Microscopic examination of bile. Duodenal contents - microscopic examination. Mixed gallstones

Leukocytes - white blood cells - are not only found in the blood. Since they are responsible for protecting the body, leukocytes have the ability to move to the foci of inflammation. In large numbers, they can be found in the presence of an inflammatory disease of the liver (liver abscess) and biliary tract (cholecystitis, cholangitis).

Epithelial cells are a component of the gallbladder's inner lining and ducts. Normally, when it is replaced, epithelial cells are rejected singly or in layers and go into the bile, where they can be found in small or moderate amounts. With destructive and inflammatory processes in the bile ducts, the amount of epithelium increases.

Leukocytoids are cells that are similar in appearance to leukocytes. They are the epithelium lining the duodenal mucosa. The epithelium is exfoliated, changes under the action of bile and acquires the appropriate appearance.

Erythrocytes - red blood cells - are found in bile in large numbers when there is damage to the vessels by an inflammatory process or tumor.

The next group of bile components that are studied using microscopy are crystals. Among them, microliths are distinguished - the smallest particles that can eventually turn into stones, cholesterol crystals, bile acids. In addition to these elements, crystalline formations include fatty acids and calcium bilirubinate.

Separately, all of them are usually not determined, but, when combined with each other, the crystalline components change the properties of bile, which can be seen under a microscope in the form of "sand". If in the laboratory, when examining a sample by eye, the doctor sees a precipitate in the bile, this is called "putty". "Putty" is also a combination of crystals.

In addition to these indicators, determine the external and physico-chemical properties of bile. Portion A should be yellow, just like C. In contrast, B may be greenish to brown. Its consistency is viscous. In the laboratory, specific gravity and acidity are determined, changes in which can also indicate an inflammatory process.

Diagnosis of diseases according to the state of bile is carried out taking into account many of the described indicators, therefore, the correct interpretation of the results is available only to a specialist. Depending on the portion of bile obtained by probing, the norms of microscopic and physico-chemical parameters differ.

An indispensable condition for microscopic analysis of duodenal contents is its immediate examination as bile is secreted. If the study cannot be carried out immediately, the material is stored for 1-2 hours by adding neutral formalin (10% solution - 1/3 volume), trasylol (1 ml, i.e. 1000 units per 10-20 ml) to it. Examine the sediment (drops of bile from the bottom of the test tube) from several portions and as many mucus flakes as possible.

Leukocytes found in flakes of mucus when carefully viewing many fields of vision. It is impossible to attach diagnostic value to bile-stained leukocytes, since the formed elements of any origin, having lost their viability, quickly stain when bile is added to them, while the cells protected by mucus remain unstained (a state of parabiosis). The main criterion for the origin of leukocytes from one or another segment of the biliary system is the conditions (from what function of the duodenal contents).

Columnar epithelium is located in strands of mucus singly and in layers. With a certain skill, it is possible to distinguish between the epithelium of the bile ducts, bladder and duodenum and thus conduct a topical diagnosis of the inflammatory process (accompanied by desquamation of epithelial cells). Epithelium hepatic bile ducts - low prismatic, round nuclei, located close to the base, no cuticle. Basic epithelium gallbladder- high prismatic with a relatively large round (or oval) nucleus located close to the base, and often vacuolated cytoplasm.

Cholesterol crystals- have the appearance of thin colorless plates of a quadrangular shape with a broken end. This is not direct evidence for the presence of gallstones, but indicates such a possibility, indicating a loss of colloidal stability of bile.

calcium bilirubinate- brown, yellow or dark brown clumps (lumps) of pigment, only occasionally found in practically healthy people. Their presence in large quantities (in flakes of mucus and drops of bile) together with cholesterol crystals is also an indicator of changes in the colloidal properties of bile (and possible stone formation).

Bile acids visible under a microscope in the form of small shiny brownish or bright yellow grains, often covering the entire field of view in the form of an amorphous mass. Detection of an abundant precipitate of bile acids in the "pure" fractions of duodenal bile with great care (due to the difficulty of completely eliminating the admixture of gastric juice) can be regarded as an indicator of dyscholia.

