All about cholelithiasis. Treatment of cholelithiasis. Other diseases from the group Diseases of the gastrointestinal tract

Or cholelithiasis– a disease of the gallbladder, accompanied by the formation of stones in its cavity or bile ducts. It is generally asymptomatic or accompanied by a variety of clinical manifestations.

Gallstone disease is widespread throughout the world and occupies a leading place among other pathologies of the human digestive system. There is a clear differentiation of the disease by gender - women are affected 2 times more than men. Moreover, mothers with many children more often suffer from stones in the gallbladder or its ducts, which arise due to insufficient emptying bile in the last trimesters of pregnancy. In 1/3 of multiparous women, characteristic symptoms of the disease are detected.

Classification of cholelithiasis

1) Initial (physiochemical) – pre-stone stage, characterized by changes in the composition of bile.
2) Asymptomatic stone carriers - the presence of stones in the gallbladder that do not manifest any complications or symptoms.
3) Clinical manifestations of the disease indicating the development of chronic or acute form inflammation of the gallbladder.

In some cases, the fourth stage of gallstone disease is included, accompanied by the development of associated complications.

Causes of stone formation

1. A disorder in the process of bile secretion, leading to its oversaturation with cholesterol, thickening and the formation of crystals.
2. Lack of bile outflow resulting from obstruction of the bile ducts, valves of Oddi, pancreatic and bile ducts, small intestine, which is combined with impaired intestinal motility.
3. Changes in intestinal microflora associated with excessive reproduction and accumulation of bacteria in ileum, with a subsequent increase in pressure in the duodenum.
4. Disorder of the digestion process and absorption of nutrients, creating the prerequisites for the development of biliary pancreatitis.

An important factor influencing the course of gallstone disease is hereditary predisposition, elderly age, diabetes, poor nutrition, taking medications, obesity, pregnancy, inflammatory diseases intestines, physical inactivity, rapid weight loss, chronic constipation etc.

Types of gallstones

homogeneous– pigment (bilirubin), cholesterol and calcareous;
mixed– the core consists of organic compound, and the shells are made of layers of bile pigment, calcium salts and cholesterol (up to 80% of all stones);
complex– the core contains cholesterol, shells of calcium, bilirubin, cholesterol (10% of cases).

Complications of gallstone disease

Acute cholecystitis;
obstructive jaundice;
choledocholithiasis;
cholangitis;
chronic pancreatitis.

Cholecystectomy, an operation to remove the gallbladder, can also be complicated by postcholecystectomy syndrome, which worsens the patient’s quality of life. Clinical manifestations of the syndrome include abdominal pain, bitterness in the mouth, diarrhea, nausea, bloating, and increased body temperature. Sometimes patients experience yellowing of the skin and sclera of the eyes.

Symptoms of gallstone disease

Diagnosis of gallstone disease

1. Medical examination of the patient to identify characteristic symptoms gallbladder disease, tension and soreness of the skin in the abdominal area, the presence of yellow spots on the skin, general yellowness of the skin and sclera of the eyes. At the same time, the medical history is studied
2. Biochemical blood test to determine elevated levels of cholesterol, bilirubin, alkaline phosphatase, alanine or aspartic aminotransferases in her serum.
3. Conducting a general blood test to determine the number of ESR and leukocytes, indicating the presence of nonspecific inflammation in the body.
4. The use of cholecystography to detect an enlarged gallbladder and the presence of calcareous deposits on its walls.
5. Ultrasonography abdominal cavity to detect gallstones, obtain additional information about the condition bile ducts, liver, pancreas.
6. Execution plain radiograph abdominal organs or cholangiography: endoscopic retrograde, magnetic resonance, percutaneous transhepatic or intraoperative, if there is a suspicion of the presence of stones in the bile ducts.

If ultrasound results are negative, it is used microscopic examination bile collected during endoscopy. The detection of cholesterol crystals in it indicates the presence of stones in the gallbladder or its ducts. The presence of pigment granules is not such an important factor in the diagnosis of gallstone disease.

Treatment of gallstone disease

1. Diet, balanced in the amount of vegetable fats and proteins. At the same time, patients are not recommended to eat high-calorie spicy and spicy foods containing high amounts of cholesterol and refined carbohydrates. To prevent acidity, their menu includes dairy products, and flour products and cereal dishes are limited. Following a diet reduces the likelihood of gallbladder spasms, which can cause migration of sand and small stones. If the patient has an exacerbation chronic pancreatitis, complete fasting and drinking water are prescribed, subsequently fractional and frequent meals by the hour, excluding spicy, sour, smoked and fried foods.

2. Drug therapy . If the patient has contraindications for surgery or refuses surgery, medications containing bile salts are prescribed. The tablets must be taken orally as prescribed by your doctor. The effectiveness of treatment is 80-100% if the stones are round in shape, cholesterol in nature, size no more than 10 mm and have a smooth surface. However, such therapy is not recommended if the patient has large pigment stones with a diameter of more than 20 mm, as well as frequent and severe attacks of biliary pain.

By agreement with the patient, a single dose of ursodeoxycholic acid (Ursosan) is prescribed. daily dose up to 900 mg. Side effects are quite rare and account for only 5%. The medicine is taken until the stones are completely dissolved for up to 12 months and continues to be used for 3 months to prevent relapse.

When cholelithiasis is complicated by attacks of cholecystitis and violation intestinal microflora antibacterial therapy is used. Medicines such as ciprofloxacin, cefuroxime, cefotaxime, imipenem are used in combination with antibacterial drugs: tetracycline, rifampicin, isoniazid. The use of probiotics that stimulate the growth of intestinal microflora is mandatory. To normalize digestion and absorption of nutrients, buffer antacids and enzyme preparations are prescribed.

Every ten years, the number of people suffering from gallstone disease doubles.
- 25% of women and 10% of men living in the northwestern regions of Russia have stones in gallbladder.
- 25% of women aged 40 suffer from gallstone disease.
- 50% of people over the age of 70 are diagnosed with gallstone disease.
- Gallstone disease is most often observed in children who have reached school age.

In some countries, extracorporeal shock wave lithotripsy is used to crush stones. Small fragments of stones are dissolved using litholytic therapy, in which oral administration bile acids.

Prevention of gallstone disease

Systematic physical activity;
limiting alcohol consumption and smoking;
proper and balanced nutrition, including proteins, vegetable fats, green tea, ripe and sweet fruits, herbs, dried bread, boiled chicken, raw pureed vegetables.

