Crushing gallstones as a method of treating gallstones. Gallstone disease - what is it? When is surgery needed for gallstone disease?

Chronic calculous cholecystitis is a disease in which stones form in the cavity of the gallbladder, which subsequently cause inflammation of the walls of the bladder.

Cholelithiasis It is a common disease and occurs in 10-15% of the adult population. In women, this disease occurs 2-3 times more often than in men. Cholecystitis is an ancient human disease. The first gallstones were discovered during the study of Egyptian mummies.

Anatomy and physiology of the gallbladder

The length of the gallbladder is from 5 to 14 centimeters, and the capacity is 30-70 milliliters. The bladder has a bottom, body and neck.

The wall of the gallbladder consists of mucous, muscular, and connective tissue membranes. The mucosa consists of epithelium and various glandular cells. The muscularis propria consists of smooth muscle fibers. At the cervix, the mucous and muscular membranes form a sphincter, which prevents the release of bile at inappropriate times.

The bladder neck continues into the cystic duct, which then merges with the common hepatic duct to form the common bile duct.
The gallbladder is located on the lower surface of the liver so that the wide end of the bladder (bottom) extends somewhat beyond the lower edge of the liver.

The function of the gallbladder is the accumulation, concentration of bile and release of bile as needed.
The liver produces bile and when it is not needed, the bile accumulates in the gallbladder.
Once bile enters the bladder, it is concentrated by absorption of excess water and microelements by the epithelium of the bladder.

Bile secretion occurs after eating. The muscle layer of the bladder contracts, increasing the pressure in the gallbladder to 200-300 mm. water column. Under the influence of pressure, the sphincter relaxes, and bile enters the cystic duct. The bile then enters the common bile duct, which opens into the duodenum.

The role of bile in digestion

Bile in the duodenum creates the necessary conditions for the activity of enzymes found in pancreatic juice. Bile dissolves fats, which promotes further absorption of these fats. Bile is involved in the absorption of vitamins D, E, K, A in the small intestine. Bile also stimulates the secretion of pancreatic juice.

Causes of development of chronic calculous cholecystitis

Constant factors:

• Floor. Most often, women get sick due to taking contraceptives, childbirth (estrogens, which are increased during pregnancy, increase the absorption of cholesterol from the intestines and its abundant excretion in the bile).
• Age. People aged 50 to 60 years are more likely to suffer from cholecystitis.
• Genetic factors. These include family predisposition and various congenital anomalies of the gallbladder.
• Ethnic factor. The largest number of cases of cholecystitis is observed among Indians living in the southwestern United States and among the Japanese.

• Nutrition . Increased consumption of animal fats and sweets, as well as hunger and rapid weight loss can cause cholecystitis.
• Obesity. The amount of cholesterol in the blood and bile increases, which leads to the formation of stones
• Diseases of the gastrointestinal tract. Crohn's disease, resection (removal) of part of the small intestine
• Medications. Estrogens, contraception, diuretics (diuretics) – increase the risk of cholecystitis.
• Physical inactivity (immobile, sedentary lifestyle)
• Decreased muscle tone of the gallbladder

How are stones formed?

First phase– disturbance in the ratio of cholesterol and solvents (bile acids, phospholipids) in bile.
In this phase, there is an increase in the amount of cholesterol and a decrease in the amount of bile acids.

Increased cholesterol occurs due to disruption of various enzymes.
- decreased hydroxylase activity (affects cholesterol reduction)
- decreased acetyl transferase activity (converts cholesterol into other substances)
- increased breakdown of fats from the fat layer of the body (increases the amount of cholesterol in the blood).

Decline fatty acids happens by the following reasons.
- Disorders of fatty acid synthesis in the liver
- Increased secretion of bile acids from the body (impaired absorption of fatty acids in the intestine)
- Impaired intrahepatic circulation

Second phase – bile saturated with cholesterol forms bile stasis (stagnation of bile in the bladder), then the process of crystallization occurs - forming crystals of cholesterol monohydrate. These crystals stick together and form stones of varying sizes and composition.
Stones consisting of cholesterol can be single or multiple, usually round or oval in shape. The color of these stones is yellow-green. The sizes of the stones vary from 1 millimeter to 3-4 centimeters.

Bile stones are formed due to an increase in the amount of unbound, water-insoluble bilirubin. These stones are composed of various polymers of bilirubin and calcium salts.
Pigment stones are usually small in size, up to 10 millimeters. Usually there are several pieces in a bubble. These stones are black or gray.

Most often (80-82% of cases) mixed stones are found. They consist of cholesterol, bilirubin and calcium salts. The stones are always multiple in number, yellow- Brown.

Symptoms of gallstone disease

Symptoms appear only if the stone moves along the cystic canal, which leads to its blockage and inflammation.

Depending on the stage of cholelithiasis, the symptoms presented in the next section of the article are also highlighted.

Clinical stages of cholelithiasis

2. Latent stage.
At this stage, the patient does not have any complaints. There are already stones in the gallbladder. The diagnosis can be made using ultrasound.

3. Stage of onset of symptoms of the disease.
- Biliary colic is a very severe, paroxysmal and sharp pain, which lasts from 2 to 6 hours, sometimes more. Attacks of pain usually appear in the evening or at night.

The pain is in the right hypochondrium and spreads to the right shoulder blade and right cervical region. Pain most often appears after heavy, fatty foods or after heavy physical activity.

Products that may cause pain after consumption:

• Cream
• Alcohol
• Cakes
• Carbonated drinks

Other symptoms of the disease:

• Increased sweating
• Chills
• Increase in body temperature to 38 degrees Celsius
• Vomiting of bile that does not bring relief

At this stage, complications develop such as:
Acute cholecystitis– this disease requires immediate surgical intervention.

Hydrocele of the gallbladder. The cystic duct becomes blocked by a stone or narrows to the point of complete blockage of the duct. The release of bile from the bladder stops. Bile from the bladder is absorbed through the walls, and a serous-mucosal secretion is released into its lumen.
Gradually accumulating, the secretion stretches the walls of the gallbladder, sometimes to enormous sizes.

Perforation or rupture of the gallbladder leads to the development of biliary peritonitis (inflammation of the peritoneum).

Liver abscess. Limited accumulation of pus in the liver. An abscess forms after a section of the liver is destroyed. Symptoms: high temperature up to 40 degrees, intoxication, enlarged liver.
This disease can only be treated surgically.

Gallbladder cancer. Chronic calculous cholecystitis greatly increases the risk of cancer.

Diagnosis of cholelithiasis

Conversation with a doctor
The doctor will ask you about your complaints. Reveals the causes of the disease. He will dwell in particular detail on nutrition (after taking what foods do you feel unwell?). Next, he will enter all the data into the medical record and then begin the examination.

Inspection
The examination always begins with a visual examination of the patient. If the patient complains of severe pain at the time of examination, then his face will express suffering.

The patient will be in a supine position with legs bent and brought to the stomach. This is a forced position (reduces pain). I would also like to note a very important sign: when the patient turns onto his left side, the pain intensifies.

Palpation (palpation of the abdomen)
On superficial palpation, flatulence (bloating) of the abdomen is determined. It is also determined increased sensitivity in the right hypochondrium. Possible muscle tension in the abdominal area.

With deep palpation, an enlarged gallbladder can be determined (normally, the gallbladder cannot be palpated). Also, with deep palpation, specific symptoms are determined.
1. Murphy's symptom - the appearance of pain during inspiration at the moment of palpating the right hypochondrium.

2. Ortner’s symptom – the appearance of pain in the right hypochondrium when tapping (percussion) on the right costal arch.

Ultrasound of the liver and gallbladder
Ultrasonography clearly identifies the presence of stones in the gall bladder.

Signs of the presence of stones on ultrasound:
1. Presence of hard structures in the gallbladder
2. Mobility (movement) of stones
3. Ultrasonographic hypoechoic (visible in the picture as a white space) trace below the stone
4. Thickening of the gallbladder walls more than 4 millimeters

Abdominal x-ray
Stones containing calcium salts are clearly visible

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

CT scan– carried out in the diagnosis of cholecystitis and other diseases

Endoscopic cholangiopancreatography- used to determine the location of the stone in the common bile duct.

The course of chronic calculous cholecystitis
The asymptomatic form of cholecystitis lasts a long time. From the moment gallstones are identified, within 5-6 years, only 10-20% of patients begin to develop symptoms (complaints).
The appearance of any complications indicates an unfavorable course of the disease. In addition, many complications can only be treated surgically.

Treatment of cholelithiasis

In the asymptomatic stage chronic cholecystitis The main treatment method is diet.