Fatty acid- crystals in the form of delicate long needles or short needles, often grouped into bundles.

It can be regarded as an indication of a decrease in the pH of bile due to an inflammatory process (bacteriocholia), as well as a decrease in the solubility of fatty acids in bile.

Microliths(microscopic stones) - dark, light-refracting round or multifaceted formations, in their compactness, significantly different from accumulations of cholesterol crystals, and exceeding liver "sand" in size. They consist of lime, mucus and only a small amount of cholesterol. Microliths are most commonly found in mucus flakes and bile drops (sediment) from a serving B, C(It is necessary to view a large number of preparations). Since microliths are associated with the process of stone formation, finding them is of diagnostic value.

In the duodenal contents (in all portions), vegetative forms of lamblia are often found. Giardia is a protozoan that lives in the duodenum (and not in the bile ducts), they are attracted to all fractions of bile due to the irritating effect of the probe and magnesium sulfate.

MICROSCOPIC the study should be carried out immediately after receiving bile, because. leukocytes and other cells are destroyed by enzymes already in the first 5-10 minutes.

red blood cells. These cells have no diagnostic value, since their appearance may be associated with trauma during probing.

Leukocytes. Leukocytes can be unstained and stained with bile. A conclusion is made about inflammation, taking into account a complex of symptoms: the presence of mucus, turbidity and leukocytes more than 10 in the field of view. The presence in the field of view of cholesterol crystals (a square with one broken corner) or calcium bilirubinate (crystalline rays depart from a grain of sand) indicates cholelithiasis or a predisposition to it. Under a microscope, you can see giardia, fluke eggs and the flukes themselves (Chinese fluke and cat fluke).

BACTERIOLOGICAL research - if asepsis is observed, portions B and C are sown. Normally, bile is sterile, microbes are sown during inflammation, more often Escherichia coli, typhoid or paratyphoid bacilli, there may be a coccal form.

Chemical research - in portions B and C, the content of cholesterol, bilirubin and bile acids is determined. Normally, it fluctuates within a fairly wide range.

Bile analysis is a laboratory diagnostic method that allows you to determine the disease and prescribe the correct treatment. This study is done simultaneously with other examinations of the patient. Analysis of the bile fluid is very important and informative, but rather time-consuming. It can be carried out in any laboratory where clinical, bacteriological, biochemical analyzes are performed. At the same time, the taken material is studied in terms of physical, microscopic, biochemical and bacteriological parameters.

The analysis of the bile secretion is carried out by the method of studying the duodenal contents.

It consists of:

the contents of the duodenum;
bile;
secret of the pancreas;
gastric juice.

In order for the material to be taken correctly, the patient should not eat in the morning.

Fractional duodenal examination using a probe is done in several stages:

Basal secretion of bile. A secretion is taken from the lumen of the duodenum and bile choledochus. The duration of the selection is about a quarter of an hour. Bile of a light straw color with a density index from 1007 to 1015, has a slightly alkaline environment.
The closing phase of the sphincter of Oddi lasts 3 to 5 minutes. The contents are taken from the moment the cytokinetic is injected, which causes the contraction of the bile reservoir, until a new batch of the bile component appears in the probe.
The selection of the bile portion A occurs within 5 minutes. Selection begins with the opening of the sphincter of Oddi and ends with the opening of the sphincter of Lütkens. The liquid has a golden yellow color.
The intake of portion B begins at the moment of opening the sphincter of Lutkens with the emptying of the organ for the accumulation of bitterness and the release of a dark brown (dark olive) cystic fluid and lasts about half an hour. The density of bile is from 1016 to 1035, the acidity is 7 pH (+/- 0.5 units).
Portion selection With hepatic bile begins at the moment of cessation of secretion of bile of a dark brown color. The bile fluid of light yellow (golden) color is secreted for 20 minutes. The density of the liquid is 1007-1011, the acidity is from 7.5 to 8.2 pH.