It is necessary to eat regularly, at least 4-5 times a day, since less frequent meals contribute to the stagnation of bile, its thickening and the formation of stones. Long breaks (over 4 hours) between traditional breakfast, lunch and dinner should be supplemented by drinking tea, juice, compote or kefir. Fried foods, legumes, garlic, onions and radishes are completely excluded from the diet. It is recommended to prepare all dishes from stewed, baked or boiled foods.

Traditional methods of treating cholelithiasis

To prevent further exacerbation of the disease, rosehip is used, which helps dissolve gallstones. A warm decoction of its roots is consumed 3-4 times a day for a month. Treatment course rosehip is repeated after 1-1.5 weeks.

There are extremely diverse folk recipes that help with severe pain in the gallbladder area, and combine honey and various herbs, such as lemon balm, buckthorn, immortelle, rose hips, and celandine. Strained herbal decoction drink warm with 1 teaspoon of honey. Treatment of gallstone disease folk ways should be carried out with the permission of the attending physician and only as additional therapeutic assistance.

An attack of cholelithiasis is a condition caused by a violation of the outflow of bile due to blockage of the gallbladder and/or bile ducts by stones. found in every 5th woman and every 10th man. Up to 60% of people with gallstones do not experience unpleasant symptoms, but the likelihood of an attack of the disease increases annually by 2–3%. What is the danger of exacerbation of cholelithiasis and what are the principles of first aid? To answer this, you should first become familiar with the causes of the pathology.

Bile is a mixture of bile acids, pigments, phospholipids and cholesterol. The action of a negative factor provokes the precipitation of solid sediment, which gradually turns into calculi (stones). This can be observed against the background of metabolic disorders, inflammatory diseases of the biliary system. In the first case, the concentration of bile acids and cholesterol in bile increases. In the second, it changes physical and chemical properties. Depending on the predominant component, cholesterol and pigment stones are distinguished. IN in rare cases there are calcifications (stones with large quantities calcium).

There are several factors that increase the risk of cholelithiasis. Namely:

• Errors in the diet. Predominance of animal fats, long-term complete parenteral nutrition(bypassing the gastrointestinal tract). The likelihood of developing cholelithiasis increases by 30% with fasting and rapid weight loss.
• Diseases of the biliary system. More often chronic cholecystitis. With liver cirrhosis, the risk of stone formation increases 10 times.
• Endocrine pathologies. Stone formation is common in individuals with uncorrected hypothyroidism. Patients with diabetes mellitus suffer from cholelithiasis 3 times more often than those who do not have this endocrine disease.
• Obesity, increased content triglycerides. 2 out of 10 people with metabolic syndrome(a complex of changes associated with metabolic disorders) symptoms of an attack of cholelithiasis develop over time.
• Taking a drug that affects the composition of bile and motility of the biliary tract. For example, ceftriaxone.
• Female gender, age. Women suffer from cholelithiasis 2 times more often than men. With age, the difference in incidence levels out. The main category of patients is people over 40 years old.
• Pregnancy. Stones form in 5–12% of pregnancy cases, but often they disappear spontaneously after childbirth. The risk is greater in 2 and subsequent pregnancies.
• Taking estrogen regardless of gender. With replacement hormone therapy in postmenopause, the risk of cholelithiasis increases 3.7 times.
• Burdened heredity. People who have blood relatives with cholelithiasis are 4-5 times more susceptible to the disease.

Pathogenesis of cholelithiasis attack

A gallbladder attack is caused by blockage of its neck/or excretory ducts by migrating stones. But the pathogenesis is not limited to this. Symptoms may be based on several processes at once. Types of manifestations of cholelithiasis and mechanisms of their occurrence:

• (biliary pain). Most common option manifestations of the disease (75% of cases). It is based on the wedging of a stone into the neck of the gallbladder, the entry of the stone into the bile ducts (cystic and common), followed by their reflex spasm. Because of this, bile cannot enter the duodenum, leading to increased pressure in the biliary tract.
• . Occurs in 10% of episodes of clinically significant cholelithiasis. Usually occurs as a complication of blockage of the neck of the gallbladder or cystic duct. They serve as provocateurs bacterial infection(50-85% of cases) and lysolecithin – a bile derivative, chemically aggressive for previously damaged areas of the biliary tract.
• Cholangitis. Inflammation of the bile ducts. The provoking factors are the same as above.
• Acute biliary pancreatitis. Inflammation of the pancreas. Associated with the reflux of bile into the pancreatic duct, lymphogenous spread of infection from the biliary system.

Causes causing an attack

Migration of stones can be caused by increased production of bile, spasm of the gallbladder and excretory ducts. Provoking factors:

Symptoms

Most often, an attack of calculous cholecystitis begins with biliary colic. If it is associated with food intake, it occurs 1-1.5 hours after eating. Colic often occurs at night, a few hours after falling asleep. Symptoms of an attack of gallstone disease:

• Pain syndrome. Sharp, pronounced. Localized in the right hypochondrium with distribution to the epigastrium (projection area of ​​the stomach). Can give under the right shovel, between the shoulder blades, thoracic region spine, neck, right shoulder. The pain increases in waves, then becomes constant, bursting. Lasts from several minutes to several hours. May lead to painful shock.
• Dyspeptic syndrome. Possible nausea and vomiting. Emptying the stomach does not bring relief. Due to a reflex slowdown of intestinal motility, the abdomen is slightly distended.
• Autonomic disorders. Sweating, increased or slow heart rate, changes blood pressure(usually a decrease).
• Hyperthermia. Body temperature usually does not exceed 38°C.

Typical biliary colic is so severe that the patient tosses and turns in bed. He is constantly looking for a comfortable position in which the discomfort will decrease. Breathing becomes shallow as every movement chest increases pain. Colic usually disappears on its own (if a small stone was able to pass into the duodenum) or after taking antispasmodics.

If colic has not disappeared after 6 hours, the development of acute cholecystitis is first suspected. The pain is similar to biliary pain. Hyperthermia from 38°C may indirectly indicate inflammation of the gallbladder, cholangitis, or pancreatitis. The condition may worsen to high fever (from 39°C) with chills. For more later stages jaundice joins.

