The occurrence of stones in the gallbladder. Gallstone disease (calculous cholecystitis)
Gallbladder stones are one of the most common pathologies of the digestive system, the causes of their occurrence are most often metabolic disorders.
gallbladder
The secretion of bile is carried out by the structural cells of the liver - hepatocytes, between which there is a system of tubules.
bile production
Through these internal bile ducts, it enters and accumulates in the gallbladder. In the process of digestion of food, it is released into the intestines.
Bile is an aqueous solution of bile acids and pigments, phospholipids, and cholesterol. In addition to these components, it also contains fatty acids, protein, trace elements, vitamins, hormones, enzymes.
Bilirubin, bile acids, cholesterol and phospholipids are in the form of a specific compound - the bile micelle. Their correct ratio ensures good solubility of this complex.
Bile plays a very important role in the process of digestion. Its components have the following effect:
- stimulate the secretion of enzymes in the pancreas;
- emulsify fats, which contributes to their further breakdown by pancreatic lipase and absorption;
- neutralize the acidic contents of the stomach before its further advancement through the digestive tract;
- remove foreign toxic substances that have entered the body.
The gallbladder is oval or spindle-shaped. Its volume is from 50 to 70 ml. The structure of the wall of this organ includes three membranes: internal mucous, muscular and external serous.
The epithelium of the inner layer absorbs water and other components of bile. Therefore, in the gallbladder, it is much thicker and darker in color than in the internal hepatic ducts.
The muscle layer is made up of smooth muscle tissue. It is especially developed in the neck of the bladder, where the muscles form a sphincter through which bile enters the duodenum through the external duct.
How stones are formed
Gallstone disease in terms of prevalence is in third place after pathologies of the endocrine and cardiovascular systems.
Stones in the gallbladder
Depending on the chemical composition, there are three types of gallstones:
- cholesterol, these are rounded yellowish calculi, the cholesterol content from them is above 80%;
- pigmented, which mainly consist of bilirubin. These are formations of dark green, brown or black irregular shape;
- mixed, in addition to cholesterol, they contain various calcium salts, they are also called calcareous, they can be of any shape and size.
In the vast majority of cases, gallstone disease is accompanied by the occurrence of cholesterol stones.
Very often, the cause of the formation of calculi is dysfunction of the external duct and a decrease in the evacuation capacity of the gallbladder.
Causes of dyskinesia
This pathology is called biliary dyskinesia. The cause of this disease is the wrong diet, insufficient fluid intake, stress.
Also an important role is played by inflammatory or viral diseases of the liver and digestive system, hormonal disorders.
What changes occur with such dysfunction? The secretion of bile in hepatocytes is carried out continuously. Normally, when eating, under the influence of a nerve impulse, the gallbladder contracts and the sphincter relaxes.
In this case, bile is secreted into the duodenum. With dyskinesia, under the influence of the above causes, the muscles of the biliary tract do not contract strongly enough.
Congestion develops in the gallbladder. At the same time, the cells of the mucous membrane of its wall continue to absorb water, so the consistency of bile becomes more and more dense.
Bile micelles, in which cholesterol is excreted, disintegrate and it crystallizes. The same process can occur with bilirubin and other salts. Over time, these crystals turn into stones.
Another cause of gallstone disease is a violation of cholesterol and bilirubin metabolism.
Bilirubin is formed as a result of the breakdown of hemoglobin. From the blood plasma, it enters the liver, where, under the influence of special enzymes, it forms the so-called conjugates.
Cholesterol
These are compounds of bilirubin with other substances. They are soluble in water and excreted in the bile into the intestines. The concentration of bilirubin may increase with anemia, cirrhosis of the liver.
In this case, part of it enters the gallbladder in an unconjugated state. In this form, it easily crystallizes. This process is the cause of the formation of black pigment stones.
In addition to bilirubin, brown pigment stones also contain significant amounts of cholesterol and calcium salts. Most often, their occurrence occurs in the bile duct.
Cholesterol plays a very important role in the life of the body. It is involved in the synthesis of many enzymes, vitamin D, is a component of cell membranes, in the composition of bile acids it promotes the breakdown of lipids.
If its concentration does not exceed the norm, then it combines with other components of bile into micelles and is excreted from the gallbladder. Excess cholesterol leads to the appearance of so-called phospholipid vesicles.
They are extremely unstable and break easily. This process is the main reason for the formation of cholesterol stones in the gallbladder.
Factors that contribute to the occurrence of gallstone disease are:
Diagnosis of gallstone disease
The simplest and most accurate method for diagnosing gallstones is ultrasound. It allows you to assess the size and shape of the bile ducts, the localization of stones, their effect on the outflow of bile.
Blood analysis
They also do a biochemical blood test. There is an increase in the level of certain enzymes, bilirubin and cholesterol.
To determine the exact localization of stones, oral or intravenous cholegraphy is performed. To do this, a contrast agent is injected into the body, which is excreted in the bile.
Then a series of x-rays or an MRI is taken. Tomography is of course preferable, as this method gives a more detailed image.
In order to evaluate the work of the musculature of the biliary tract, a fairly simple study is carried out. In the morning on an empty stomach they do an ultrasound.
Assess the size of the gallbladder, its volume and contours. Then the patient is given a raw egg to drink. This stimulates the evacuation function of the biliary tract. After that, the ultrasound is repeated.
Normally, the bubble size should decrease by 50%. A deviation from this parameter indicates the occurrence of dyskinesia.
If a diagnosis of gallstone disease has already been made using ultrasound or MRI, then it is possible to determine the type of stone with a conventional x-ray. Cholesterol stones are not visible on the pictures.
Treatment
Very often, gallstone disease is asymptomatic.
If the cause of its appearance is dyskinesia, then this condition is accompanied by loss of appetite, weakness, fatigue, and aching pain in the right hypochondrium or in the navel may occur.
Choice of treatment regimen
However, if the stone comes out of the gallbladder, it can block the bile duct. This is the cause of renal colic.
It can provoke fatty or fried foods, alcohol. It usually begins with a sharp pain in the right side. There may be a slight fever, nausea or vomiting. Often there is an eructation of bitterness.
Symptoms
If the obstruction of the biliary tract continues for a long time, then the level of bilirubin in the blood gradually increases. This is the reason for the development of obstructive jaundice.
There is yellowness of the skin, mucous membranes, whites of the eyes. Usually, the symptoms disappear after the restoration of the normal functioning of the biliary tract.
Gallstone disease sometimes causes dyspeptic syndrome. This condition is accompanied by symptoms of indigestion, the patient often complains of a bitter taste in the mouth.
If the size of the stones in the gallbladder does not exceed 1 cm, then special litholytic preparations are prescribed for treatment. Sometimes these drugs are injected directly into the gallbladder.
Shock wave lithotripsy is very common. In this case, large stones in the gallbladder are crushed into smaller ones, which are painlessly removed.
If there is a risk of blockage of the bile ducts, then litholytics are prescribed to further dissolve the stones.
Be sure to follow a diet. Fractional regular meals in small portions are necessary, foods containing cholesterol, high-calorie foods should be excluded from the diet.
However, there are many contraindications for such methods of treatment. Firstly, only cholesterol stones are amenable to drug therapy.
Also, the size of stones should not exceed 3 cm. In all other cases, an operation is performed to remove the gallbladder.
Gallstone disease (GSD) is a pathology in which stones form in the gallbladder or in the bile ducts (cholecystolithiasis, choledocholithiasis). The occurrence of stones is due to the precipitation of several components of bile: cholesterol, protein, calcium salts and bile pigments. They cause stagnation of bile in the bladder, disruption of lipid metabolism, and even lead to infection of the bile. The main symptoms of gallstones are pain in the right hypochondrium and jaundice.
Causes
Stones in the bile and ducts are most often formed due to a violation of the composition of bile, namely, the quantitative ratio of its components. In this case, the solid components of bile precipitate in the form of sediment, it is they who subsequently grow and form stones. Cholelithiasis often develops with an increase in the content of cholesterol in bile (such bile is called lithogenic).
Elevated cholesterol in bile can be due to various reasons, provoking factors:
- excessive consumption of foods containing cholesterol ()
- a decrease in the concentration of bile acids in bile (impaired function of hepatocytes, decreased secretion of bile);
- a decrease in the content of phospholipids (prevent precipitation);
- violation of the outflow of bile (stagnation)
- obesity
- in women, a provocative factor is the intake of female hormones - estrogens, as well as frequent childbirth
- surgical operations - vagotomy, removal of the lower lobe of the ileum, etc.
- concomitant diseases - diabetes mellitus, hemolytic anemia, Caroli syndrome, Crohn's disease
Stagnation of bile in the gallbladder can have a mechanical or functional origin. Mechanical stagnation of bile is due to the presence of an obstacle in the way of the outflow of bile (adhesions, swelling, swelling of the bladder wall, bending of the bile duct, narrowing of the duct, enlarged lymph nodes, etc.). Functional disorders are caused by impaired motility of the biliary tract (dyskinetic processes).