It should be noted that normally each of the portions of bile is characterized by transparency, despite the difference in color. Examination under a microscope makes it possible to detect a slight content of the epithelium and mucus - this is normal. The absence of a crystal lattice of cholesterol and calcium bilirubinate is also the norm, only in isolated cases is their presence observed in portion C.

The bile obtained by this method is immediately subjected to laboratory tests and analysis is done:

biochemical;
histological;
microscopic;
on microflora;
for sensitivity to antibiotics.

Studies are carried out within 1.5 hours after probing, since enzymes quickly destroy the substances necessary for analysis. The results of a fractional study provide information about functional failures in the biliary system: biliary dyskinesia, hypo- or hypertension of the bile reservoir, sphincter of Oddi and cystic duct.

Using the analysis of bile in patients, cardiovascular diseases associated with an increase in blood pressure are determined.

Based on the results of the conducted sounding, it is possible to determine:

Inflammation of internal organs. This is evidenced by a violation of the transparency of one of the portions of the bile secretion. Turbidity and the presence of flakes in portion A is a sign of the presence of duodenitis, in portion B - inflammation of the bile reservoir, in portion C - cholangitis.
Inflammation in the bile reservoir and bile ducts. This is indicated by an increase in leukocytes in portions B and C.
Intestinal disorders. Accompanied by the presence of an excess amount of epithelium in portions B and C.
Inflammation of the ducts for the removal of bile. This is evidenced by cylindrical cells.
Cholelithiasis and stagnation of bitter fluid. Manifested by an excess of cholesterol crystal lattices and bilirubin calcium crystals.
Helminthiasis (opisthorchiasis, fascioliasis, clonorchiasis) of the intestines and bile ducts. Determined by the presence of Giardia activity in the bile fluid.
Stagnation of bile in the storage reservoir and ducts. It is observed with an increase in the density of bile.
Duodenal ulcer, hemorrhagic diathesis, oncological neoplasms and seals in the pancreas and pyloric stomach. It is diagnosed by staining the bile fluid with blood secretions.
Viral hepatitis and cirrhosis of the liver. The presence of these diseases is indicated by the light yellow hue of portion A and the pale color of portion C.
Hemolytic (prehepatic) jaundice is characterized by the dark yellow color of portion A and the dark color of portion C.
Inflammatory processes that have a chronic course, with atrophy of the mucous membrane of the bile organ, are detected in the presence of a slightly colored portion of B.
Diabetes mellitus and pancreatitis. These diseases are characterized by high cholesterol. A decrease in the amount of bile acids is characteristic of pancreatitis.

Bacteriological culture of bile reveals infection with Escherichia coli, Klebsiella spp., Enterobacter spp., Peptostreptococcus, bacteroids, Clostridium perfringens. Seeding of bacteria (Proteus, Escherichia collie, Klebsiella) and Pseudomonas aeruginosa carries an unfavorable prognosis and requires the appointment of antibacterial drugs. Bile is sterile, bacteriological contamination causes inflammatory processes in the bile organ and its ducts: cholecystitis, cholangitis, cholelithiasis, liver abscess.

Deciphering the results of duodenal sounding is not one hundred percent reliable. To confirm the diagnosis, the patient is prescribed additional blood tests and ultrasound. To confirm helminthiasis, an analysis of excrement is done.

Cholelithiasis- this disease is associated with the formation of calculi in the bile ducts and gallbladder, which, often migrating through the bile ducts, cause an attack of hepatic colic, obstruction of the cystic, hepatic or common bile duct, bedsores or inflammation of the gallbladder and bile ducts, cholestasis and damage to the liver type reactive cholangiogenic hepatitis and biliary cirrhosis.

Gallstone disease is one of the most common diseases. The disease becomes more frequent in people older than 40 years.