Important! Progressive deterioration of the condition, a hard “board-shaped” abdomen may indicate a rupture of the gallbladder with the development of peritonitis - inflammation of the peritoneum. This condition is life-threatening and requires immediate intervention surgeon

Diagnostics

The primary determination of the cause of colic is based on the study of complaints and examination data. In emergency situations medical specialist this is enough to urgently relieve an attack of gallstone disease and prevent painful shock. Laboratory and instrumental research methods help to definitively confirm the diagnosis. The main ones:

• Ultrasound of the abdominal organs. It is possible to visualize stones and change the contractility of the gallbladder.
• Clinical blood test. Signs are often observed bacterial inflammation: acceleration of ESR, increase in the number of leukocytes.
• Blood chemistry. Signs of bile stagnation. The level of bilirubin increases due to the direct fraction, the activity of alkaline phosphatase, ALT, and AST increases.

If necessary, ERCP (endoscopic retrograde cholangiopancreatography) is performed. This is x-ray visualization of the bile and pancreatic ducts using endoscopic insertion contrast agents. More often, such a study is combined with therapeutic manipulations, for example, dissection of the mouth of the duodenal papilla. ERCP is performed outside of exacerbation of cholelithiasis, so an attack of the disease is a direct contraindication to the procedure.

The abdominal form of myocardial infarction can simulate an attack of biliary colic. To avoid diagnostic errors, it is better to immediately contact a medical specialist.

What should you do if you have an attack of gallstone disease?

Typical biliary colic (not to be confused with mild dyspepsia due to dietary errors) - absolute reading to call an ambulance medical care. The condition may require emergency surgery. The main task is to prevent complications until the team of specialists arrives. First aid for an attack of gallbladder colic:

• Provide bed rest;
• Stop the supply of food;
• Give an antispasmodic, avoiding exceeding the dosage (mebeverine, drotaverine, papaverine);
• Cover with a blanket if you have a chill;
• Constantly monitor the patient, as he may lose consciousness from pain.

Attention! Despite recommendations in some sources, you should not warm up your right hypochondrium and take a hot bath. An attack of colic may mask other diseases in which such procedures are dangerous. In case of cholelithiasis, it is forbidden to give choleretic drugs.

How can you relieve an attack of gallstone disease yourself? If this is typical biliary pain, then it is better to follow the above measures and wait for the doctor.

Prevention

Measures to prevent biliary colic are based on correction of diet and lifestyle. Namely:

• Dieting. Frequent fractional meals 4-5 times a day in small portions. Exclusion of fatty, fried, spicy food, marinades. The restrictions include products that stimulate the production of bile: garlic, coffee, egg yolks, carbonated drinks. The diet should be observed especially strictly after an attack of gallstone disease. You should not eat for 12 hours after colic.
• Balanced physical activity. Avoid physical inactivity and heavy lifting.
• Eliminate sources of stress. This also includes compliance with the work and rest regime.

Conclusion

Colic due to cholelithiasis is a condition that requires specialist intervention. Even if it was managed to stop on its own, it can recur at any time and lead to life-threatening complications. If gallstones are an asymptomatic ultrasound finding, a scheduled visit to a gastroenterologist and surgeon is mandatory. IN otherwise, sooner or later they will cause an attack of cholelithiasis.

Drug treatment of gallstone disease is primarily aimed at eliminating the expression large quantity unpleasant symptoms of such a disorder, which may have varying degrees intensity. To remove stones large sizes used only surgical intervention. However, if sand or stones were found during diagnosis small sizes in the gallbladder or bile ducts, they are often tried to dissolve them with medications.

Despite this, drug dissolution of stones is possible only if cholesterol levels are detected. gallstones volumes up to fifteen millimeters. In addition, the course of the disease should be accompanied by normal contractile function gallbladder, as well as the patency of the biliary tract.

However, there are several contraindications to drug therapy for gallstone disease. These include:

• bearing a child;
• breastfeeding a child;
• inflammation of the gallbladder or ducts;
• the presence of stones with a diameter exceeding two centimeters;
• diabetes;
• the presence of any stage of obesity;
• ulcerative lesions of the duodenum or stomach;
• chronic pancreatitis;
• tumor of this organ;
• detection during instrumental diagnostic measures of multiple stones that occupy more than fifty percent of the total volume of the gallbladder.

In most cases, the following groups of drugs are prescribed for gallstone disease:

• choleretic substances;
• ursodeoxycholic acid;
• antispasmodics;
• antibiotics;
• anti-inflammatory and painkillers.

Choleretic drugs

One of the most effective choleretic substances is Allochol, which consists of the following herbal components:

• nettle;
• garlic;
• Activated carbon;
• dry animal bile.

The drug exists in several forms - syrup and tablets.

The properties of Allochol include:

• acceleration of bile secretion in the duodenum, which helps stimulate intestinal motility;
• preventing the accumulation of large amounts of cholesterol, which prevents the formation of new stones;
• elimination of the inflammatory process in the gallbladder and its ducts;
• reduction of intoxication of the body with bile acids - such medicinal effect achieved thanks to activated carbon.

Indications this medicine are:

• chronic constipation, which is caused by impaired intestinal motility and insufficient bile secretion;
• inflammatory process in the bile ducts and walls of the gallbladder.

There are also several contraindications to taking Allochol for cholelithiasis:

• closure of the duct with a large stone. This is what causes obstructive jaundice;
• hepatitis;
• gastritis and gastrointestinal ulcers.

The duration of therapy with this drug is approximately one month, it is best to repeat it twice a year. It must be consumed after every meal.

In addition to Allohol to the group choleretic drugs can be attributed:

• Urolesan – consists of natural ingredients. Contraindications are: allergic reaction on any component of the medicine, gastritis or ulcer, the size of the stones is more than three millimeters;
• Holosas – based on rosehip. Contraindications – diabetes or allergies;
• Flamin is a drug based on immortelle. Contraindications include: high performance HELL;
• Holagol is an extract of curcuma longa rhizomes, emodin from buckthorn. Prohibited for use if there is a violation of the blood clotting process, blockage of the bile duct, patients under sixteen years of age, or the presence of renal or liver failure.

Antispasmodics

A disease such as cholelithiasis in all cases is accompanied by severe pain, which often spreads to other areas of the abdomen, so taking painkillers is important.

In almost all cases, doctors prescribe No-shpa to their patients, which also has several analogues:

• Bespa;
• Drotaverine;
• Nosh-pa forte;
• Spazoverine;
• Pakovin;
• Spasmol;
• Spasmalgon.

These drugs eliminate spasm of smooth muscles that occurs due to damage to the ducts by stones.

The drug exists in several forms - tablets and solutions for injection. It can be taken during pregnancy or breastfeeding baby.

Among the undesirable situations for use it is worth highlighting:

• individual intolerance;
• acute nature of renal or liver failure;
• small syndrome cardiac output, which causes heart failure.