The cause of gallstones can be an infectious and inflammatory process in the biliary system, autoimmune conditions, various types of allergies, a sedentary lifestyle, starvation, pregnancy, trauma, endocrine diseases, liver pathology, etc. (see).
Symptoms of gallstone disease
Depending on the size of the calculi (stones) in the gallbladder and their localization, the clinical picture of the disease may be different.
The main symptoms that appear in the presence of stones in the gallbladder are:
- pain localized in the right hypochondrium;
- nausea (sometimes vomiting);
- weakness, malaise;
- increase in body temperature;
- jaundice;
- belching with air or bitterness
- discoloration of feces;
- - bloating;
- heartburn;
- unstable chair.
With stones in the gallbladder, the main symptom is pain in the right hypochondrium (the location of the gallbladder). These pains are called biliary (hepatic) colic. The pain is sharp, has a cutting character, can be given to the back, right shoulder blade, right shoulder and right half of the neck. Sometimes the pain extends to the region of the heart - in the left side of the sternum and causes an attack of angina pectoris.
Pain is most often caused by eating spicy, fatty, fried foods, as well as drinking alcohol, the action of increased physical or stressful stress. In the pathogenesis of the formation of pain lies a reflex spasm of the smooth muscles of the gallbladder and its ducts to irritation of the bladder wall with gallstones or as a result of overstretching of the walls of the gallbladder with an abundance of bile accumulated in it (obstructive nature of pain).
Complete blockage of the bile duct causes a significant expansion of the hepatic bile ducts, which causes an increase in the liver and stretching of its capsule, which houses many pain receptors. Irritation of these receptors causes a feeling of constant dull pain in the right hypochondrium and a feeling of heaviness.
A symptom of cholelithiasis is often nausea and vomiting, which, unfortunately, does not bring the patient a sense of relief. Vomiting is a reflex reaction to irritation of a certain area of the duodenum (its parapapillary zone). When the inflammatory process spreads to the pancreas, indomitable vomiting occurs with an admixture of bile.
The patient may also have an increase in body temperature (a sign of intoxication) from subfebrile indicators to high numbers. If stones clog the lumen of the common bile duct, obstructive jaundice occurs, accompanied by discoloration of the feces.
With prolonged presence of stones in the gallbladder, the mucosa is constantly injured, which can cause inflammation - calculous cholecystitis, which is characterized by a decrease in appetite, fever, increased fatigue.
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, surgical treatment is recommended, the main purpose of which is the removal of the gallbladder (cholecystectomy).
Today, there are many methods of treatment to preserve the integrity of the gallbladder and bile ducts:
- This is achieved by dissolving stones with the help of special preparations containing acids (henofalk, ursosan). However, with this treatment, after a while, stones in the gallstone gallstone can form again.
- Excellent destroys stones in the gallbladder and bile ducts shock wave lithotripsy. This method is most often used to grind a single calculus 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, an active lifestyle, and the systematic oral use of drugs that promote the destruction of stones.
In addition to taking medications, how to treat gallstones? With cholelithiasis, rational nutrition is shown in small portions (diet No. 5, see). It is necessary to limit the amount of food taken, to exclude from the daily diet fatty foods, fried and spicy foods, as well as foods rich in cholesterol that can cause an attack of colic. Frequent consumption of fiber (vegetables, fruits) is recommended.
Patients are recommended moderate exercise (they improve the outflow of bile), in the presence of excess weight - its normalization, in the presence of endocrine diseases - their timely treatment. If cholelithiasis is accompanied by infectious lesions of the biliary tract, the patient is prescribed antibiotics.
For the treatment of gallstone disease, the following drugs are prescribed in parallel:
- bile acid secretion stimulants (phenobarbital, zixorin);
- drugs that help normalize the composition of bile (ursofalk, lyobil);
- enzyme preparations that improve digestion processes, in particular lipid digestion processes (creon).
- For pain caused by contraction of the gallbladder, patients are recommended various muscle relaxants (platafillin, drotaverine, metacin, pirencipin).
As the size of the stones in the gallbladder increases, lithotripsy (drug, shock wave) or surgery is recommended for treatment. Indications for lithotripsy are:
- large and multiple stones,
- frequent bouts of pain
- the presence of comorbidities
Medicamentous lithotripsy is carried out with drugs henochol and henofalk, which can be taken for quite a long time - decades. In this treatment, large gallstones in the gallbladder are crushed to smaller sizes, after which their remains are dissolved with oral medications (they are usually prescribed a few weeks before shock wave lithotripsy).
One of the rather effective methods of treatment of gallstone disease is percutaneous transhepatic litholysis. At the same time, a thin catheter is introduced into the gallbladder, through which methylterzbutyl ether is dripped, which dissolves most of the stones. This method of treatment can be used at any stage of the disease.
Surgical treatment is recommended for patients whose disease is accompanied by frequent relapses, attacks of severe pain, large stones, high body temperature, and various complications. Surgical treatment can be laparoscopic and open (cholecystolithotomy, cholecystectomy, papillosphincterotomy, cholecystostomy). The variant of surgical intervention is determined for each patient individually.
Cholelithiasis, or gallstone disease, is a disease in which hard stones form in the gallbladder. What causes gallstones to form? The main reason for the development of pathology is a violation of metabolism; the risk group includes women of all ages and those who consume large amounts of fatty and protein foods.
Why and where do gallstones form? How to prevent it? Is the disease treatable? All this will be discussed in the article.
Reasons for the formation of stones in the gallbladder
Why stones are formed in the normal state has a liquid structure, which does not interfere with its outflow and does not contribute to the formation of solid deposits. The following are the main factors that can lead to pathological changes that cause the formation of gallstones:
- Excessive intake of food rich in animal fats.
- Liver dysfunction, in which the production of
- Tendency to obesity, the presence of excess body weight.
- Side effects after taking hormonal contraceptives.
- Cirrhosis of the liver.
- Acute allergic reaction.
- Diabetes.
- Excessively high pressure in the gastrointestinal tract, interfering with the natural outflow of bile.
- Consequences of surgical interventions.
- Various autoimmune conditions.
- Lack of physical activity, sedentary lifestyle.
- Pregnancy.
- The lack of a balanced and complete diet, prolonged fasting and a sharp loss of body weight.
- Kinks or damage to the bile ducts.
- Malignant or benign neoplasms.
- genetic predisposition.
Types of stone formation
We figured out what causes gallstones. Now let's talk about the types of stone formation. Specialists distinguish two types: at the initial stage, solid deposits form and form in the biliary tract. This pathology is capable of not causing any symptoms for a long time.
The formation of stones gradually leads to disruption of the processes associated with the outflow of bile. This contributes to a significant decrease in the volume of bile entering the intestine; increased pressure and dilation of the bile ducts, as well as their subsequent blockage. Against the background of these processes, secondary stone formation occurs. At this stage, there is an increased risk of infection from the gastrointestinal tract.
Symptoms of gallstone disease
From what stones are formed in the gallbladder, you already know. What are the symptoms of cholelithiasis? The disease can proceed for 5-10 years without any pronounced symptoms. The development of the clinical picture depends on the volume of stones, their diameter and localization. Gradually, the following symptoms of the disease begin to appear:
- Attacks of boring or stabbing pain, the focus is in the region of the right hypochondrium or liver. Discomfort increases after drinking alcohol or fatty foods, as well as after significant physical exertion. Attacks can pass independently 4-6 hours after the onset.
- Feeling of nausea, which often turns into profuse vomiting.
- The appearance of belching and a bitter taste in the oral cavity, which indicates the entry of bile into the stomach.
- Complex disorders of the digestive system, leading to increased gas formation, diarrhea or constipation. There may be discoloration of the feces.
- Feeling of general malaise and weakness, even in the absence of significant stress on the body.
- The occurrence of febrile conditions, an increase in body temperature. Usually this symptom is a sign of inflammatory processes occurring due to the addition of a secondary infection.
Risk of Complications
If you suspect gallstone disease, you need to seek professional medical help. Specialists will conduct diagnostics to confirm the diagnosis, after which a course of therapy will be prescribed. The lack of timely measures can lead to the development of dangerous conditions, among which the following complications can be distinguished:
- Inflammation of the gallbladder in an acute form.
- Rupture of the gallbladder.
- Accession of a secondary infection that can lead to the development of chronic diseases.
- Intestinal obstruction.
- The development of neoplasms in the gallbladder.
Treatment and prevention
Suitable treatments are selected by specialists depending on the size of the stones and their location, as well as the general condition of the patient. To date, the following main methods are used:
- Endoscopic methods of removal belong to minimally invasive surgery, this is the most preferred technique, since it has a low risk of complications.
- In the presence of large stones, their preliminary crushing is practiced, after which the fragments are removed using special equipment and tools.
