Symptoms of an attack of gallstone disease. Gallstone disease (calculous cholecystitis). Causes, symptoms, modern diagnosis and effective treatment of gallstones Dull pain in gallstone disease

is a disease accompanied by the formation of stones in the gallbladder (cholecystolithiasis) or in the bile ducts (choledocholithiasis). Stones are formed as a result of precipitation of bile pigments, cholesterol, some types of proteins, calcium salts, infection of bile, its stagnation, lipid metabolism disorders. The disease may be accompanied by pain in the right hypochondrium, biliary colic, jaundice. Requires surgical intervention. Pathology can be complicated by cholecystitis, fistula formation, peritonitis.

General information

- a disease characterized by a disorder in the synthesis and circulation of bile in the hepatobiliary system as a result of a violation of cholesterol or bilirubin metabolism, resulting in the formation of stones (calculi) in the bile ducts and gallbladder. Pathology is dangerous by the development of severe complications with a high probability of death. The disease is much more common in women. Treatment is carried out by specialists in the field of clinical gastroenterology and abdominal surgery.

The reasons

In case of violation of the quantitative ratio of bile components in the body, solid formations (flakes) are formed, which, with the course of the disease, grow and merge into stones. The most common cholelithiasis occurs with impaired cholesterol metabolism (excessive content in bile). Cholesterol-rich bile is called lithogenic. Excess cholesterol is formed due to the following factors:

• With obesity and the use of a large amount of cholesterol-containing foods.
• With a decrease in the amount of bile acids entering the bile (low secretion with estrogen, deposition in the gallbladder, functional insufficiency of hepatocytes).
• With a decrease in the amount of phospholipids, which, like bile acids, do not allow cholesterol and bilirubin to pass into a solid state and settle.
• With congestion in the bile circulation system (bile thickening due to absorption of water and bile acids in the gallbladder).

Stagnation of bile, in turn, can be mechanical and functional. With mechanical stagnation, there is an obstruction to the outflow of bile from the bladder (tumors, adhesions, kinks, enlargement of nearby organs and lymph nodes, scars, inflammation with swelling of the wall, strictures). Functional disorders are associated with a disorder of the motility of the gallbladder and biliary tract (biliary dyskinesia of the hypokinetic type). Also, infections, inflammation of the organs of the biliary system, allergic reactions, and autoimmune conditions can lead to the development of cholelithiasis.

Risk factors for the development of cholelithiasis are advanced and senile age, taking medications that interfere with the metabolism of cholesterol and bilirubin (fibrates, estrogens in menopause, ceftriaxone, ocreotide), genetic factors (cholelithiasis in the mother), malnutrition (obesity, sudden weight loss, starvation , elevated levels of cholesterol and high-density lipoproteins in the blood, hypertriglycerinemia).

The likelihood of developing pathology is increased by multiple pregnancies, metabolic diseases (diabetes mellitus, fermentopathy, metabolic syndrome), diseases of the gastrointestinal tract (Crohn's disease, diverticula of the duodenum and bile duct, biliary tract infection), postoperative conditions (after gastric resection, stem vagoectomy ).

Pathoanatomy

Gallstones are diverse in size, shape, there can be a different number (from one calculus to hundreds), but they are all divided according to their predominant component into cholesterol and pigment (bilirubin).

Yellow cholesterol stones consist of undissolved cholesterol with various impurities (minerals, bilirubin). Almost the vast majority of stones are of cholesterol origin (80%). Pigment stones of dark brown to black color are formed with an excess of bilirubin in bile, which happens with functional disorders of the liver, frequent hemolysis, and infectious diseases of the biliary tract.

Classification

According to the modern classification, gallstone disease is divided into three stages:

• Initial (pre-stone). It is characterized by changes in the composition of bile) is not clinically manifested, it can be detected by biochemical analysis of the composition of bile.
• Stone formations. Latent stone carrying is also asymptomatic, but with instrumental diagnostic methods, it is possible to detect stones in the gallbladder.
• Clinical manifestations. It is characterized by the development of acute or chronic calculous cholecystitis.

Sometimes a fourth stage is distinguished - the development of complications.

Symptoms of gallstone disease

The symptomatic manifests itself depending on the localization of stones and their size, the severity of inflammatory processes and the presence of functional disorders. A characteristic pain symptom in cholelithiasis is biliary or hepatic colic - a pronounced acute sudden pain under the right rib of a cutting, stabbing character. After a couple of hours, the pain is finally concentrated in the projection of the gallbladder. It can radiate to the back, under the right shoulder blade, to the neck, to the right shoulder. Sometimes irradiation to the region of the heart can cause angina pectoris.

Pain often occurs after eating spicy, spicy, fried, fatty foods, alcohol, stress, heavy physical exertion, prolonged work in an inclined position. The causes of the pain syndrome are spasm of the muscles of the gallbladder and ducts as a reflex response to irritation of the wall with stones and as a result of overdistension of the bladder with excess bile in the presence of obstruction in the bile ducts. Global cholestasis with blockage of the bile duct: the bile ducts of the liver expand, increasing the organ in volume, which responds with a pain reaction of an overstretched capsule. Such pain has a constant dull character, often accompanied by a feeling of heaviness in the right hypochondrium.

Accompanying symptoms - nausea (up to vomiting, which does not bring relief). Vomiting occurs as a reflex response to irritation of the peripapillary region of the duodenum. If the inflammatory process has captured the tissues of the pancreas, vomiting can be frequent, with bile, indomitable. Depending on the severity of intoxication, there is an increase in temperature from subfebrile numbers to severe fever. With blockage of the common bile duct by a calculus and obstruction of the sphincter of Oddi, obstructive jaundice and discoloration of the feces are observed.

Complications

The most common complication of cholelithiasis is inflammation of the gallbladder (acute and chronic) and obstruction of the biliary tract with a calculus. Blockage of the lumen of the bile ducts in the pancreas can cause acute biliary pancreatitis. Also, inflammation of the bile ducts - cholangitis is considered a common complication of cholelithiasis.

Diagnostics

If symptoms of hepatic colic are detected, the patient is referred for a consultation with a gastroenterologist. Physical examination of the patient reveals symptoms characteristic of the presence of calculi in the gallbladder: Zakharyin, Ortner, Murphy. Skin tenderness and muscle tension of the abdominal wall in the area of ​​the gallbladder projection are also determined. Xanthemas are noted on the skin, with obstructive jaundice, a characteristic yellow-brownish color of the skin and sclera.