Diet for gallstone disease

Prohibited products:

Alcoholic drinks
- legumes, in any form of preparation
- dairy products with increased fat content(cream, full fat milk)
- any fried foods
- meat from fatty varieties(goose, duck, pork, lamb), lard
- fatty fish, salted, smoked fish, caviar
- any types of canned food
- mushrooms
- fresh bread (especially hot bread), croutons
- spices, herbs, salinities, pickled foods
- coffee, chocolate, cocoa, strong tea
- salty, hard and fatty types of cheese

Cheeses can be consumed, but low-fat

Vegetables should be consumed boiled or baked (potatoes, carrots). You can eat finely chopped cabbage, ripe cucumbers, and tomatoes. Green onions, use parsley as an addition to dishes

Meat from low-fat varieties (beef, veal, rabbit), as well as (chicken and turkey without skin). Meat should be consumed boiled or baked. It is also recommended to use minced meat (cutlets)

Vermicelli and pasta are allowed

Sweet ripe fruits and berries, as well as various jams and preserves

Drinks: not strong tea, not sour juices, various mousses, compotes

Butter (30 grams) for dishes

Low-fat types of fish are allowed (pike perch, cod, pike, bream, perch, hake). It is recommended to use fish boiled, in the form of cutlets, aspic

You can use whole milk. You can also add milk to various cereals.
Non-sour cottage cheese and non-sour low-fat yoghurts are allowed

Effective treatment of cholecystitis when symptoms are present is possible only in a hospital setting!

Drug treatment of biliary colic (pain symptom)

If anticholinergics do not help, antispasmodics are used:
Papaverine 2% - 2 milliliters intramuscularly or Drotaverine (Noshpa) 2% -2 milliliters.

Baralgin 5 milliliters intramuscularly or Pentalgin also 5 milliliters are used as painkillers.
In case of very severe pain, use Promedol 2% - 1 ml.

Direct stone breaking method
The method is based on direct injection of a strong stone dissolver into the gallbladder.

Extracorporeal shock wave lithotripsy- crushing stones using the energy of shock waves created outside the human body.

This method is carried out using various devices that produce different types of waves. For example, waves created by a laser, an electromagnetic device, or a device that produces ultrasound.

Any of the devices is installed in the projection of the gallbladder, then waves from various sources act on the stones and they are crushed into small crystals.

These crystals are then freely released along with bile into the duodenum.
This method is used when the stones are no larger than 1 centimeter and when the gallbladder is still functioning.
In other cases, if symptoms of cholecystitis are present, it is recommended surgery to remove the gallbladder.

Surgical removal of the gallbladder

The first type has been used for a long time. The standard method is based on abdominal surgery (with an open abdominal cavity). IN Lately it is used less and less due to frequent postoperative complications.

The laparoscopic method is based on the use of a laparoscope apparatus. This device consists of several parts:
- video cameras with high magnification ability
- different types of tools
Advantages of method 2 over the first:
1. Laparoscopic surgery does not require large incisions. The incisions are made in several places and are very small.
2. The seams are cosmetic, so they are practically invisible
3. Performance is restored 3 times faster
4. The number of complications is ten times less

Prevention of gallstone disease

Secondary prevention consists of preventing complications. The main method of prevention is the effective treatment of chronic cholecystitis described above.

Why is gallstone disease dangerous?

Gallstone disease is dangerous primarily due to the following complications:

• Gallbladder perforation. Perforation is a rupture of the gallbladder. It can be caused by the movement of stones or too strong contraction ( spasm) smooth muscles of the organ. In this case, the contents of the organ enter the abdominal cavity. Even if there was no pus inside, the bile itself can cause serious irritation and inflammation of the peritoneum. The inflammatory process spreads to the intestinal loops and other neighboring organs. Most often, the cavity of the gallbladder contains opportunistic microbes. In the abdominal cavity, they multiply rapidly, realizing their pathogenic potential and leading to the development of peritonitis.
• Empyema of the gallbladder. Empyema is an accumulation of pus in a natural cavity of the body. With calculous cholecystitis, the stone often gets stuck at the level of the bladder neck. At first, this leads to dropsy - the accumulation of mucous secretion in the cavity of the organ. The pressure inside increases, the walls stretch, but can contract spastically. This leads to severe pain - biliary colic. If such a blocked gallbladder becomes infected, the mucus turns into pus and empyema occurs. Typically, the causative agents are bacteria from the genera Escherichia, Klebsiella, Streptococcus, Proteus, Pseudomonas, and less commonly Clostridium and some other microorganisms. They can enter through the bloodstream or ascend through the bile duct from the intestines. With the accumulation of pus, the patient's condition worsens greatly. Temperature rises, headaches intensify ( due to the absorption of breakdown products into the blood). Without urgent surgery, the gallbladder ruptures and its contents enter the abdominal cavity, causing purulent peritonitis. At this stage ( after the breakup) the disease often ends in the death of the patient, despite the efforts of doctors.
• Reactive hepatitis. The inflammatory process from the gallbladder can spread to the liver, causing its inflammation. The liver also suffers from deterioration of local blood flow. Typically, this problem ( unlike viral hepatitis) goes away quite quickly after removal of the gallbladder, the main center of inflammation.
• Acute cholangitis. This complication involves blockage and inflammation of the bile duct. In this case, the outflow of bile is disrupted by a stone stuck in the duct. Since the bile ducts connect to the pancreatic ducts, pancreatitis can develop in parallel. Acute cholangitis occurs with a strong increase in temperature, chills, jaundice, and severe pain in the right hypochondrium.
• Acute pancreatitis. Usually occurs due to lack of bile ( which does not come out of a clogged bladder) or blockage common duct. Pancreatic juice contains a large number of strong digestive enzymes. Their stagnation can cause necrosis ( death) the gland itself. This form acute pancreatitis poses a serious threat to the patient's life.
• Biliary fistulas. If gallstones do not cause severe pain, the patient can ignore them for a long time. However, the inflammatory process in the wall of the organ ( directly around the stone) is still developing. Gradually, the wall is destroyed and “soldered” to neighboring anatomical structures. Over time, a fistula may form, connecting the gallbladder to other hollow organs. Such organs can be the duodenum ( more often), stomach, small intestine, large intestine. There are also possible variants of fistulas between the bile ducts and these organs. If the stones themselves do not bother the patient, then fistulas can cause accumulation of air in the gallbladder, disruption of the outflow of bile ( and intolerance to fatty foods), jaundice, vomiting bile.
• Paravesical abscess. This complication is characterized by the accumulation of pus near the gallbladder. Usually the abscess is delimited from the rest of the abdominal cavity by adhesions that arise against the background of the inflammatory process. From above, the abscess is limited by the lower edge of the liver. The complication is dangerous due to the spread of infection with the development of peritonitis and liver dysfunction.
• Scar strictures. Strictures are places of narrowing in the bile duct that prevent the normal flow of bile. In gallstone disease, this complication can occur as a result of inflammation ( the body responds with excessive formation of connective tissue - scars) or as a consequence of an intervention to remove stones. Either way, strictures can persist even after recovery and seriously affect the body's ability to digest and absorb fatty foods. In addition, if stones are removed without removing the gallbladder, strictures can cause bile stagnation. In general, people with such narrowing of the duct are more likely to have relapses ( repeated inflammation of the gallbladder).
• Secondary biliary cirrhosis . This complication can occur if stones in the gall bladder interfere with the flow of bile for a long time. The fact is that bile enters the gallbladder from the liver. Its overflow causes stagnation of bile in the ducts in the liver itself. It can eventually lead to the death of hepatocytes ( normal cells liver) and their replacement by connective tissue, which does not perform the necessary functions. This phenomenon is called cirrhosis. The consequence is serious blood clotting disorders, disturbances in the absorption of fat-soluble vitamins ( A, D, E, K), accumulation of fluid in the abdominal cavity ( ascites), severe intoxication ( poisoning) organism.

Is it possible to cure calculous cholecystitis without surgery?

The main advantages of surgical treatment of calculous cholecystitis are:

• Radical solution to the problem. Removing the gallbladder guarantees the cessation of pain ( biliary colic), since colic appears due to contractions of the muscles of this organ. In addition, there is no threat of relapse ( repeated exacerbations) cholelithiasis. Bile will no longer be able to accumulate in the bladder, stagnate and form stones. It will flow directly from the liver to the duodenum.
• Patient safety. Nowadays endoscopic removal gallbladder ( cholecystectomy) is a routine operation. The risk of complications during surgery is minimal. If all rules of asepsis and antisepsis are observed, postoperative complications are also unlikely. The patient recovers quickly and can be discharged ( in consultation with the attending physician) just a few days after the operation. After a few months, he can lead a very normal lifestyle, apart from a special diet.
• Possibility of treating complications. Many patients turn to the doctor too late, when complications of calculous cholecystitis begin to appear. Then surgical treatment is simply necessary to remove pus, examine neighboring organs, and adequately assess the risk to life.

Nowadays, there are several methods of non-surgical treatment of calculous cholecystitis. Wherein we're talking about not about symptomatic treatment ( relieving muscle spasms, eliminating pain syndrome), namely about getting rid of stones inside the gallbladder. The main advantage of these methods is the preservation of the organ itself. If the result is successful, the gallbladder is freed from stones and continues to perform its functions of accumulating and dispensing bile.

