Gallstone disease (GSD) - symptoms, causes, diet and treatment of gallstone disease. An attack of cholelithiasis: the main symptoms Symptoms of cholelithiasis during an exacerbation

Gallstones (cholelithiasis, cholelithiasis, cholelithiasis, cholelithiasis) is a disease characterized by the formation of stones in the gallbladder, usually consisting of cholesterol. In most cases, they do not cause any symptoms and do not require treatment.

However, if the stone becomes lodged in the duct (opening) of the gallbladder, it can cause sudden, severe abdominal pain that usually lasts one to five hours. This pain in the abdomen is called biliary colic.

Stones in the gallbladder can also cause inflammation (cholecystitis). Cholecystitis may be accompanied by prolonged pain, yellowness of the skin, and fever above 38°C.

In some cases, the stone, descending from the bladder, can clog the duct through which the digestive juice from the pancreas flows into the intestine (see picture on the right). This causes its irritation and inflammation - acute pancreatitis. This condition causes pain in the abdomen, which is constantly increasing.

gallbladder

The gallbladder is a small sac-like organ located under the liver. You can see the structure of the gallbladder and its ducts in the image on the right.

The main function of the gallbladder is to store bile.

Bile is a fluid produced by the liver that helps break down fats. It passes from the liver through the channels - the hepatic ducts and enters the gallbladder.

Bile accumulates in the gallbladder, where it becomes more concentrated, which contributes to a better breakdown of fats. As needed, bile is secreted from the gallbladder into the common bile duct (see picture), and then into the intestinal lumen, where it participates in digestion.

It is believed that stones are formed due to a violation of the chemical composition of bile in the gallbladder. In most cases, the level of cholesterol is greatly increased, and excess cholesterol turns into stones. Gallbladder stones are very common. In Russia, the prevalence of gallstone disease ranges from 3–12%.

Usually, treatment is needed only when the stones are bothersome, such as abdominal pain. Then minimally invasive surgery to remove the gallbladder may be recommended. This procedure, called laparoscopic cholecystectomy, is fairly simple and rarely has complications.

A person can do without a gallbladder. This organ is useful, but not vital. After a cholecystectomy, the liver still produces bile, which, instead of being stored in the bladder, drips into the small intestine. However, some of the operated patients develop postcholecystectomy syndrome.

Thus, in most cases, gallstone disease (GSD) is easily treated surgically. Very severe cases can be life-threatening, especially in people who are in poor health, but death is rare.

Symptoms of gallstones

Many people with gallstone disease (GSD) do not experience any symptoms and are unaware of the disease unless stones are accidentally found in the gallbladder during an examination done for another reason.

However, if the stone blocks the bile duct, through which bile flows from the gallbladder to the intestines, severe symptoms occur.

The main one is abdominal pain. However, with a certain location of the stones, other symptoms may occur against the background of pain in the gallbladder.

Abdominal pain

The most common symptom of gallstones is sudden, severe abdominal pain, usually lasting one to five hours (but can sometimes go away in a few minutes). This is called biliary colic.

Pain with biliary colic can be felt:

• in the center of the abdomen, between the sternum and the navel;
• in the hypochondrium on the right, from where it can give to the right side or shoulder blade.

During an attack of colic, the gallbladder hurts constantly. Bowel movements or vomiting do not relieve the condition. Sometimes gallstone pain is triggered by eating fatty foods, but it can start at any time of the day or wake you up at night.

As a rule, biliary colic occurs irregularly. There may be weeks or months between attacks of pain. Other symptoms of biliary colic may include episodes of heavy sweating, nausea, or vomiting.

Doctors call this course of the disease uncomplicated gallstone disease (GSD).

Other symptoms of gallstones

Rarely, stones can cause more severe symptoms if they block the flow of bile from the bladder for a longer time or move to other parts of the bile duct (for example, blocking the flow from the pancreas to the small intestine).

In such cases, you may experience the following symptoms:

• temperature 38°C or higher;
• longer-lasting pain in the abdomen (gall bladder);
• cardiopalmus;
• yellowing of the skin and whites of the eyes (jaundice);
• skin itching;
• diarrhea;
• chills or shivering attacks;
• lack of appetite.

Doctors call this more severe condition complicated gallstone disease (GSD).

If you have gallbladder pain, make an appointment with or see a doctor who specializes in diseases of the digestive system.

Call an ambulance immediately (mobile 112 or 911, landline - 03) in the following cases:

• yellowness of the skin and mucous membranes;
• abdominal pain that does not go away for more than eight hours;
• high fever and chills;
• such severe pain in the abdomen that you cannot find a comfortable position.