A general blood test during a clinical exacerbation shows signs of nonspecific inflammation - leukocytosis and a moderate increase in ESR. Biochemical analysis of blood reveals hypercholesterolemia and hyperbilirubinemia, increased activity of alkaline phosphatase. With cholecystography, the gallbladder is enlarged, has calcareous inclusions in the walls, the stones with lime present inside are clearly visible.

The most informative and most widely used method for examining the gallbladder is abdominal ultrasound. It accurately shows the presence of echo-impermeable formations - stones, pathological deformations of the bladder walls, changes in its motility. Ultrasound clearly shows the presence of signs of cholecystitis. Also, MRI and CT of the biliary tract allow visualization of the gallbladder and ducts. Informative in terms of identifying bile circulatory disorders, it can always be transferred to an open abdominal operation if technically necessary.

There are methods for dissolving stones with the help of ursodeoxycholic and chenodeoxycholic acid preparations, but this kind of therapy does not lead to a cure for cholelithiasis and, over time, the formation of new stones is possible. Another way to destroy stones is shock wave lithotripsy - it is used only in the presence of a single calculus and in patients who do not suffer from acute inflammation of the gallbladder or ducts.

Forecast and prevention

The prognosis directly depends on the rate of formation of stones, their size and mobility. In the vast majority of cases, the presence of stones in the gallbladder leads to the development of complications. With successful surgical removal of the gallbladder - a cure without pronounced consequences for the quality of life of patients. Prevention consists in avoiding factors that contribute to increased cholesterolemia and bilirubinemia, bile stasis.

A balanced diet, normalization of body weight, an active lifestyle with regular physical activity can avoid metabolic disorders, and timely detection and treatment of pathologies of the biliary system (dyskinesia, obstruction, inflammatory diseases) can reduce the likelihood of bile stasis and sedimentation in the gallbladder. Particular attention should be paid to the exchange of cholesterol and the state of the biliary system in persons with a genetic predisposition to stone formation.

In the presence of stones in the gallbladder, prevention of attacks of biliary colic will be following a strict diet (exclusion from the diet of fatty, fried foods, muffins, confectionery creams, sweets, alcohol, carbonated drinks, etc.), normalization of body weight, drinking enough liquid. To reduce the likelihood of movement of calculi from the gallbladder through the ducts, work associated with a long stay in an inclined position is not recommended.

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 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

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 years 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.

• Food . 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?

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 a crystallization process 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

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

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

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

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

Diet for gallstone disease

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)

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

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

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

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

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 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 ( most 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?

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?

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 addressed through 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?

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 that predispose 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 is 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 glass 2-3 times a day.
• Mummy. Shilajit 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?

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 ( ultrasound procedure) 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?

• 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 that patients who present with symptoms and signs of calculous cholecystitis be admitted to the hospital 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?

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, 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?

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?

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 notice 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.

Cholelithiasis, also known as cholelithiasis or cholelithiasis, is a disease in which stones form in the gallbladder or bile ducts. Gallstone disease, the symptoms of which are noted in patients, as the results of medical practice show, is ineffective in treatment using conservative therapy and various types of techniques, therefore the only way to cure the disease is surgery.

general description

Gallstone disease is a fairly common diagnosis, and the peculiarity lies in the fact that susceptibility to it, as well as the causes provoking its development, is quite difficult to trace. The fact is that in most people, gallstone disease occurs latently, that is, in a latent form without any special manifestations. In the structure of various diseases that affect the digestive organs, cholelithiasis occupies a significant place precisely because of its prevalence.

Industrialized countries have statistics on this score of about 15% incidence, while it can be noted that the prevalence directly depends on the age and sex of patients. In particular, men suffer from this disease twice as rarely as, respectively, women. Every fifth of women aged 40 and over is faced with gallstone disease, while men of the same age experience it in every tenth case. Up to 50 years, gallstone disease is observed in about 11%, from 50 to 69 - up to 23%, from 70 years and more - up to 50%.

Let us dwell directly on the features of the course of the disease. The movement of bile, carried out by it along the biliary tract, occurs due to the coordination of the functions of the gallbladder, liver, pancreas, bile duct and duodenum. Already due to this, in turn, bile enters the intestines in a timely manner during digestion, in addition to this, it accumulates in the gallbladder. With the stagnation of bile and with a change in its composition, the process of formation of stones begins, which is also facilitated by inflammatory processes in combination with motor-tonic disorders of bile secretion (that is, dyskinesia).

Gallstones are cholesterol (the vast majority, about 90% of the variants of gallstones), as well as stones pigmented and mixed . So, due to a supersaturation of bile with cholesterol, the formation of cholesterol stones, its precipitation, and the formation of crystals occur. Violation in the gallbladder of the motility leads to the fact that these crystals do not enter the intestine, which ultimately leads to their gradual growth. Pigment stones (also called bilirubin stones) are formed by increased breakdown, which occurs with topical hemolytic anemia. As for mixed stones, they are a kind of combination based on the processes of both forms. Such stones contain cholesterol, bilirubin and calcium, the very process of their formation occurs as a result of inflammatory diseases affecting the biliary tract and, in fact, the gallbladder.

As for the reasons that contribute to the formation of gallstones, among them are the following:

• unbalanced diet (in particular, when it comes to the predominance of animal fats in it with simultaneous damage to vegetable fats);
• hormonal disorders (with a weakening of the functions characteristic of the thyroid gland);
• sedentary lifestyle;
• disorders associated with fat metabolism, which intersects with an increase in body weight;
• inflammation and other abnormalities that occur in the gallbladder;
• various kinds of liver damage;
• spinal injuries;
• pregnancy;
• starvation;
• heredity;
• spinal injuries;
• diseases of the small intestine, etc.

As factors provoking the development of the disease we are considering, the following are distinguished:

• helminthiases;
• (due to the use of alcohol);
• biliary tract infections (in chronic form);
• chronic hemolysis;
• demographic aspects (relevance of the disease for residents of rural areas, as well as the Far East);
• elderly age.

Gallstone disease: classification

Based on the features of the disease accepted today, the following classification is distinguished according to the stages that are relevant to it:

• physico-chemical (initial) stage - or, as it is also called, the pre-stone stage. It is characterized by changes occurring in the composition of bile. There are no special clinical manifestations at this stage, the detection of the disease at the initial stage is possible, for which a biochemical analysis of bile is used for the features of its composition;
• formation of stones stage, which is also defined as latent lithology. In this case, there are no symptoms of cholelithiasis, however, the use of instrumental diagnostic methods makes it possible to determine the presence of stones in the gallbladder;
• clinical manifestations - stage, the symptoms of which indicate the development of an acute or chronic form of calculus.

