Gallstones ( cholelithiasis , gallstones ) - Causes, Symptoms and Treatment .MF .
Gallstones (cholelithiasis or how wrong call - gallstone disease) - a disease associated with impaired cholesterol metabolism and bilirubin, resulting in formation of calculi (stones) in the gallbladder (cholecystolithiasis) and / or in the bile duct (choledocholithiasis).
The disease prevalence is on the third place after cardio - vascular disease and diabetes.It is more common in developed countries, in individuals whose work is associated with stress and leading a sedentary lifestyle.As
The gallbladder is a reservoir for the bile produced by the liver.for biliary ways bile flow is generated by a coordinated activity of the liver, gallbladder, common bile duct, pancreas, duodenum.This ensures the timely flow of bile into the intestine during digestion, and its accumulation in the gallbladder fasting.
formation of stones in it is due to changes in the composition and stagnation of bile (diskholiya), inflammatory processes, motor-tonic disorders biliary excretion (dyskinesia).
Distinguish cholesterol (up to 80-90% of gallstones), pigment and mixed stones.
The formation of cholesterol stones contributes to a glut of bile cholesterol, its loss in the sediment, formation of cholesterol crystals.When impaired motility of the gallbladder, the crystals do not appear in the intestine but remain and start to grow.
pigment (bilirubin) stones are the result of intensive disintegration of erythrocytes in hemolytic anemia.
Mixed stones are a combination of both forms.Contains calcium, bilirubin, cholesterol.
arise mainly in inflammatory diseases of the gallbladder and biliary tract.
1. biliary tract inflammation (cholecystitis, cholangitis).
infection plays a role in the formation of stones.Bacteria are able to translate bilirubin, soluble in water, insoluble precipitated.
2. Endocrine disorders:
- hypothyroidism (insufficient secretion of thyroid hormones);
- violation of estrogen metabolism in various gynecological diseases, taking hormonal contraceptives means pregnancy.There
violation of the contractile function of the gallbladder, bile stasis.
3. Violation of cholesterol metabolism:
When the cholesterol level, the conditions for the formation of stones.
4. hyperbilirubinemia - increased bilirubin levels with increasing its content in bile:
- hemolytic anemia.
5. Hereditary predisposition.
6. Fasting, irregular meals cause disruption of normal function of the gallbladder.
7. Excessive consumption of the rich in animal fats, cholesterol food.This promotes a shift in the bile acid side reactions that lead to the formation of stones.
Symptoms of gallstones
a long time, the disease can be asymptomatic and finding on ultrasound.When migrating stones, infection joining in the gall bladder and ducts symptoms appear.Symptoms of gallstones depends on the location of the stones, their size, inflammatory activity, as well as the involvement of other digestive organs.
When leaving the stones from the gall bladder and the promotion of their bile ducts there is an attack of biliary colic.Triggers an error in the diet, especially the abuse of fatty foods, vibration, stress.The pain is sudden, sharp in the upper abdomen, in the right hypochondrium, gives to the right shoulder, right shoulder.Often pain in cholelithiasis accompanied by nausea, vomiting, not bringing relief, dry mouth.Worried itching.
Occurrence jaundice of the sclera and skin, dark urine and stool discoloration.
duration pain attack from a few minutes to a few hours, the pain subsides spontaneously or after anesthesia.
Symptoms of biliary colic do not always have the classic version of manifestation, they can often resemble other diseases: right-pneumonia, acute appendicitis, especially when it is not a typical situation, liver abscess, renal colic - with urolithiasis, acute pancreatitis.
may occur holetsistokardialnym syndrome when heart pain is the only symptom of gallstones.
to establish an accurate diagnosis, when the first signs of the disease need to seek immediate medical care - physician, family doctor.
survey in cholelithiasis
instrumental methods of diagnosis.
1. Ultrasonography of the abdomen - the main and most effective method for diagnosing gallstones.It detects the presence of stones in the gallbladder wall thickening of the gallbladder, its deformation, the expansion of the bile ducts.
Its main advantages are non-invasive (non-traumatic), safety, accessibility and reusability of.
2. X-ray examination of the abdominal cavity - to identify rentgenpozitivnyh carbonate rocks.
3. Endoscopic retrograde cholangiopancreatography (under suspicion of the presence of stones in the bile ducts).
4. In cases of dispute, used magnetic resonance cholangiography, it allows you to accurately assess the state of the biliary tract due to two- and three-dimensional images;computed tomography.
1. Total bilirubin and its fractions, transaminases.Explore to assess the functional state of the liver.
2. lipidogram.Determine the level of cholesterol, triglycerides.With their increasing need to pursue treatment aimed at reducing these figures, for the prevention of stone formation.
mandatory inspection of the surgeon - to choose tactics of treatment.
Treatment of gallstone disease.
If cholelithiasis use surgical and conservative treatment.
conservative method is used in the presence of cholesterol gallstones (rentgennegativnyh) up to 15 mm when stored contractility of the gallbladder and cystic duct patency.