Causes of gallstones

It is believed that stones form due to an imbalance in the chemical composition of bile in the gallbladder. Bile is a fluid that is essential for digestion and is produced by the liver.

It is still not clear what causes this imbalance, but it is known that gallstones can form in the following cases:

• unusually high cholesterol levels in the gallbladder - about four out of five gallstones are made up of cholesterol
• unusually high levels of bilirubin (a breakdown product of red blood cells) in the gallbladder - about one in five gallstones are made up of bilirubin.

A chemical imbalance can lead to the formation of tiny crystals in the bile, which gradually turn (often over many years) into hard stones. Gallstones can be as small as a grain of sand or as large as a pebble. Stones are single and multiple.

Who can get gallstones?

Gallbladder stones are more common in the following groups of people:

• women, especially those who gave birth;
• people who are overweight or obese - if the body mass index (BMI) is 25 or higher;
• people 40 and older (the older you are, the higher the risk of stones);
• people with cirrhosis (liver disease);
• people with diseases of the digestive system (Crohn's disease, irritable bowel syndrome);
• people who have relatives with gallstones (about a third of people with gallstones have a close relative with the same disease);
• people who have recently lost weight, either as a result of dieting or surgery, such as gastric banding;
• people taking a drug called ceftriaxone, an antibiotic used to treat a number of infectious diseases, including pneumonia, meningitis, and gonorrhea.

There is also an increased risk of gallstones in women taking combined oral contraceptives or undergoing treatment with high doses of estrogen (for example, in the treatment of osteoporosis, breast cancer, menopausal manifestations).

Diagnosis of stones in the gallbladder

For many people, gallstones do not cause any symptoms, so they are often found by chance during an examination for another condition.

If you have gallbladder pain or other symptoms of gallstone disease (GSD), contact your general practitioner or gastroenterologist so that the doctor can conduct the necessary examinations.

Consultation with a doctor

First of all, the doctor will ask you about your symptoms and then ask you to lie down on the couch and examine your abdomen. There is an important diagnostic sign - Murphy's symptom, which the doctor usually checks during the examination.

To do this, you need to inhale, and the doctor will lightly tap on your abdominal wall in the gallbladder area. If abdominal pain occurs during this intake, Murphy's symptom is considered positive, which indicates inflammation in the gallbladder (in this case, urgent treatment is required).

The doctor may also order a complete blood count to check for signs of infection or a blood chemistry test to determine how the liver is working. If the stones have moved from the gallbladder into the bile duct, the liver will be disrupted.

If your symptoms or test results point to gallstones, your doctor will likely refer you for additional testing to confirm the diagnosis. If you have signs of a complicated form of gallstone disease (GSD), you may be admitted to the hospital for examination on the same day.

Ultrasound examination of the gallbladder (ultrasound)

You can usually confirm the presence of gallstones with an ultrasound, which uses high-frequency sound waves to create an image of your internal organs.

When diagnosing gallstones, the same type of ultrasound is used as during pregnancy, when a small sensor is driven along the upper abdomen, which is also a source of ultrasonic vibrations.

It sends sound waves through the skin into the body. These waves are reflected from body tissues, forming an image on the monitor. A gallbladder ultrasound is a painless procedure that takes about 10-15 minutes. Use our service to find a clinic where they do ultrasound of the gallbladder.

Ultrasound of the gallbladder does not detect all types of stones. Sometimes they are not visible on the ultrasound picture. It is especially dangerous to “miss” a stone that has blocked the bile duct. Therefore, if by indirect signs: the results of tests, an enlarged view of the bile duct on ultrasound or others, the doctor suspects the presence of gallstone disease, you will need a few more studies. In most cases, this will be an MRI or cholangiography (see below).

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) may be done to look for stones in the bile ducts. This type of scan uses strong magnetic fields and radio waves to create a detailed picture of your body's internal structure. Find out where MRI is done in your city.

X-ray examination of the gallbladder

There are several types of x-ray examination of the gallbladder and bile ducts. All of them are carried out using a special dye - a radiopaque substance, which is clearly visible on an x-ray.

Cholecystography - before the study, they ask to drink a special dye, after 15 minutes they take a picture of the gallbladder, and then another one after eating. The method allows you to evaluate the structure of the gallbladder, see the stones, their size and location, and also study the work of the gallbladder (how well it contracts after eating). When the cystic duct is blocked by a stone, the gallbladder is not visible in the picture, since the dye does not enter it. Then appoint other types of research.

Cholegraphy- X-ray examination of the gallbladder, similar to cholecystography. But the dye is injected into a vein.