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

Gallstone disease: symptoms

Manifestations characteristic of cholelithiasis are determined based on the specific localization and size of the formed stones. Based on the degree of severity relevant to inflammatory processes, as well as on the basis of functional disorders, the severity of the manifestations of the disease, as well as the features of its course, are subject to change.

With cholelithiasis, in particular, a pronounced pain symptom (biliary or) is noted - this is an acute pain that suddenly occurs in the right hypochondrium. It can be piercing or cutting. After a few hours, the final concentration of pain is concentrated within the projection of the gallbladder. It is also possible to radiate pain to the right shoulder, neck, right shoulder blade, or back. In some cases, the pain radiates to the heart, which provokes the appearance.

Mostly pain occurs due to the use of spicy, fatty, fried or spicy foods and alcohol, against the background of severe stress or significant physical exertion. Also, pain can be provoked by a long stay in an inclined position during work. Causes pain spasm, which is formed in the area of ​​the muscles and ducts of the gallbladder, which is a reflex response to the acting irritation experienced by the wall due to stones.

In addition, the cause of spasm is the overdistension of the bladder, formed by excess bile, which occurs as a result of obstruction (blockage) that has arisen in the biliary tract. For the global, in the presence of blockage in the bile duct, the characteristic manifestations are the expansion of the bile ducts of the liver, as well as an increase in the volume of the organ, resulting in a corresponding pain reaction of the pain capsule. The pain in this case is constant, often in the right hypochondrium there is a characteristic feeling of heaviness.

As concomitant symptoms, nausea is also distinguished, which in some cases may be accompanied by vomiting without proper relief after it. It is noteworthy that vomiting is also a reflex response to the stimulus. At the same time, the capture of pancreatic tissues by the inflammatory process is a factor leading to an increase in vomiting, which in this case has an indomitable character and is accompanied by the release of bile with vomit.

Based on the severity of intoxication, there may be an elevated temperature, fluctuating in subfebrile levels, but in some cases reaching a pronounced fever. Blockage of the bile duct by a calculus in combination with obstruction of the sphincter leads to discoloration of the feces and jaundice.

Late diagnosis of the disease often indicates the presence of empyema (accumulation of pus) in the wall of the gallbladder, which arose against the background of the closure of the bile ducts with a calculus. Vesicoduodenal fistulas and biliary tract may also develop.

Diagnosis of gallstone disease

Identification of symptoms characteristic of hepatic colic requires consultation with a specialist. Under the physical examination that he conducts, it means the identification of symptoms characteristic of the presence of calculi in the gallbladder (Murphy, Ortner, Zakharyin). In addition, a certain tension and soreness of the skin in the region of the muscles of the abdominal wall is revealed within the framework of the projection of the gallbladder. Also, the presence of xanthomas on the skin (yellow spots on the skin, formed against the background of a violation in the body of lipid metabolism) is noted, yellowness of the skin and sclera is noted.

The results of the surrender determine the presence of signs indicating non-specific inflammation at the stage of clinical exacerbation, which in particular consist in the moderation of the increase and in leukocytosis. When hypercholesterolemia is determined, as well as hyperbilirubinemia and increased activity characteristic of alkaline phosphatase.

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

The most informative method, which is also the most common in the study of the area of ​​interest to us and for the disease in particular, is. When examining the abdominal cavity, in this case, accuracy is ensured with respect to identifying the presence of certain echo-impermeable formations in the form of stones in combination with pathological deformities that the walls of the bladder undergo during the disease, as well as with changes that are relevant in its motility. Well seen with ultrasound and signs indicating cholecystitis.

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

Treatment of gallstone disease

Patients with a diagnosis of cholelithiasis are assigned a general type of hygienic regimen, rational nutrition, as well as a systematic load in dosed volumes. Diet No. 5 is also shown with the exclusion of certain foods in it (fats in particular). It is recommended to eat meals "by the hour". In general, the absence of complications often excludes the use of specific treatment - in this case, first of all, the emphasis is on waiting tactics.

With the development of an acute or chronic form of calculous cholecystitis, the removal of the gallbladder is required, which in this case is the process of stone formation. The specificity of the surgical intervention is determined on the basis of the general condition of the body and the changes accompanying the pathological process, concentrated in the area of ​​the walls of the bladder and the tissues surrounding it, and the size of the calculi is also taken into account.

If symptoms relevant to cholelithiasis occur, it is necessary to contact a gastroenterologist, and a surgeon's consultation may be additionally prescribed.

Among the pathologies of the internal organs, cholelithiasis occupies one of the leading positions in terms of its prevalence, but not everyone knows the symptoms of the pathology. The difficulty lies in the fact that for a long time the disease proceeds in a latent form, without making itself felt.

According to statistics, in developed countries, 15% of the population suffers from this pathology. If we analyze the age groups of the sick, we can find a direct relationship between the age, sex of the sick and their number. In particular, it is noted that women get sick twice as often as men.

If we consider women whose age has exceeded the mark of 40 years, then every fifth will be sick. Men of the same age have one case per 10 people. The distribution of the number of cases by age groups is as follows:

• 40 - 50 years - 11%;
• 50 - 69 years old - 23%;
• 70 years and older - 50%.

Features of the course of the disease

The following organs are responsible for the function of bile movement: gallbladder, liver, bile duct, duodenum,. Each body on the list has its own “duties”. Together they organize the transport of bile throughout the body.

Part of the bile must enter the intestines to ensure normal digestion. Some of it heats up in the bubble itself. If it stagnates, stones begin to form. Motor-tonic disorders of bile secretion, aggravated by inflammatory processes, exacerbate the situation. They lead to an acceleration of the process of stone formation. All stones that can form in the gallbladder are divided into the following varieties:

• cholesterol (90% of the total);
• pigment;
• mixed.

Cholesterol stones form when bile contains too much cholesterol. At the same time, stones form in the bile, then they sink to the bottom, release into sediment. The process is accompanied by the formation of crystals. Since motility is impaired, these crystals cannot enter the intestines and empty the bladder cavity. Therefore, the stones only increase over time. This process becomes irreversible.

Pigment stones have another name - bilirubin. The reason for their appearance is the high rate of erythrocyte decay. This phenomenon is characteristic of hemolytic anemia.

The mixed type of stones bears the features of both described types. They have bilirubin, cholesterol, calcium in their composition, which, after precipitation, are assembled and gradually overgrown with an increasingly significant amount of deposits. The formation of stones in this case provokes an inflammatory process that affects the bile ducts. The development of a violation of bile secretion (dyskenesia) becomes an additional factor contributing to the development of pathology.

