinal obstruction caused by gallstones. Repeated exacerbations of cholecystitis associated with wedging of a stone into the infundibulum of the gallbladder or the cystic duct near the common bile duct, as well as chronic cholecystitis involving neighboring tissues in the process can lead to the formation of an inflammatory scar tumor-like conglomerate (Mirisi syndrome), consisting of the gallbladder and the common bile duct , causing compression and deformation of the latter, which leads to the occurrence of jaundice, an increase in the level of bilirubin in the serum and the activity of alkaline phosphatase, GGTP.

Perforation of the gallbladder is the most dangerous complication of gallstone disease. The contents of the bladder, most often purulent, enter the abdominal cavity. Severe biliary peritonitis develops, often leading to death. It is allowed that this state can develop without perforation, due to the penetration of bile through the wall of the bladder. It is believed that in this case, bile penetrates through the enlarged Luschke ducts or through microscopic damage to the wall of the bladder. When the physicochemical composition of bile changes, the wall of the organ becomes permeable to some of its components.

Pericholecystitis occurs when the gallbladder wall becomes inflamed, including serosa. Observed reactive changes from the peritoneum, leading to the development of adhesions.

Depending on the severity of chronic calculous cholecystitis, there are:

• mild exacerbations are rare and short-lived (13 during the year); biliary colic occurs no more than 4 times during the year;
• moderate course of exacerbations of the disease are frequent and long-lasting (34 during the year), biliary colic up to 56 during the year;
• Severe cases are characterized by pronounced and persistent pain syndrome, accompanied by significant disorders. Exacerbation of the disease occurs more than 5 times a year.

Diagnosis of cholelithiasis:

Features of diagnostics. In diagnosis, ultrasound and ERCP are of decisive importance (see Fig. XLII, XLIII color insert). Concretions of the gallbladder and bile ducts are echocardiographically located as light, highly echogenic single and multiple formations various shapes and sizes.

When conducting ultrasound diagnostics of cholelithiasis, the following classification of stones is used:

• weakly echogenic young, subject to destruction, sometimes similar to papillomas (it is necessary to carry out echographic monitoring);
• medium echogenic with uneven acoustic density;
• highly echogenic, having uniform acoustic density, giving a general acoustic shadow;
• concretions that provide a general acoustic shadow (completely filling the cavity of the bladder, which explains the non-differentiability of its contours).

As a rule, it is possible to locate stones larger than 1 mm, and sometimes gall sand in the form of a floating luminous mass.

Rare complications of cholelithiasis are hydrocele of the gallbladder, calcification of its wall ("porcelain" gallbladder, "lactine" ("lime") bile), fistulas between the gallbladder and other organs, cholelithiasis intestinal obstruction. Most patients seek medical help with a repeated attack of pain, so a well-collected anamnesis allows you to make the correct diagnosis even before the examination begins. Factors predisposing to the development of cholelithiasis should be taken into account: female gender, age over 40 years, the presence of hemolytic anemia, obesity, diabetes mellitus, multiple pregnancies, long-term use of medications that promote lithogenesis (nicotinic acid, clofibrate, etc.). According to the Standards for the diagnosis and treatment of diseases of the digestive system, mandatory research in the diagnosis of cholelithiasis is general tests blood, urine; biochemical research, including determination of total bilirubin and its fractions, activity of LAT, AST, alkaline phosphatase, angleamyl transpeptidase, content total protein, protein fractions, reactive protein, cholesterol, amylase, blood sugar; blood group and rhesus factor.

In the diagnosis of latent lithiasis (presence clinical symptoms cholelithiasis with negative ultrasound results) attach great importance to determining the content of lipid complex components in bile, reducing bile acids, phospholipids, disrupting the ratio of cholic and cheiodeoxycholic acids, and increasing the amount of cholesterol. The most reliable biochemical criterion for assessing cholelithiasis is the lithogenicity index (calculated from the molecular ratio of cholesterol, bile acids and phospholipids). The detection of cholesterol crystals with a high degree of certainty indicates the presence of stones. Identification of crystals (granules) of pigments has less diagnostic value.