Causes of gallstone disease

Gallstone disease is formed as a result of the action on the body of a number of factors. The age of the patient is essential, which is associated with a change in the effect on the liver of the nervous and humoral systems of the body. It often develops in overweight people who take a large amount of lipids and cholesterol with food. The individual characteristics of the regulation of cholesterol metabolism are important. Pigment stones are formed in 10-27% of patients, more often with increased hemolysis - hemolytic anemia, repeated blood transfusions, etc. Calcium bilirubinate precipitates in thick, concentrated bile. Cholesterol precipitates if the content of bile acids in bile decreases. An important cause of stone formation is infection of the biliary tract.

The lithogenicity of bile is associated with a lack of bile acids. The most important function of bile acids is the ability to “dissolve” lipids by forming a micellar solution. With their participation, bile micelles of a complex composition are formed, called the “bile lipid complex”. In the intestine, bile acids are involved in the emulsification of fat and play the role of a stabilizer of the fat emulsion, facilitating the action of lipases on them. Decreased bile acid production leads to reduced intestinal absorption of fat and fat-soluble vitamins. After completing their function here, they are absorbed and again enter the bile. An indicator of the lithogenicity of bile is the cholate-cholesterol index - the ratio between the content of bile acids and cholesterol in bile.

Changes in the composition of bile can occur:

In the gallbladder, due to a violation of its absorption and motor-evacuation function (vesical dyscholia).
In the liver - due to a violation of the formation and excretion of cholesterol, bile acids, calcium, a number of enzymes, mucoproteins, protein and other compounds by the liver cells, which ultimately leads to colloidal instability of bile and precipitation of cholesterol crystals, calcium bilirubinate or calcium compounds (hepatic dyscholia).

In the initial period of stone formation, bile becomes thick, viscous. Granules are formed in it, which are further compacted, overgrown with crystals of cholesterol, calcium bilirubinate or lime deposits. In some cases, cholesterol crystals, calcium bilirubin salts precipitate in the wall of the gallbladder (these are intramural cholesterol granulomas, cholesterosis of the gallbladder).

Gallbladder stones and bile duct stones can be single or multiple. They are able to move along the bile ducts along with bile, irritate the mucous membrane of the ducts, and cause their spasm. This process of stone migration and bile duct dyskinesia underlies the clinical syndrome - hepatic colic.

Obstruction of the bile duct by a stone can lead to dropsy of the gallbladder. Stone obstruction of the common hepatic or common bile duct causes cholestasis and jaundice.

According to their composition, gallstones are divided into:

cholesterol stones.
Pigment-cholesterol stones.
Complex cholesterol-pigment-limestones. The most common stones, which are characterized by a variety of shapes and sizes. When cut, such stones have a concentric structure and a core of pigments and cholesterol. In the gallbladder, there can be from one to several thousand stones.
pigment stones.
Lime stones.

Gallstones can be found in the ducts of the liver. They can cause blockage of the bile ducts. As a result of a violation of the outflow of bile, the duct above the obstruction expands and becomes inflamed.

In the gallbladder, stones cause mucosal atrophy and inflammation. Characteristic for cholelithiasis is the appearance of Lushka's passages - growths of the mucous glands of the gallbladder and smooth muscles. The passages are lined with prismatic epithelium, reach the muscular membrane, and contribute to the penetration of infection into the gallbladder. An important sign of cholelithiasis are intraparietal cholesterol granulomas. They arise as a result of ulcerative necrotic lesions of the walls of the gallbladder and penetration into the muscular membrane of bile. Cholesterol crystals are resorbed by giant cells, are walled up by the regenerating epithelium, and are found in large quantities in granulomas. Granulomas are localized in the body and neck of the gallbladder.

Symptoms of gallstone disease

Gallstone disease occurs with a wide variety of clinical signs. In a significant number of patients, especially in the initial period of the disease, the symptoms are poor. Periodically, there are mild pains in the right hypochondrium of a stabbing, aching nature, which quickly disappear without treatment. In some patients, sensations of pain in the right hypochondrium acquire a aching character, intensify after eating, nausea sometimes appears, more often diarrhea after eating fatty foods (dyspeptic form). On physical examination of such patients, there are signs of obesity, mild pain in the gallbladder and epigastric region, some patients have a slightly evenly enlarged liver, slightly painful, with a smooth, pointed edge, smooth surface.