Another effective remedy to treat gallstone disease - Duspatalin. It acts selectively on the smooth muscles of the gastrointestinal tract. You should take it one tablet at a time.

Contraindications for use are:

• the patient's age is up to twelve years;
• individual intolerance;
• dysfunction of the liver and kidneys.

Spazmalgon is often used, which is indicated during exacerbation of the disease.

It is contraindicated in the following conditions:

• intestinal obstruction;
• bronchial asthma;
• decreased blood pressure;
• arrhythmia.

Anti-inflammatory and painkillers

Non-steroidal anti-inflammatory substances are used to treat gallstone disease. They are often prescribed for relapses of the disease.

The list of such drugs includes:

• Paracetamol and its analogues;
• Ibuprofen and Nurofen;
• Analgin;
• Diclofenac;
• Indomethacin.

In cases of exacerbation of the symptoms of the disease, you can take any of the above substances, but always after meals.

Strict contraindications include:

• ulcerative lesion;
• liver or kidney failure.

Ursodeoxycholic acid

Ursofalk is a fairly new drug based on ursodeoxycholic acid (a natural component of bile). Analogues of such a substance can be:

• Holacid;
• Destolite;
• Urdoxa;
• Solutrate;
• Ursahol;
• Urososan;
• Urzofalk.

The action of the substance is aimed at:

• decreased cholesterol formation;
• prevention of stone formation;
• dilution of bile;
• splitting existing stones;
• improving the functioning and protection of the liver.

Contraindications include:

• pregnancy and breastfeeding;
• allergic reaction to the components of the drug;
• acute cholecystitis;
• liver damage by cirrhosis;
• obstruction of the ducts;
• presence of cholangitis.

Antibiotics

Antibiotics should be used only when indicated. In preventive measures against cholelithiasis, such medications are not only ineffective, but can also be harmful.

Indications for use antibacterial agents are:

• development of an inflammatory process in the gallbladder or duct;
• recovery after surgery to remove the gallbladder.

The course of antibiotic therapy ranges from five to nine days. In such treatment, it is very important not to skip taking the drug.

Treatment regimens

All of the above drugs are used for exacerbation and remission of the disease.

In case of exacerbation, a regimen from the following groups of drugs is prescribed:

• antispasmodics;
• non-steroidal anti-inflammatory drugs;
• antibiotics.

During the remission phase, the treatment regimen will consist of:

• choleretic substances;
• Ursofalka.

To prevent the disease, such enzyme substances are used, in particular Mezim and Festal.

It is worth noting that patients should not wait positive effect from medication treatment of cholelithiasis in cases of addiction to junk food or bad habits.

It is important to remember that it is best not to make independent attempts to eliminate symptoms and small stones, but rather to consult a specialist in a medical facility. Since only after laboratory and instrumental diagnostics will the doctor be able to establish the daily dosage and duration of taking this or that medicinal product individually for each patient.

Similar materials

Treatment of cholelithiasis with folk remedies is considered effective technique eliminating symptoms, sand and small stones. In most cases, a person does not suspect that he has such a disease, which is why the onset of symptoms occurs abruptly and unexpectedly. Against this background, it is necessary to carry out surgical intervention as soon as possible, aimed at removing large stones, and, if necessary, the gallbladder itself.

Cholelithiasis is a disease of the gallbladder and bile ducts with the formation of stones. Although, correct name the medical term is “cholelithiasis” - ICD-10 code: K80. The disease is complicated by poor liver function, hepatic colic, cholecystitis (inflammation of the gallbladder) and may cause obstructive jaundice with the need surgery to remove the gallbladder.

Today we will look at the causes, symptoms, signs, exacerbation, treatment of cholelithiasis without surgery using medical and folk remedies, what to do in case of an attack of pain, when surgery is needed. We’ll especially talk about the patients’ nutrition (diet), menus, what foods can and cannot be eaten during treatment without surgery and after it.

What it is?

Gallstone disease is pathological process, in which stones (calculi) form in the gallbladder and ducts. Due to the formation of stones in the gall bladder, the patient develops cholecystitis.

How gallstones form

The gallbladder is a reservoir for bile produced by the liver. The movement of bile along the biliary tract is ensured by the coordinated activity of the liver, gallbladder, common bile duct, pancreas, and duodenum. This ensures the timely entry of bile into the intestines during digestion and its accumulation in the gallbladder on an empty stomach.

The formation of stones in it occurs due to changes in the composition and stagnation of bile (dyscholia), inflammatory processes, motor-tonic disorders of bile secretion (dyskinesia).

There are cholesterol (up to 80-90% of all gallstones), pigment and mixed stones.

1. The formation of cholesterol stones is facilitated by the oversaturation of bile with cholesterol, its precipitation, and the formation of cholesterol crystals. If the motility of the gallbladder is impaired, the crystals are not excreted into the intestines, but remain and begin to grow.
2. Pigment (bilirubin) stones appear as a result of increased breakdown of red blood cells during hemolytic anemia.
3. Mixed stones are a combination of both forms. Contains calcium, bilirubin, cholesterol.

They occur mainly in inflammatory diseases of the gallbladder and bile ducts.

Risk factors

There are several reasons for the occurrence of cholelithiasis:

• excess secretion of cholesterol into bile
• decreased secretion of phospholipids and bile acids into bile
• bile stagnation
• biliary tract infection
• hemolytic diseases.

Most gallstones are mixed. They include cholesterol, bilirubin, bile acids, proteins, glycoproteins, various salts, and trace elements. Cholesterol stones contain mainly cholesterol and are round or oval shape, layered structure, diameter from 4–5 to 12–15 mm, localized in the gallbladder.

1. Cholesterol-pigment-calcareous stones are multiple, have edges, and have different shapes. They vary significantly in quantity - tens, hundreds and even thousands.
2. Pigment stones are small in size, multiple, hard, fragile, completely homogeneous, black in color with a metallic tint, located both in the gallbladder and in the bile ducts.
3. Calcium stones consist of various calcium salts, have a bizarre shape, have spiky processes, and are light or dark brown in color.

Epidemiology

According to numerous publications throughout the 20th century, especially its second half, there was a rapid increase in the prevalence of cholelithiasis, mainly in industrialized countries, including Russia.