Cholangiography - X-ray examination of the gallbladder, when dye is injected into the bile ducts either through the skin (using a long needle) or during surgery.

Retrograde cholangiopancreatography (ERCP) is a method of X-ray examination of the gallbladder and bile ducts, using endoscopic techniques. ERCP can only be a diagnostic procedure or, if necessary, expand to a therapeutic procedure (when stones are removed from the ducts using endoscopic techniques) - see the section "Treatment of gallstones" .

During retrograde cholangiopancreatography, the dye is injected using an endoscope (a thin flexible tube with a light and a camera at the end), which is passed through the mouth into the esophagus, stomach, and then the duodenum to the place where the bile duct opens.

After the injection of the dye, x-rays are taken. They will show any abnormalities in the gallbladder or pancreas. If everything is in order, then the contrast will freely enter the gallbladder, bile ducts, liver and intestines.

If an obstruction is found during the procedure, the doctor will try to remove it with an endoscope.

Computed tomography (CT)

If you suspect a complication of gallstone disease (GSD), such as acute pancreatitis, you may have a computed tomography (CT) scan. This type of scan consists of a series of x-rays taken from different angles.

CT is often done in an emergency to diagnose severe abdominal pain. Equipment for computed tomography of the abdomen is usually equipped with radiology departments. See where you can get a CT in your city.

Treatment of gallstones

Treatment for gallstone disease (GSD) will depend on how its symptoms affect your life. If there are no symptoms, active surveillance is usually recommended. This means that you will not receive any treatment right away, but you will need to see a doctor if you notice any symptoms. Generally, the longer you don't experience any symptoms, the lower the chance that the disease will ever get worse.

You may need treatment if you have conditions that increase your risk of developing gallstone complications, such as the following:

• scarring of the liver (cirrhosis);
• high blood pressure inside the liver - this is called portal hypertension and often develops as a complication of liver disease caused by alcohol abuse;

If you are experiencing bouts of abdominal pain (biliary colic), treatment will depend on how they interfere with your normal life. If the attacks are mild and infrequent, the doctor will prescribe pain medication to take during the attack and advise on the diet to follow for gallstones.

If symptoms are more severe and occur frequently, gallbladder removal surgery is recommended.

Laparoscopic cholecystectomy

In most cases, it is possible to remove the gallbladder using a minimally invasive intervention. This is called laparoscopic cholecystectomy. During a laparoscopic cholecystectomy, three or four small incisions (each about 1 cm long) are made in the abdominal wall. One incision will be near the navel, and the rest - on the abdominal wall on the right.

The abdominal cavity is temporarily filled with carbon dioxide. This is safe and allows the surgeon to see your organs better. Then, through one of the incisions, a laparoscope (a thin, long optical device with a light source and a video camera at the end) is inserted. Thus, the surgeon will be able to observe the operation on a video monitor. The surgeon will then remove the gallbladder using special surgical instruments.

To exclude blockage of bile duct stones, an X-ray examination of the bile ducts is performed during the operation. Detected stones can usually be removed immediately, during laparoscopic surgery. If for some reason it is not possible to perform an operation to remove the gallbladder or stones using a minimally invasive technique (for example, complications develop), they proceed to an open operation (see below).

If the laparoscopic cholecystectomy is successful, the gas is removed from the abdominal cavity through the laparoscope, and the incisions are sutured with dissolvable surgical sutures and covered with dressings.

Usually, laparoscopic cholecystectomy is performed under general anesthesia, which means you will be asleep and not in pain during the operation. The operation takes an hour and a half. Recovery after removal of the gallbladder using a minimally invasive technique is very fast, usually a person stays in the hospital for 1-4 days, and then is discharged home for further recovery. You can start working, as a rule, 10-14 days after the operation.

Removal of the gallbladder with one puncture (sils-cholecystectomy) is a newer type of operation. During it, only one small puncture is made in the navel area, which means that you will only have one scar hidden in the crease of the navel. However, single-incision laparoscopic cholecystectomy is not yet as mature as conventional laparoscopic cholecystectomy, and there is still no consensus about it. Such an operation can not be done in every hospital, as this requires an experienced surgeon who has undergone special training.

Removal of the gallbladder through a wide incision

In some cases, laparoscopic cholecystectomy is not recommended. This may be due to technical reasons, safety reasons, or because you have a stone stuck in your bile duct that cannot be removed during minimally invasive surgery.

• third trimester (last three months) of pregnancy;
• obesity - if your body mass index (BMI) is 30 or higher;
• an unusual structure of the gallbladder or bile duct, which is why minimally invasive surgery is potentially dangerous.