There are three main methods of non-surgical treatment of calculous cholecystitis:

• Drug dissolution of stones. This method is perhaps the safest for the patient. The patient must take drugs based on ursodeoxycholic acid for a long time. It helps dissolve stones containing bile acids. The problem is that even to dissolve small stones, you need to take the medicine regularly for several months. If we are talking about larger stones, the course may take 1–2 years. However, there is no guarantee that the stones will dissolve completely. Depending on the individual characteristics metabolism, they may contain impurities that will not dissolve. As a result, the stones will decrease in size and the symptoms of the disease will disappear. However, this effect will be temporary.
• Ultrasonic stone crushing. These days, crushing stones using ultrasonic waves is a fairly common practice. The procedure is safe for the patient and easy to perform. The problem is that the stones are crushed into sharp fragments, which still cannot leave the gallbladder without injuring it. In addition, the problem of bile stagnation is not solved radically, and after a while ( usually several years) stones may form again.
• Laser stone removal. It is used quite rarely due to its high cost and relatively low efficiency. The stones also undergo a kind of crushing and fall apart. However, even these parts can injure the mucous membrane of the organ. In addition, the risk of relapse is high ( re-formation of stones). Then the procedure will have to be repeated.

When is surgery needed for gallstone disease?

Cholecystectomy involves complete removal of the bladder along with the stones it contains. In an uncomplicated course of the disease, it guarantees a solution to the problem, since the bile formed in the liver will no longer accumulate and stagnate. The pigments simply will not be able to form stones again.

There are quite a few indications for cholecystectomy. They are divided into absolute and relative. Absolute indications are those without which serious complications can develop. Thus, if surgery is not performed when there is an absolute indication, the patient's life will be at risk. In this regard, doctors in similar situations always try to convince the patient of the need for surgical intervention. There are no other treatments or they will take too long, increasing the risk of complications.

The absolute indications for cholecystectomy for cholelithiasis are:

• A large number of stones. If there are stones in the gall bladder ( regardless of their number and size) occupy more than 33% of the organ volume, cholecystectomy should be performed. It is almost impossible to crush or dissolve such a large number of stones. At the same time, the organ does not work, since the walls are greatly stretched, do not contract well, stones periodically clog the cervical area and interfere with the outflow of bile.
• Frequent colic. Attacks of pain due to gallstone disease can be very intense. They are relieved with antispasmodic drugs. However, frequent colic indicates that drug treatment is not successful. In this case, it is better to resort to removing the gallbladder, regardless of how many stones there are and what size they are.
• Stones in the bile duct. When the bile ducts are blocked by a stone from the gallbladder, the patient's condition greatly worsens. The outflow of bile stops completely, the pain intensifies, and obstructive jaundice (due to the free fraction of bilirubin).
• Biliary pancreatitis. Pancreatitis is inflammation of the pancreas. This organ shares an excretory duct with the gallbladder. In some cases, with calculous cholecystitis, the outflow of pancreatic juice is disrupted. Tissue destruction during pancreatitis puts the patient's life at risk, so the problem must be urgently solved through surgery.

Special mention should be made of surgical treatment of complications of acute cholecystitis. IN in this case We are talking about the spread of the inflammatory process. Problems with the gallbladder also affect the functioning of neighboring organs. In such situations, the operation will include not only the removal of the gallbladder with stones, but also the solution of the problems resulting from this.

Surgery V mandatory may also be needed for the following complications of gallstone disease:

• Peritonitis. Peritonitis is an inflammation of the peritoneum, the lining that covers most of the abdominal organs. This complication occurs when the inflammatory process spreads from the gallbladder or perforation ( gap) of this organ. Bile, and often a large number of microbes, enters the abdominal cavity, where intense inflammation begins. The operation is necessary not only to remove the gallbladder, but also to thoroughly disinfect the abdominal cavity as a whole. Surgical intervention cannot be postponed, since peritonitis can lead to the death of the patient.
• Strictures of the bile ducts. Strictures are narrowings of the canal. Such narrowings can form as a result of the inflammatory process. They impede the flow of bile and cause stagnation in the liver, although the gallbladder itself can be removed. Surgery is necessary to relieve strictures. As a rule, the narrowed area is expanded or a bypass path is made for bile from the liver to the duodenum. Apart from surgery effective solution there is no such problem.
• Accumulation of pus. Purulent complications of cholelithiasis occur when an infection enters the gallbladder. If pus accumulates inside an organ, gradually filling it, this complication is called empyema. If pus accumulates near the gallbladder, but does not spread throughout the abdominal cavity, they speak of a paravesical abscess. With these complications, the patient's condition deteriorates significantly. There is a high risk of spreading the infection. The operation includes removal of the gallbladder, emptying of the purulent cavity and its thorough disinfection to prevent peritonitis.
• Biliary fistulas. Gall fistulas are pathological openings between the gallbladder ( less often through the biliary tract) and adjacent hollow organs. Fistulas may not cause acute symptoms, but they disrupt the natural process of bile flow, digestion, and also predispose to other diseases. The operation is performed to close pathological holes.

How to treat cholelithiasis with folk remedies?

Possible effects of medicinal plants for gallstone disease are:

• Smooth muscle relaxation. Some medicinal plants relax the muscular sphincter of the gallbladder and the smooth muscles of its walls. Thanks to this, attacks of pain are relieved ( usually caused by spasm).
• Decreased bilirubin levels. Increased level bilirubin in bile ( especially with prolonged stagnation) may promote stone formation.
• Outflow of bile. Due to the relaxation of the sphincter of the gallbladder, bile flows out. It does not stagnate, and crystals and stones do not have time to form in the bubble.

Thus, the effect of using folk remedies will be predominantly preventive. Patients with liver problems or other factors that predispose them to gallstones will benefit from periodic treatment. This will slow down the formation of stones and prevent the problem before it occurs.

To prevent gallstone disease, you can use the following folk remedies:

• Radish juice. Black radish juice is diluted with honey in equal proportions. You can also cut a cavity in the radish and pour honey into it for 10–15 hours. After this, the mixture of juice and honey is consumed 1 tablespoon 1 - 2 times a day.
• Barberry leaves. Green barberry leaves are thoroughly washed with running water and filled with alcohol. For 20 g of crushed leaves, 100 ml of alcohol is needed. Infusion lasts 5 – 7 hours. After this, drink 1 teaspoon of the tincture 3 to 4 times a day. The course lasts 1 – 2 months. After six months it can be repeated.
• Rowan infusion. 30 g of rowan berries are poured into 500 ml of boiling water. Leave for 1 – 2 hours ( until the temperature drops to room temperature). Then the infusion is taken half a glass 2 - 3 times a day.
• Mumiyo. Shilajit can be taken both to prevent the formation of stones and for cholelithiasis ( if the diameter of the stones does not exceed 5 - 7 mm). It is diluted in a ratio of 1 to 1000 ( 1 g mummy per 1 liter of warm water). Before meals, drink 1 glass of solution, three times a day. This product can be used for no more than 8 - 10 days in a row, after which you need to take a break of 5 - 7 days.
• Mint with celandine. Equal proportions of dry leaves of these herbs are consumed as an infusion. For 2 tablespoons of the mixture you need 1 liter of boiling water. Infusion lasts 4 – 5 hours. After this, the infusion is consumed 1 glass per day. Sediment ( grass) filtered before use. It is not recommended to store the infusion for more than 3 - 4 days.
• Snake knotweed. To prepare the decoction, you need to pour 2 tablespoons of dry crushed rhizomes into 1 liter of boiling water and cook for 10 - 15 minutes over low heat. 10 minutes after turning off the heat, strain the broth and allow it to cool ( usually 3 – 4 hours). Take 2 tablespoons of the decoction half an hour before meals, twice a day.

To prevent bile stagnation using blind probing, you can use pharmacological drugs or some natural mineral waters. Water or medicine should be drunk on an empty stomach, after which the patient lies on the right side, placing it under right hypochondrium (to the area of ​​the liver and gallbladder) warm heating pad. You need to lie down for 1 – 2 hours. During this time, the sphincter will relax, the bile duct will expand, and bile will gradually flow into the intestines. The success of the procedure is indicated by dark stool with an unpleasant odor after a few hours. It is advisable to consult with your doctor about the methodology for conducting blind probing and its advisability in each specific case. After the procedure, you need to follow a low-fat diet for several days.

Thus, folk remedies can successfully prevent the formation of gallstones. In this case, regularity of treatment courses is important. It is also advisable to undergo preventive examinations with a doctor. This will help detect small stones ( using ultrasound) in case traditional methods do not help. After the formation of stones, the effectiveness of traditional medicine is greatly reduced.

What are the first signs of gallstone disease?