Thus, according to a number of authors, the incidence of cholelithiasis in the former USSR almost doubled every 10 years, and stones in the bile ducts were detected at autopsies in every tenth person who died, regardless of the cause of death. At the end of the 20th century, more than 5 million and in the USA more than 15 million patients with cholelithiasis were registered in Germany, and about 10% of the adult population suffered from this disease. According to medical statistics, cholelithiasis occurs in women much more often than in men (ratio from 3:1 to 8:1), and with age the number of patients increases significantly and after 70 years reaches 30% or more in the population.

The increasing surgical activity for cholelithiasis observed throughout the second half of the 20th century has led to the fact that in many countries the frequency of biliary tract operations has surpassed the number of other abdominal operations (including appendectomy). Thus, in the USA in the 70s, more than 250 thousand cholecystectomies were performed annually, in the 80s - more than 400 thousand, and in the 90s - up to 500 thousand.

Classification

Based on the characteristics of the disease accepted today, the following classification is distinguished in accordance with the stages relevant to it:

1. Stone formation is a stage that is also defined as latent stone formation. IN in this case There are no symptoms of cholelithiasis, but the use instrumental methods diagnostics allows you to determine the presence of stones in the gallbladder;
2. Physico-chemical (initial) stage - or, as it is also called, the pre-stone stage. It is characterized by changes occurring in the composition of bile. There are no special clinical manifestations at this stage; detection of the disease at the initial stage is possible, for which it is used biochemical analysis bile on the features of its composition;
3. Clinical manifestations are a stage whose symptoms indicate the development of an acute or chronic form of calculous cholecystitis.

In some cases, a fourth stage is also distinguished, which consists of the development of complications associated with the disease.

Symptoms of gallstone disease

In principle, cholelithiasis can occur for a very long time without any symptoms or manifestations. This is explained by the fact that the stones in the early stages are small, do not clog the bile duct and do not injure the walls. The patient can long time not even suspect that he has this problem. In these cases, they usually talk about stone-carrying. When gallstone disease itself makes itself felt, it can manifest itself in different ways.

Among the first symptoms of the disease, heaviness in the abdomen after eating, stool disturbances (especially after eating fatty foods), nausea and moderate jaundice should be noted. These symptoms may appear even before severe pain in the right hypochondrium - the main symptom of cholelithiasis. They are explained by unexpressed disturbances in the outflow of bile, which makes the digestion process worse.

Most characteristic of cholelithiasis following symptoms and signs:

1. Temperature increase. An increase in temperature usually indicates acute cholecystitis, which often accompanies cholelithiasis. An intense inflammatory process in the area of ​​the right hypochondrium leads to release into the blood active substances, contributing to a rise in temperature. Prolonged pain after colic accompanied by fever almost always indicates acute cholecystitis or other complications of the disease. A periodic increase in temperature (wavy) with a rise above 38 degrees may indicate cholangitis. However, in general, fever is not a mandatory symptom of gallstone disease. The temperature may remain normal even after severe, prolonged colic.
2. Pain in the right hypochondrium. The most typical manifestation of cholelithiasis is the so-called biliary (biliary, hepatic) colic. This is an attack acute pain, which in most cases is localized at the intersection of the right costal arch and the right edge of the rectus abdominis muscle. The duration of an attack can vary from 10–15 minutes to several hours. At this time, the pain can be very severe, radiating to the right shoulder, back or other areas of the abdomen. If an attack lasts more than 5–6 hours, then you should think about possible complications. The frequency of attacks may vary. Often, about a year passes between the first and second attack. However, in general, they become more frequent over time.
3. Fat intolerance. IN human body bile is responsible for the emulsification (dissolution) of fats in the intestines, which is necessary for their normal breakdown, absorption and assimilation. With cholelithiasis, stones in the cervix or bile duct often block the path of bile to the intestines. As a result, fatty foods are not broken down normally and cause intestinal disturbances. These disorders can manifest as diarrhea (diarrhea), accumulation of gases in the intestines (flatulence), and mild abdominal pain. All these symptoms are nonspecific and can occur with various diseases Gastrointestinal tract ( gastrointestinal tract). Intolerance to fatty foods can also occur at the stone-carrying stage, when other symptoms of the disease are still absent. At the same time, even a large stone located at the bottom of the gallbladder may not block the flow of bile, and fatty foods will be digested normally.
4. Jaundice. Jaundice occurs due to stagnation of bile. The pigment bilirubin is responsible for its appearance, which is normally secreted with bile into the intestines, and from there is excreted from the body with feces. Bilirubin is a natural metabolic product. If it ceases to be excreted in the bile, it accumulates in the blood. This is how it spreads throughout the body and accumulates in tissues, giving them a characteristic yellowish tint. Most often, the sclera of the eyes turn yellow in patients first, and only then the skin. In fair-skinned people, this symptom is more noticeable, but in dark-skinned people, unexpressed jaundice may even be missed experienced doctor. Often, simultaneously with the appearance of jaundice, patients' urine also darkens (dark yellow, but not brown color). This is explained by the fact that the pigment begins to be released from the body through the kidneys. Jaundice is not a mandatory symptom of calculous cholecystitis. Also, it does not appear only with this disease. Bilirubin can also accumulate in the blood due to hepatitis, liver cirrhosis, some hematological diseases or poisoning.

In general, the symptoms of cholelithiasis can be quite varied. Meet various disorders chair, atypical pain, nausea, periodic bouts of vomiting. Most doctors are aware of this variety of symptoms, and just in case, they prescribe an ultrasound of the gallbladder to exclude cholelithiasis.

Attack of cholelithiasis

An attack of cholelithiasis usually means biliary colic, which is the most acute and typical manifestation of the disease. Stone carriage does not cause any symptoms or disorders, and patients usually do not attach importance to mild digestive disorders. Thus, the disease proceeds latently (hidden).

Biliary colic usually appears suddenly. Its cause is a spasm of smooth muscles located in the walls of the gallbladder. Sometimes the mucous membrane is also damaged. Most often this happens if the stone moves and gets stuck in the neck of the bladder. Here it blocks the outflow of bile, and bile from the liver does not accumulate in the bladder, but flows directly into the intestines.

Thus, an attack of cholelithiasis usually manifests itself as characteristic pain in the right hypochondrium. At the same time, the patient may experience nausea and vomiting. Often the attack occurs after sudden movements or stress or after eating a large amount of fatty foods. Once during an exacerbation, stool discoloration may be observed. This is explained by the fact that pigmented (colored) bile from the gallbladder does not enter the intestine. Bile from the liver flows only in small quantities and does not give intense color. This symptom called acholia. In general, the most typical manifestation of an attack of cholelithiasis is characteristic pains, which will be described below.