The main causes of the formation of gallstones

It is quite difficult to determine the cause of the formation of gallstones. As a rule, this is not one factor, but a whole complex of problems that influenced the development of pathology. There are several main reasons that provoke the formation of stones:

• malnutrition, in which vegetable fats are consumed little, and animals are too much;
• hormonal dysfunction (disorders in the thyroid gland);
  sedentary standard of living;
• lipid imbalance (usually accompanied by overweight);
• inflammatory phenomena;
• spinal injuries;
• starvation;
• pregnancy;
• diabetes;
• hereditary predisposition;
• small intestine problems.

There is another group of factors that sometimes contribute to the formation of stones:

The last factor is considered demographic. It has no specific explanations, it was revealed on the basis of long-term observations.

stages

The disease has several stages. The division of the disease development process into stages is based on the typical manifestation of this pathology in our time. Traditionally, the following stages are distinguished:

1. the initial stage, it is customary to call it the physicochemical or pre-stone (it is accompanied by a change in the bile composition, does not show itself clinically, therefore it can be detected only with the help of laboratory data, namely with the help of a biochemical analysis of bile);
2. the stage of stone formation is considered a latent stone carrier, there are no clinical signs, there are no specific symptoms, but formations in the gallbladder can already be determined by an instrumental method;
3. the stage of clinical manifestations, during this period, the formation of calculous cholecystitis of both acute and chronic forms occurs;
4. the fourth stage is the appearance of complications that develop as a result of the destructive effects of the underlying disease

signs

Cholelithiasis will manifest itself depending on the size of the stones, where they are located. The disease can manifest itself in different ways. This is due to the type of accompanying inflammatory process, as well as functional disorders.

Almost always present (biliary colic, hepatic colic). They are determined in the region of the hypochondrium on the right. They occur most often unexpectedly, patients complain that they have a “prickly side” or “cut”. Subsequently, the pain is localized specifically at the location of the bladder. The pain can radiate to the shoulder, neck, back, shoulder blade, pain is always felt exclusively on the right. When the pain radiates to the heart, angina pectoris develops, which greatly worsens the general condition.

The appearance of pain is associated with the use of heavy and junk food. This includes spices, fatty foods, alcohol, spicy. Fried foods are especially difficult to perceive. Strong physical exertion, exhausting sports, hard work can provoke an exacerbation of the disease and pain. Stress is also one of the causes of pain syndrome. If the work is associated with a long stay in an inclined position, then you can also experience pain during illness.

After all, this situation contributes to the appearance of obstacles to the outflow of bile. The source of pain is a spasm of the muscles located in the bile zone, as well as a spasm of its ducts. Spasms in this case are reflex in nature, they arise due to the fact that the calculi irritate the bile wall with their action.

Also, a spasm appears when the walls of the bladder are stretched above normal due to the accumulation of excessive volumes of bile in it.

This happens when the bile ducts are clogged, that is, obstruction occurs. Global cholestasis can be diagnosed by dilated bile ducts in the liver. All this is accompanied by blockage of the bile duct. The liver may also enlarge. Therefore, in the region of the right hypochondrium, in addition to constant pain, heaviness appears.

Often associated with pain. Nausea strongly and almost constantly. This condition may include vomiting. But the relief that should occur, such vomiting does not give. Vomiting also occurs due to irritation, in fact, it is a reflex response of the body. If vomiting has become uncontrollable, most likely, the inflammation is spreading and has already touched the pancreas. In this case, bile can be seen in the vomit.

Gradually, intoxication develops, which can be expressed in malaise, weakness, in temperature at a subfebrile level. Sometimes the temperature rises much higher, a real fever can begin. If the stone clogs the bile duct and the sphincter loses patency, the stool will become light, jaundice will develop.

Diagnostic methods

Stones in the gallbladder

If you have hepatic colic, you should definitely consult a doctor. This state of affairs should not be ignored. This is fraught with complications. You should be referred for an examination, which will show if there are stones of various types in the bladder. An external inspection is also carried out.

On the abdominal wall in the area of ​​​​the bladder, you can see the tension, soreness of the skin. Yellow spots appear on the skin, they are called xanthomas. They are perfectly visible during external examination. The reason for these spots lies in the violation of lipid metabolism. The skin turns yellow in general, the sclera also become yellow.

According to general blood tests, signs of inflammation of a nonspecific nature in the acute stage can be determined. These signs include a moderate increase in ESR, increased leukocytes. If a biochemical analysis is carried out, an increase in cholesterol (hypercholesterolemia), (hyperbilirubinemia) will be detected, there will be increased activity, which occurs with alkaline phosphatase.

Also carry out cholecystography. Its purpose is to identify an increase in the gallbladder and the presence of calcareous inclusions in the walls of this organ. This method makes it possible to see lime stones inside the bubble. This method is considered to be very effective in making a diagnosis.

Ultrasound is a very informative diagnostic method. This study reveals echo-impermeable formations (stones), as well as pathological deformities. The diagnostic accuracy in this case is very high. The sizes and localization of calculi, their approximate number are revealed. You can track changes associated with the motility of this organ. Signs of cholecystitis are also found on ultrasound.

MRI and CT perfectly show the condition of the bile and ducts, so their use for examination for the disease in question is very effective. Scintigraphy (the introduction of isotopes with radioactivity into the body in order to obtain an image on a gamma tomograph) shows disturbances in the circulation of bile. For examinations in the same direction, endoscopic retrograde cholangiopancreatography is used.

Treatment

Treatment of the disease is complex

People suffering from cholelithiasis are limited to loads, the menu is formed for them in accordance with the principles of rationality. Hygienic mode corresponds to the general type. Diet number 5 is prescribed, it is supplemented with the exclusion of fats. The main tactic in treatment is waiting. Specific treatment is rarely prescribed. A certain mineral water is often recommended.

If calculous cholecystitis begins, then surgical removal is performed. The tactics of the operation depends on the patient's condition, as well as on the condition of the tissues adjacent to the gallbladder. The size of the stones must also be taken into account.

With surgical intervention in this case, it is impossible to delay, because this condition can lead to peritonitis, perforation, acute pancreatitis and obstructive jaundice.

If there is a suspicion of gallstone disease, you should go for a consultation with a surgeon. It is easier to correct the condition in the initial stages than in advanced cases. After all, following a diet, leading a measured lifestyle is easier than having an operation.