Typically, gallstone disease first appears as follows:

• Heaviness in the stomach. A subjective feeling of heaviness in the abdomen is one of the first manifestations of the disease. Most patients complain about it when visiting a doctor. Heaviness is localized in the epigastrium ( in the pit of the stomach, in the upper abdomen) or in the right hypochondrium. It may appear spontaneously after physical activity, but most often - after eating. This sensation is explained by stagnation of bile and enlargement of the gallbladder.
• Pain after eating. Sometimes the first symptom of the disease is pain in the right hypochondrium. IN in rare cases- This is biliary colic. It is a severe, sometimes unbearable pain that can radiate to the right shoulder or shoulder blade. However, most often the first attacks of pain are less intense. It is rather a feeling of heaviness and discomfort, which, when moving, can turn into stabbing or bursting pain. Discomfort occurs an hour to an hour and a half after eating. Painful attacks are especially common after taking large quantity fatty foods or alcohol.
• Nausea. Nausea, heartburn, and sometimes vomiting can also be the first manifestations of the disease. They also usually appear after eating. The connection of many symptoms with food intake is explained by the fact that the gallbladder normally secretes a certain amount of bile. It is needed for emulsification ( a kind of dissolution and assimilation) fats and activation of certain digestive enzymes. In patients with gallstones, bile is not secreted and food is digested less easily. Therefore, nausea occurs. The reverse reflux of food into the stomach leads to belching, heartburn, gas accumulation, and sometimes vomiting.
• Stool changes. As mentioned above, bile is necessary for the normal absorption of fatty foods. With uncontrolled bile secretion, prolonged constipation or diarrhea may occur. Sometimes they appear even before other symptoms typical of cholecystitis. For more late stages stool may become discolored. This means that the stones have blocked the ducts, and practically no bile is released from the gallbladder.
• Jaundice. Yellowing of the skin and sclera of the eyes is rarely the first symptom of gallstone disease. Usually it is observed after digestive problems and pain. Jaundice is caused by stagnation of bile not only at the level of the gallbladder, but also in the ducts inside the liver ( where is bile formed?). Due to liver dysfunction, a substance called bilirubin accumulates in the blood, which is normally excreted in bile. Bilirubin enters the skin, and its excess gives it a characteristic yellowish tint.

It is usually difficult to make a correct diagnosis based on the first symptoms and manifestations of gallstone disease. Nausea, vomiting and digestive disorders can also occur with disorders in other organs digestive system. To clarify the diagnosis, an ultrasound is prescribed ( ultrasonography) abdominal cavity. It allows you to detect a characteristic enlargement of the gallbladder, as well as the presence of stones in its cavity.

Is it possible to treat calculous cholecystitis at home?

• Acute forms of the disease. In the acute course of calculous cholecystitis, a serious inflammatory process develops. Without proper care for the patient, the course of the disease can become very complicated. In particular, we are talking about the accumulation of pus, the formation of an abscess or the development of peritonitis ( inflammation of the peritoneum). In the acute course of the disease, hospitalization cannot be delayed, since the above-mentioned complications can develop within 1 to 2 days after the first symptoms.
• First signs of illness. It is recommended to admit patients to the hospital who exhibit symptoms and signs of calculous cholecystitis for the first time. There they will do all the necessary research within a few days. They will help you figure out exactly what form of the disease the patient has, what his condition is, and whether there is a question of urgent surgical intervention.
• Accompanying illnesses. Cholecystitis can develop in parallel with other health problems. For example, in patients with chronic heart failure, diabetes mellitus or other chronic diseases, it can cause exacerbation and serious deterioration of the condition. To closely monitor the course of the disease, it is recommended to admit the patient to the hospital. There, if necessary, he will be quickly provided with any help.
• Patients with social problems . It is recommended to hospitalize all patients who cannot be provided urgent help at home. For example, a patient with chronic cholelithiasis lives very far from the hospital. In the event of an exacerbation, it will be impossible to quickly provide qualified assistance ( Usually we are talking about surgery). During transportation, serious complications may develop. A similar situation arises with older people who have no one to care for them at home. In these cases, it makes sense to operate even acute process. This will prevent exacerbation of the disease in the future.
• Pregnant women. Calculous cholecystitis in pregnant women is associated with a higher risk for both mother and fetus. In order to provide assistance in time, it is recommended to hospitalize the patient.
• Patient's wish. Any patient with chronic cholelithiasis can voluntarily go to the hospital for surgical removal of gallstones. This is much more profitable than operating on an acute process. Firstly, the risk of complications during surgery and in postoperative period. Secondly, the patient chooses the time himself ( vacation, planned sick leave, etc.). Third, he deliberately eliminates risk repeated complications illnesses in the future. Prognosis for such planned operations much better. Doctors have more time to thoroughly examine the patient before treatment.

At home, the disease can be treated under the following conditions:

• chronic course of cholelithiasis ( no acute symptoms);
• finally formulated diagnosis;
• strict adherence to the instructions of the specialist ( regarding prevention and treatment);
• the need for long-term drug treatment ( for example, non-surgical stone dissolution can last 6 – 18 months);
• possibility of caring for the patient at home.

Is it possible to exercise if you have gallstone disease?

One of the important conditions of the preventive regimen is limiting physical activity. This is necessary after the discovery of stones, during the acute stage of the disease, as well as during treatment. At the same time, we are talking not only about professional athletes, whose training requires every effort, but also about everyday physical activity. At each stage of the disease, they can affect the development of events differently.

The main reasons for limiting physical activity are:

• Accelerated formation of bilirubin. Bilirubin is a natural product of metabolism ( metabolism). This substance is formed during the breakdown of hemoglobin, the main component of red blood cells. The more physical activity a person performs, the faster red blood cells break down and the more hemoglobin enters the blood. As a result, the level of bilirubin also rises. This is especially dangerous for people who have stagnation of bile or a predisposition to the formation of stones. Bile with a high concentration of bilirubin accumulates in the gallbladder, which gradually crystallizes and forms stones. Thus, people who already have cholestasis ( bile stagnation), but stones have not yet formed, heavy physical activity is not recommended for preventive purposes.
• Movement of stones. If the stones have already formed, then severe loads can cause them to move. Most often, stones are located in the bottom of the gallbladder. There they can cause a moderate inflammatory process, but do not interfere with the outflow of bile. As a result of physical activity, intra-abdominal pressure rises. This also affects the gallbladder to some extent. It is compressed, and the stones can begin to move, moving towards the neck of the organ. There the stone gets stuck at the level of the sphincter or in the bile duct. As a result, a serious inflammatory process develops, and the disease becomes acute.
• Progression of symptoms. If the patient already has digestive disorders, pain in the right hypochondrium or other symptoms of cholelithiasis, then physical activity can provoke an exacerbation. For example, pain due to inflammation can develop into biliary colic. If the symptoms are caused by the movement of stones and blockage of the bile duct, they will not go away when you stop exercising. Thus, there is a chance that even a single exercise session ( running, jumping, lifting weights, etc.) can lead to emergency hospitalization and surgery. However, we are talking about people who already suffer from a chronic form of the disease, but do not comply with the regimen prescribed by the doctor.
• Risk of gallstone complications. Calculous cholecystitis is almost always accompanied by an inflammatory process. Initially, it is caused by mechanical trauma to the mucous membrane. However, many patients also develop an infectious process. As a result, pus may form and accumulate in the cavity of the bladder. If, under such conditions, intra-abdominal pressure rises sharply or the patient makes a sharp, unsuccessful turn, the swollen gallbladder may burst. The infection will spread throughout the abdominal cavity and peritonitis will begin. Thus, playing sports and physical activity in general can contribute to the development of serious complications.
• Risk of postoperative complications. Often acute cholecystitis must be treated surgically. There are two main types of operations - open, when an incision is made in the abdominal wall, and endoscopic, when removal occurs through small holes. In both cases, after surgery, any physical activity is contraindicated for some time. With open surgery, healing takes longer, more stitches are required, and the risk of stitch dehiscence is higher. With endoscopic removal of the gallbladder, the patient recovers faster. As a rule, full exercise is allowed only 4 to 6 months after surgery, provided that the doctor does not see other contraindications for this.

• daily walks of 30–60 minutes at an average pace;
• gymnastic exercises without sudden movements and limiting the load on the abdominal muscles;
• swimming ( not for speed) without diving to great depths.

Is pregnancy dangerous if you have gallstones?

The prevalence of this problem during pregnancy is explained as follows:

• Metabolic changes. As a result of hormonal changes, the metabolism in the body also changes. This can lead to accelerated stone formation.
• Motor changes. Normally, the gallbladder stores bile and contracts, releasing it in small portions. During pregnancy, the rhythm and strength of its contractions are disrupted ( dyskinesia). As a result, bile stagnation may develop, which contributes to the formation of stones.
• Increased intra-abdominal pressure. If a woman already had small gallstones, the growth of the fetus may cause them to move. This is especially true in the third trimester, when the growing fetus pushes the stomach, colon and gall bladder upward. These organs are compressed. As a result, the stones located near the bottom of the bubble ( at the top of it), can enter the bile duct and block it. This will lead to the development of acute cholecystitis.
• Sedentary lifestyle. Pregnant women often neglect walks or basic physical exercises, which also contribute to the normal functioning of the gallbladder. This leads to stagnation of bile and accelerated formation of stones.
• Changing your diet. Changing food preferences can affect the composition of the microflora in the intestines and worsen the motility of the bile ducts. If the woman had latent ( asymptomatic) form of cholelithiasis, the risk of exacerbation increases greatly.

Exacerbation of gallstone disease during pregnancy is especially dangerous for the following reasons:

• high risk of rupture due to increased intra-abdominal pressure;
• high risk infectious complications (including purulent processes) due to weakened immunity;
• fetal intoxication due to an inflammatory process;
• Fetal nutritional disorders due to poor digestion ( food is digested worse, since bile does not enter the duodenum);
• limited opportunities treatment ( not all drugs and treatment methods that are usually used for gallstone disease are suitable for pregnant women).