In these cases, open (laparotomy, cavity) cholecystectomy is recommended. During surgery, a 10–15 cm long incision is made in the right hypochondrium in the abdominal wall to remove the gallbladder. An open cholecystectomy is performed under general anesthesia, so you will be asleep and not in pain during the operation.

Removal of the gallbladder by laparotomy (wide incision) is just as effective as laparoscopic surgery, but takes longer to recover and leaves a more visible scar. You usually have to stay in the hospital for 5 days after the operation.

Therapeutic retrograde cholangiopancreatography (ERCP)

During therapeutic retrograde cholangiopancreatography (ERCP), stones are removed from the bile ducts, and the bladder itself, along with the stones in it, remains in place, unless the methods described above are used.

ERCP is similar to diagnostic cholangiography (read more about this in the Diagnosis of gallstones section), in which an endoscope (a thin, flexible tube with a light and a camera at the end) is passed through the mouth to where the bile duct opens into the small intestine.

However, during ERCP, the orifice of the bile duct is widened with an incision or with an electrically heated wire. The stones are then removed into the intestines so that they can be naturally eliminated from the body.

Sometimes a small expansion tube called a stent is permanently placed in the bile duct to help the free flow of bile and stones from the bladder into the intestines.

Usually, sedatives and pain medications are administered before the ERCP, which means that you will be conscious but will not feel pain. The procedure lasts from 15 minutes or more, usually about half an hour. After the procedure, you may be left overnight in the hospital to monitor your condition.

Dissolution of gallstones

If your gallstones are small and do not contain calcium, you may be able to dissolve them by taking medications based on ursodeoxycholic acid.

Means for dissolving gallstones are not often used. They do not have an extremely strong effect. To get the result, they need to be taken for a long time (up to 2 years). After stopping the use of ursodeoxycholic acid, stones may form again.

Side effects of ursodeoxycholic acid are rare and usually mild. The most common of these are nausea, vomiting and pruritus.

Ursodeoxycholic acid is not recommended for pregnant and breastfeeding women. Sexually active women taking gallstone dissolvers should use barrier methods of contraception such as condoms or low-estrogen oral contraceptives, as other contraceptive drugs may reduce the effectiveness of ursodeoxycholic acid treatment.

Ursodeoxycholic acid medications are also sometimes prescribed to prevent gallstones if you are at risk. For example, you may be given ursodeoxycholic acid if you have recently had weight loss surgery, as rapid weight loss can cause gallstones to form.

Diet for gallstone disease (GSD)

In the past, people who couldn't have surgery were sometimes advised to cut their fat intake to a minimum to stop the growth of stones.

However, recent studies have shown that this does not help, as sudden weight loss as a result of reducing fat in the diet, on the contrary, can cause the growth of gallstones.

Therefore, if surgery is not recommended for you or you would like to avoid it, you should eat a healthy and balanced diet. This includes eating a variety of foods, including moderate amounts of fat, and eating regularly.

Complications of gallstone disease (GSD)

Complications of gallstone disease are rare. As a rule, they are associated with blockage of the gallbladder duct or displacement of stones in other parts of the digestive tract.

Acute cholecystitis (inflammation of the gallbladder)

In some cases, a gallstone firmly clogs the bile duct and interferes with the outflow of bile. Stagnation of bile in the bladder and the attachment of infection leads to the development of inflammation - acute calculous cholecystitis.

Symptoms of acute calculous cholecystitis:

• constant pain in the upper abdomen, radiating to the shoulder blade (unlike biliary colic, the pain usually lasts no longer than five hours);
• cardiopalmus.

In addition, about one in seven people develop jaundice (see below). If acute cholecystitis is suspected, consult a surgeon as soon as possible. With the help of our service, you can without leaving your home.

To treat calculous cholecystitis, antibiotics are usually given first to clear the infection in the gallbladder. And after a course of antibiotic therapy, a laparoscopic cholecystectomy (removal of the gallbladder) is performed.

In severe cases of acute cholecystitis, surgery sometimes needs to be done urgently, which increases the likelihood of complications. In addition, due to the possible risk, they often resort to abdominal cholecystectomy (removal of the gallbladder using a wide incision).

Acute cholecystitis is dangerous for its complications. For example, suppuration of the gallbladder - empyema. In this case, antibiotic treatment is often not enough and there is a need for emergency pumping of pus and subsequent removal of the gallbladder.

Another complication of acute cholecystitis is gallbladder perforation. A severely inflamed gallbladder can burst, leading to peritonitis (inflammation of the thin lining of the abdomen, or peritoneum). In this case, you may need intravenous antibiotics, as well as surgery to remove part of the peritoneum if it has been badly damaged.