- Laparotomy is practiced when it is impossible to use endoscopic methods. The main difference lies in the obligatory imposition of a connection between the intestine and the bile duct.
- Antibiotics are prescribed when a secondary infection is attached, which provokes inflammatory processes in the gallbladder. Depending on the pathologies and complications that have arisen, pharmacological preparations are selected individually.
There are no measures that allow you to completely protect yourself from the occurrence of stones in the gallbladder. Below is a list of rules that will help minimize this risk:
- Sports, physical activity.
- Maintain optimal body weight.
- Frequent but moderate consumption of food, which will prevent unwanted accumulation of bile.
- Limiting the consumption of animal fats, the inclusion in the diet of a sufficient amount of plant foods.
- The inclusion of dietary fiber in the diet in an amount of about 20-30 g per day.
- Complete exclusion from the diet of hot spices and smoked foods.
- Prophylactic administration of drugs based on ursodeoxycholic acid.
Stones after gallbladder removal
Do stones form This question is of interest to most patients who have undergone gallbladder surgery, since it does not eliminate the problems with metabolic processes that lead to the formation of stones. However, the risk of recurrence of gallstone disease is minimized, since the increase in stones usually occurs directly in the gallbladder. If it is absent, then such deposits, together with bile, are transported to the intestines and leave the body without having time to acquire dimensions that can cause discomfort to a person.
What stones form in the gallbladder?
The main classification implies the division of stones into two groups, the division criterion is the mechanism of formation. True stones are most often formed during the progression of gallstone disease: they have a dark color, an elongated shape and a soft structure; the size does not exceed 30 mm. False stones are deposits that were not detected during the operation due to localization features.
Depending on the structure, fibrous, amorphous, crystalline or layered stones are distinguished.
An alternative way to classify is to classify stones by composition. In accordance with it, calcareous, cholesterol, mixed or pigmented formations can be distinguished. Deposits in the gallbladder rarely consist of a single component, much more often they have a mixed composition, in which the concentration of cholesterol predominates.
How fast do gallstones form?
According to statistics, every fifth person is prone to gallstone disease. The average growth rate of formations is about 3-5 mm annually, but these figures are individual and depend on many factors. For example, in the absence of a balanced diet or adherence to strict dietary complexes and fasting techniques, growth occurs much faster. The process is undulating, the stage of active growth is replaced by stabilization, in some cases, partial dissolution of stones is observed in a natural way.
Now you know why gallstones form, how quickly, and how to prevent it. And if the disease still overcame you, do not hesitate to go to the doctor. Your health is in your hands! Do not be ill!
Recently, an increasing number of people are faced with such a problem as the presence of stones in the gallbladder cavity. In this article, you will learn about the symptoms and treatment of gallstones.
The human liver secretes a sufficiently large amount of bile per day, which serves to improve fat digestibility and activate the movement of food in the intestines. And the gallbladder is a pear-shaped digestive organ, which is a kind of reservoir for the accumulation and excretion of this bile.
It consists of the following main components:
- cholesterol
- water insoluble bilirubin (bile pigment)
- fatty acids
- salts
When our digestive system is functioning well, there is an accumulation of bile in the bladder. Then, as needed, it is excreted into the duodenum, passing through the bile ducts.
In cases where, for any reason, bile stagnates in the cavity of the bladder or its composition changes, the dense components can crystallize, precipitate and form hard stones or calculi. A pathology characterized by the presence of stones in the gallbladder is called calculous cholecystitis, or cholelithiasis.
Experts point to main causes of gallstone formation:
- in the composition of the biliary structure, the balance of its components is disturbed
- stagnation of bile fluid due to the lack of its timely outflow
- bladder or duct infection
Bile calculi are distinguished by:
- chemical structure - lime, pigment, cholesterol, mixed
- structure - homogeneous or complex
- quantity - single or multiple
- localization - directly in the bladder, liver or their ducts
- size - from the smallest to the size of a walnut
By clinical course diseases, there are such forms:
- chronic
- sharp
Experts describe several stages of development of gallstone disease, each of which is accompanied by certain symptoms.
Stage I- the physico-chemical structure of bile is disturbed:
- detected by biochemical analysis
- is asymptomatic
- characterized by the fact that the concentration of cholesterol is increased, and the amount of acids decreases
Stage II- latent:
- Stones (usually cholesterol) are usually detected only on ultrasound
- Patients usually do not care
Stage III- manifestations of symptoms, which may be different, depending on the form of the course of the disease:
- Dyspeptic - bitterness in the mouth, nausea, heaviness after eating, flatulence.
- Paroxysmal - periodic occurrence of pain attacks (biliary colic) in the right hypochondrium. Such attacks can be provoked by eating fatty foods, intense exercise, etc.
- Torpid - the pain has a aching dull character. Acute attacks are usually absent or rare.
Stage IV- complications caused by the disease:
- Hydrocele of the gallbladder - bile is absorbed into the walls of the gallbladder due to blockage of the bile duct by a calculus.
- Acute cholecystitis is an acute inflammation of the gallbladder.
- Oncological formations of the gallbladder.
- Non-infectious jaundice - due to blockage of the bile duct, the amount of bilirubin in the plasma increases, the skin, whites of the eyes, and urine are stained. The stool becomes white.
- Rupture of the walls of the gallbladder - the integrity of the organ can be destroyed due to excessive accumulation of fluid.
- Abscess intrahepatic - the presence of pus in the liver.
If you observe symptoms similar to gallstone disease, be sure to consult a doctor. After all, detecting a problem in a timely manner will help alleviate the condition and avoid negative consequences.
To diagnose stones in the gallbladder, a gastroenterologist may prescribe a number of modern studies:
- plain radiography
- cholecystocholangiography
- computed or magnetic resonance imaging
- endoscopic retrograde cholangiopancreatography
The treatment of calculous cholecystitis should be approached comprehensively. Modern treatment includes several approaches:
- following a strict diet
- medical treatment
- removal of stones non-surgical
- surgical removal of stones
All types of therapy are prescribed only by a doctor. Any self-treatment for gallstones is not allowed.
Removal of stones from the gallbladder without surgery
There are two ways to remove stones from the gallbladder without using surgery:
- dissolving them
- crushing them into particles of such a size that they can independently pass into the duodenum through the bile ducts
This is possible with the use of modern methods of therapy, the main of which are:
- Lithotripsy- crushing of the calculus by a shock wave into the smallest particles, which are then excreted through the bile duct
- Litholytic oral therapy- dissolution of gallstones by taking medications
- Cholelitholysis- through punctures in the skin and liver tissues, a catheter is inserted into the bladder, and a drug is injected through it, which dissolves the formations
However, you need to know that non-surgical methods of removing stones are shown only in cases where:
- small formations
- bubble has good contractility
- the disease is not acute, but chronic
- there are certain risks during the operation
How are gallstones removed from the gallbladder?
According to doctors, the most effective and justified method of treating calculous cholecystitis and removing gallstones remains surgery.
The most common method is cholecystectomy (removal of the gallbladder), which results in:
- guaranteed cessation of pain caused by biliary colic
- the possibility of re-stone formation is excluded
- it is possible to assess the state of neighboring organs
- no risk of complications associated with stone migration
Absolute indications for cholecystectomy are:
- frequent bouts of hepatic colic
- localization of stones in the bile ducts
- a large number of stones in the bladder
The operation to remove the gallbladder is carried out in two ways:
- classic abdominal (laparotomy) - with an open abdominal cavity (an incision is made from 15 to 30 cm in size)
- laparoscopic - using a laparoscope through small holes in the abdominal wall
Nowadays, laparoscopic cholecystectomy is preferred due to a number of advantages:
- Virtually no scarring on the skin
- the body recovers quickly after surgery
- slight blood loss during
- reduces the risk of postoperative hernia formation
Laparoscopic cholecystectomy is contraindicated in such cases:
- in late pregnancy
- with obesity
- stones too large
- the presence of pathologies of the heart, respiratory system, gastrointestinal tract
In cases where laparoscopic cholecystectomy is difficult or contraindicated, an open abdominal operation is performed. Unfortunately, this method has a number of disadvantages:
- longer recovery after surgery
- major tissue trauma
- chance of internal bleeding or infection
- increased risk of postoperative complications
Modern medicine makes it possible to extract stones from the cavity of the gallbladder without removing this organ - by the laparoscopic method.
With this operation, the removal of stones occurs as follows:
- an incision is made under the ribs
- through which a laparoscope is inserted into the peritoneum
- using the device determine the location of the gallbladder, as well as its condition
- pull the bubble up to the incision
- an incision is made in the wall of the gallbladder
- stones are removed
- bladder is sutured with absorbable suture
This method has a number of disadvantages:
- certain complexity of the operation and the risk of subsequent complications
- likelihood of recurrence
For these reasons, this operation is practiced quite rarely and not in every clinic.
Diet and nutrition for gallstones
Calculous cholecystitis is usually accompanied by other diseases of the gastrointestinal tract. This circumstance requires changes in your daily diet. It is important to adhere to dietary nutrition during periods of exacerbation of the disease, and upon the onset of remission.