In the absence of complications of cholelithiasis, the prognosis for mother and child remains favorable. If the patient turned to a specialist too late, and the inflammatory process began to spread in the abdominal cavity, the question of removing the fetus by cesarean section may be raised. The prognosis in this case worsens somewhat, since we are talking about a technically complex surgical intervention. It is necessary to remove the gallbladder, extract the fetus, and carefully examine the abdominal cavity to prevent the development of peritonitis.

What are the types of calculous cholecystitis?

From the point of view of the main manifestations of the disease(clinical form)The following types of calculous cholecystitis are distinguished:

• Stone-carrying. This form is latent. The disease does not manifest itself in any way. The patient feels great, does not experience any pain in the right hypochondrium or digestive problems. However, the stones have already formed. They gradually increase in number and size. This will happen until the accumulated stones begin to disrupt the functioning of the organ. Then the disease will begin to manifest itself. Stone carriage can be detected during a preventive ultrasound examination. It's harder to spot the rocks on the overlook x-ray abdominal cavity. If stone-carrying stones are detected, there is no talk of emergency surgery. Doctors have time to try other treatments.
• Dyspeptic form. In this form, the disease manifests itself various disorders digestion. It can be difficult to suspect cholecystitis at first, since there is no typical pain in the right hypochondrium. Patients are concerned about heaviness in the stomach and epigastrium. Often after a heavy meal ( especially fatty foods and alcohol) there is belching with a bitter taste in the mouth. This is due to impaired bile secretion. Patients may also have problems with bowel movements. In this case, an ultrasound examination will help confirm the correct diagnosis.
• Biliary colic. In fact, biliary colic is not a form of gallstone disease. This is a common specific symptom. The problem is that in the acute stage of the disease, severe pain attacks occur frequently ( every day, and sometimes more often). The effect of antispasmodic drugs is temporary. Biliary colic is caused by painful contraction of the smooth muscles in the walls of the gallbladder. They are usually observed with large stones, overstretching of the organ, or stone entry into the bile duct.
• Chronic recurrent cholecystitis. The recurrent form of the disease is characterized by repeated attacks of cholecystitis. The attack is manifested by severe pain, colic, fever, characteristic changes in blood tests ( the level of leukocytes and the erythrocyte sedimentation rate - ESR - increases). Relapses occur when unsuccessful attempts conservative treatment. Medicines temporarily reduce the inflammatory process, and some medical procedures can temporarily improve the flow of bile. But as long as there are stones in the cavity of the gallbladder, the risk of relapse remains high. Surgery ( cholecystectomy – removal of the gallbladder) decides once and for all this problem.
• Chronic residual cholecystitis. This form is not recognized by all specialists. It is sometimes talked about in cases where an attack of acute cholecystitis has passed. The patient's temperature dropped and his general condition returned to normal. However, the symptoms remained moderate pain in the right hypochondrium, which intensified with palpation ( palpating this area). Thus, we are not talking about a complete recovery, but about a transition to special shape– residual ( residual) cholecystitis. As a rule, over time, the pain goes away or the disease worsens again, turning into acute cholecystitis.
• Angina form. Is rare clinical form calculous cholecystitis. Its difference from others is that pain from the right hypochondrium spreads to the heart area and provokes an attack of angina pectoris. Heart rhythm disturbances and other symptoms may also occur. of cardio-vascular system. This form is more common in patients with chronic coronary heart disease. Biliary colic in this case plays the role of a kind of “trigger mechanism”. The problem is that due to an attack of angina, doctors often do not immediately detect the main problem - calculous cholecystitis itself.
• Saint's syndrome. It is a very rare and little-studied genetic disease. With it, the patient has a tendency to form stones in the gall bladder ( actually calculous cholecystitis), apparently due to the lack of certain enzymes. In parallel, diverticulosis of the colon and diaphragmatic hernia are observed. This combination of defects requires a special approach to treatment.

Proper nutrition is an ideal option that any person should adhere to. But, unfortunately, in life, people often allow themselves to be consoled by a cake, chocolate, or unhealthy chips in order to suppress depression or simply lift their spirits. Some people find out that they have gallstones: symptoms, treatment without surgery may differ in each individual case. Not everyone can adhere to the principles of proper nutrition, although if you prepare a variety of dishes, you can quickly get used to it and eat deliciously.

But people often don’t have enough time to prepare healthy home-cooked meals, which is why they often end up in fast food cafes. By allowing himself small weaknesses, a person causes enormous harm to the body, which can have a destructive effect over a period of time. long period time. This can also lead to gallstones. In this case, specialists first prescribe a special diet to prevent the occurrence and formation of new stones. When sick, a person may experience severe pain. And the best option is prevention, but, unfortunately, not everyone understands this at an early age.

How do stones form in the gallbladder?

When the digestion process starts, the liver begins to intensively produce bile. This liquid allows you to digest food better. Bile is heated in an organ called the gallbladder. It is a special conductor that directly leads to the small intestine. If negative factors play a role, for example, a person has not eaten properly for a long time, some diseases have appeared, the salts that are in the bile begin to come into contact with cholesterol cells. As a result of this interaction, microscopic grains accumulate in the gallbladder.

These grains gradually transform into crystals and begin to increase in size. Over time, if the disease is not treated, entire stones can form in the gallbladder. This disease is very painful and unpleasant. The patient constantly suffers from sharp and cutting pain during the process of urination. The pain can also be permanent. Doctors often encounter this disease in their practice. And some of them discover stones the size of a small plum during diagnosis in their patients. Just imagine! Sometimes the stones may have an indistinct shape and look more like a cluster of particles similar to buckwheat. In this case, the bile in the bladder begins to stagnate, and it no longer penetrates so freely into the small intestine.

Causes

In most cases, the development of this disease is negatively affected by improper and irrational nutrition. In some cases, doctors may discover hereditary, congenital diseases, which lead to changes in the body's metabolic processes.

Common reasons:

• bad heredity;
• frequent consumption of too fatty foods;
• poor nutrition (the main factor);
• congenital diseases of the pancreas and liver;
• hypodynamia of the gallbladder;
• passive lifestyle;
• obesity.

IN separate group Risk factors include people who actively lose weight and try various diets, and also often indulge in fasting. Proper nutrition can eliminate obesity, but this is a long process. After all, excess fat does not accumulate in a week. But the diet allows you to lose a lot of extra pounds, but it can lead to disturbances in the functioning of organs. If you don't drink enough, you also run the risk of developing gallstones.

In most cases, people may not notice any problems or symptoms that could be associated with cholelithiasis for a long time. Severe symptoms appear only in the last stages of this disease. If there are individual grains or a small amount of sand in the gallbladder, then the person, as is correct, does not feel any problems. However, if you find yourself frequent belching or severe bloating stomach after eating a portion of food, then you should go for an examination. It's better to be safe, especially if you know what you're doing. wrong image life and eat junk food.

Main symptoms:

• vomit;
• dizziness;
• bitter taste;
• weakness;
• pain under the ribs on the right;
• yellowness of the skin and mucous membranes of the eyes;
• nausea.

It is worth noting that even large stones may not bother the patient for a long time until they begin to move and deliver discomfort. In some cases, they can block the outflow of bile fluid. And in this case the symptoms will be characteristic.

How to treat?

A doctor can diagnose gallstones not only by indirect signs and complaints of a sick person. For correct diagnosis You will need to undergo some examinations. First of all, the patient will be prescribed an ultrasound diagnostic. To confirm the diagnosis, an x-ray is prescribed. In some cases, the following diagnostic methods are used: cutaneous cholangiography, cholecystocholangiography, ERCP. Small stones can be successfully destroyed and removed using a laser. There are therapeutic and surgical methods treatment of this problem.

The first type of treatment includes a special diet, as well as the destruction and dissolution of stones using special drugs. But this option Suitable only at the initial stage of the disease, when the stones are small and sporadic. Surgical methods can get rid of the problem, but the person will have to part with the gallbladder forever. We will not dwell on the surgical method in detail.

Proper nutrition

Doctors often recommend that patients with gallstones go on a specially designed diet. You need to eat in small portions, five times a day. However, you will have to eliminate many harmful foods from your diet. It is permissible to eat only dairy products that are not too high in fat and plant foods.

Prohibited products:

• seasonings, spices;
• smoked products;
• fatty foods;
• carbonated drinks;
• salinity;
• fried foods;
• alcohol.

But basically, this diet helps only at the initial stage or as a preventive measure if there is a predisposition to the disease. If the patient controls his diet, he can save himself from numerous problems. Even if there are no disturbances in metabolic processes or digestion, you should still eat right or eat unhealthy foods very, very rarely.

How do stones dissolve?

Stones have a very unpleasant property; even after getting rid of them, they can form again and again. If the diagnosis reveals single stones in a patient, then only special medications can help dissolve them, which must be prescribed strictly by a specialist. Do not self-medicate. Treatment can be lengthy. Another option for treatment is to follow a special diet and avoid harmful foods and then replace them with healthy foods.