Gallstone disease, watch the video:

There are many reasons for the exacerbation, the question remains: what to do with an attack of gallstone disease, how to stop the pain and prevent a relapse.

Symptoms and development of the disease

The disease develops slowly and imperceptibly: initially, several stones form in the bile ducts, making it difficult to remove bile, and no inflammation, abscess formation, or other complications are observed. Already at the initial stage, the first clear sign appears: colic in the liver. Pain is associated with the passage of stones through the bile ducts - the stones are trying to get into the intestines, so that they can then leave the body with the rest of the waste. However, the size of the stones sometimes does not allow to pass through the narrow ducts, the flow of bile gets stuck halfway, causing pain.

Symptoms of an advanced gallstone attack include:

• intense and prolonged pain;
• the patient has rapid breathing with small breaths and small exhalations;
• there is a general change in the skin, the color becomes pale;
• due to increased metabolism, sweating develops;
• pain shock may occur.

If a person directly encounters the listed symptoms, it is not worth delaying a further visit to the doctor.

A little about hepatic colic

Hepatic colic is the first and surest symptom of gallstone disease. Hepatic colic has the following properties:

• the pain is localized in the right side, is acute;
• at times, the pain radiates to the back - the shoulder blade, neck, in rare cases, the buttock and arm;
• the main symptom may be external bloating;
• in some cases, the patient's temperature jumps - he gets chills or throws him into a fever;
• often exacerbation corresponds to a disorder of the functions of the gastrointestinal tract, difficulties in digestion;
• arrhythmia (violation of the heartbeat) is observed.

Acute pain annoys the patient for half an hour, then smoothly turns into a aching character. If it is impossible to anesthetize the stomach, after a couple of hours the pain subsides completely, sometimes it lasts for a minute.

Of course, the presence of one of the list of symptoms does not mean the formation of gallstones, but such an attack will serve as a good call to change habits and go to the hospital.

How to help yourself

If the attack is taken by surprise, you will need to remove the attack of gallstone disease yourself.

First aid is as follows: you need to lie down on a sofa, bed or chair - a place where you can stretch your legs, feel peace. If the patient is alone at home, it does not hurt to call friends, relatives asking for help. Ask friends to come, there may be a case of vomiting or an increase in the attack (pain medication does not always help) so much that you have to call an ambulance.

Painkillers are often:

Attending physicians warn the problem in advance - they offer the patient a painkiller in case of an attack. If you don't get a suggestion from your doctor, discuss the names of the medicines at the appointment.

Some doctors recommend taking a bath. Water is gaining a pleasant, warm temperature (from 37 to 39C), should not burn the human body. You do not need to lie in the bath for a long time: it is enough to relax for minutes. Then it is recommended to quickly go to bed so that the warmed body does not cool down again, and the body temperature does not change. An alternative option that allows you to "warm up" the body, improve the functioning of blood vessels - attach a heating pad to your legs. It is recommended that the patient be wrapped as much as possible in blankets and warm clothes; in case of cholelithiasis, heat will do a good job. If the patient's temperature jumps, the patient feels chills, wrap the person in a blanket more tightly.

Drink plenty of water to avoid dehydration. Mineral, filtered water is recommended, tap water, carbonated drinks are strictly prohibited.

As a rule, serious attacks last 20-30 minutes, after the specified time it is allowed to leave the bed or bath and continue to do business. If the attack has not ended, it means that the matter is serious, and a doctor's consultation is urgently needed. We'll have to call the hospital and call an ambulance.

Remember: the sooner a stone is found in the gallbladder (or several) and the patient goes to the doctor with a complaint, the higher the likelihood of avoiding surgery.

Complications of gallstone disease and parallel diseases

If you do not see a doctor in time with stones in the gallbladder, you may encounter a number of rather serious complications that greatly affect the state of your body. At first, the stones are small, painkillers cope with the task of muffling the pain, but gradually the formations become more massive, the passage through the biliary tract becomes more complicated. When stones get stuck, clogging the bile ducts, unpleasant phenomena occur:

• biliary cirrhosis of the liver;
• jaundice;
• cholecystitis (inflammation of the gallbladder);
• cholangitis.

Cholecystitis is accompanied by recognizable symptoms:

• the pain is localized on two sides of the body, acquiring a girdle character;
• yellowed skin;
• change in body temperature;
• pain sensations radiate to the back, create a feeling of pulsation;
• problems with food processing - vomiting, nausea.

With an increase in stones and blockage of the ducts, it is scary that the pain does not stop, it is very intense. In order not to delay treatment, leading up to surgery, it is better to worry about preventing the consequences in advance.

The listed diseases will serve as a prerequisite for the appearance of gallstones:

The common cause of the transition of diseases into each other is the deterioration of the body. As a rule, clinics remember such a relationship, follow preventive measures to reduce the likelihood of gallstones.

Due to complications and parallel diseases, not treated in time, a person suffers many times: the first time when he tries to cope with the diagnosed disease, the second - when an additional disease appears, and the patient has to fight on several fronts at the same time. The metabolism and life of a person depends on the complications of cholelithiasis, the symptoms indicating the occurrence of complications require an urgent need to call an ambulance. The attending physician will be able to decide whether it is worth hospitalizing the patient or whether it will be possible to get by with a set of elementary measures.

When hospitalized, a further treatment course is prescribed individually, depending on the cause of the attack, in addition to the running gallbladder.

Prevention

A gallstone attack of a single character is a warning and a reminder of the need to take care of health. To protect yourself from repetition, it is enough to follow a number of preventive measures. The extreme importance of the requirement is obtained after an attack. For example:

• within 12 hours after the onset of pain should fast;
• then they switch to drinking rosehip broth, use soups cooked with fresh vegetables;
• on the third day after inflammation, cereals boiled in water, cottage cheese (necessarily low-fat), milk (low-fat), broths on lean meat, bread (rye), fresh vegetables and fruits are returned to the diet - excluding sour taste;
• with great care after an attack, river fish, turkey meat, chicken (without skin) should be added to food. Discuss with your doctor the possibility of a treatment course of taking mineral water.

The diet, developed by nutritionists solely to prevent new attacks of gallstone disease, is accompanied by a list of prohibited foods:

• pasta (even the highest grade);
• sausage;
• spinach;
• dairy products with high fat content;
• dishes subject to heat treatment, in addition to boiling and steaming;
• forget about seasonings, pickled and highly salted foods;
• coffee;
• alcohol.

Adhering to a diet is required during an attack and after it. The diet helps to reduce the load on the gallbladder, on the processing system as a whole. Take care of the diet, it is easy and does not require much effort.