Contraindications for medical dissolution of gallstones:
- acute inflammatory diseases of the gallbladder and biliary tract;
- stones with a diameter greater than 2 cm;
- liver disease, diabetes, gastric ulcer and duodenal ulcer, chronic pancreatitis;
- inflammatory diseases of the small and large intestine;
- «Disabled" - non-functioning gall bladder;
- pigment or carbonate rocks;
- cancer of the gallbladder;
- multiple concretions that occupy more than 50% of the gallbladder.
Apply ursodeoxycholic acid drugs that target only the dissolution of cholesterol stones, take medication for 6 - 24 months.But the probability of recurrence after dissolution of stones is 50%.The dose, duration of reception sets only the doctor - internist or gastroenterologist.Conservative treatment is possible only under medical supervision.
Shock wave holelitotrepsiya - treatment by crushing large stones into small fragments by a shock wave, followed by administration of bile acid preparations (ursodeoxycholic acid).The likelihood of recurrence is 30%.
Gallstone disease for a long time may be asymptomatic or malosimptomno that it creates certain difficulties identifying at early stages.This is the reason for late diagnosis, stage already formed gallstones, when the use of conservative methods of treatment is limited, and the only treatment is surgical.
Surgical treatment of cholelithiasis
Patients should undergo elective surgery until the first attack of biliary colic, or immediately thereafter.This is due to the fact that there is a risk of complications.
After surgical treatment must be personalized dietary regime (frequent, smaller meals with the limitation or exclusion of individual intolerance product, fatty, fried foods), compliance with work and rest, physical education classes.Avoid drinking alcohol.Perhaps spa treatment after surgery, provided a stable remission.
Complications of cholelithiasis.
Upon accession infection develops acute cholecystitis, empyema (accumulation of pus considerable) cholangitis (inflammation of the bile ducts), which in turn can lead to peritonitis.The main symptoms are sudden, intense pain in the right upper quadrant, chills, fever, severe weakness, impaired consciousness.
Choledocholithiasis (stones in the bile duct) with the development of jaundice.After one of the attacks of biliary colic appears itching, yellowness of the skin and sclera, discolored feces, dark urine.
During prolonged blockage of the cystic duct and the absence of infection arises hydrops of the gallbladder.The gall bladder is sucked out, but the mucosa continues to produce mucus.There is an increase in the size of the bubble.Manifested attacks of biliary colic, the pain subsides subsequently remains heaviness in the right upper quadrant.
Against the background of prolonged cholelithiasis is often a cancer of the gallbladder,
developing acute and chronic pancreatitis.During prolonged occlusion of intrahepatic bile ducts developed secondary biliary cirrhosis.Large gallstones practically do not migrate, but they can lead to the formation of a fistula between the gallbladder and the duodenum.As a result, loss of bladder stone it begins to migrate and can lead to intestinal obstruction.
untimely removal of the gallbladder (cholecystectomy) is one of the causes of postcholecystectomy syndrome.
complications are life-threatening and the patient requires immediate inspection of the surgeon and the hospital in the surgical hospital.
prevention of gallstone disease.
Even after successful surgery in 10% of cases, relapses occur.To prevent the development of new stones must be a lifestyle change.Classes in the gym, active, promote the flow of bile, eliminate its stagnation.It is necessary to gradually normalize body weight, it will reduce the cholesterol hypersecretion.
Patients who are forced to take long-estrogens, clofibrate, ceftriaxone, octreotide should undergo ultrasound examination for early detection of changes in the gall bladder.An increase in blood cholesterol levels, statin therapy is recommended.
Diet for cholelithiasis
limited or excluded from the diet of fatty, high-calorie, cholesterol-rich meals, especially in the genetic susceptibility to gallstones.Meals should be frequent (4-6 times a day), in small portions, which helps to reduce stagnation of bile in the gallbladder.The food should contain a sufficient amount of dietary fiber, due to vegetables and fruits.food bran (15g for 2-3 times a day) can be added.This reduces lithogenicity (propensity to stone formation) bile.
Konsultatsiyavracha for cholelithiasis
question: how is it that is called a disease, gallstone or gallstones?
Answer: on the international classification of diseases name "cholelithiasis" does not exist, there is only a gallstone.
Question: What medicines, folk remedies, spa treatment withdrawn stones from the gall bladder?
Answer: There are no medicines.All cholagogue in cholelithiasis should be taken exactly as prescribed and supervised by a doctor.To self-medicate in this situation is not safe because of the high risk of complications.When a planned cholecystectomy (surgery to remove the gall bladder), the mortality rate is 0.5%, while cholecystectomy for acute cholecystitis (which is self-complication) mortality reaches 20%. Spa treatment in the presence of stones in the gall bladder is contraindicated .
Question: Should the patient be observed after surgery for gallstones, have a specialist, how long and what drugs to carry out follow-up treatment?
Answer: Patients after surgery are observed at the family doctor, internist.Annually dispensary examination, ultrasound examination of the abdominal cavity, the control lipid profile, liver function tests.Based on the survey data, diagnostic tests the doctor recommends a set of necessary therapeutic measures to prevent recurrence of the disease.
therapists Vostrenkova IN