The goal of a proper diet for gallstones is:
- normalization of the functioning of the gallbladder with the liver
- reduction of cholesterol in bile
- an increase in the period of remission after an exacerbation
- preventing the formation of new formations
- stopping the increase in the size of old stones
With cholelithiasis, you need to adhere to the following main rules of nutrition daily:
- spicy, smoked, fried foods and alcohol should be excluded from the diet
- eat about 5 small meals a day
- eat at the same time whenever possible
- food should only be warm (not hot and not cold)
- reduce daily fat to 60g and sugar to 70g
- be sure to use soup (vegetable or milk)
- boil, bake or steam foods
- drink plenty of fluids (2 liters per day)
Foods approved by nutritionists for gallstones:
- lean meat (rabbit, skinless chicken, veal, turkey fillet)
- lean fish (pike, pike perch, hake, cod, seafood)
- cereals (oatmeal, rice, buckwheat)
- vegetables (almost everything except garlic, spinach, radishes, radishes, onions, legumes)
- sweet fruits (pear, banana, apple, melon, watermelon)
- low-fat dairy products (cottage cheese, curdled milk, sour cream, cheese)
- non-carbonated drinks (tea, weak coffee with milk, mineral water, diluted non-acidic fruit juices)
- sweets (marmalade, marshmallow, meringue)
- flour products (pasta from durum wheat, yesterday's insipid bread)
Limit your use:
- tomatoes (use them without the skin)
- fresh cabbage (especially in the presence of pancreatitis)
- black rye bread (it can provoke fermentation in the intestines)
- eggs (eat no more than one per day, preferably soft-boiled)
- nuts and seeds (buy them unshelled, peel just before eating)
Eliminate completely from your diet:
- sour fruits (mango, gooseberry, citrus fruits, cranberries)
- mushrooms in any form
- first courses on a steep meat or fish broth
- smoked meats
- sausage (including milk)
- canned fish and meat
- pickled vegetables and fruits
- hot spices, seasonings and sauces
- sweet carbonated drinks
- cakes, shortbread or puff pastries, pancakes and pancakes
- chocolate products
In acute calculous cholecystitis, as well as in the period after removal of the bladder, a dietary table No. 5 according to the Pevzner classification is prescribed.
Crushing stones in the gallbladder
Crushing of stones (lithotripsy) is one of the methods of therapy for gallstone disease. Its essence is the grinding of dense formations into small particles with the aim of their subsequent unhindered removal through the bile ducts.
The following conditions are required for lithotripsy manipulation:
- stones must be brittle enough
- the gallbladder must remain contractile
- bile ducts must have good patency
This manipulation can be carried out in the following main ways:
1. Ultrasound (shock wave lithotripsy):
- waves focus on the calculus, without damage to the tissues of the patient's organs
- with the help of shock wave vibration, pathological formations are crushed
- the patient is prescribed drugs that promote the removal of gallstones
Contraindications:
- pregnancy
- poor blood clotting
- pathology of the gastrointestinal tract
- inflammation of the mucosa in the gallbladder
Disadvantages of this method:
- Requires medication to dissolve stones
- effective only for cholesterol stones, moreover, of recent origin
- there is a possibility of damage to the walls in the gallbladder with sharp fragments of crushed calculus
- risk of blockage of the duct by stone particles
- there is a risk of inflammation and adhesions
- high chance of recurrence
2. Using a laser (minimally invasive manipulation):
- an incision is made in the abdominal wall
- a catheter with a laser device is inserted into the gallbladder
- the laser beam is brought to the immediate location of the formation
- there is a splitting of formations of any chemical composition almost to the size of sand
Contraindications:
- elderly age
- obesity
- serious conditions of the body as a whole
With the recognized effectiveness of this method, it also has a number of significant drawbacks:
- during manipulation, a burn of the bladder mucosa is possible, which subsequently can cause an ulcer
- too high recurrence rate (about 30%)
- possibility of bile duct obstruction
In addition, the following conditions must be met:
- stones must be brittle
- their total size should not exceed 2 cm
- no inflammation of the gallbladder mucosa
- bladder has good contractility
As you can see, the crushing of calculi cannot give a full guarantee of getting rid of gallstone disease.
How to dissolve gallstones?
One of the options for non-surgical disposal of gallstones is their dissolution with special medications taken orally. According to experts, the most effective of them are acids:
- chenodeoxycholic - Henosan, Henofalk, Henohol
- ursodeoxycholic - Ursohol, Ursofalk, Ursosan
In addition, the doctor may additionally prescribe antispasmodic medications that expand the bile ducts:
- Papaverine
- No-shpa
- Drotaverine
You should know that only such stones can be dissolved in this way:
- cholesterol, formed as a result of an increase in the concentration of cholesterol in the bile fluid
- small sizes and in small quantities
- at an advanced stage of the disease
- in cases of maintaining good patency of the bile ducts
The chemical composition of stones can be determined by special methods:
- x-ray - cholesterol stones will not be visible in the picture, and ultrasound will show them
- probing the duodenum - using a probe, bile is collected from the patient to study its chemical composition
According to doctors, the method of dissolving stones has several disadvantages:
- the probability of dissolution of stones is quite low
- long-term medication is required (up to a year)
- high cost of essential medicines
- there is a high chance of recurrence
- in many cases, the patient has diarrhea as a side effect
In addition, there is a number of contraindications to taking stone-dissolving drugs:
- pregnancy period
- use of oral contraceptives
- obesity
- various pathologies of the kidneys and gastrointestinal tract
- diabetes
- infectious diseases
- taking certain medications (antacids, which reduce acidity)
A more effective option for dissolving stones is percutaneous transhepatic cholelitholysis, when a drug (usually methyl tert-butyl ether) is injected through a catheter directly into the gallbladder. This method allows you to dissolve stones of various chemical composition. The efficiency of the method is about 90%.
However, this method does not guarantee that calculi are not formed again. It should be noted that, according to many experts, it is completely impossible to dissolve stones in the gallbladder, and the listed medicines can simply reduce the size of the formations.
Many traditional healers claim that bile formations can be dissolved by natural means:
- mixtures of vegetable juices (4 parts of cucumber and beetroot are taken for 10 parts of carrot)
- lemon juice dissolved in hot water (1 piece per 200 ml)
- herbal preparations (10 tablespoons of sweet clover, celandine and wormwood herbs mixed with dandelion root, valerian, chicory and gentian (6 tablespoons each)
- dill greens
- thick beet broth
However, doctors are skeptical about these methods. In any case, if you decide to dissolve the stones with folk remedies, first consult with your doctor.
What not to do with gallstones?
Often, people who have calculi in their gallbladder during a medical examination wonder how to avoid further aggravation of the disease and the occurrence of painful attacks. Doctors point out such main principles that patients with calculous cholecystitis should adhere to:
- it is forbidden to take choleretic drugs, as they can provoke the movement of stones, and this, in turn, can lead to serious complications
- you can’t independently use means (including natural medicine) that “dissolve” stones
You need to know that the diagnosis of "calculous cholecystitis" involves a change in a person's habitual lifestyle and a number of adjustments:
- stop smoking
- limit or completely stop drinking alcohol
- eliminate foods that raise cholesterol levels from your diet
- don't overeat
- watch your weight
- avoid long breaks between meals
- when losing weight, do not lose weight too quickly
- do not clean the liver and gallbladder with folk remedies without consulting a doctor
- take mineral water with caution
- avoid intense and abrupt physical movements
Do not forget that during attacks of hepatic colic it is impossible:
- apply heat to the focus of pain - this will provoke swelling of the bladder
- massage a painful place or perform intense movements - this increases the spasm of the bile or liver ducts
- eat and drink - the intake of food will lead to the formation of bile, and this, in turn, can increase colic
The unanimous opinion of all experts: with gallstone disease, you can not self-medicate definitely need to see a doctor. Be healthy!
Video: Gallstones: causes, symptoms, treatment
Chronic calculous cholecystitis- This is a disease in which stones form in the cavity of the gallbladder, which subsequently cause inflammation of the walls of the gallbladder.
Cholelithiasis refers to common diseases - 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 gallbladder is a hollow, pear-shaped organ. The gallbladder is projected approximately in the middle of the right hypochondrium.The length of the gallbladder is from 5 to 14 centimeters, and the capacity is 30-70 milliliters. In the bladder, the bottom, body and neck are distinguished.
The wall of the gallbladder consists of mucous, muscular, and connective tissue membranes. The mucosa consists of epithelium and various glandular cells. The musculature is made up of smooth muscle fibers. At the neck, the mucous and muscular membranes form a sphincter that prevents the release of bile at the wrong time.
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 gallbladder (bottom) slightly extends beyond the lower edge of the liver.
The function of the gallbladder is to store, concentrate bile and excrete bile as needed.