Jaundice

Blockage of the bile ducts often leads to jaundice, which manifests itself:

• yellowing of the skin and whites of the eyes;
• the appearance of dark brown urine (beer-colored urine)
• light (white or almost white) feces;
• skin itching.

Inflammation of the bile ducts (cholangitis)

When stones block the bile ducts, a bacterial infection easily develops in them and acute cholangitis develops - inflammation of the bile ducts.

Symptoms of acute cholangitis:

• pain in the upper abdomen, radiating to the shoulder blade;
• high temperature (fever);
• jaundice;
• chills;
• disorientation in space and time;
• skin itching;
• general malaise.

Antibiotics can help fight the infection, but it is also necessary to drain bile from the liver using retrograde cholangiopancreatography (ERCP).

Acute pancreatitis

Acute pancreatitis can develop when a stone moves out of the gallbladder and blocks the pancreatic duct, causing it to become inflamed. The most common symptom of acute pancreatitis is sudden, severe, dull pain in the upper abdomen.

Pain in acute pancreatitis gradually increases until it develops into a constant cutting pain. It can radiate to the back and get worse after eating. Try leaning forward or curling up to ease the pain.

Other symptoms of acute pancreatitis:

• nausea;
• vomit;
• diarrhea;
• lack of appetite;
• body temperature 38°C or higher;
• painful sensitivity in the abdomen;
• less often - jaundice.

If there are signs of acute pancreatitis, you should immediately consult a doctor. As a rule, the disease requires hospitalization in the hospital, where doctors can reduce pain and help the body cope with inflammation. Treatment will consist of the introduction of intravenous drugs (in the form of droppers), the supply of oxygen through nasal catheters (tubes brought to the nose).

With treatment, most people with acute pancreatitis get better within a week and can leave the hospital in 5 to 10 days.

gallbladder cancer

Gallbladder cancer accounts for 2 to 8% of all malignant neoplasms in the world. This is a rare but serious complication of gallstone disease. If you have had gallstones, you are at increased risk of gallbladder cancer. About four out of five people with gallbladder cancer have had gallstones in the past. However, less than one person in 10,000 with gallstones develops gallbladder cancer.

If you have additional risk factors, such as family history (a family history of gallbladder cancer) or high levels of calcium in your gallbladder, you may be advised to have it removed to prevent cancer, even if the stones don't cause you any symptoms.

Symptoms of gallbladder cancer are similar to those of severe gallstone disease:

• pain in the abdomen;
• body temperature 38°C or higher;
• jaundice.

An oncologist deals with the treatment of gallbladder cancer. With our service you can in your city. Oncologists use a combination of surgery, chemotherapy and radiation to treat cancer.

Gallstone obstruction of the intestine

Another rare but serious complication of gallstones is gallstone ileus. This is a disease in which a gallstone clogs the intestines. According to statistics, intestinal obstruction as a result of blockage by a gallstone develops in 0.3-0.5% of people with gallstones.

With a long stay of a large stone in the gallbladder, a bedsore can form there, and then a fistula - an atypical communication with the small intestine. If the stone passes through the fistula, it can block the intestines.

Symptoms of gallstone obstruction of the intestine:

• pain in the abdomen;
• vomit;
• bloating;
• constipation.

Bowel obstruction requires emergency medical attention. If the obstruction is not corrected in a timely manner, there is a risk that the intestines will break through (rupture of the intestine). This can lead to internal bleeding and spread of infection throughout the abdomen.

If you suspect you have a bowel obstruction, contact your surgeon immediately. If this is not possible, call the ambulance number - 03 from a landline, 112 or 911 - from a mobile phone.

Surgery is usually required to remove the stone and clear the obstruction. The type of surgery will depend on which part of the bowel is blocked.

Prevention of gallstones

Some studies have shown that changing your diet and losing weight (if you are overweight) can help prevent gallstones.

Diet for the prevention of gallstone disease (GSD)

Since high cholesterol in the blood is responsible for the formation of most of the stones, it is recommended to refrain from foods high in fat and cholesterol in the diet to prevent gallstone disease.

Foods high in cholesterol:

• meat pies;
• sausages and fatty meat;
• butter and lard;
• pastries and cookies.

There is also evidence that regular consumption of nuts, such as peanuts or cashews, can reduce the risk of gallstones.

Drinking a small amount of alcohol can also help reduce the risk of stone formation, but do not exceed your daily allowance of alcohol, as this can lead to liver problems and other diseases.

Proper weight loss

Being overweight, and especially obese, increases the level of cholesterol in bile, which in turn increases the risk of gallstones. Therefore, you should control your weight by eating right and exercising regularly.