Ultrasound examination plays a leading role in diagnosis. With its help, it is possible to determine the size and shape of the gallbladder, the thickness of its wall, the presence of stones in it, their number and size. Endoscopic ultrasound provides information about the presence of sludge or stones in the gallbladder. Ultrasound method has an advantage over x-ray examinations in identifying cholesterol stones, although stones containing large amounts of calcium are radiopaque and are often detected even on a plain radiograph. Radionuclide and thermographic methods in the diagnosis of cholelithiasis are of only auxiliary value. It is advisable to perform endoscopic retrograde cholangiopancreatography and computed tomography.

In some cases, laparoscopic examination is indicated. Patients with cholelithiasis are advised to consult a surgeon.

Treatment of Gallstones:

Features of treatment. Therapeutic measures for cholelithiasis include a general hygienic regime, systematic physical activity, and rational fractional nutrition.

Against the background of physiological, strictly balanced diet No. 5, with the exception of nutritional excesses, fatty, high-calorie and cholesterol-rich foods, daily consumption of 100-150 g of raw vegetables and fruits (carrots, sauerkraut, celery, unsweetened and non-acidic varieties of fruit) is recommended.

At stage I of cholelithiasis the following are indicated:

• an active lifestyle, physical exercise, which promotes the outflow of bile, eliminates its stagnation, and reduces hypercholesterolemia;
• therapeutic nutrition (table No. 5);
• normalization of body weight;
• correction endocrine disorders(hypothyroidism, diabetes mellitus, estrogen metabolism disorder, etc.);
• antibacterial therapy of infectious inflammatory diseases of the biliary tract;
• treatment of chronic diseases of the liver and blood system;
• stimulation of the synthesis and secretion of bile acids by the liver (phenobarbital 0.2 g per day (0.05 g in the morning, at lunch and 0.1 g in the evening), zixorine 0.1 g 3 times a day; the course of treatment ranges from 34 up to 67 weeks);
• normalization of the physicochemical composition of bile (lyobil 0.40.6 g 3 times a day after meals for 34 weeks, ursofalk 250 mg at night for 36 months);
• the use of enzyme preparations (for example, Creon) to normalize digestive processes: with cholelithiasis, not only the digestion of fats is disrupted, but also, as a result of insufficient bactericidal activity of bile and increased bacterial growth in the small intestine, the utilization of proteins and carbohydrates.

Features of the treatment of patients in stage II cholelithiasis are:

• therapeutic nutrition, similar to that recommended in stage I of cholelithiasis;
• normalization of body weight, combating physical inactivity;
• correction of lipid metabolism;
• medicinal dissolution of stones using bile acid preparations;
• combination therapy (shock wave and drug lithotripsy);
• surgical treatment.

Therapeutic tactics are determined by the peculiarities of the clinical picture of the disease. Indications for drug dissolution of gallstones are:

• cholesterol stones;
• the size of the stones does not exceed 1520 mm;
• Functioning gallbladder;
• The gallbladder is less than half filled with stones;
• patent cystic duct;
• the common bile duct is free of stones;
• no use of clofibrate, estrogens, antacids, cholestyramine.

The exclusion criteria for lytic therapy are stones with a diameter of more than 1520 mm; multiple stones occupying more than 50% of the area of ​​the gallbladder shadow; acute inflammatory disease of the gallbladder and bile ducts; frequent attacks of hepatic colic; complications of gallstone disease; non-visualized and “porcelain” gallbladder; cirrhosis of the liver, peptic ulcer stomach and duodenum; chronic pancreatitis; inflammatory bowel diseases; resection ileum, diarrhea; pregnancy; diabetes mellitus, obesity; the patient's unwillingness to follow treatment recommendations.

Bile (ursodeoxycholic and chenodeoxycholic) acid preparations are used to dissolve lipid stones. The daily dose of chenodeoxycholic acid (henochol, henofalk, etc.) for patients weighing less than 60 kg is 750 mg (250 mg in the morning and 500 mg before bed), more than 70 kg - 1000 mg. The optimal daily dose of drugs is 1215 mg/kg of the patient's body weight. The duration of treatment ranges from 3 months to 23 years.

During treatment with henofalk, side effects are possible dyspeptic symptoms, diarrhea, increased transaminase activity. Epigastric pain and nausea disappear, as a rule, after 23 weeks from the start of taking the drug.