You already know that stones begin to appear due to cholesterol, as well as salts contained in the gallbladder. However, this process can be stopped and reversed if you eliminate the consumption of harmful foods. If we talk about folk methods, they are effective, but only if the stones are small. Among other things, this treatment may not always help, and at this time the stones will only increase without proper treatment. Therefore, you need to seek help from a specialist.

Gallstones are a dangerous pathology: as they develop, these formations can cause harm to health, injuring the walls and provoking an inflammatory process that spreads to other organs. Occurring when there are disturbances in the metabolic processes of bile components, cholelithiasis does not manifest itself in specific symptoms for a long time.

Therefore, it is often discovered when formations have already penetrated the ducts or even clogged them. The condition characterized by the presence of gallstones is called cholelithiasis. In women it is diagnosed two to three times more often than in representatives of the opposite sex. Doctors have not found sufficient justification for such a phenomenon.

Causes of formation of gallstones

The main reason for the formation of stones is a violation of the composition of bile - the balance between cholesterol and bile acids. Bile with excess cholesterol and deficiency of bile acids is called lithogenic.

Healthy bile has a liquid consistency and does not form stones. Factors that provoke their formation include:

• Increased cholesterol levels in bile, which changes its properties;
• Impaired outflow and stagnation of bile;
• Infection in the gallbladder and subsequent development of cholecystitis.

The reasons for the obstructed outflow of bile and its stagnation are the following factors:

• The presence of certain diseases: dyskinesia (impaired contractile function) biliary tract, flatulence (increased pressure in the gastrointestinal tract impedes the flow of bile), as well as a history of surgical interventions on the gastrointestinal tract (vagotomy, etc.);
• Sedentary lifestyle;
• Pregnancy (pressure of the uterus on the peritoneal organs also prevents the outflow of bile);
• Improper diet with significant gaps between meals, as well as fasting and sudden weight loss.

Increased cholesterol content in bile is caused by the following reasons:

• Excessive consumption of foods with high cholesterol levels (animal fats);
• Liver dysfunction, when the production of bile acids decreases;
• The presence of obesity, which is observed in approximately 2/3 of patients;
• Long-term use of oral contraceptives containing estrogens (in women);
• The presence of other diseases such as diabetes mellitus, hemolytic anemia, liver cirrhosis, allergies, Crohn's disease and other autoimmune conditions.

the third reason is infection of the gallbladder, which occurs ascending from the intestine or through the blood and lymph flow and as a result leads to cholecystitis (inflammation of the mucous membrane of the bladder walls) and cholangitis (inflammation of the bile ducts). Chronic cholecystitis and cholelithiasis are interdependent conditions when one of the diseases supports, accelerates and complicates the course of the other.

Based on their chemical composition, the following types of gallstones are distinguished:

1. Bilirubin stones. They are formed due to changes in blood composition and certain congenital anomalies. Stones of this type can be found in the gallbladder, as well as in the excretory ducts and liver. They have a dense structure, as they contain calcium salts. These are small stones in the gall bladder, the size of which is a centimeter, no more. They are irregular in shape and usually there are many of them. Bilirubin stones can be black or brown, depending on the dominant component. Black stones contain calcium bilirubinate, a black pigment, and do not contain cholesterol. Brown ones consist of less polymerized calcium bilirubinate and contain a small amount of protein and cholesterol. Pigment stones are radiopaque formations, making them easy to diagnose.
2. Cholesterol. This type is the most common and therefore has been studied in more detail than other types of gallstones. Their main component is cholesterol microcrystals, so they have a homogeneous structure. Cholesterol stones in the gall bladder reach significant sizes - up to 2 cm. They are white or yellowish in color, oval or round in shape. These stones are localized precisely in the gallbladder, and not in its ducts. Cholesterol stones cannot be detected by x-ray.
3. Calcareous (calcifications). They are quite rare and are formed from calcium salts and cholesterol crystals. The gallbladder with such stones usually has inflamed walls. Calcareous stones take the form of rounded formations, single or multiple. It can be a large stone over 10mm or a small one (less than 10mm in diameter). Calcifications can be detected using x-rays.
4. Mixed. The complex composition of stones is due to the growth of calcifications on cholesterol and pigment stones. As a result, formations with a pronounced layered structure are formed. More often, mixed stones have a pigmented center and a cholesterol shell.

Thus, disturbances in the structural composition of bile play a decisive role in the appearance of primary stones. The formation of secondary stones is the result of cholestasis and infection of the gallbladder. Primary stones are formed mainly in the gallbladder due to stagnation and thick consistency of bile. Secondary stones can form both in the bladder itself and in the bile and intrahepatic ducts.

Symptoms

The main signs of gallstones depend on the location of the stone - the manifestation of gallstones will be associated with the size and shape of the latter. The symptoms that all patients with gallstones experience are as follows:

• pain under the rib on the right side (paroxysmal, stabbing);
• nausea;
• bitter taste in the mouth;
• flatulence and other intestinal problems;
• belching air;
• development of jaundice.

Sometimes symptoms such as fever and chills are also noted - this can occur when the stone begins to move through the ducts. However, most often, an increase in temperature indicates the addition of an infection and the development of cholecystitis, the symptoms of which are characteristic of the inflammatory process.

Predisposing factors that cause hepatic colic are stress and physical overexertion, eating spicy, fatty and fried foods, and excessive alcohol consumption.

The first symptoms of the disease are a deterioration in general well-being and pain, which, although localized under the ribs on the right side, radiates to other parts of the body. The pain develops due to the fact that the stone in the gallbladder, starting to come out, irritates and stretches the walls of the ducts. Or pain syndrome may be caused by overstretching of the bladder due to the accumulation of bile in it.

Note that the symptoms in case of blockage of the ducts are as follows: the sclera and skin of a person become yellow, the person feels heaviness on the right side under the ribs, vomiting appears mixed with bile, which does not bring relief. This condition is extremely dangerous, as it can lead to seizures and a critical increase in temperature.

Diagnostics

Often, stones in the gallbladder ducts are discovered accidentally during an ultrasound or x-ray. Qualified specialist Based on the research results, it will determine not only the size of the stones and the presence of inflammation, but also determine the approximate composition of the stones and assess the risk of developing biliary colic.

To obtain more detailed information about the disease, the following may be prescribed:

• blood tests (general and biochemistry);
• cholecystocholangiography;
• CT, MRI;
• retrograde cholangioradiography (during endoscopic procedure the doctor may remove small stones).

Complications

If you don't take action more necessary measures for the treatment of gallstones, the patient’s condition may worsen due to the following complications:

1. Acute cholecystitis.
2. Blockage of the bile ducts, which is the basis for the development of infection, chronic cholecystitis and pancreatitis.
3. Rupture of the gallbladder and, as a result, peritonitis.
4. Penetration of large gallstones into the intestines with subsequent blockage.
5. Increased risk of developing gallbladder cancer.

How to treat gallstones?

If there are stones in the gallbladder, but there are no pronounced clinical symptoms and complications of the disease, there is no need for specific treatment. At the same time, experts are taking a wait-and-see approach. With the development of severe acute or chronic calculous cholecystitis, it is recommended surgical treatment, the main purpose of which is to remove the gallbladder (cholecystectomy).

Today, there are several methods for treating gallstones without surgery, they allow you to preserve the integrity of the gallbladder and ducts:

1. This is achieved by dissolving the stones using special drugs containing acids (henofalk, ursosan). However, with this treatment, after some time, gallstones may form again.
2. Shock wave lithotripsy is excellent at destroying stones in the gallbladder and bile ducts. This method is most often used to grind a single stone in patients who do not have concomitant inflammation of the gallbladder or ducts.

Conservative treatment of cholecystolithiasis during remission is based on proper nutrition and regimen, active lifestyle, and systematic oral use of drugs that promote the destruction of stones.

For the treatment of cholelithiasis, the following drugs are prescribed in parallel:

• drugs that help normalize the composition of bile (ursofalk, lyobil);
• stimulants of bile acid secretion (phenobarbital, zixorine);
• for pain caused by contraction of the gallbladder, patients are recommended to use various muscle relaxants (plataphylline, drotaverine, no-spa, metacin, pirencipin).
• enzyme preparations that improve digestion processes, in particular the processes of lipid digestion (Creon).

As the size of gallstones increases, lithotripsy (drug, shock wave) or surgery is recommended for treatment. Indications for lithotripsy are:

• frequent attacks of pain,
• large and multiple stones,
• presence of concomitant diseases

Drug lithotripsy is carried out with the drugs henochol and henofalk, which can be taken for quite a long time - tens of years. With this treatment, large stones in the gallbladder are crushed to smaller sizes, after which their remains are dissolved using oral medications (these are usually prescribed several weeks before shock wave lithotripsy).

Extracorporeal shock wave lithotripsy

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

The indication for ESWL is the absence of obstruction of the biliary tract, single or multiple cholesterol stones with a diameter of no more than 3 cm.