Diagnostics

Identification of symptoms characteristic of hepatic colic requires consultation with a specialist. The physical examination carried out by him means identifying symptoms characteristic of the presence of stones in the gallbladder (Murphy, Ortner, Zakharyin). In addition, a certain tension and soreness of the skin is detected in the area of ​​the abdominal wall muscles within the projection of the gallbladder. The presence of xanthomas (yellow spots on the skin formed against the background of a disorder in the body's lipid metabolism) is also noted, and yellowness of the skin and sclera is noted.

The results of a general blood test determine the presence of signs indicating nonspecific inflammation at the stage clinical exacerbation, which in particular consist of moderation increasing ESR and in leukocytosis. At biochemical research blood is determined by hypercholesterolemia, as well as hyperbilirubinemia and increased activity, characteristic of alkaline phosphatase.

Cholecystography, used as a method for diagnosing cholelithiasis, determines the enlargement of the gallbladder, as well as the presence of calcareous inclusions in the walls. In addition, in this case, the stones with lime inside are clearly visible.

The most informative method, which is also the most common in the study of the area of ​​interest to us and for the disease in particular, is ultrasound of the abdominal cavity. When examining the abdominal cavity in this case, accuracy is ensured regarding the identification of the presence of certain echo-proof formations in the form of stones in combination with pathological deformations to which the walls of the bladder are exposed during the disease, as well as with changes that are relevant in its motility. Signs indicating cholecystitis are also clearly visible on ultrasound.

Visualization of the gallbladder and ducts can also be performed using MRI and CT techniques for this purpose in specifically indicated areas. Scintigraphy, as well as endoscopic retrograde cholangiopancreatography, can be used as an informative method indicating disturbances in the processes of bile circulation.

Drug treatment of gallstone disease

Treatment of cholelithiasis without surgery is used in the presence of cholesterol gallstones (X-ray negative) up to 15 mm in size with preserved contractility of the gallbladder and patency of the cystic duct.

Contraindications for drug dissolution of gallstones:

• inflammatory diseases small and large intestines;
• obesity;
• pregnancy;
• “disabled” - non-functioning gallbladder;
• acute inflammatory diseases of the gallbladder and biliary tract;
• stones with a diameter of more than 2 cm;
• liver diseases, diabetes mellitus, peptic ulcer stomach and duodenum, chronic pancreatitis;
• pigment or carbonate stones;
• gallbladder cancer;
• multiple stones that occupy more than 50% of the volume of the gallbladder.

Ursodeoxycholic acid preparations are used, the action of which is aimed at dissolving only cholesterol stones, the drug is taken for 6 to 24 months. But the probability of relapse after the stones dissolve is 50%. The dosage of the drug and duration of administration are determined only by a general practitioner or gastroenterologist. Conservative treatment only possible under medical supervision.

Shock wave cholelithotrepsia is treatment by crushing large stones into small fragments using shock waves, followed by taking bile acid preparations (ursodeoxycholic acid). The chance of relapse is 30%.

Gallstone disease can be asymptomatic or minimally symptomatic for a long time, which creates certain difficulties in identifying it in the early stages. This is the reason for late diagnosis, at the stage of already formed gallstones, when the use conservative methods Treatment is limited and surgery remains the only treatment option.

Treatment with folk remedies for cholelithiasis

I will give an example of several recipes for dissolving stones. There are a large number of them.

1. Green tea. Drink as a preventive measure against cholelithiasis, since green tea prevents stone formation.
2. Lingonberry leaves. The leaves of this plant help dissolve gallstones. Pour a glass of boiling water over 1 tablespoon of dried lingonberry leaves and leave for 20-30 minutes. Take 2 tablespoons 4-5 times a day.
3. Ivan-tea or narrow-leaved willowherb. Brew 2 tablespoons of dry fireweed leaves in a thermos, pour boiling water (0.5 l). Leave for 30 minutes. Drink 100 ml of tea an hour before meals three times a day for six months. You can infuse the same brew as long as the tea has color. Consult a doctor before use, as stones may be dislodged.

The main thing in treating cholelithiasis with folk remedies is to make sure that you have cholesterol stones that can be dissolved. To do this, you need to undergo an ultrasound (the stones are visible) and an x-ray (cholesterol stones are not visible).

After this, visit a herbalist and choose the most effective combination herbs for your case. In parallel with the use folk remedies, it is necessary to adhere to the principles rational nutrition- sometimes only a change in diet allows you to get rid of small cholesterol stones. It is also necessary to devote time to physical activity - walking, a little exercise in the morning - that is, move more.

Diet for gallstone disease

It is necessary to limit or exclude from the diet fatty, high-calorie, cholesterol-rich foods, especially when hereditary predisposition to cholelithiasis. Meals should be frequent (4-6 times a day), in small portions, which helps reduce stagnation of bile in the gallbladder. Food must contain sufficient amounts dietary fiber, due to vegetables and fruits. You can add food bran (15g 2-3 times a day). This reduces the lithogenicity (propensity to form stones) of bile.

The therapeutic diet for gallstone disease lasts from 1 to 2 years. Following a diet is the best prevention of exacerbations of cholelithiasis, and if you do not adhere to it, severe complications may develop.

The consequences of non-compliance include: the occurrence of atherosclerosis, the appearance of constipation, which is dangerous due to stones in the bladder, increased load on the gastrointestinal tract and increased bile density. A therapeutic diet will help you cope with overweight, improve intestinal microflora and protect the immune system. As a result, a person’s mood improves and sleep normalizes.

In severe cases, non-compliance with the diet leads to ulcers, gastritis, and colitis. If you want to recover from pathology without surgery, then diet is a primary requirement.

Operation

Patients should undergo elective surgery before the first attack of biliary colic or immediately after it. This is due to the high risk of complications.

After surgical treatment it is necessary to observe individual diet regimen(frequent, split meals with limitation or exclusion of individually intolerant foods, fatty, fried foods), adherence to work and rest regime, physical education. Avoid drinking alcohol. Maybe Spa treatment after surgery, subject to stable remission.

Complications

The appearance of stones is fraught not only with disruption of organ functions, but also with the occurrence of inflammatory changes in the gallbladder and nearby organs. So, because of the stones, the walls of the bladder can be injured, which, in turn, provokes inflammation. If the stones pass through the cystic duct with bile from the gallbladder, the flow of bile may be obstructed. In the most severe cases, stones can block the entrance and exit of the gallbladder, becoming lodged in it. With such phenomena, stagnation of bile occurs, and this is a prerequisite for the development of inflammation. The inflammatory process can develop over several hours and over several days.