Ursofalk is available in capsules of 250 mg. For a body weight of less than 60 kg, ursofalk is used at 500 mg before bedtime; for a body weight of up to 80 kg, 750 mg; up to 100 kg, 1000 mg; over 100 kg, the dose of ursodeoxycholic acid is increased to 1250 mg. UDCA is the drug of choice and has a number of advantages compared to CDCA (smaller doses of drugs, faster dissolution of stones, absence of side effects in the form of diarrhea and increased aminotransferase activity) Currently, a combination of two acids (lithofalk) is used in the treatment of cholelithiasis. The use of lithopalk helps to significantly reduce the level of cholesterol in bile. During litholytic therapy, dynamic ultrasound is performed every 6 months.

When carrying out medicinal oral litholytic therapy with chenodeoxy and ursodeoxycholic acids, in some cases complications are observed in the form of blockage of the cystic duct, recurrent colic, obstructive jaundice, cholecystitis, cholangitis, pancreatitis, and calcification of gallstones. Our experience suggests that oral litholytic therapy does not increase the risk of surgical treatment.

The effectiveness of drug dissolution of stones depends on the correct selection of patients, the dose of the drug, the duration and continuity of treatment. The frequency of complete dissolution of stones is 90-30%. top scores(6070%) were obtained from patients with stones less than 5 mm in diameter. With “floating” stones, the frequency of dissolution increases. Such therapy is not recommended for patients with large (more than 20 mm in diameter) stones.

The disadvantage of drug litholytic therapy is its duration, which increases as the diameter of the stones increases. In 50% of patients, relapses of cholelithiasis are observed within 5 years after the dissolution of stones.

Currently, extracorporeal shock wave lithotripsy (ESWL) is becoming increasingly used in the treatment of the disease. Several methods of lithotripsy are used:

• piezoelectric method of generating shock waves;
• underwater spark discharge;
• electromagnetic method of generating shock waves.

The peculiarity of therapy using shock wave lithotripsy is that after it is carried out, stone fragments are formed with a maximum diameter of 8 mm. To dissolve them, oral lytic therapy is performed, which begins 2 weeks before lithotripsy and continues for a month after confirming the absence of stones.

The selection criteria for shock wave lithotripsy are:

• stone volume (diameter up to 30 mm);
• cholesterol stones;
• normal contractility of the gallbladder after the use of a nutritional stimulus (reduction in bladder size by 3050%);
• no history of recurrent fever, cholestasis, or jaundice.

Contraindications to shock wave lithotripsy are significant stone sizes, their calcification, pigment stones, gallbladder dysfunction and blood coagulation. An effective method for the treatment of cholelithiasis is percutaneous transhepatic Itolysis. Its essence lies in the introduction of a thin catheter into the gallbladder through the liver tissue. Methyl tertzbutyl ether (510 ml) is slowly injected through the catheter. Percutaneous transhepatic litholysis is indicated for patients with cholelithiasis at various stages of the disease. In this case, it is possible to dissolve up to 90% of the stones; additional intake of ursodeoxycholic acid during this procedure prevents the precipitation of cholesterol.

Treatment of patients with stage III cholelithiasis includes the following components:

• therapeutic nutrition;
• normalization of body weight;
• correction of lipid metabolism;
• drug dissolution of stones;
• relief of an attack of biliary colic (taking into account the fact that the formation of pain syndrome in cholelithiasis is based on excessive contraction of the smooth muscles of the wall of the gallbladder and biliary tract, it is advisable to use antispastic agents, smooth muscle relaxants: non-selective anticholinergics (metacin, platifillin) and selective (pirencipin) drugs; myotropic (drotaverine, papaverine, etc.) antispasmodics; special tropism for muscle tissue possesses mebeverine hydrochloride;
• antibacterial and detoxification therapy;
• surgical treatment.

The indication for surgical treatment of patients with cholelithiasis is the continuously relapsing course of the disease and the presence of complications. The method of choice for surgical treatment is cholecystectomy. The operation is indicated in all cases when early clinical symptoms of calculous cholecystitis appear (colic, fever, lack of stable remission between attacks). Currently, the following types of surgical treatment are used: open and laparoscopic cholecystectomy, cholecystolithotomy, cholecystostomy, papillosphincterotomy.