Contact (local) dissolution of stones

Contact litholysis is a technique that involves introducing a special organic solvent (methyl tert-butyl ether or propionate) into the gallbladder or bile ducts. The effectiveness of this method is 90%, however, after the stones are dissolved, the patient requires maintenance therapy. With the help of contact litholysis, cholesterol stones of various sizes and quantities are completely dissolved in about 14-16 hours.

Surgery

During surgery, the gallbladder can be removed along with the stones in it, or just the stones. Currently, several types of operations are used in surgical practice for the treatment of cholecystolithiasis:

• classical (open) cholecystectomy (removal of the gallbladder);
• laparoscopic cholecystectomy;
• laparoscopic cholecystolithotomy (organ-preserving surgery involving the removal of stones).

Diet and nutrition rules

The composition of the diet is of great importance for this disease. It is recommended to adhere to fractional meals, eat 5-6 times a day. The meal itself has a choleretic effect, so the entry of a small amount of food into the stomach at the same hours stimulates the outflow of bile and prevents its stagnation. But with a large portion of food, the gallbladder may instinctively contract, and this will cause an exacerbation.

• Legumes, radishes, radishes, eggplants, cucumbers, artichokes, asparagus, onions, garlic;
• Fried, sour and spicy foods;
• Rich broths;
• Fatty meats (pork, lamb, beef) and fish, as well as lard, liver and offal;
• Sausages, smoked meats, canned food, pickles;
• Butter (limit, preferably added to porridge);
• Coffee, cocoa and alcohol.

• Lean meat and fish;
• Fruits and vegetables: pumpkin, carrots, zucchini, cauliflower, apples, watermelon, prunes;
• Cheese, cottage cheese, milk with a fat content of no more than 5%;
• Cereals, especially buckwheat and oatmeal;
• Compotes, fruit drinks, mineral water, blueberry, pomegranate, quince juices.

The diet should contain a sufficient amount of animal protein; animal fats are also not prohibited, but are usually poorly tolerated, so give preference to vegetable fats. For gallstone disease, it is useful to eat foods rich in magnesium.

Prevention of relapse

If a person starts pathological process stone formation in the gallbladder, it is quite difficult to completely stop it without surgery. After a mandatory course of treatment, the patient must regularly undergo preventive examination. Even after surgery, the patient is prescribed courses of litholytic drugs.

An important point is the correction of lifestyle, especially nutrition.

The fight against excess weight often helps to minimize the risk of recurrent stone formation and significantly reduces the frequency of relapses.

Gallstones treatment without surgery

What are gallstones?

Gallstones are tiny stones (hard pieces of matter) found in the gallbladder, which is a small “bag”-shaped organ that plays a major role in storing bile produced by the liver. Gallstones (cholelithiasis) consist of particles of cholesterol, calcium deposits and other substances that are found in bile. They can vary in size, shape, composition, density and severity of symptoms, but for the most part they are all caused by the same things and are treated in much the same way.

They are formed when cholesterol, calcium and other particles bind together and enter the gallbladder, causing pain and other problems such as indigestion and back pain. Normally the gallbladder only stores liquid material, so when hard stones accumulate, it can become severe and noticeable in terms of symptoms.

Gallstones can vary in size from small and softer ones (almost like sand or sediment) to very large and dense stones that expand almost to full size gallbladder. Compared to kidney stones, gallstones are usually softer because they are made primarily of cholesterol, which is not hard.

Who is most at risk for developing gallstones?

Several factors can make people more susceptible to developing gallstones, including their diet, age, gender, body composition and genetics ().

Gallstones are most common in the following populations:

• women
• people over 40 years old
• people with overweight or obesity (especially if they have excess fat around the waist)

Other risk factors for gallstones include:

• poor nutrition
• Losing weight too quickly (for example, during fasting)
• pregnancy
• diabetes
• heredity
• high level (a type of fat in the blood)
• lack of physical activity
• low levels of HDL “good” cholesterol

Why is this happening? It has been shown that gallstones are influenced by hormonal imbalances. This is the reason why women who are pregnant or taking birth control pills are more likely to experience gallstones than the general population. It is currently believed that women reproductive age, especially those aged 20 to 60 years, are the group most at risk development of gallstone disease. According to National Foundation of Diabetes, Digestive and Kidney Diseases, the female sex hormone estrogen may be the reason why gallstones are more common in women than in men.

Estrogen can increase the amount of cholesterol in bile and possibly also decrease gallbladder movement, which promotes the formation of gallstones. This is one reason why a gallstone preventive diet can be beneficial—it reduces the likelihood of “estrogen dominance,” or excess estrogen. High estrogen levels are more common today due to the growing presence of endocrine disruptors. They are found in chemical cosmetics or cleaning products, certain water sources, and chemicals added to processed foods. These chemicals “mimic” the effects of true estrogen, bind to receptor sites and promote excess estrogen, which can cause fat cells to become resistant to normal breakdown.

Some medications you take contain estrogen. These include birth control pills and hormone replacement therapy, so they may increase the risk of gallstones. Taking medications that lower blood cholesterol levels can also lead to the formation of gallstones because they cause the liver to release more cholesterol into bile. It can affect everything from mood and metabolism to sleep and sexual functioning.

Causes of gallstone formation

The gallbladder itself is usually described as a soft, bag-like organ. It has the ability to expand when bile accumulates in it, which can happen when a person has not eaten for a long time, for example, if they are hungry, sick, or severely restrict themselves in food during a diet. Bile is a digestive fluid produced by the liver. It contains bile salts and other substances that help break down fats from food.

The size of the gallbladder varies from person to person depending on eating patterns and diet, but it usually ranges somewhere between the size of a small plum and a large apple. The gallbladder is attached to the liver and rests on the small intestine, which is important for it to function properly. The gallbladder has the ability to drain and store bile by transporting it through a tube called the cystic duct.

To visualize how gallstones form, some experts recommend depicting the digestive organs as a “biliary tree” (). The purpose of the biliary tree is to move secretions from one organ to another, which helps with digestion, absorption nutrients and removing waste from the body. Secretions move from the liver, gallbladder and pancreas to the small intestine. Their job is to get rid of body waste in the form of bile, which the liver produces to collect waste particles and carry them to the small intestine before they are eliminated through bowel movements.

The body typically stores waste, such as bile, until it is needed, rather than continually dumping excess waste into the small intestine and wasting it. Our bodies retain these important fluids so that we can use them effectively when we eat food and must perform digestion. We have an important valve-like muscle that is our " bile duct", the controller where bile is released in response to food intake. When we haven't eaten anything and there is no food in the small intestine, the bile duct valve is closed. Then when we eat, the valve opens so enzymes, secretions and bile can do their work.

The trick is that the liver and pancreas do not stop producing bile or other digestive substances. They have no way of knowing when we'll eat next and no feedback system to turn off production, so they're basically always storing excess bile, whether it's needed at a certain time or not. The liver continues to produce bile, which reaches the bile duct valve, but the valve remains closed until we eat anything, so the bile has no choice but to remain in the gallbladder.

This is why the gallbladder is so important - it acts as a reservoir for excess bile, which is used at the right time to aid digestion. When you eat something, the gallbladder contracts and squeezes out enough bile to keep the system running smoothly.

So, what disrupts this process and leads to gallstone disease?

When cholesterol and other substances in bile bind together and become harder, they can settle inside the gallbladder, eventually becoming cholesterol gallstones. The exact reason why gallstones form is not agreed upon by most doctors or researchers. One leading theory is that they can form when your bile contains too much cholesterol, which can be caused by a poor diet or hormonal imbalance.

Typically, bile contains the enzymes needed to properly dissolve the cholesterol released by your liver, but in some cases, the liver may secrete more cholesterol than it can dissolve, causing it to clump into solid particles. Other reasons why gallstones can form is because the bile duct valve stops working properly or because the liver begins to produce too much bilirubin (forming "pigmented gallstones"), which is a chemical used to break down red blood cells () .

Symptoms of gallstones

It is believed that most people with gallstones do not even know they have them. Symptoms of gallstones can vary from person to person and can vary in intensity and duration. Some people with gallstones have no pain or noticeable symptoms at all, while others experience severe pain and other symptoms. Attacks of cholelithiasis often occur at night. Some people first become aware of their problem during a CT scan ordered to detect another problem, and gallstones are discovered by doctors at random.

Symptoms may also vary depending on where the stone is located. Gallstones always form inside the gallbladder, but sometimes they can become dislodged and moved into the gallbladder. different places, for example, into the bile duct or even inside the small intestine.

When a stone forms in the area of ​​the drainage tube that connects the gallbladder to the bile duct, bile can become blocked and pain can occur as the gallbladder contracts and there is nowhere for the bile to escape. As a result of this excess pressure, the normally soft gallbladder can become tense and hard. Gallstones that cause blockages can also cause inflammation of the liver or pancreas. This is another cause of pain and swelling in the abdomen, sometimes up to the back or shoulders.