The liver produces bile and, as unnecessary, bile accumulates in the gallbladder.
Once in the bladder, bile is concentrated by absorption of excess water and trace elements by the epithelium of the bladder.
The secretion of bile occurs after eating. The muscular layer of the bladder contracts, increasing the pressure in the gallbladder to 200-300 mm. water column. Under the action 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 in the pancreatic juice. Bile dissolves fats, which contributes to the 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 the development of chronic calculous cholecystitis
The main cause of calculous cholecystitis is the formation of stones.There are many factors that lead to the formation of gallstones. These factors are divided into: immutable (those that cannot be influenced) and those that can be changed.
Fixed Factors:
- Floor. Most often, women get sick due to the use of contraceptives, childbirth (estrogens, which are elevated during pregnancy, increase the absorption of cholesterol from the intestines and its abundant excretion with bile).
- Age. Persons aged 50 to 60 are more likely to suffer from cholecystitis.
- genetic factors. These include - family predisposition, various congenital anomalies of the gallbladder.
- ethnic factor. The greatest number of cases of cholecystitis is observed in Indians living in the southwestern United States and in 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, contraceptives, diuretics (diuretics) - increase the risk of cholecystitis.
- Hypodynamia (fixed, sedentary lifestyle)
- Decreased tone of the muscles of the gallbladder
How are stones formed?
Stones are from cholesterol, from bile pigments and mixed.The process of formation of stones from cholesterol can be divided into 2 phases:
First phase- violation in bile of the ratio of cholesterol and solvents (bile acids, phospholipids).
In this phase, there is an increase in the amount of cholesterol and a decrease in the amount of bile acids.
An increase in cholesterol occurs due to a malfunction of various enzymes.
- decreased hydroxylase activity (affects cholesterol lowering)
- decreased activity of acetyl transferase (converts cholesterol to other substances)
- increased breakdown of fats from the fatty layer of the body (increases the amount of cholesterol in the blood).
The decrease in fatty acids occurs for the following reasons.
- Violations of the synthesis of fatty acids in the liver
- Increased excretion of bile acids from the body (impaired absorption of fatty acids in the intestine)
- Violation of intrahepatic circulation
Second phase - bile saturated with cholesterol forms a stasis of bile (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 various sizes and compositions.
Cholesterol stones may be single or multiple and are usually round or oval in shape. The color of these stones is yellow-green. The sizes of stones vary from 1 millimeter to 3-4 centimeters.
Bile pigment 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 the bubble. These stones are black or grey.
Most often (80-82% of cases) there are mixed stones. They consist of cholesterol, bilirubin and calcium salts. By the number of stones are always multiple, yellow-brown.
Symptoms of gallstone disease
In 70-80% of cases, chronic calculous cholecystitis develops asymptomatically for several years. Finding stones in the gallbladder in these cases occurs by chance - during an ultrasound done for other diseases.Symptoms appear only if the stone moves through 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 distinguished.
Clinical stages of gallstone disease
1. Stage of violation of the physicochemical properties of bile.There are no clinical symptoms at this stage. The diagnosis can be made only by the study of bile. Cholesterol "snowflakes" (crystals) are found in bile. Biochemical analysis of bile shows an increase in the concentration of cholesterol and a decrease in the amount of bile acids.
2. Latent stage.
At this stage, there are no complaints from the patient. There are already stones in the gallbladder. Diagnosis can be made by ultrasound.
3. The stage of onset of symptoms of the disease.
- Biliary colic is a very severe, paroxysmal and sharp pain that 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 occurs most often after a rich, fatty meal or after a lot of physical activity.
Products after taking, which may cause pain:
- Cream
- Alcohol
- cakes
- Carbonated drinks
Other symptoms of the disease:
- Increased sweating
- Chills
- Increase in body temperature up to 38 degrees Celsius
- Vomiting bile that does not bring relief
At this stage, complications such as:
Acute cholecystitis This disease requires immediate surgical intervention.
Hydrocele of the gallbladder. There is a blockage of the cystic duct by a stone or narrowing to a complete blockage of the duct. The release of bile from the bladder stops. Bile is absorbed from the bladder through the walls, and a serous-mucous secret is secreted into its lumen.
Gradually accumulating, the secret stretches the walls of the gallbladder, sometimes to a huge size.
Perforation or rupture of the gallbladder leads to the development of biliary peritonitis (inflammation of the peritoneum).
hepatic abscess. Limited accumulation of pus in the liver. An abscess forms when a section of the liver is destroyed. Symptoms: high temperature up to 40 degrees, intoxication, liver enlargement.
This disease is treated only surgically.
gallbladder cancer. Chronic calculous cholecystitis greatly increases the risk of cancer.
Diagnosis of gallstone disease
In the case of the above symptoms, you should consult a gastroenterologist or general practitioner.Conversation with a doctor
The doctor will ask you about your complaints. Reveal the causes of the disease. He will dwell in particular detail on nutrition (after taking, what foods do you feel bad about?). Then he will enter all the data into the medical record and then proceed to the examination.
Inspection
The examination always begins with a visual examination of the patient. If the patient at the time of examination complains of severe pain, then his face will express suffering.
The patient will be in a supine position with the legs bent and brought to the stomach. This position is forced (reduces pain). I would also like to note a very important sign, when the patient is turned over to the left side, the pain intensifies.
Palpation (palpation of the abdomen)
With superficial palpation, flatulence (bloating) of the abdomen is determined. Hypersensitivity in the right hypochondrium is also determined. There may be muscle tension in the abdomen.
With deep palpation, an enlarged gallbladder can be determined (normally, the gallbladder is not palpable). Also, with deep palpation, specific symptoms are determined.
1. Murphy's symptom - the appearance of pain during inspiration at the time of probing 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
On ultrasonography, the presence of stones in the gallbladder is well determined.
Signs of the presence of stones on ultrasound:
1. Presence of solid structures in the gallbladder
2. Mobility (movement) of stones
3. Ultrasonographic hypoechoic (visible as a white gap in the picture) trace below the stone
4. Thickening of the walls of the gallbladder more than 4 millimeters
Abdominal x-ray
Clearly visible stones, which include calcium salts
Cholecystography- study using contrast for better visualization of the gallbladder.
CT scan- performed in the diagnosis of cholecystitis and other diseases
Endoscopic cholangiopancreatography- used to determine the location of a stone in the common bile duct.
The course of chronic calculous cholecystitis
The asymptomatic form of cholecystitis lasts a long time. From the moment of detection of stones in the gallbladder 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 are treated only surgically.
Treatment of gallstone disease
Stages of treatment:1. Prevention of stone movement and related complications
2. Litholytic (stone crushing) therapy
3. Treatment of metabolic (exchange) disorders
In the asymptomatic stage of chronic cholecystitis, the main method of treatment is diet.
Diet for gallstone disease
Meals should be fractional, in small portions 5-6 times a day. The temperature of the food should be - if cold dishes, then not lower than 15 degrees, and if hot dishes, then not higher than 62 degrees Celsius.Prohibited Products:
Alcoholic drinks
- legumes, in any kind of preparation
- high-fat dairy products (cream, full-fat milk)
- any fried food
- meat from fatty varieties (goose, duck, pork, lamb), lard
- fatty fish, salted, smoked fish, caviar
- any kind of canned goods
- mushrooms
- fresh bread (especially hot bread), croutons
- spices, spices, salinity, pickled products
- coffee, chocolate, cocoa, strong tea
- salty, hard and fatty types of cheese
Cheeses can be eaten, but low-fat
Vegetables should be consumed in boiled, baked form (potatoes, carrots). It is allowed to use finely chopped cabbage, ripe cucumbers, tomatoes. Green onion, parsley to use as an addition to dishes
Meat from non-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 allowed
Sweet ripe fruits and berries, as well as various jams and concoctions
Drinks: not strong tea, not sour juices, various mousses, compotes
Butter (30 grams) in dishes
Low-fat types of fish are allowed (perch, cod, pike, bream, perch, hake). It is recommended to use the fish in boiled form, in the form of cutlets, aspic
You can use whole milk. You can also add milk to various cereals.
Not sour cottage cheese, non-sour fat-free yogurts are allowed
Effective treatment of cholecystitis, when symptoms are present, is possible only in a hospital setting!
Drug treatment of biliary colic (pain symptom)
Usually, treatment begins with M-anticholinergics (to reduce spasm) - atropine (0.1% -1 milliliter intramuscularly) or Platifilin - 2% -1 milliliter intramuscularlyIf 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, Promedol 2% - 1 ml is used.
1. stones containing cholesterol
2. less than 5 millimeters in size
3. the age of the stones is not more than 3 years
4. no obesity
Use drugs such as Ursofalk or Ursosan - 8-13 mg per kilogram of body weight per day.
The course of treatment should be continued for 6 months to 2 years.
Method of direct destruction of stones
The method is based on the direct injection of a strong stone dissolver into the gallbladder.