Absolute indications for surgical treatment:

• gallstones, manifested by clinical symptoms;
• chronic cholecystitis (recurrent biliary colic, non-functioning gallbladder);
• common bile duct stones;
• empyema and hydrocele of the gallbladder;
• gallbladder gangrene;
• perforation and penetration of the bladder and formation of fistulas;
• Mirizi syndrome;
• the need to exclude gallbladder cancer;
• intestinal obstruction caused by gallstones.

Relative indications for surgery are chronic calculous cholecystitis with symptoms associated with the presence of stones in the gallbladder.

Among the listed indications, the main one is chronic calculous cholecystitis. In this case, the size of the stones, their number, and the duration of the disease do not matter when choosing the method of surgical treatment. The choice of treatment tactics for a patient with gallstone disease is determined by the coordination of actions between the therapist, surgeon and patient. When determining indications for cholecystectomy, international recommendations are used .

Currently, open cholecystectomy is a definite standard in the treatment of patients with cholelithiasis that occurs with clinical manifestations. In this case, a number of complications may occur. Damage to the bile ducts during surgical treatment leads to the flow of bile into the abdominal cavity or the formation of a stricture. Such complications occur only in 0.20.5% of cases during laparoscopic cholecystectomies.

The following types of damage to the biliary tract are distinguished:

• damage to the ducts with deterioration or complete disruption of the bile flow without bile entering the abdominal cavity;
• entry of bile into the abdominal cavity with preserved flow through the bile ducts,
• entry of bile into the abdominal cavity and damage to the bile ducts with disruption of bile flow.

Classification of bile duct damage:

• type A: leakage of bile from the hepatic duct with preservation of continuity of bile flow between the liver and duodenum;
• type B; occlusion (as a result of ligation) of the right hepatic duct or one of its branches;
• type C: bile leakage resulting from transection of the aberrant right hepatic duct;
• type D: lateral damage to the extrahepatic bile duct with preservation of bile flow between the liver and duodenum;
• type E: occlusion of the common bile duct at any level.

Diagnosis of biliary tract damage can be carried out during surgery and be delayed. The entry of bile into the abdominal cavity is manifested by pain, jaundice, fever, changes in functional tests, and the presence of intraperitoneal fluid according to ultrasound and CT. In this situation, ERCP is indicated. When bile enters the abdominal cavity, it is advisable to reduce the resistance to bile flow into the duodenum using sphincterotomy or the application of a stent, drainage, and the prescription of antibiotics. In the presence of benign strictures, stents are used.

Abdominal surgery has made a significant step forward in recent years thanks to the development and implementation of clinical practice a number of laparoscopic operations, among which the leading place is occupied by cholecystectomy (see Fig. XLV, color insert). Laparoscopic cholecystectomy has advantages over open cholecystectomy. With cholecystectomy under laparoscopic control, visibility of the intervention area is better, a non-traumatic examination of the gallbladder is possible, and, if necessary, an instrumental examination of all organs of the abdominal cavity and pelvis.

Indications for laparoscopic cholecystectomy are stage III cholelithiasis, chronic cholecystitis.

Contraindications to laparoscopic cholecystectomy are divided into absolute and relative, as well as local and general.

Absolute contraindications:

• terminal state of the patient, coma;
• progressive decompensation of cardiopulmonary activity;
• sepsis, diffuse purulent peritonitis;
• severe concomitant diseases;
• portal hypertension;
• intestinal obstruction;
• blood clotting disorders;
• acute cholangitis,
• acute pancreatitis,
• Mirizi syndrome;
• cholangiocarcinoma.

Relative contraindications

• acute cholecystitis,
• common bile duct stones,
• severe degree of obesity,
• previous abdominal surgery;
• wrinkled gallbladder,
• "porcelain" gallbladder,
• empyema of the gallbladder;
• diaphragmatic hernia.

Local contraindications:

• infectious inflammatory processes of the anterior abdominal wall,
• previous open abdominal surgeries, gross adhesions in the abdominal cavity, scar deformities abdominal wall,
• acute cholecystitis (more than 34 days),
• acute pancreatitis,
• obstructive jaundice,
• malignant neoplasms of the gallbladder;
• calcification of the gallbladder wall.

General contraindications are associated with severe concomitant pathology.

To reduce the symptoms of abdominal pain, the use of antispasmodics (mebeverine, etc.) is indicated.