If a diagnosis of gallstone disease is made, you will have to temporarily forget about intensive methods of losing weight. Quite often, women mistakenly believe that fitness can improve health, gallstones are an exception. Such diets disrupt metabolism, food processing and the release of bile from the bile ducts are disturbed. It is better to discuss the need to lose weight with a doctor, finding a way out that suits both parties.

The diet has a list of allowed and prohibited foods, recommendations on dosage and frequency of daily meals. The daily norm of useful substances in people varies, only a doctor can give clear individual advice. However, there are rules that are common to each case.

For example, you will need to plan the menu and the quantitative ratio of dishes in the list in the morning. A large portion of food should be divided into 5-6 meals. The size of the dish should not be massive, so as not to overload the inflamed organs too much.

By following simple preventive rules, it will be possible to forget about stones in the bile ducts for a long time. It is important to remember - you should not provoke attacks, so that later the task does not arise to relieve unwanted pain.

How does the gallbladder hurt in humans?

Soreness in the projection of the gallbladder occurs more often in the case of dyskinesia (motor dysfunction) of the bile ducts or channels, inflammation, and movement of gallstones. The insidiousness of these pathological conditions lies in the fact that the gallbladder already hurts with an old disorder. The early stages are usually asymptomatic. The root causes of pain in the gallbladder are congenital defects in the structure of the organ, its channels (narrowing, tortuosity), tumor formations, and helminthic invasion. Early stages are treated with medication, advanced ones are treated surgically, more often by laparoscopy (cholecystectomy).

Pain in the right hypochondrium may indicate ailments in the gallbladder.

How does it hurt and where is the gallbladder located?

How the gallbladder hurts in various diseases, only a doctor can know. To eliminate discomfort, people usually drink painkillers or antispasmodics, but not every drug is allowed for different types of pain in the gallbladder. Only a specialist can also say what medicines to drink. But before you understand why there is pain in the gallbladder, you need to know its structure and location. This will allow you to more accurately determine the localization of painful sensations.

The organ is located directly above the liver. They are inextricably linked by bile ducts. The bubble is small and pear-shaped. The task of the organ is the accumulation and timely excretion of bile produced in the liver. This fluid is necessary for normal digestion, in particular for the absorption of fats. Bile helps the food bolus to flow through the intestines. In 48 hours, the human liver is able to produce up to 2 liters of bile.

Symptoms

The main sign of pathology is detected on palpation, when a greatly enlarged bubble is felt. A person has pain in the area on the right in the hypochondrium with the scapula. Sensations are distinguished by constancy and return to the right side, lower back, shoulder. Additionally, there is a strong tension of the muscle tissue of the peritoneum from the painful organ.

At different stages, the gallbladder hurts in different ways:

• At the beginning of the development of the pathology, unpleasant sensations are similar to colic, as during an attack. Pain in the gallbladder is aggravated by coughing, rapid and deep breathing, during the movement of the body. Possible manifestation at night.
• In the later stages of the disease, pain becomes constant, sharp, intense. The patient is constantly nauseated.
• In especially severe cases, pain shock develops.

A diseased gallbladder weakens a person, causes fever, vertigo, vomiting, dry mouth, in addition to pain in the right side.

Signs of deviations can be long-term or short-term (from 5 minutes to several hours). Additionally appear:

• bilious vomiting without relief;
• weakness, dizziness;
• profuse sweating;
• fever (39-40°C);
• drying of the oral mucosa;
• rapid heart rate.

If there is severe pain in the gallbladder, you should immediately contact a specialist who diagnoses the root cause of discomfort, prescribes an examination and adequate treatment.

The reasons

Various factors can provoke cystic colic. Main provocateurs:

Below are the most basic factors that explain why soreness appears in the gallbladder area.

Cholecystitis

The disease involves inflammation of the organ in acute and chronic form. The condition is accompanied by a general violation of the biliary function with such manifestations as:

• aching pain with constant discomfort in the right hypochondrium;
• worsening of the patient's condition;
• increased soreness and discomfort after nutritious, fatty, peppery foods, eggs, soda, coffee, alcohol.

• nausea;
• drying of the mucous membrane in the mouth.

• malnutrition;
• abuse of junk food, alcohol-containing drinks;
• constant overeating;
• other inflammations of nearby organs, in particular, the pancreas with pancreatitis.

Acute pathology usually develops against the background of cholelithiasis due to blockage of the main duct, which removes burning from the organ. Symptoms:

The patient needs an ambulance.

Bad habits and improper diet can cause inflammation in the gallbladder.

In chronic cholecystitis, the clinical picture gradually develops. The initial stages are asymptomatic. Discomfort usually appears 2 hours after eating or exercising.

The patient complains that he is in pain and pulls in the area of ​​​​the inflamed organ with recoil in the shoulder blade, lower back, neck, nape, he is regularly sick. Additionally appears:

• metallic aftertaste in the mouth;
• air belching;
• digestive upset (constipation, diarrhea);
• headache;
• insomnia with irritability (rarely).

Gallstone disease is provoked by stagnation of bile and a failure in the metabolic processes occurring in the organ. More often the disease affects women who are over 40 years old. Usually the disease is asymptomatic. It becomes very painful if the calculus enters the bile duct. Small stones are able to leave the body naturally with feces. If the stone is large, surgical removal is required.

The nature of pain in gallstone disease, spilled, that is, spreading to the entire abdomen with a gradual concentration in the area on the right in the side and hypochondrium. Additionally, patients develop:

• severe nausea leading to vomiting;
• chronic constipation.

With cholelithiasis, bile calculi are formed, which, depending on the composition, can be:

Different methods are used to remove each type of calculus, so it is important to undergo an ultrasound of the gallbladder. Provocateurs of the appearance of cholelithiasis:

• improper diet and regimen;
• sedentary lifestyle;
• overweight;
• long-term use of hormonal drugs;
• pathology of the pancreas (pancreatitis).

Dyskinesia

Motor dysfunction of the gallbladder and biliary tract causes disturbances in the flow of bile from the liver to the organ and the duodenum for digestion. There are two types of dyskinesia:

• hypotonic with reduced motility;
• hypertensive with excessive motor activity.

Disease symptoms:

1. For hypotension:

• pain - pulling, aching, localized in the right hypochondrium zone, more often at night;
• feeling of fullness and swelling;
• refusal to eat;
• airy belching with a bitter taste;
• nausea.

If left untreated, the disease can lead to stones in the bile.