However, do not resort to low-calorie diets for quick weight loss. There is evidence that rigid diets disrupt the composition of bile, which contributes to stone formation. It is recommended to reduce weight gradually, lose weight correctly.

To choose the right diet for the prevention or treatment of gallstone disease, as well as normalize weight, consult a dietitian. With our service you can in your city.

Which doctor should I contact for gallstone disease?

The treatment of gallstone disease is at the interface between surgery and therapy, so you may need to consult with doctors of both profiles in order to have a comprehensive understanding of the condition of the gallbladder and possible options for the development of the disease. This is necessary to choose the right treatment tactics.

With the help of our service, you can, which deals with the diagnosis and conservative treatment of gallstone disease, as well as the consequences of cholecystectomy. On the Mend you can, which treats gallstones through surgery.

If you need planned hospitalization, you can use our service to find a decent clinic for gastroenterology or abdominal surgery (if we are talking about surgery).

Localization and translation prepared by site. NHS Choices provided the original content for free. It is available from www.nhs.uk. NHS Choices has not been reviewed, and takes no responsibility for, the localization or translation of its original content

Copyright notice: “Department of Health original content 2019”

All materials on the site have been checked by doctors. However, even the most reliable article does not allow taking into account all the features of the disease in a particular person. Therefore, the information posted on our website cannot replace a visit to the doctor, but only complements it. Articles are prepared for informational purposes and are advisory in nature.

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, certain 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 (reduced 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 symptomatology 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 a spasm of the muscles of the gallbladder and ducts as a reflex response to irritation of the wall with calculi and as a result of overdistension of the bladder with excess bile in the presence of obstruction in the biliary tract. 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.

Gallstone disease (GSD) is a pathological process accompanied by the formation of stones in the gallbladder.

The second name of the disease is calculous cholecystitis. Since cholelithiasis affects the organ of the digestive tract (gall bladder), it is usually treated.

Features of gallstones

Calculi are the main manifestation of gallstone disease. They are made up of calcium, cholesterol, and bilirubin, and come in a variety of sizes. With a small value, we are talking about the so-called "sand" in the gallbladder, but if the formations are large, they are considered full-fledged stones (calculi).

Such formations can increase in size over time. So, from a small grain of sand, a stone of 1 cm or more can appear. The calculus can have a different shape - from round or oval to the outlines of a polyhedron. The same applies to the density of stones. There are quite strong calculi, but there are also very fragile ones that can crumble from one touch.

The surface of the stone can be smooth, spike-like or porous (in cracks). These features are characteristic of all stones, regardless of their location. However, stones are often found in the gallbladder. Such an anomaly is called gallstone disease, or gallbladder calculosis. Less commonly, stones are found in the bile ducts. This disease is called choledocholithiasis.

Stones in the gallbladder can be either single or multiple. There may be dozens, or even hundreds. However, it should be remembered that the presence of even one calculus can cause serious harm to health. Moreover, dangerous complications are often the result of small rather than large gallstones.

Reasons for the formation of stones

If for some reason the quantitative balance of the components that make up bile is disturbed, the formation of solid structures - flakes occurs. As they grow, they coalesce to form stones. Often the disease develops under the influence of the accumulation of excessively large amounts of cholesterol in the bile. In this case, bile is called lithogenic.

Hypercholesterolemia may result from:

• obesity;
• abuse of fatty foods containing a large amount;
• reducing the amount of specific acids entering the bile;
• reducing the amount of phospholipids that prevent hardening and settling and cholesterol;
• stasis of bile.

Bile stasis can be mechanical or functional. If we are talking about the mechanical nature of this deviation, then factors in the form of:

• tumors;
• adhesions;
• kinks of the gallbladder;
• enlargement of neighboring organs or lymph nodes;
• scar formation;
• inflammatory processes accompanied by edema of the organ wall;
• stricture.

Functional failures are associated with impaired motility of the gallbladder itself. In particular, they occur in patients with hypokinetic. In addition, the development of cholelithiasis can be the result of disorders in the biliary system, infectious and allergic diseases, autoimmune pathologies, etc.

Classification

Gallstone disease is divided into several stages:

1. Physicochemical or pre-stone. This is the initial stage of the development of cholelithiasis. During its course, gradual changes occur in the composition of bile. There are no special clinical manifestations at this stage. It is possible to detect the initial stage of cholelithiasis during a biochemical study of the composition of bile.
2. The phase of latent (hidden) stone-carrying. At this stage, stones in the gallbladder or its ducts are just beginning to form. The clinical picture is also not typical for this phase of the pathological process. It is possible to identify gallstone neoplasms only during instrumental diagnostic procedures.
3. The stage when the symptoms of the disease begin to appear brighter and harder. In this case, we can talk about the development of acute calculous cholecystitis, or else state the fact of its transition to a chronic form.