Extracorporeal shock wave lithotripsy- crushing stones using the energy of shock waves generated 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 installation, an installation 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 to small crystals.
Then these crystals are freely excreted 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, in the presence of symptoms of cholecystitis, surgery is recommended to remove the gallbladder.
Surgical removal of the gallbladder
There are two main types of cholecystectomy (removal of the gallbladder)1. Standard cholecystectomy
2. Laparoscopic cholecystectomy
The first type has been used for a long time. The standard method is based on abdominal surgery (with an open abdominal cavity). Recently, it has been used less and less due to frequent postoperative complications.
The laparoscopic method is based on the use of a laparoscope apparatus. This apparatus consists of several parts:
- high magnification video cameras
- different kinds of tools
Advantages of the 2nd method 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. Health is restored 3 times faster
4. The number of complications is ten times less
Prevention of gallstone disease
Primary prevention is to prevent the formation of stones. The main method of prevention is sports, diet, exclusion of alcohol, exclusion of smoking, weight loss in case of overweight.Secondary prevention is to prevent complications. The main method of prevention is the effective treatment of chronic cholecystitis described above.
Why is gallstone disease dangerous?
Gallstone disease or calculous cholecystitis is the formation of stones in the gallbladder. Often this causes a pronounced inflammatory process and leads to the appearance of serious symptoms. First of all, the disease is manifested by severe pain, a violation of the outflow of bile from the gallbladder, and digestive disorders. Treatment of gallstone disease is usually referred to as a surgical profile. This is explained by the fact that the inflammatory process caused by the movement of stones poses a serious threat to the health and life of patients. That is why the problem is usually solved in the fastest way - removal of the gallbladder along with stones. Gallstone disease is dangerous, first of all, with the following complications:
- Gallbladder perforation. A perforation is a rupture of the gallbladder. It can be caused by the movement of stones or too much contraction ( spasm) smooth muscle 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 extends to intestinal loops and other neighboring organs. Most often, in the cavity of the gallbladder there are opportunistic microbes. In the abdominal cavity, they multiply rapidly, realizing their pathogenic potential and leading to the development of peritonitis.
- Empyema of the gallbladder. An empyema is a collection of pus in a natural body cavity. 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 may contract spastically. This leads to severe pain - biliary colic. If such a clogged gallbladder becomes infected, the mucus turns into pus and empyema occurs. Usually pathogens are bacteria from the genera Escherichia, Klebsiella, Streptococcus, Proteus, Pseudomonas, less often Clostridium and some other microorganisms. They can be ingested through the bloodstream or travel up the bile duct from the intestines. With the accumulation of pus, the patient's condition worsens greatly. The temperature rises, headaches intensify ( due to absorption of waste products into the blood). Without urgent surgery, the gallbladder ruptures, its contents enter the abdominal cavity, causing purulent peritonitis. At this stage ( after the break) 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 inflammation. The liver also suffers from a deterioration in local blood flow. Typically, this problem unlike viral hepatitis) passes 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 disturbed by a stone stuck in the duct. Since the bile ducts are connected to the ducts of the pancreas, pancreatitis can also develop in parallel. Acute cholangitis occurs with severe fever, chills, jaundice, severe pain in the right hypochondrium.
- Acute pancreatitis. Usually occurs due to lack of bile ( that is not released from the clogged bladder) or blockage of the common duct. Pancreatic juice contains a large amount of strong digestive enzymes. Their stagnation can cause necrosis ( death) of the gland itself. This form of acute pancreatitis poses a serious threat to the patient's life.
- Biliary fistulas. If gallstones do not cause severe pain, the patient may ignore them for a long time. However, the inflammatory process in the organ wall ( directly around the stone) is still evolving. The destruction of the wall and its “soldering” with neighboring anatomical structures gradually occur. Over time, a fistula may form, connecting the gallbladder with other hollow organs. These organs can be the duodenum ( more often), stomach, small intestine, large intestine. There are also options for fistulas between the bile ducts and these organs. If the stones themselves do not bother the patient, then fistulas can cause air accumulation in the gallbladder, violations of the outflow of bile ( and intolerance to fatty foods), jaundice, vomiting of bile.
- Paravesical abscess. This complication is characterized by the accumulation of pus near the gallbladder. Usually, an abscess is delimited from the rest of the abdominal cavity by adhesions that have arisen against the background of an inflammatory process. From above, the abscess is limited to the lower edge of the liver. The complication is dangerous by the spread of infection with the development of peritonitis, impaired liver function.
- Scar strictures. Strictures are places of narrowing in the bile duct that prevent the normal flow of bile. In cholelithiasis, this complication may 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 stasis. In general, people with these duct narrowings are more likely to relapse ( repeated inflammation of the gallbladder).
- Secondary biliary cirrhosis. This complication can occur if gallstones prevent 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 liver cells) and their replacement with connective tissue that does not perform the necessary functions. This phenomenon is called cirrhosis. The result is serious violations of blood clotting, impaired absorption of fat-soluble vitamins ( A, D, E, K), accumulation of fluid in the abdominal cavity ( ascites), severe intoxication ( poisoning) organism.
Can calculous cholecystitis be cured without surgery?
Currently, surgical intervention remains the most effective and justified way to treat calculous cholecystitis. With the formation of stones in the gallbladder, as a rule, an inflammatory process develops, which not only disrupts the functioning of the organ, but also poses a threat to the body as a whole. Surgery to remove the gallbladder along with stones is the most appropriate treatment. In the absence of complications, the risk to the patient remains minimal. The organ itself is usually removed endoscopically ( without dissection of the anterior abdominal wall, through small holes).The main advantages of surgical treatment of calculous cholecystitis are:
- Radical solution to the problem. Removal of 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 risk of recurrence ( repeated exacerbations) gallstone disease. Bile can no longer accumulate in the bladder, stagnate and form stones. It will go directly from the liver to the duodenum.
- Patient safety. Today, endoscopic removal of the gallbladder ( cholecystectomy) is a routine operation. The risk of complications during surgery is minimal. Subject to all the rules of asepsis and antisepsis, postoperative complications are also unlikely. The patient recovers quickly and can be discharged ( in consultation with the attending physician) a few days after the operation. After a few months, he can lead the most normal life, apart from a special diet.
- Ability to treat complications. Many patients go 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 ways of non-surgical treatment of calculous cholecystitis. This is not about symptomatic treatment. muscle spasm relief, pain relief), namely, getting rid of stones inside the gallbladder. The main advantage of these methods is the preservation of the organ itself. With a successful result, the gallbladder is freed from stones and continues to perform its functions of accumulating and dosed bile secretion.
There are three main methods of non-surgical treatment of calculous cholecystitis:
- Medical dissolution of stones. This method is perhaps the safest for the patient. For a long time, the patient must take drugs based on ursodeoxycholic acid. It promotes the dissolution of stones containing bile acids. The problem is that even to dissolve small stones, it is necessary to take the medicine regularly for several months. If we are talking about larger stones, the course can be delayed for 1 - 2 years. However, there is no guarantee that the stones will dissolve completely. Depending on the individual characteristics of metabolism, they may contain impurities that will not dissolve. As a result, the stones will decrease in size, the symptoms of the disease will disappear. However, this effect will be temporary.
- Ultrasonic crushing of stones. Today, crushing stones with the help of ultrasonic waves is a fairly common practice. The procedure is safe for the patient, 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 stagnation of bile is not solved radically, and after a while ( usually several years) stones can form again.
- Laser stone removal. It is used quite rarely due to the high cost and relatively low efficiency. Stones are also subjected to a kind of crushing and fall apart. However, even these parts can injure the mucous membrane of the organ. In addition, there is a high risk of recurrence ( re-formation of stones). Then the procedure will have to be repeated.
When is surgery needed for gallstone disease?
Gallstone disease or calculous cholecystitis in the vast majority of cases at a certain stage of the disease require surgical treatment. This is due to the fact that the stones that form in the gallbladder are usually found only with a pronounced inflammatory process. This process is called acute cholecystitis. The patient is concerned about severe pain in the right hypochondrium ( colic), which are exacerbated after eating. The temperature may also rise. In the acute stage, there is a possibility of serious complications, so they are trying to solve the problem radically and quickly. Cholecystectomy is such a solution - an operation to remove the gallbladder. Cholecystectomy involves the complete removal of the bladder along with the stones it contains. With 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 won't be able to form stones again.
There are many indications for cholecystectomy. They are divided into absolute and relative. Absolute indications are those without which serious complications can develop. Thus, if the operation is not performed when there are absolute indications, the life of the patient will be endangered. In this regard, doctors in such situations always try to convince the patient of the need for surgical intervention. There are no other treatments available or they will take too long and increase the risk of complications.
Absolute indications for cholecystectomy in cholelithiasis are:
- A large number of stones. If gallstones ( 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 very stretched, they contract poorly, stones periodically clog the neck area and interfere with the outflow of bile.