Under such conditions, the patient may develop an acute inflammatory process of the gallbladder. In this case, both the degree of damage and the rate of development of inflammation can be different. Thus, both slight swelling of the wall and its destruction and, as a consequence, rupture of the gallbladder are possible. Such complications of cholelithiasis are life-threatening. If the inflammation spreads to the abdominal organs and peritoneum, the patient develops peritonitis. As a result, infectious-toxic shock and multiple organ failure can become a complication of these phenomena. In this case, disruption of the functioning of blood vessels, kidneys, heart, and brain occurs. At severe inflammation and the high toxicity of microbes multiplying in the affected wall of the gallbladder, infectious-toxic shock can appear immediately.

In this case, even resuscitation measures do not guarantee that the patient will be able to be brought out of this state and death will be avoided.

Prevention

To prevent the disease, it is useful to carry out the following activities:

• do not practice long-term therapeutic fasting;
• To prevent cholelithiasis, it is useful to drink enough fluid, at least 1.5 liters per day;
• in order not to provoke the movement of stones, avoid work associated with prolonged stay in an inclined position;
• follow a diet, normalize body weight;
• increase physical activity, give the body more movement;
• eat more often, every 3-4 hours, to cause regular emptying of the bladder from accumulated bile;
• Women should limit their intake of estrogen; this hormone promotes the formation of stones or their enlargement.

For the prevention and treatment of cholelithiasis, it is useful to include daily diet a small amount of(1-2 tsp.) vegetable oil, better than olive. Sunflower is only 80% digestible, while olive oil is completely digestible. It is also more suitable for frying as it produces fewer phenolic compounds.

The intake of vegetable fat stimulates the activity of the bile bladder, as a result of which it is able to empty itself at least once a day, preventing congestion and stone formation.

To normalize metabolism and prevent cholelithiasis, it is worth including magnesium in your diet. The microelement stimulates intestinal motility and bile production, removes cholesterol. In addition, sufficient zinc intake is necessary for the production of bile enzymes.

If you have cholelithiasis, it is better to stop drinking coffee. The drink stimulates the contraction of the bladder, which can cause blockage of the duct and a subsequent attack.

ZhKB is a well-known abbreviation, and medical term sounds like cholelithiasis - from the words hole (bile) and litos (stone). That is, the transformation of stagnant bile into stone-like formations. What entails complete obstruction of the bile duct and the impossibility of functioning of the hepato-biliary apparatus digestive tract. It has characteristic symptoms and typical complications.

The epidemiology of cholelithiasis has been studied and illustrates that women are more often affected, in almost 60-70% of cases; those who have given birth more than once suffer from the disease especially often. The age when the frequency of diagnosis and treatment increases is after 35-40 years. Registration of cholelithiasis, conservative or surgical treatment - observed in 10% of the population. And the statistical share of this disease is growing every decade in all countries of the world. Moreover, cholecystectomy (removal of the gallbladder) in some countries in industrial regions exceeds the number of appendectomies (removal of the appendix).

Predisposing factors for the development of gallstone disease

Exogenous factors:

• physical inactivity, lack of regular necessary for the body physical activity;
• constitutional factor - average pyknic physique with a tendency to gain weight in women and men;
• irregular unbalanced diet, excess fried and fatty foods, abuse of spices and alcohol. Excessive consumption of meat and meat by-products, canned food and spicy seasonings;
• frequent diets and fasting courses with non-compliance with the rules.

Endogenous factors:

• congenital anomalies of the anatomy of the gallbladder and its duct - bends, narrowings, hypotension and cysts;
• hereditary predisposition;
• violation fat metabolism and diseases endocrine system(diabetes);
• chronic diseases of the gastrointestinal tract - gastritis, duodenitis, colitis, cholecystitis. Hepatosis and cirrhosis;
• chronic liver diseases and consequences of viral hepatitis (A, B and C);
• hemolytic anemia, due to increased breakdown of red blood cells, causes overload of the gallbladder.

Pathogenesis

The pathogenesis of cholelithiasis is divided into the stages of stone formation. It is the mechanism and staged nature of the violation of the composition of bile towards the pathological ratio of its components, changes in its density and evacuation rate that determine the mechanism of development of cholelithiasis. In the initial stage of the disease, there is an accumulation of bile, its thickening and the formation of biliary sludge. This is usually caused by pregnancy or climacteric changes in women, a sudden change in diet or incorrect sports nutrition in men, excessive use of dietary supplements and diet for weight loss.

According to the time and mechanism of occurrence, gallstones are distinguished:

• Primary– accumulating and forming slowly, evenly, without accompanying clinical signs and symptoms of gallbladder dysfunction. Their share in the total mass of gallstones is 70%. They consist of dry bile residue (calcium salts and bile pigments) and are mainly localized directly in the gallbladder.
• Secondary– the result of dysfunction of the hepatobiliary mechanism, due to obstruction of the ducts by primary stones. Their presence is accompanied by clinical signs - cholestasis, “jaundice”, enzymatic deficiency, reflux. And the consequences of cholelithiasis are cholecystitis and biliary pancreatitis. The structure of such stones is saturated with cholesterol; they fill not only the bladder itself, but also large and small bile and hepatic ducts. Calcification occurs with the help of calcium salts exuded with inflammatory exudate.

The causes of gallstone disease determine the composition of bile and the predominance of individual elements in it, depending on this stones are classified:

• limestone with excess cholesterol;
• mixed - pigment-calcareous, with a core of bilirubin and a surrounding cholesterol mass;
• pigmented, in which bilirubin predominates. They are predominantly primary stones that occur after hemolytic anemia.

Morphological diversity is observed in the contents of one gallbladder:

1. structures (wavy, layered, amorphous);
2. shapes (spherical, oval, subulate);
3. size (from fine sand to 70 gram formations).

The clinical picture appears 7-10 years from the onset of morphological changes in the gallbladder itself. Gallstone disease, the symptoms of which are characteristic and pathognomic, can also occur in a latent form. When the compensatory mechanisms of the hepato-biliary system are still working and the stones are small in size.