In 1/3 of patients, the so-called pain form of cholelithiasis develops, in which pain in the right hypochondrium becomes more distinct, but moderately expressed. At times, after a more pronounced attack of pain, a short-term icteric staining of the visible mucous membranes appears. After an attack, weakness is observed, body temperature rises to 38 ° C. These symptoms may go away on their own.

The most typical is an attack of hepatic colic, which in most cases develops suddenly and is characterized by severe pain in the right hypochondrium and, in some patients, jaundice. The attack is provoked by negative emotions, the intake of fatty foods, alcohol, sudden physical movements, physical activity. In women, colic may coincide with menstruation. The pains are very strong, localized in the right hypochondrium, less often in the epigastric region, they radiate to the back, right arm, sometimes radiate to the region of the heart and provoke an attack of angina pectoris. During a severe attack of pain, shock may develop. There may be nausea and repeated vomiting. When examining a patient, a swollen abdomen is noted, tense in the right hypochondrium. The area of the right hypochondrium is painful, the abdominal muscles are tense. There is also a zone of distinct hyperalgesia. When pressing on the gallbladder area, inhalation is impossible. Tapping along the edge of the costal arch causes pain. Tachycardia (rarely bradycardia), arrhythmia, muffled heart sounds are also detected. Jaundice joins on the second day and indicates a stone stuck in the bile duct or beginning cholangitis. There is an increase in body temperature. If the stone passes through the biliary tract, the body temperature returns to normal. The continuation of fever indicates a bacterial complication of the disease (cholangitis, cholecystitis). Blood tests may show leukocytosis and elevated ESR. The duration of the attack is usually 1-2 days. The end of the attack is often accompanied by the separation of a large amount of light urine.

Obstruction of the cystic duct is characterized by severe pain in the right hypochondrium, fever, leukocytosis, and an increase in ESR. In people with a thin abdominal wall, an enlarged, soft, elastic, painful gallbladder (gallbladder hydrops) can be palpated. With duodenal sounding in this case, gallbladder bile is not released.

If the stone gets stuck in the hepatic duct, often in the lobar, intense jaundice develops, the size of the liver increases, it becomes painful. With duodenal sounding, hepatic and cystic bile is absent.

Obturation of the common bile duct occurs more often in the area of the Vater sphincter. The gallbladder overflows with bile and is palpable in some patients. Mechanical jaundice develops. The liver enlarges and becomes painful. With obstructive jaundice, the content of bilirubin in the blood increases due to the direct fraction. Bile pigments appear in the urine. Kal is aholic. The release of urobilin stops. When examining the duodenal contents with a thin probe, bile is not detected or is excreted in a meager amount. The diagnosis is specified with the help of instrumental methods.

Attention is drawn to the rapid increase in the content of bilirubin in the blood. The activity of alkaline phosphatase also increases, while the activity of alanine and aspartic aminotransferases, lactate dehydrogenase, aldolase and other enzymes does not change.

With cholelithiasis in the gallbladder, ultrasound detects echo-dense formations that give echo shadows. They can also be detected in the bile ducts of the liver, the common bile duct, if the area under study is not covered by air-bearing organs - the stomach or intestines. In case of infringement of the stone in the bile duct, its diameter increases.

When using ascending cholangiography, a symptom of a "stump" of the duct is detected on the radiograph. On cholecystograms, the shadows of stones in the gallbladder are mostly clearly identified. Less common are stones in the bile ducts. Gallstones in the bile ducts are better detected during surgical cholangiography, which is used to monitor the patency of the bile ducts.

Diagnosis of gallstone disease

The diagnosis of gallstone disease is based on clinical findings. The typical attack of hepatic colic, subsequent jaundice, an increase in the direct fraction of bilirubin in the blood, and alkaline phosphatase activity are taken into account. The diagnosis is confirmed by findings of calculi on cholecystograms or by ultrasound examination of the gallbladder and ducts.