In addition to pain, a person with gallstone disease may experience the following symptoms:

• stomach pain and nausea
• tension in the stomach, intestines and other organs, especially after meals (including those high in fat and protein)
• strong pain in the upper right side of the abdomen, usually occurring suddenly and lasting from 30 minutes to many hours
• pain under the right shoulder or inside the back under the right shoulder blade

While most gallstones do not cause serious problems, in some cases they require surgery. If they cause unbearable pain and problems, your doctor may recommend removing the entire gallbladder. If you suspect you have gallstones, you can talk to your doctor, who will likely order an ultrasound or x-ray. Ultrasonography counts the best method to detect them, since CT is not always able to show the presence of stones due to the fact that they may not be dense enough.

People who experience persistent symptoms of gallstones (such as severe pain) may have a surgery called cholecystectomy to remove the stones. But this does not guarantee that they will not form again. Doctors typically wait an average of several months to recommend noninvasive surgery or medical therapy ().

How to Treat Gallstones Naturally

Nutrition and natural medicine experts recommend doing everything you can to treat gallstones without surgery and prevent stone formation with natural remedies.

1. Maintain normal body weight

If you are thinking about how to get rid of gallstones without surgery, you first need to normalize your weight. Overweight or obesity may increase the risk of gallstones (especially among overweight women), since studies show that in obese people the liver may produce too much cholesterol (). Research shows that people who do not maintain a healthy weight may experience more inflammation and swelling in the gallbladder, especially if they have a large amount of fat around the waist, which also indicates the presence of visceral fat around the organs.

The healthiest thing for your body (in general) is to maintain your weight at a normal level. Constantly alternating between gaining extra pounds and losing weight has a negative impact on your hormones, digestion, immune system and metabolism. This is thought to increase the risk of gallstones, so if you think you need to lose weight for health reasons, do it the right way by improving your diet on an ongoing basis, increasing exercise (especially if you sedentary lifestyle life), without using strict low-calorie diets.

2. Avoid rapid weight loss and fad diets

Obesity appears to be a greater risk factor for gallstone disease than weight loss, but rapid weight loss can cause electrolyte imbalances and other problems that increase the likelihood of gallstones. Research shows that people who lose more than 1.5 kg per week may be susceptible to increased risk development of gallstone disease, compared with those who lose weight more slowly naturally ().

This also applies to people who have had weight loss surgery and people on a very low-calorie diet. Most experts recommend losing between 250 and 900 grams of weight per week, which is slow and steady improvement that won't lead to gallstones.

3. Follow an anti-inflammatory diet that supports liver and gallbladder health

To regulate your body's use of cholesterol, consume more anti-inflammatory foods that have many useful properties in addition to reducing the risk of developing gallstones. An anti-inflammatory diet also reduces your intake of estrogen-rich foods, which can contribute to an increase in this hormone in the body.

To cleanse your liver, avoid eating the following foods:

• hydrogenated oils (corn, sunflower, safflower)
• refined sugar
• semi-finished products
• excess alcohol
• animal products or dairy products derived from animals raised on modern large farms (they are difficult to digest and often pro-inflammatory)

Focus on incorporating new, fresher foods and vegetable juices, organic animal products, and potassium-rich foods such as leafy greens, tomatoes, etc.

4. Be physically active

People who are more physically active tend to have better protection from the formation of gallstones (). You're probably already aware of the many benefits of exercise—regular physical activity not only improves your overall health, but can also be beneficial for maintaining a healthy weight without having to drastically cut calories, and can also improve digestive function.

A general recommendation for most adults who are able to be active is to aim for 30 to 60 minutes of moderate-intensity exercise each day, or a little less. If you also do high-intensity workouts, such as high-intensity interval training or explosive training, they will provide the same beneficial effects on the body, but in a shorter time.

5. Reconsider taking birth control pills or unnecessary medications

Birth control pills and some hormonal medications increase the amount of estrogen in the body, which affects the production and storage of cholesterol (in addition to body weight in some cases). In a study published in the journal Canadian Medical Association Journal, researchers found a “statistically significant increase in the risk of developing gallstones” in women using hormonal contraceptives ().

If you have gallstones or if anyone in your family has/has gallstones, talk to your doctor about other non-hormonal options for your medications.

Helpful Supplements for Gallstones

Several additives and natural herbs may help improve liver health and reduce inflammation, which are important for regulating the production and use of cholesterol. These include:

• . Helps with digestion, fights inflammation and supports liver metabolism.
• Milk thistle. Eliminates the accumulation of medications, heavy metals and other harmful substances in the liver.
• Dandelion root. Helps the liver remove toxins by acting as a natural diuretic.
• Activated carbon. Binds to toxins and helps remove them from the body.
• Lipase (enzyme). 2 capsules with meals help improve fat digestion and bile utilization.
• Bile salts or bile. 500-1000 milligrams with meals can improve gallbladder function and fat breakdown.

Means for cleansing the gallbladder from stones without surgery

Treatment of gallstones without surgery is also possible with the help of the following means, however, their effectiveness has not been scientifically proven.

1. Olive oil and lemon juice

Some people claim that cleaning the gallbladder can help break down and remove gallstones (). However, no scientific evidence There is no evidence to support these statements. The body is able to cleanse itself.

However, some people use a combination of olive oil, lemon juice and herbs for two or more days to cleanse their gallbladder. During this time, they should not consume anything other than the oil mixture. There is no standard mixture or recipe. This mixture may be dangerous for people with diabetes or those experiencing low blood sugar.

One study looked at the effects of olive oil and sunflower oil for gallstones. Researchers have found that although olive oil affects the composition of bile, it does not affect gallstones ().

Talk to your doctor before starting any type of gallbladder cleanse at home. It may not be safe for all people.

2. Apple juice

Some people use apple juice to remove gallstones without surgery. They believe that apple juice can soften and remove gallstones from the gallbladder. This claim was made public by a letter published in 1999 detailing the anecdotal story of a woman who successfully cleared gallstones using apple juice(). However, there is no scientific research to support this claim.

Drinking large amounts of fruit juice may be harmful to the body if you have diabetes, hypoglycemia, stomach ulcers, or other diseases.

3. Apple cider vinegar

Natural Apple vinegar is a popular health product that is often included in cleanses to treat gallstones without surgery. Although apple cider vinegar may have positive influence on blood sugar levels, there are no studies supporting its use for the treatment of cholelithiasis (). There is little evidence that cleanses are necessary or effective.

4. Yoga

There are some claims that yoga can help you naturally remove gallstones. One study found that yoga improves lipid profile in people with diabetes (). In another study, researchers studied people with cholesterol gallstones and found that people with these types of gallstones were more likely to have abnormal lipid profiles (). However, researchers were unable to find a link between these abnormal levels and the presence of gallstones.

Although yoga can help relieve some of the symptoms associated with gallstones, there is no scientific evidence to support the effectiveness of yoga in treating gallstones.

5. Milk thistle

Milk thistle ( Silybum marianum) can help treat liver and gallbladder diseases (). It is believed to stimulate both organs, but researchers have not specifically looked at the benefits of milk thistle for treating gallstones.

Milk thistle is available in tablet form as a dietary supplement. Talk to your doctor before using milk thistle, especially if you have diabetes. Milk thistle may lower blood sugar levels in people with type 2 diabetes. Some people may also be allergic to milk thistle ().

6. Artichoke

Artichoke has been found to be beneficial for gallbladder function (). It helps stimulate bile and is also good for the liver. No studies have been conducted on the effect of artichoke on the treatment of gallstones without surgery.

The artichoke can be steamed, marinated or grilled. If you can tolerate artichokes, there is no harm in eating them. Artichoke in pill form or sold as a supplement should only be taken after you have talked to your doctor about it.

7. Loosestrife

Loosestrife is used in traditional Chinese medicine for the treatment of cholelithiasis (). Taking medications based on it has been associated with a decrease in the formation of gallstones. Some people recommend taking loosestrife before starting a gallbladder cleanse to help loosen the stones.

You can purchase loosestrife in powder or liquid form. These supplements can be found in stores natural products or other places where dietary supplements are sold.

8. Castor oil

Castor oil lotions are another folk remedy for treating gallstone disease without surgery. Some people choose to use this method instead of a gallbladder cleanse. A warm cloth is dipped in castor oil and then placed on the abdomen in the area of ​​the gallbladder. Lotions are intended to relieve pain and treat gallstone disease. There is no scientific research to support claims that this treatment is effective.

9. Acupuncture

Some people, thinking about how to remove stones from the gallbladder without surgery, resort to alternative medicine, such as acupuncture.

Acupuncture (acupuncture) may help relieve pain from gallstones by reducing spasms, reducing bile flow, and restoring proper function gallbladder. Acupuncture has been reported to be able to treat gallstone disease, but it is necessary additional research.

One a little research was conducted to study the effects of acupuncture on cholecystitis (inflammation of the gallbladder) in 60 participants. Acupuncture has been found to relieve symptoms and reduce gallbladder volume ().

More research needs to be done to specifically look at the benefits of acupuncture for treating gallstones without surgery.

Acupuncture is relatively safe. When choosing an acupuncturist, look for a licensed, experienced professional and make sure they use new, disposable needles.

Treatment of gallstones without surgery can be carried out only after consultation with a doctor, since in the presence of complications of gallstone disease, self-medication can lead to unforeseen consequences.