1. For hypertension:

• pain - short-term acute, paroxysmal, localized in the right hypochondrium zone;
• sensations are provoked by strong physical activity, abuse of high-calorie food.

inflection

Such organ defects are accompanied by:

• constant nausea;
• vomiting;
• headache;
• severe intoxication with sensations similar to poisoning.

Less commonly, the pathological condition is characterized by:

• diffuse pain in the abdomen due to impaired patency of the gastrointestinal tract;
• sensations, as with gastric reflux, when gastric contents are thrown into the throat, mouth, less often into the nose.

Against the background of pathology, gastric ulcer, pancreatitis, erosive damage to the mucous membranes, gallstone disease often develop due to changes in the composition and density of bile. The root causes of kinks:

• congenital anomalies;
• displacement of internal organs during excessive physical activity, weight lifting, pregnancy;
• liver enlargement with cirrhosis, hepatitis.

Multiple kinks are additionally accompanied by:

• impaired blood supply to internal organs;
• sweating;
• flatulence;
• gradually increasing strong, diffuse pains in the side from the side of the bile.

Such manifestations may indicate the risk of developing a crack in the bladder and leakage of bile into the peritoneum. Diagnosis is carried out by ultrasound.

The result of prolonged gallstone disease is cancer. Tumors in the gallbladder can appear in the later stages:

• chronic pain in the right hypochondrium zone, which is not stopped by conventional antispasmodics;
• nausea, vomiting and other dyspeptic disorders;
• rapid weight loss.

The insidiousness of the disease is the asymptomaticity of the early stages, even without the occurrence of jaundice. In 30% of people, the tumor is palpable in the form of a dense, bumpy, almost painless formation, which is located below the rib. The outcome of treatment depends on the timeliness of the diagnosis of pathology. Early detection gives a 100% chance of a cure.

What to treat?

Soreness in the area of ​​​​the projection of the gallbladder and other manifestations can be deciphered by an experienced gastroenterologist. You can find out from him how and how much to treat the disease, what medicines to use, after a full examination and identifying the root causes of discomfort.

Diagnosis is often carried out by ultrasound, which allows you to obtain data on the state of the body:

• the presence of stones, sand;
• inflammation;
• increase in size;
• bile consistency.

The general course for all types of gallbladder pathologies includes:

The last two points are applied after the exacerbation of the disease has been removed.

Operation

Surgery is a necessary method of improving the condition in such cases:

• lack of results of drug treatment and diet therapy;
• blockage of the bile duct with a large calculus;
• detection of a tumor of any nature;
• calculous inflammation of the organ, that is, with stones in the bile.

The following techniques are commonly used to remove the gallbladder:

• classical cavity method;
• minimally invasive resection during laparoscopy (cholecystectomy).

What to do with first aid?

If the cause of the pain syndrome is known to the patient, and it is not an ulcer, diverticulitis, chronic organ pathology, the pain can be removed independently, at home. First aid rules:

In the event of an attack of pain in the gallbladder, it is necessary to ensure peace and minimize stress, as well as drink preparations prepared in advance to relieve pain.

1. Ensuring complete rest, that is, nothing can be done, especially lifting weights.
2. Take the medicines prescribed by the doctor for such cases.
3. Drink suitable folk remedies prepared at home. For example, honey syrup with horseradish or birch tincture, which guarantee the removal of soreness in a week.
4. It is forbidden to take any anti-inflammatory agent on your own, especially with acetylsalicylic acid.
5. You can not drink coffee and caffeinated drinks, alcohol.
6. It is forbidden to do enemas, even with constipation.

If the cause of the pain is stones in the gallbladder, an urgent call for an ambulance is needed.

Manifestations without knowledge of the underlying causes, requiring urgent medical intervention:

• stitching pain in the navel with a sharp jump in body temperature, dark urine, yellowness of the mucous membranes, nausea, ending in vomiting;
• stabbing pains in the stomach with simultaneous pain sensations of a pulling nature in the forearm;
• pulling intestinal pains;
• a sharp attack of soreness, spilled over the abdominal wall, with intestinal bleeding and vomiting;
• severe pain in the liver region, dizziness, increased heart rate, the appearance of sticky, profuse, cold sweat.

Painkillers are not suitable for such pain. If you drink an antispasmodic, the manifestations will be smeared and it will be more difficult to diagnose the problem.

Important information

If help is not provided in time, pathologies of the bile-forming system can lead to serious consequences, such as:

• stagnation due to a weak outflow of bile;
• infection of the bladder contents;
• purulent-inflammatory process on the bladder walls;
• the formation of biliary fistulas;
• formation of subhepatic abscesses.

Doctors

For pain in the bladder, you should seek advice from the following specialists:

ATTENTION! The information on this site is for informational purposes only! None of the sites will be able to solve your problem in absentia. We recommend that you consult a doctor for further advice and treatment.

Gallbladder Stones: Symptoms and Treatment

Gallbladder stones - the main symptoms:

• Weakness
• convulsions
• Nausea
• Loss of appetite
• Vomiting bile
• Chills
• Diarrhea
• Belching
• Bitterness in the mouth
• Pain in the right hypochondrium
• Heaviness in the right hypochondrium
• Constipation
• Spread of pain to other areas
• Fever
• Malaise
• Discolored feces
• Flatulence
• Vomiting without relief
• yellowing of the skin
• Yellowing of the eye

Gallbladder stones form due to metabolic problems in the body. They are the cause of the occurrence of GSD. Calculi formed in the organ can be located anywhere - both in the bladder itself and in its ducts, and even in the liver, while their shape and size vary from very small (sand) to very large.

The appearance of stones often causes irritation of the mucous membrane of the organ, resulting in the development of a disease such as cholecystitis.

Stones are formed in the gallbladder mainly from cholesterol crystals, but for the time being they do not bother a person - biliary colic is the result of blockage by one of the duct stones.

Most often, women over the age of forty and older suffer from this pathology. Men, on the other hand, experience the disease 6–8 times less often, but why this happens is not fully understood.

Symptoms

For a long time, gallstones do not make themselves felt and people find out about their presence randomly during the examination or when they begin to move along the ducts and even clog them.

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

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

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

Predisposing factors that cause hepatic colic are stressful conditions and physical overstrain, eating spicy, fatty and fried foods, and excessive alcohol consumption.

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

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

Usually the attack ends after the stone enters the small intestine. To improve the patient's condition, lay him on his right side and put a heating pad. But sometimes the size of the stone is such that it cannot pass through the ducts and gets stuck in them - in this case, the removal of stones from the gallbladder is carried out by surgical extraction.