Emerging Possibilitycnm drug therapy Cholelithiasis has made certain adjustments to determine the treatment strategy for this pathology. The presence or absence of clinical symptoms of the disease is decisive for determining the treatment tactics for cholelithiasis. Patients with pronounced clinical manifestations of the disease (frequent biliary colic) are subject, as before, to surgical treatment. In turn, medicinal dissolution of stones can be recommend to patients whose clinical manifestations of the disease do not require urgent surgical intervention, as well as to patients who have increased risk operations, or patients who categorically refuse surgery.

Forecast. The prognosis for gallstone disease depends on many factors, possible complications Known rare cases spontaneous recovery when an attack of biliary colic ends with the release of a small stone into the intestinal lumen. As a rule, the prognosis is favorable and depends on timely conservative therapy or surgical treatment. The prognosis for chronic cholecystitis is favorable, but it is worse in older people with concomitant diseases. With timely surgical treatment outside of exacerbation, the prognosis improves.

Which doctors should you contact if you have gallstone disease:

• Surgeon
• Gastroenterologist

Is something bothering you? Do you want to know more detailed information about Gallstone disease, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can make an appointment with a doctor– clinic Eurolab always at your service! The best doctors will examine you and study you external signs and will help you identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolab open for you around the clock.

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Other diseases from the group Gastrointestinal tract diseases:

Cholelithiasis or calculous cholecystitis is 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 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 cholelithiasis are manifested by 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. They radiate to the 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: xanthelasma ( small rashes in the form of flat grains) yellow 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 has hypersensitivity when touched. Here the compacted and tense muscles of the abdominal wall are determined.

Causes of exacerbation and consequences

Patients associate the manifestations of exacerbation symptoms with diet violations, alcohol intake, severe physical activity, 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.

Long-term 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 the 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.

The formation of fistulous tracts between the gallbladder and the small intestine due to the independent breakthrough of a stone through the wall can be indicated severe diarrhea. 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

The following examination results help to establish the correct diagnosis:

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

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.

Gallstone disease is a pathology associated with impaired metabolism of fat-soluble substances such as bilirubin and cholesterol, resulting in the formation of one or more stones in the gallbladder or ducts leading from it. The disease can develop in children under one year of age, but is most often detected in the older generation - in more than 30% of people over 70 years of age. Women suffer 5 or more times more often than men, especially multiparous women.

Gallstone disease is the main evidence of metabolic disorders

Excess weight, eating animal fats and proteins, diseases of the hepato-biliary zone, as well as a sedentary lifestyle are the main risk factors for this disease. It is dangerous because calculi (stones) can create an obstruction in the path of bile, which can cause damage to many internal organs.

How are stones formed?

- an organ in the form of a small “bag” that can contract. Its main function is to store bile formed in the liver and remove excess water from it. When fatty foods enter the intestines, the bladder contracts and pushes bile (it is extremely necessary for processing fats) into the ducts, which bring it to the duodenum.

Stones begin to form in one of two cases:

1. when it is violated normal composition bile: this is due both to the nature of the food and to general diseases or infections of the liver or gall bladder itself;
2. if bile stagnates in its “storage” due to violations of its contractility or motility of the biliary tract.

There are three types in the gallbladder, each of them has its own mechanism of formation:

1. Cholesterol stones, which are found in almost 90% of all gallstones, are formed due to the oversaturation of bile with cholesterol.
2. Bilirubin (also known as pigment) stones most often occur when red blood cells break down in increased quantities, releasing hemoglobin, which turns into bilirubin.
3. Mixed stones contain cholesterol, and calcium, which gives the stone hardness and X-ray contrast properties.

The process of stone formation is as follows. Under the influence of taking hormonal drugs, sharp decline weight, pregnancy, full intravenous nutrition and other phenomena, a sediment of putty-like consistency appears at the bottom of the gallbladder - sludge. Excessive amounts of cholesterol, under the influence of certain substances contained in this sediment, fall into the lumen of the bladder in the form of solid crystals. Further, if the inflammation of the biliary tract or the nature of the food does not change, the crystals bind together, forming stones. The latter grow and become denser; Bilirubin and calcium may be deposited on them.

Why are stones formed?