Often an attack of hepatic colic ends with the passage of small stones. In this case, the diagnosis relies mainly on clinical data, since instrumental research methods cannot confirm the diagnosis. Findings in the bile of cholesterol crystals or calcium bilirubinate salts can be used for an approximate diagnosis.

The course of gallstone disease is long:

Intercurrent infections can cause a severe attack of calculous cholecystitis or cholangitis.
Purulent cholangitis leads to liver abscess, biliary cirrhosis, hepatic coma.
Purulent and gangrenous cholecystitis can be the cause of the formation of pressure ulcers and vesico-intestinal fistula in the wall of the gallbladder. Less commonly, biliary peritonitis occurs due to rupture of the gallbladder or pericholecystitis.
A severe complication of calculosis of the biliary tract is pancreatitis (cholecystopancreatitis).

Diet for gallstone disease

Patients are advised to reduce the calorie content of the daily diet, eat more vegetables. Food should be complete, provided with vitamins. Refined dishes are excluded from the diet - cookies, white bread, fancy products, fats are limited, especially dishes rich in cholesterol, bread with bran, from wholemeal flour is more often used. Patients are prescribed one bottle of mineral water per day (Essentuki, Minsk, Slavyanovsk and other mineral waters are used).

Treatment of gallstone disease

For the relief of an attack of hepatic colic analgesics are used (50% solution of analgin - 2 ml intramuscularly), thalamonal intravenously. Less often they resort to narcotic drugs (promedol, omnopon, morphine), they are used together with antispasmodics, since the drugs themselves increase the spasm of the sphincter of Oddi.

To eliminate spasm of the bile ducts 2% solution of no-shpy - 2 ml or 2% solution of papaverine - 2 ml are injected subcutaneously. You can enter subcutaneously atropine, arpenal, antispasmodic, etc. Nitroglycerin also has an antispasmodic effect. It is advisable to give choleretic agents inside - 2-3 tablets of allochol or cholenzym. Stronger choleretic drugs (chologon, decholine, magnesium sulphate, olive or sunflower oil) should not be used because of the risk of increasing pain.

Relaxation of the bile ducts and the passage of stones contribute to warm tea (1 cup without sugar), a heating pad placed on the right hypochondrium, a warm bath. If a few hours after the treatment, there is no improvement, the patient is sent to the surgical department under the supervision of a surgeon.

Treatment of calculosis in the interictal period of the disease : in order to improve the function of the nervous system, sedatives are prescribed - corvalol, valerian tincture, trioxazine, luminal - in case of sleep disturbance and skin itching. Hologol is given 5 drops on sugar 3 times a day. With cholesterol stones, it is advisable to prescribe a drug from lyophilized bile lyobil 1-2 tablets (each 0.2 g) 3 times a day. Treatment continues for 3-6 months. There are reports in the literature that chenodeoxycholic acid, given at 0.5 g 3 times a day for several months, is able to prevent cholesterol crystals from precipitating into bile and reduce (or dissolve) formed stones. A more effective remedy is the Yugoslav drug henochol. It is prescribed in the morning and in the afternoon, 1 capsule (250 mg) and in the evening - 2 capsules. Treatment lasts from 6 months to 2 years. Antispasmodics (papaverine, no-shpa 0.04 g 2-3 times a day) are indicated for pain in the right hypochondrium.

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Doctors do not have the concept of bilirubin stones in the gallbladder. Such an interpretation is incorrect. There are few types of stones, two are known - cholesterol and pigment. Calcium bilirubinate in a certain form is constantly present. Pigment stones do not dissolve and are comparable to a piece of granite stuck in a duct, but the Mohs hardness factor is slightly lower.

The cholesterol variety dissolves under a number of conditions: the size is not more than 10 mm (in some sources - 20 mm), the bubble is filled by a third, and the contractility of the walls is preserved. Each type of treatment has specific features. We will describe ways to get rid of stones in the gallbladder.