There are three main symptom complexes:

• Biliary (biliary) colic– a sharp, sudden paroxysmal encircling unbearable pain, due to an obstruction of the outflow of bile from the cholecyst or common bile duct. By nature it is associated with strong pricks or stings. With irradiation the right half lower jaw, subclavian and scapular region, lower back and sternum. Retrosternal pain with its clinical coloring can simulate angina pectoris; such a false sign is called Botkin’s cholecystocoronary symptom. The pain syndrome is accompanied by a violation general condition, according to the type of painful shock - weakness, sweating, pallor, confusion.
• Dyspeptic syndrome manifests all indirect signs of cholelithiasis. Heaviness and distension in the stomach and right hypochondrium, nausea and vomiting, heartburn with belching, flatulence and loose stool. Digestion of food. Hypo- and vitamin deficiencies. Quick satiety and indigestion from multi-component complex dishes.
• Obstructive syndrome – clinical manifestations obstructive jaundice: constant subfebrile body temperature with rare rises to 38º, yellowing of the skin, total itching followed by long-lasting marks from scratching. Fatigue, irritability, mood swings, emotional lability, sleep disturbances. Allergic alertness to household chemicals or pet hair.

data driven ultrasound examination, which with high verification shows the location, size, shape and number of gallstones.
Additional methods for studying the degree and severity functional disorders, the presence of complications of gallstone disease are:

• cholecystoangiography;
• retrograde cholangiopancreatography;
• computed tomography or magnetic resonance imaging.

Laboratory tests are required:

1. blood - biochemical and general analysis, markers on viral hepatitis, assessment of lipid metabolism;
2. urine analysis for bile pigments, sugar;
3. coprogram.

Treatment

Treatment of cholelithiasis is varied and multi-stage, depending on the stage of the disease. If there are no acute indications for surgery, conservative or minimally invasive treatment is traditionally undertaken.

Conservative treatment

1. Nutrition correction according to the Pevzner system - diet N5. Excluding fatty, salty and sickly sweet, spicy and fried foods. Food is prepared by boiling, stewing, and baking. The consumption of cold drinks and chilled foods is not recommended. Excluded from the diet raw vegetables and fruits, carbonated and alcoholic drinks. Frequent and small meals and increased fluid intake to 1.5 liters per day are encouraged. The purpose of the diet is to provide the body with balanced and proper nutrition and, if possible, if necessary, to reduce body weight.
2. Drug treatment:
   • Therapy specific drugs, which are natural bile acids– urodeoxycholic (Urosan) and chenodeoxycholic acids. By their action, they reduce the synthesis and increase the absorption of cholesterol in the intestines, stimulate the formation and evacuation of bile. They cause dilution of bile and hypersecretion of pancreatic and gastric enzymes. Reduce blood sugar levels. They have an immunomodulatory and immunocorrective effect, potentiating an increase in the number of lymphocytes and a decrease in the percentage of eosinophils. Treatment with bile acids is indicated in the initial stage of cholelithiasis with a documented accumulation of sludge over 3 months, the appearance of characteristic symptoms and the failure of nutritional correction. If the stones are no more than 20 mm, they are predominantly cholesterol. The duration of treatment is 1-2 years with monitoring every 6 months to assess the effectiveness of treatment. After this treatment method, relapses of cholelithiasis cannot be excluded, therefore regular monitoring of the function of the hepato-biliary system is recommended for 3 years.
   • Taking antispasmodics aimed at relieving inflammatory contractures and relaxing muscle fibers sphincter, to improve the outflow of accumulated thick stagnant bile. The drugs used are duspatalin (mebeverine) and diceteline (pinaverine bromide).
   • Enzyme replacement therapy prescribed when chronic course diseases, the presence of signs of dysfunction of the pancreas and duodenum. The following drugs are used: Creon, pancreazemin, licreaz, pancitrate, pensital.
   • Prophylactic antibiotic therapy– azithromycin (sumamed), ampiox, ciprofloxacin, imipinem, metronidazole, fluoroquinolones, rifaxin.
   • Must apply probiotics– Duphalac (lactulose).
   • Antacids– omeprazole, gastal, maalox, renu, phospholugel.
   • Bioactive additives and herbal remedies for the restoration of liver cells (hepatoprotectors) - hepabene, artichoke preparations, rose hips.
3. is used if the tone of the gallbladder is preserved and the total total diameter and number of stones is no more than 30 mm and 3 pieces. The duration of the disease does not exceed 2 years. The effectiveness of this method depends on the uniformity and quality of the structure of the stones and their composition, therefore the success rate is quite small.
4. Endoscopic sphincterotomy (papillosphicterotomy)– dissection of the duodenal papilla to facilitate outflow and improve the quality evacuation of bile from the gallbladder. It is performed by inserting an endoscope through the oral cavity and esophagus.

Surgery

Surgical treatment methods are indicated for clinically and diagnostically documented complications of cholelithiasis:

• frequent, intensifying attacks of cholelithiasis, difficult to stop;
• large stone formations occupying more than a third of the bladder volume;
• severe hypotension of the gallbladder, danger of swelling or suppuration (empyema);
• the appearance of biliary fistulas, signs of penetration and perforation;
• diagnosed biliary pancreatitis with frequent gastroduodenoesophageal refluxes leading to repeated vomiting;
• Mirizzi syndrome - blockage of the large and hepatic duct from external compression of stones accumulated in the common bile duct and gall bladder;
• clinically significant obstructive jaundice in severe form;
• risk of peritonitis.

Laparoscopic interventions using special instruments inserted through 4-5 holes with a diameter of 1 cm. Thanks to this, rapid recovery period and a minimum of postoperative complications.
There are:

• cholecystectomy;
• cholecystolithotomy.

The classic laparotomy method in Berlin is still used quite actively, with access through a dissected abdominal wall. In the presence of large dense stones, signs of peritonitis, extensive adhesions and congenital anatomical failure of the gallbladder or its duct.

A common consequence of any surgical treatment is postcholecystectomy syndrome - signs of cholelithiasis persist in a mild, low-intensity form.

Alternative medicine

offers traditional methods treatment of gallstone disease itself, its consequences and postoperative phantom phenomena.

Bolotov method:

1. Taking black radish juice to dissolve gallstones and have a choleretic effect. The juice is squeezed from unpeeled black radish tubers and taken 1 teaspoon after meals, with gradual increase up to 2 tablespoons. Upon completion of the course of taking 3 liters of juice, the cake remaining after squeezing the juice is used. It is mixed with whey and honey or sugar to taste. Such courses are recommended 1-2 times a year. Confirmation from the attending physician is required regarding the admissibility of this treatment method. During the intake process, it is important to monitor your feelings.
2. Using poultry bile - fresh chicken, duck, turkey or goose.