- Frequent colic. Attacks of pain in cholelithiasis can be very intense. Remove them with antispasmodic drugs. However, frequent colic suggests that drug treatment is not successful. In this case, it is better to resort to the removal of the gallbladder, regardless of how many stones are in it 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 worsens greatly. The outflow of bile stops completely, the pain intensifies, obstructive jaundice develops ( due to the free fraction of bilirubin).
- Biliary pancreatitis. Pancreatitis is an inflammation of the pancreas. This organ has a common excretory duct with the gallbladder. In some cases, with calculous cholecystitis, the outflow of pancreatic juice is disturbed. The destruction of tissues in pancreatitis endangers the life of the patient, so the problem must be urgently solved by surgical intervention.
Separately, it should be noted the surgical treatment of complications of acute cholecystitis. In this case, we are talking about the spread of the inflammatory process. Problems with the gallbladder are reflected in the work 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 resulting problems.
Surgical treatment without fail may also be necessary for the following complications of gallstone disease:
- Peritonitis. Peritonitis is an inflammation of the peritoneum, the membrane 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. It is impossible to postpone surgical intervention, since peritonitis is fraught with the death of the patient.
- Bile duct strictures. Strictures are called narrowing of the canal. Such narrowing can be formed due to the inflammatory process. They obstruct the outflow of bile and cause stagnation in the liver, although the gallbladder itself can be removed. Surgery is needed to remove strictures. As a rule, the narrowed area is expanded or a bypass is made for bile from the liver to the duodenum. Apart from surgery, there is no effective solution to this problem.
- accumulation of pus. Purulent complications of gallstone disease occur when an infection enters the gallbladder. If pus accumulates inside the organ, gradually filling it, such a complication is called empyema. If pus accumulates near the gallbladder, but does not spread through the abdominal cavity, they speak of a paravesical abscess. The patient's condition with these complications is greatly deteriorating. The risk of spreading the infection is high. The operation includes removal of the gallbladder, emptying the purulent cavity and thoroughly disinfecting it to prevent peritonitis.
- Biliary fistulas. Gallbladder fistulas are pathological openings between the gallbladder ( less commonly by biliary tract) and neighboring hollow organs. Fistulas may not cause acute symptoms, but they disrupt the natural flow of bile, digestion, and predispose to other diseases. The operation is performed to close pathological openings.
How to treat gallstone disease with folk remedies?
In the treatment of gallstone disease, folk remedies are ineffective. The fact is that with this disease, stones begin to form in the gallbladder ( usually crystals containing bilirubin). It is almost impossible to dissolve these stones with folk methods. For their splitting or crushing, respectively, powerful pharmacological preparations or ultrasonic waves are used. However, folk remedies play a role in the treatment of patients with gallstone disease. Possible effects of medicinal plants in gallstone disease are:
- Relaxation of smooth muscles. Some medicinal plants relax the muscular sphincter of the gallbladder and the smooth muscles of its walls. This relieves pain attacks usually caused by spasm).
- Decreased bilirubin level. Elevated levels of bilirubin in bile especially if it's been stuck for a long time) may contribute to the formation of stones.
- outflow of bile. Due to the relaxation of the sphincter of the gallbladder, the outflow of bile occurs. It does not stagnate, and crystals and stones do not have time to form in the bubble.
Thus, the effect of the use of folk remedies will be predominantly preventive. Patients with abnormal liver function or other factors predisposing to gallstone disease will benefit from periodic treatment. This will slow down the formation of stones and prevent the problem before it occurs.
For the prevention of 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 a radish and pour honey into it for 10-15 hours. After that, a mixture of juice and honey is consumed 1 tablespoon 1-2 times a day.
- barberry leaves. Green leaves of barberry are thoroughly washed with running water and filled with alcohol. For 20 g of crushed leaves, 100 ml of alcohol are needed. Infusion lasts 5 - 7 hours. After that, the tincture is drunk 1 teaspoon 3-4 times a day. The course lasts 1 - 2 months. It can be repeated after six months.
- Rowan tincture. 30 g of rowan berries pour 500 ml of boiling water. Insist 1 - 2 hours ( while the temperature drops to room temperature). Then the infusion is taken half a cup 2-3 times a day.
- Mummy. Mumiyo can be taken both for the prevention of stone formation 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 tool can be used 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 the dry leaves of these herbs are consumed as an infusion. For 2 tablespoons of the mixture, 1 liter of boiling water is needed. Infusion lasts 4 - 5 hours. After that, the infusion is consumed 1 glass per day. Sediment ( grass) is filtered before use. It is not recommended to store the infusion for more than 3 - 4 days.
- Highlander snake. To prepare a decoction, you need 2 tablespoons of dry chopped rhizome, pour 1 liter of boiling water and cook for 10-15 minutes over low heat. 10 minutes after turning off the fire, the broth is decanted and allowed to cool ( usually 3 - 4 hours). The decoction is taken 2 tablespoons half an hour before meals twice a day.
To prevent stagnation of bile with the help of blind probing, pharmacological preparations or some natural mineral waters can be used. Water or medicine should be drunk on an empty stomach, after which the patient lies on his right side, placing it under the right hypochondrium ( on 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 the bile will gradually come out into the intestines. The success of the procedure is indicated by dark stools with an unpleasant odor after a few hours. It is advisable to consult with your doctor about the method of blind probing and its expediency 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. At the same time, the regularity of treatment courses is important. It is also advisable to undergo preventive examinations with a doctor. This will help to detect small stones ( using ultrasound) in case folk 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?
Gallstone disease can proceed secretly for a long time, without showing itself in any way. During this period, stagnation of bile in the gallbladder and the gradual formation of stones occur in the patient's body. Stones are formed from pigments found in bile ( bilirubin and others), and resemble crystals. The longer the stagnation of bile, the faster these crystals grow. At a certain stage, they begin to injure the inner shell of the organ, interfere with the normal contraction of its walls and prevent the normal outflow of bile. From this point on, the patient begins to experience certain problems. Usually, gallstone disease manifests itself for the first time as follows:
- Heaviness in the abdomen. A subjective feeling of heaviness in the abdomen is one of the first manifestations of the disease. Most patients complain about it when they see a doctor. The severity is localized in the epigastrium ( under the pit of the stomach, in the upper abdomen) or in the right hypochondrium. It can appear spontaneously, after physical exertion, but most often - after eating. This feeling is due to stagnation of bile and an increase in the gallbladder.
- Pain after eating. Sometimes the first symptom of the disease is pain in the right hypochondrium. In rare cases, it is biliary colic. It is a severe, sometimes unbearable pain that can radiate to the right shoulder or shoulder blade. However, 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 and a half after eating. Especially often pain attacks are observed after taking a large amount of 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 releases a certain portion 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 excreted, food is digested worse. Therefore, nausea occurs. Backward 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 secretion of bile, prolonged constipation or diarrhea may occur. Sometimes they appear even before other symptoms typical of cholecystitis. In later stages, the stool may become discolored. This means that the stones clogged the ducts, and bile is practically not excreted from the gallbladder.
- Jaundice. Yellowing of the skin and sclera of the eyes is rarely the first symptom of gallstone disease. It usually occurs 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 bile is produced). Due to a violation of the liver, a substance called bilirubin accumulates in the blood, which is normally excreted with 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 indigestion can also occur with disorders in other organs of the digestive system. To clarify the diagnosis, an ultrasound is prescribed ( ultrasonography) of the abdominal cavity. It allows you to detect a characteristic increase in the gallbladder, as well as the presence of stones in its cavity.
Can calculous cholecystitis be treated at home?
Where the treatment of calculous cholecystitis will take place depends entirely on the condition of the patient. Hospitalization is usually subject to patients with acute forms of the disease, but there may be other indications. At home, gallstone disease can be treated with medication if it occurs in a chronic form. In other words, a patient with gallstones does not need urgent hospitalization unless they have acute pain, fever, and other signs of inflammation. However, sooner or later the question of surgical elimination of the problem arises. Then, of course, you need to go to the hospital. In general, it is recommended to hospitalize the patient in the following cases:
- Acute forms of the disease. In the acute course of calculous cholecystitis, a serious inflammatory process develops. Without proper patient care, 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 should not be postponed, since the above-mentioned complications can develop within 1 to 2 days after the first symptoms.
- The first signs of the disease. It is recommended to hospitalize patients who have 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 to figure out what kind of disease the patient has, what his condition is, 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 an exacerbation and a serious deterioration in the condition. To carefully monitor the course of the disease, it is recommended to put the patient in the hospital. There, if necessary, he will be quickly provided with any assistance.
- Patients with social problems. Hospitalization is recommended for all patients who cannot receive urgent care at home. For example, a patient with chronic cholelithiasis lives very far from the hospital. In the event of an exacerbation, it will not be possible for him to quickly provide qualified assistance ( usually about surgery.). During transportation, serious complications may develop. A similar situation arises with older people who have no one to look after at home. In these cases, it makes sense to operate even a non-acute process. This will prevent an exacerbation of the disease in the future.