The composition of the stones

Calcium bilirubinate is found in most gallstones. Formations differ in the degree of polymerization of the substance, the specific gravity in the composition of the calculus. Cholesterol stones are soluble and more common. Pregnant women are at risk for these stones. The ratio between pigment and cholesterol stones depends on the region, ecology and nationality.

Gallstone disease in a woman

cholesterol stones

More than half are made up of cholesterol. Other substances:

calcium bilirubinate.
Mucin.
Mineral calcium salts (phosphate, palmitate, carbonate).

Periodically come across pure cholesterol stones, consisting of a single component. Most of the stones have structural features, include the above substances. Similar types of gallstones are also referred to as cholesterol, called mixed. A high risk of formation refers to the following cases:

Gender Female.
Obesity.
Old age.
Sudden weight loss.
Pregnancy.
Irrational nutrition.

Cholesterol formations are white or light, large, relatively soft, characterized by a layered structure, easily crumble. Sometimes they resemble the fruit of a raspberry (blackberry) or are round. They consist of crystals of cholesterol monohydrate, united by mucin glycoproteins. Mixed stones are predominantly multiple.

pigment stones

These formations account for 10-25% of cases, depending on the region and other factors. They differ from cholesterol ones in the almost complete absence of cholesterol, it is permissible to conditionally call such structures bilirubin, although the name is not accepted in the medical environment. In the family, according to the genesis, there are additionally two classes.

black stones

They differ in composition from cholesterol ones in that they contain almost no cholesterol. Other components are similar. The binding link is the polymer of calcium bilirubinate. deposited in the bubble. Rarely - in the ducts. Risk factors are:

Hemolysis of blood (oversaturation of bile with unbound bilirubin).
Changing the pH factor of the medium.
Cirrhosis of the liver.
Old age.
Nutrition, bypassing the oral route.

The basis is polymers of copper compounds. They do not show a clearly defined structure.

brown stones

They differ from black ones in the presence of calcium salts, bypassing bilirubinate. The latter exhibits a lower degree of polymerization. The rest is cholesterol. Brown stones are formed under the action of enzymes secreted by pathogenic flora, the cause is a bacterial disease.

Stones are more often formed in the ducts, and this is an additional difference from black ones.

Reasons for education

Any kind of gallstones have causes for growth, external and internal. Much depends on the doctor's ability to understand the cause of the pathology. Otherwise, relapses occur.

Cholesterol

Participation in the formation of cholesterol calculi takes a number of factors:

A sharp increase in the level of cholesterol in the blood.
An increase in calcium in the blood (hypercalcemia).
Abundance of mucin (protein mucus).
Decreased contractility of the bladder walls.
Lack of bile acids.

From cholesterol and phospholipids (make up 20% of the dry matter of bile), a core is formed, to which calcium salts and mucin protein are attached. In a normal body, cholesterol is bound by bile salts (acids) and lecithin to form micelles. The rupture of the formed bonds is already made in the duodenum. The role of increasing cholesterol in bile is entirely assigned to the liver. The process goes in two ways:

Isolation of the finished product from the blood stream.
The formation of cholesterol is not only produced by the liver, it occurs in the skin and intestines.

Please note that the blood is cleared of cholesterol exclusively by the liver. Excess products with feces are excreted from the body. The reasons for excessive production lie in the disruption of the special receptors of hepatocyte membranes. This is due to a hereditary factor or a consequence of the above reasons.

Lecithins (phospholipids) serve to bind cholesterol and bile salts in the form of vesicles to avoid damage to the walls of the duct. However, with a deficiency of bile acids, minerals begin to connect to the nucleus. There are several reasons: a violation of the reabsorption of bile acids in the intestine, a decrease in the level of synthesis in the liver. In the normal state, excess cholesterol is distributed between micelles and vesicles.