The following are the main causes of cholelithiasis:

1. Inflammation of organs that produce, concentrate or excrete: cholecystitis, hepatitis, cholangitis.
2. Diseases of the endocrine organs: decreased thyroid function, diabetes mellitus, impaired estrogen metabolism.
3. Taking contraceptives.
4. Pregnancy.
5. Conditions leading to changes in cholesterol metabolism: obesity, atherosclerosis, consumption of large amounts of animal fats and proteins.
6. Increase in blood and bile levels is not direct bilirubin– with hemolytic anemia.
7. Starvation.
8. Hereditary predisposition.
9. Congenital anomalies in which the outflow of bile is obstructed: S-shaped gallbladder, stenosis of the common bile duct, duodenal diverticulum.

Primary and secondary processes of stone formation can occur in the biliary tract.

Primary stone formation

It occurs only in the gallbladder that is not affected by the infectious process, where the bile remains for a long time, becoming very concentrated.

Cholesterol, formed by liver cells, does not dissolve in water, so it enters the bile in the form of special colloidal particles - micelles. Under normal conditions, micelles do not disintegrate, but with an excess of estrogen, cholesterol precipitates. This is how cholesterol stones are formed.

For the formation of pigment stones, not only the breakdown of red blood cells is needed - hemolysis, but also some bacteria. In addition to inflammation, they cause the transition of direct bilirubin to indirect bilirubin, which precipitates.

Primary calcium stones form only when the level of calcium in the blood is elevated, for example, with hyperfunction of the parathyroid glands.

Secondary stones

These stones form not only in the gallbladder, but also in the bile ducts affected by the inflammatory process. They are based on primary stones made of cholesterol or bilirubin, which have a small diameter and, as a result, do not exert gravitational pressure on the walls of the bile ducts. Calcium dissolved in the inflammatory fluid is deposited on such stones.

Thus, if stones consist of more than just calcium, and increased level This electrolyte is not detected in the blood, then gallstones are secondary.

How does the disease manifest itself?

Warning! Symptoms of cholelithiasis do not appear when the first microcrystals of cholesterol or bilirubin fall out, but only after a few years, when the stone interferes with the normal outflow of bile.

Signs of the disease vary from biliary colic or inflammation of the gallbladder (if the stone does not block biliary tract completely, or located closer to the duodenum) to dangerous disease– inflammation of the intrahepatic bile ducts.

Manifestations of biliary colic are pain under the right costal arch, which has the following characteristics:

The main symptom of the pathology is pain in the right hypochondrium

• begins suddenly;
• radiates under the right shoulder blade or in the back;
• within the first hour the pain becomes very intense;
• it remains the same for another 1-6 hours, then disappears within an hour;
• accompanied by nausea and/or vomiting;
• the temperature does not rise.

The same symptoms, only with elevated temperature, are accompanied by cholangitis and cholecystitis.

The danger of cholelithiasis

Warning! Gallstones can lead to conditions that can be life-threatening.

These are conditions such as:

1. obstructive jaundice;
2. inflammation of intrahepatic bile ducts;
3. liver abscess;
4. cirrhosis;
5. bile duct ruptures;
6. cancer developing from the bile ducts;
7. intestinal obstruction caused by a stone passing from the gallbladder into the intestine;
8. fistulas;
9. sepsis.

How is the diagnosis made?

Diagnosis of cholelithiasis is carried out by a gastroenterologist. It is based on:

• complaints and examination of the patient;
• Ultrasound: both sludge and almost all stones, even the smallest in diameter, are detected;
• X-rays: a plain X-ray shows calcium stones;
• magnetic resonance cholangiopancreatography – the most informative method diagnosis of gallstones;
• retrograde cholangiopancreatography – endoscopic method, used for diagnosing stones in the bile ducts;
• to determine liver disorders caused by a stone, laboratory tests are needed - “liver tests”;
• In order to detect the cause of stone formation, it is necessary to determine the level of calcium, cholesterol, and parathyroid hormone in the blood.

Is this disease treatable? Of course, but quite often this is done surgically. In addition, there are other methods of combating pathology, namely the dissolution of stones with the help of medications and non-contact crushing with subsequent removal naturally. Latest Methods are more gentle, but cannot be used in all cases. Details about everyone existing methods We talked about getting rid of gallstones in the article.