The reasons

Normally, stones should not form in a healthy body. However, there are predisposing factors that affect the violation of metabolic processes, and become the causes of the formation of stones in the gallbladder.

Excessive consumption of food rich in cholesterol is the main cause of the development of cholelithiasis. From here comes the second predisposing factor - obesity, due to a violation of the nutrition process. Also cause a violation of the composition of bile with the formation of sediment in the form of solid particles, which later form calculi, can be caused by such causes as disturbances in the functioning of the liver, long-term use of oral contraceptives, and some pathologies of internal organs.

The formation of stones occurs against the background of a decrease in the ability of the walls of the gallbladder to contract, which, in turn, also depends on completely objective reasons. For example, the reasons for the decrease in contractile function are the presence of pathologies such as dyskinesia, flatulence, and others. If operations were performed on the organ, this can also cause a violation of its performance.

Other reasons are hypodynamia and poor nutrition. And during pregnancy, there may be an additional load on the gallbladder, as a result of which its transport function is disturbed.

Mechanical obstacles to the outflow of bile also cause the appearance of stones. In particular, this can occur with various tumors, in the presence of adhesions and cysts, with severe edema of the walls of the bladder, and even due to a birth defect - an inflection of the duct.

Causes of cholelithiasis can also be caused by infections that enter the organ with the bloodstream or lymph flow from other body systems. Any infection that has penetrated the gallbladder causes its inflammation, after which inflammation of its ducts develops. This leads to the development of cholecystitis and cholangitis, against the background of which cholelithiasis often develops.

To date, doctors distinguish two types of stone formation in this organ:

• primary, in which gallstones form for a long time and do not make themselves felt for a long time;
• secondary, when the formation of stones occurs due to the development of congestion in the gallbladder.

Features of treatment

The diagnosis of GSD is made on the basis of examination data. Patients are advised to do an ultrasound of the gallbladder, but if it is difficult to establish the presence and location of stones on ultrasound, cholecystography or retrograde cholangiopancreatography is performed.

Treatment of pathology directly depends on the size and number of calculi in the organ and their location. It can be either conservative or surgical. Timely conservative treatment makes it possible to preserve the integrity of the organ and ducts, and it consists in carrying out such procedures as:

• dissolution of stones by taking certain medications;
• crushing with ultrasound.

Also, in some cases, percutaneous cholelitholysis and laparoscopy are indicated - minimally invasive methods for removing stones. Sometimes treatment involves an operation - cholecystectomy. Diet is also important for gallstones. And the treatment of folk methods has also proven itself well.

Drug treatment consists in treatment with such means as Henofalk and Ursosan - they allow you to dissolve stones and remove them from the body painlessly.

Drug treatment is indicated only in cases where the stones are small and when the work of the organ itself is not disturbed. A method such as crushing stones in the gallbladder using ultrasound or a laser can be used when large stones need to be broken into small pieces that can move independently through the bile ducts into the intestine. It usually takes several sessions to destroy the stones, but this method is used in cases where a person has several large stones in the gallbladder that cannot be dissolved by taking medications.

Percutaneous cholelitholysis is rarely used and consists in the introduction of a substance that dissolves stones through a special catheter. The removal of stones from the gallbladder through small incisions (laparoscopy) is much more commonly used.

The most common operation for patients with gallstone disease is cholecystectomy, which consists in a large-scale operation to remove the organ. This procedure should be resorted to in cases where other methods are not able to solve the problem, or when the entire body is filled with large stones.

Treatment of this pathology is also associated with the need to adhere to a certain diet. A diet for gallstones includes the following recommendations:

• eat food up to six times a day in small portions;
• increase the intake of foods rich in magnesium;
• increase the amount of animal protein in the diet.

In addition, the diet for gallstones recommends completely abandoning foods such as sausages and smoked meats, pickles and preservation, legumes and butter, and also excluding some vegetables (cucumbers, eggplant, radishes). It is not recommended to drink coffee, alcohol and offal.

A diet for gallstones allows you to eat fish and white meat, cereals (oatmeal and buckwheat are especially useful), cottage cheese and low-fat milk, fruits and vegetables that do not irritate the gastrointestinal mucosa, as well as drink mineral water and natural juices.

Traditional medicine methods

Treatment of this disease is carried out and folk remedies. In particular, the dissolution of stones is carried out by drinking a glass of hot water with the juice of one lemon squeezed into it. In this case, slow dissolution occurs, so you need to use this recipe for a long time.

Other mixtures of juices are also used for a long time:

• carrots, cucumbers and beets;
• carrots, celery and parsley juice.

There are other folk remedies to get rid of the disease. For example, you can treat an ailment with raisins, which are mixed with holosas and Borjomi mineral water. Or tincture of pine nuts.

Note that folk remedies can remove those stones from the gallbladder that are small in size, provided that there are few of them. It is dangerous to “drive out” large stones, as this can lead not only to blockage of the ducts, but also to their rupture.

If you think that you have gallstones and symptoms characteristic of this disease, then doctors can help you: therapist, gastroenterologist.

We also suggest using our online disease diagnostic service, which, based on the symptoms entered, selects probable diseases.

Jaundice is a pathological process, the formation of which is affected by a high concentration of bilirubin in the blood. The disease can be diagnosed in both adults and children. Any disease can cause such a pathological condition, and they are all completely different.

Reactive hepatitis is a pathological process that leads to dystrophic-inflammatory processes in the liver. Most often, such a disease develops against the background of gastroenterological ailments of a chronic nature, systemic and other diseases. It should be noted that nonspecific reactive hepatitis, in contrast to viral, toxic and other forms of this disease, responds well to treatment.

Drug-induced hepatitis is an inflammatory process in the liver, provoked by certain medications. If the treatment of the disease is not started in a timely manner, then the onset of necrotic processes in the affected organ and cirrhosis is quite possible. In advanced stages, death is no exception. According to statistics, drug-induced hepatitis is three times more likely to be diagnosed in women than in men. This circumstance has no scientific explanation yet.

Cholecystitis is an inflammatory disease that occurs in the gallbladder and is accompanied by severe symptoms. Cholecystitis, the symptoms of which occur, as, in fact, this disease itself, in about 20% of adults, can occur in an acute or chronic form.

Ischemic colitis is an ailment characterized by ischemia (impaired circulation of blood) of the vessels of the large intestine. As a result of the development of pathology, the affected segment of the intestine does not receive the necessary amount of blood, so its functions are gradually impaired.

With the help of exercise and abstinence, most people can do without medicine.

Symptoms and treatment of human diseases

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