The mucin lying on the walls of the gallbladder begins to capture excess vesicles and individual crystals of cholesterol monohydrate, acting as the beginning of the formation of stones. Gradually, the formations harden. Calcium salts are woven into the structure. The process occurs against the background of a decrease in the contractility of the gallbladder. The internal environment is hardly updated and does not mix. The mechanism for reducing smooth muscle activity is not fully understood; it is largely controlled by hormones and the direct action of cholesterol on the walls.

The process is greatly facilitated by the absorption of water. The walls of the gallbladder are leaders among other organs of the body. The volume of bile is reduced by a factor of five, contributing to an increase in the density of vesicles. The acids produced by the liver are oxidized by hydrogen ions, preventing the stones from falling out. Scientists admit that they have not fully revealed the mechanism, explaining the dominance of surgical intervention.

pigment

Pigment stones are more dangerous, there are no chances for dissolution. Try talking to a therapist about lithotripsy, clarifying your own prognosis. Black varieties of gallstones accompany the course of various chronic diseases:

Cirrhosis.
Pancreatitis.
Hemolysis.

The main factor is an excess of bilirubin. The substance is a poison, binds to hepatocytes with glucuronic acid. With hemolysis of the blood, the influx of bilirubin doubles, the acid is no longer enough. As a result, the gallbladder is filled with bilirubin monoglucuronide, the basis of the genesis of stones.

The process is aggravated by a violation of the reabsorption of bile acids by the intestine. As a result, the pH in the bubble rises, the medium is filled with calcium salts (phosphate and carbonate). Doctors note that the motor function in this case is not impaired.

The mechanism of formation of brown stones is more complicated and is not known for certain. It is believed that infection with mucus and cytoskeletons clogs the ducts, and the enzyme produced by the anaerobic flora unbinds bilirubin from acid residues. At the same time, bile acids are released (from taurine and glycine), followed by stearic and palmitic acids. These ions bind calcium, causing the products to precipitate and bind to each other.

Medicinal dissolution

Only cholesterol stones lend themselves to this method of exposure. It is based on the ability to envelop bile acids with the formation of micelles. Cholesterol molecules are split off from the stone and carried away. Primary bile acids are involved in the process. Many patients are helped by taking herbal decoctions with a specific effect:

Corn stigmas.
Tansy flowers.
Artichoke extract.
Immortelle.

Of the drugs for medicinal purposes, ready-made bile acids are used. For example, the drug Ursosan. The acids are absorbed in the intestines and then transported by the portal vein to the liver. Selected criteria for the applicability of treatment:

Modest size calculi (up to 10 mm).
The dominance of cholesterol in the composition.
Permeability of the bile ducts.
Round shape of stones.
Homogeneous structure of stones.
Non-intense shadow during ultrasound examination.
Low specific gravity of the stone (the parameter is directly related to the dominance of cholesterol).

Lithotripsy

The technique is most effective against cholesterol stones, and is also applied to pigment stones. Indications and contraindications depend on the method:

Shock wave.
Laser.

Shock wave lithotripsy

The technique was developed in Germany, the first treatment falls on the beginning of the 80s. The studies were carried out a decade earlier. A special reflector directs the generated acoustic wave to the right place. The device is equipped with x-ray vision, the doctor and the patient are able to see the process directly.

Initially, low power is applied, later, as the stone is focused, the power of action increases. The technique was originally used to treat the kidneys, then migrated to the gallbladder. Application indicators:

No complications of gallstone disease.
The size of stones with a diameter of 2 cm is no more than three (sand is not considered).
The optimal number of stones is one.
Deposition of salts exclusively on the periphery. The core is cholesterol.
The presence of contractility of the gallbladder.

Medicine does not offer promises to dissolve bilirubin stones. In recent years, laser lithotripsy has entered the medical services market. Little has been written about the gallbladder procedure. Consequently, pigment stones are not amenable to lithotripsy or dissolution in most cases.

Numerous contraindications have been described. In the event of a medical error, the fragments will clog the duct, and it will be extremely difficult to knock out the pieces. Readers can now outline the process of treating gallstones.

Source: GastroTract.ru

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