- Pregnant women. Calculous cholecystitis in pregnancy carries a higher risk for both mother and fetus. In order to have time to provide assistance, it is recommended to hospitalize the patient.
- Patient's wish. Any patient with chronic cholelithiasis can voluntarily go to the hospital for the surgical removal of gallstones. This is much more profitable than operating on an acute process. Firstly, the risk of complications during surgery and in the postoperative period is reduced. Secondly, the patient himself chooses the time ( vacation, scheduled sick leave, etc.). Thirdly, he deliberately excludes the risk of repeated complications of the disease in the future. The prognosis for such elective operations is much better. Doctors have more time to carefully examine the patient before treatment.
At home, the disease can be treated under the following conditions:
- chronic course of gallstone disease ( no acute symptoms);
- final diagnosis;
- strict adherence to the instructions of a specialist ( regarding prevention and treatment);
- the need for long-term medical treatment ( for example, non-surgical dissolution of stones can take 6 to 18 months);
- the possibility of caring for the patient at home.
Is it possible to play sports with gallstone disease?
Gallstone disease or calculous cholecystitis is a fairly serious disease, the treatment of which must be taken very seriously. The formation of gallstones may not cause noticeable symptoms at first. Therefore, some patients, even after accidentally discovering a problem ( during preventive ultrasound examination) continue to lead a normal life, neglecting the regimen prescribed by the doctor. In some cases, this can lead to accelerated progression of the disease and deterioration of the patient's condition. One of the important conditions of the preventive regimen is the limitation of 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 all the strength, but also about everyday physical activity. At each stage of the disease, they can affect the development of events in different ways.
The main reasons for limiting physical activity are:
- Accelerated production of bilirubin. Bilirubin is a natural metabolic product ( 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 bile stasis or a predisposition to the formation of stones. The gallbladder accumulates bile with a high concentration of bilirubin, which gradually crystallizes and forms stones. Thus, people who already have cholestasis ( bile stasis), but the stones have not yet formed, heavy physical activity is not recommended for preventive purposes.
- Movement of stones. If the stones have already formed, then serious loads can lead to their movement. Most often, stones are located in the area of 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 is reflected to some extent in the gallbladder. It is compressed, and the stones can set in motion, moving to 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 acquires an acute course.
- Progression of symptoms. If the patient already has digestive disorders, pain in the right hypochondrium or other symptoms of gallstone disease, then physical activity can provoke an exacerbation. For example, pain due to inflammation can turn into biliary colic. If the symptoms are caused by the movement of stones and blockage of the bile duct, then they will not disappear after the cessation of exercise. Thus, there is a chance that even a single exercise ( running, jumping, lifting weights, etc.) can lead to urgent 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 complications of gallstone disease. Calculous cholecystitis is almost always accompanied by an inflammatory process. At first, 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 bladder cavity. If under such conditions the intra-abdominal pressure rises sharply or the patient makes a sharp bad turn, the swollen gallbladder may burst. The infection will spread throughout the abdominal cavity, and peritonitis will begin. Thus, sports and physical activity in general can contribute to the development of serious complications.
- Risk of postoperative complications. Acute cholecystitis often has to 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 openings. In both cases, after the operation, any physical activity is contraindicated for some time. With open surgery, healing takes longer, more sutures are placed, and the risk of divergence is higher. With endoscopic removal of the gallbladder, the patient recovers faster. As a rule, full-fledged loads are allowed to be given only 4-6 months after the operation, provided that the doctor does not see other contraindications for this.
- daily walks for 30 - 60 minutes at an average pace;
- gymnastic exercises without sudden movements with limited load on the abdominal press;
- swimming ( not for speed) without diving to great depths.
Is pregnancy dangerous with gallstone disease?
Gallstone disease in pregnant women is a fairly common occurrence in medical practice. On the one hand, this disease is typical for older women. However, it is during pregnancy that there are quite a few prerequisites for the appearance of stones in the gallbladder. Most often it occurs in patients with a hereditary predisposition or with chronic liver diseases. According to statistics, an exacerbation of gallstone disease usually occurs in the third trimester of pregnancy. 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.
- Motility changes. Normally, the gallbladder stores bile and contracts, releasing it in small portions. During pregnancy, the rhythm and strength of its contractions are disturbed ( dyskinesia). As a result, bile stasis can develop, which contributes to the formation of stones.
- Increased intra-abdominal pressure. If a woman already had small gallstones, then the growth of the fetus can lead to their movement. This is especially true in the third trimester, when the growing fetus pushes up the stomach, colon, and gallbladder. 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 walking or elementary physical exercises, which contribute, among other things, to the normal functioning of the gallbladder. This leads to stagnation of bile and acceleration of the formation of stones.
- Diet change. Changing food preferences can affect the composition of the microflora in the intestine, worsen the motility of the bile ducts. If at the same time the woman had a latent ( asymptomatic) form of gallstone disease, the risk of exacerbation greatly increases.
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 of infectious complications ( including purulent processes) due to weakened immunity;
- fetal intoxication due to the inflammatory process;
- malnutrition of the fetus due to poor digestion ( food is absorbed worse, as bile does not enter the duodenum);
- limited treatment options not all drugs and treatments that are commonly used for gallstone disease are suitable for pregnant women).
In the absence of complications of gallstone disease, the prognosis for the 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 extracting the fetus by caesarean section may be raised. At the same time, the prognosis worsens somewhat, since we are talking about a technically complex surgical intervention. It is necessary to remove the gallbladder, remove the fetus, carefully examine the abdominal cavity to prevent the development of peritonitis.
What are the types of calculous cholecystitis?
Calculous cholecystitis is not the same for all patients. This disease is caused by the formation of stones in the gallbladder, due to which an inflammatory process develops. Depending on how exactly this process will proceed, as well as on the stage of the disease, there are several types of calculous cholecystitis. Each of them has not only its own characteristics of the course and manifestations, but also requires a special approach to treatment. From the point of view of the main manifestations of the disease(clinical form)There are the following types of calculous cholecystitis:
- stone carrier. This form is latent. The disease does not show up. The patient feels great, does not experience any pain in the right hypochondrium, or problems with digestion. 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. Stone carriers can be detected during a preventive ultrasound examination. It is more difficult to see stones on a plain x-ray of the abdomen. When a stone carrier is found, there is no question of an emergency operation. Doctors have time to try other treatments.
- Dyspeptic form. In this form, the disease is manifested by a variety of digestive disorders. It can be difficult to suspect cholecystitis at first, since there are no typical pains in the right hypochondrium. Patients are concerned about heaviness in the stomach, in the epigastrium. Often after a large meal especially fatty foods and alcohol) there is an eructation with a taste of bitterness in the mouth. This is due to violations of bile secretion. Also, patients may have problems with the stool. 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 often appear ( every day and sometimes more). The effect of antispasmodic drugs is temporary. Gallbladder colic is caused by painful contraction of smooth muscles in the walls of the gallbladder. They are usually observed with large stones, overstretching of the organ, ingress of a stone into the bile duct.
- Chronic recurrent cholecystitis. The recurrent form of the disease is characterized by repeated bouts of cholecystitis. The attack is manifested by severe pain, colic, fever, characteristic changes in blood tests ( increases the level of leukocytes and the erythrocyte sedimentation rate - ESR). Relapses occur when unsuccessful attempts at conservative treatment. Medicines temporarily bring down the inflammatory process, and some medical procedures can temporarily improve the outflow of bile. But as long as there are stones in the gallbladder cavity, the risk of recurrence remains high. Surgery ( cholecystectomy - removal of the gallbladder) solves this problem once and for all.
- Chronic residual cholecystitis. This form is not recognized by all experts. It is sometimes spoken of in cases where an attack of acute cholecystitis has passed. The patient's temperature decreased, and the general condition returned to normal. However, the symptoms remained moderate pain in the right hypochondrium, which is aggravated by palpation ( palpation of this area). Thus, we are not talking about a complete recovery, but about the transition to a special form - residual ( residual) cholecystitis. As a rule, over time, the pain disappears or the disease worsens again, turning into acute cholecystitis.
- angina pectoris form. It is a rare clinical form of calculous cholecystitis. Its difference from others is that the pain from the right hypochondrium spreads to the region of the heart and provokes an attack of angina pectoris. Heart rhythm disturbances and other symptoms of the cardiovascular system may also be observed. This form is more common in patients with chronic ischemic heart disease. Biliary colic in this case plays the role of a kind of "trigger". The problem is that due to an attack of angina pectoris, doctors often do not immediately detect the main problem - the actual calculous cholecystitis.
- Saint's syndrome. It is a very rare and poorly understood genetic disease. With it, the patient has a tendency to form stones in the gallbladder ( actually calculous cholecystitis), which appears to be due to the absence of certain enzymes. In parallel, diverticulosis of the colon and diaphragmatic hernia are observed. This combination of defects requires a special approach in treatment.