In some sources, you can see a four-stage gradation of gallstone disease. The last, fourth, phase of the disease is characterized as such, in which concomitant complications of the pathological process develop.

Types of gallstones

Stones localized in the gallbladder may have a different chemical composition. According to this criterion, they are usually divided into:

1. Cholesterol. Cholesterol is one of the components of bile, but when it is overabundant, calculi can form. This substance enters the human body with food, and is evenly distributed throughout its cells, contributing to its full functioning. If there is a violation of the process of assimilation of cholesterol, it begins to accumulate in the bile, forming stones. Cholesterol stones are round or oval in shape and can be 1 to 1.5 centimeters in diameter. Their location often becomes the bottom of the gallbladder.
2. Bilirubin. Bilirubin is a breakdown product of hemoglobin. Stones that form with its excess in the body are also called pigment stones. Bilirubin calculi are smaller in size than cholesterol calculi, but they may be larger in number. At the same time, they affect not only the bottom of the gallbladder, but are also able to be localized in the biliary tract.

Gallbladder stones can have varying degrees of calcium saturation. It depends on it how clearly it will be possible to see the neoplasm on the screen of the ultrasound machine or on the x-ray. In addition, the choice of therapeutic technique also depends on the degree of saturation of stones with calcium. If the stone is calcified, then it will be much more difficult to deal with it with medications.

Depending on the size of the gallstones are:

1. small. The size of such neoplasms does not exceed 3 cm in diameter. With single stones localized in the area of ​​the bottom of the gallbladder, no specific clinical symptoms appear in the patient.
2. large. These are called stones whose diameter exceeds 3 cm. They interfere with the normal outflow of bile, and can cause attacks of biliary colic, or other unpleasant symptoms.

Not only the types, but also the size of the calculi can affect the choice of therapeutic tactics for cholelithiasis. Large stones, as a rule, are not subjected to drug dissolution. They are also not crushed with ultrasound, since such a therapeutic approach is unlikely to give the expected results.

In this case, cholecystectomy is performed - an operation to remove the gallbladder along with the stones in it. If the stones are small, more gentle treatment methods are considered.

In some cases, the attention of doctors can also be focused on the location of the neoplasms. Stones located in the area of ​​the bottom of the gallbladder rarely disturb the patient, since they are not characterized by any clinical picture.

If the stones are localized in the immediate vicinity of the neck of the diseased organ, this can cause obstruction of the bile duct. In this case, the patient will be disturbed by unpleasant symptoms, manifested by pain in the right hypochondrium and a violation of the digestive process.

Symptoms and signs of gallstone disease

Gallstone disease is a pathological process that can be completely asymptomatic for a long time. This is especially true of the initial stages of the disease, when the stones are still too small, and therefore do not clog the bile ducts, and do not injure the bladder wall.

The patient may not be aware of the presence of the disease for a long time, that is, be a latent stone carrier. When the neoplasms reach a fairly large size, the first alarming signs of the pathological process in the gallbladder appear. They may appear in different ways.

The first symptoms of gallstone disease that occur even before the onset of pain in the right hypochondrium include:

• feeling of heaviness in the abdomen after eating;
• bouts of nausea;
• slight yellowing of the skin (mechanical jaundice).

Such a clinical picture occurs due to a violation of the outflow of bile. Under the influence of such a failure, deviations occur in the work of the organs of the digestive tract.

The most common symptoms and signs of GSD include:

1. , which signal the development of biliary colic. The duration of the attack can last from 10 minutes to several hours, while the pain can be acute, unbearable, and give to the right shoulder, other parts of the abdomen or back. If the attack does not go away within 5-6 hours, the patient may develop serious complications.
2. An increase in body temperature, indicating the development of an acute disease, which is a frequent companion of cholelithiasis. Intense inflammation of the gallbladder leads to an active release of toxic substances into the blood. If there are frequent attacks of pain after biliary colic, and they are accompanied by fever, this indicates the development of acute cholecystitis. If the temperature rises are temporary, and the thermometer reaches 38 ° C, this may indicate the occurrence of cholangitis. But, nevertheless, temperature is not an obligatory sign of cholelithiasis.
3. development of jaundice. This anomaly occurs due to prolonged stagnant processes due to a violation of the outflow of bile. First of all, the eye sclera turn yellow, and only then - the skin. In people with fair skin, this symptom is more noticeable than in swarthy patients. Often, along with yellowing of the skin and whites of the eyes, patients change color and urine. It acquires a dark shade, which is associated with the release of a large amount of bilirubin by the kidneys. With calculous cholecystitis, jaundice is only an indirect, but not an obligatory symptom. In addition, it can become a consequence of other diseases - cirrhosis, hepatitis, etc.
4. An acute response of the body to the intake of fats. Under the influence of bile, lipids are broken down and absorbed into the blood. If stones are located near the neck or bile duct with cholelithiasis, they simply block the path of bile. As a result, it cannot circulate normally in the intestines. Such an anomaly causes diarrhea, nausea, flatulence, dull pain in the abdomen. But these symptoms are not specific manifestations of cholelithiasis, since they occur in most diseases of the gastrointestinal tract. Fatty food intolerance can occur at different stages in the development of gallstone disease. However, even a large calculus, if it is at the bottom of the diseased organ, is not an obstacle to the outflow of bile. Therefore, fatty foods will be digested and absorbed quite normally.

If we talk about the general symptoms of cholelithiasis, then it can be quite diverse. Abdominal pains of different intensity and nature, digestive disorders, nausea, sometimes with bouts of vomiting are possible. But since the clinic of the disease is characteristic of many pathologies of the gastrointestinal tract, experienced doctors always prescribe an ultrasound of the gallbladder to understand the cause of the patient's ailment.

Diagnostics

If there are symptoms characteristic of biliary colic, you should immediately consult a specialist. First of all, a physical examination and history taking is carried out, based on finding out which symptoms the patient suffers from.

On palpation of the abdomen, there is tension and soreness of the skin in the muscles of the abdominal wall in the immediate vicinity of the diseased gallbladder. In addition, the doctor notes that the patient has yellowish spots on the skin, which occur due to a violation of lipid metabolism, yellowing of the eye sclera and skin.

But a physical examination is not the main diagnostic procedure. This is a preliminary examination, which gives the doctor the basis for referring the patient to certain studies. In particular:

1. . In the presence of an inflammatory process in the gallbladder, a moderate increase in ESR and a pronounced leukocytosis will be noticed in the test results.
2. . When deciphering the data, the doctor notes an increased level of cholesterol and bilirubin against the background of abnormal activity of alkaline phosphatase.
3. Cholecystography. This diagnostic technique helps to accurately examine the state of the gallbladder. During the procedure, an increase in the organ and the appearance of lime inclusions on its walls are revealed. With the help of cholecystography, calcareous stones located inside the diseased organ are detected.
4. Ultrasound of the abdominal cavity is the most informative diagnostic technique for suspected development of gallstone disease. In addition to identifying neoplasms, specialists note deformation of the gallbladder wall. Negative changes in the motility of the diseased organ are also recorded. Well visible on ultrasound and signs characteristic of cholecystitis.

A thorough examination of the state of the gallbladder is also possible with an MRI or CT scan. No less informative diagnostic technique, during which violations in the circulation of bile are detected, is scintigraphy. The method of retrograde endoscopic cholangiopancreatography is also widely used.

Complications

The formation of stones in the gallbladder is fraught not only with a violation of the motility of the diseased organ. GSD can have an extremely negative impact on the functioning of other organs, especially those that are in close proximity to the gallbladder.

So, the edges of the stones can injure the walls of the bladder, causing the development of inflammatory processes in them. In especially severe cases, neoplasms clog the entrance and exit from the gallbladder, thereby making it difficult for the outflow of bile. With such deviations, stagnant processes begin to occur, entailing the development of inflammation. This process can take from several hours to several days, but sooner or later it will definitely make itself felt. The extent of the lesion and the intensity of the pathological phenomenon may be different.

So, the formation of a small edema of the gallbladder wall, or its destruction is possible. The consequence of this dangerous process is the rupture of the diseased organ. Such a complication of cholelithiasis directly threatens the patient's life.

The spread of the inflammatory process to the abdominal organs is fraught with the development of peritonitis. A complication of this condition can be infectious-toxic shock or multiple organ failure. With its development, serious malfunctions occur in the functioning of the heart, kidneys, blood vessels and even the brain.

If the inflammation is too intense, and pathogens release too many toxins into the blood, TTS can appear immediately. Under such circumstances, even immediate resuscitation measures are not a guarantee that the patient will exit the dangerous state and prevent death.

Treatment of gallstone disease

Treatment of pathology can be conservative and surgical. As a rule, therapeutic methods are used to begin with. These include:

1. Dissolution of gallstones with the help of special medications. In particular, chenodeoxycholic and ursodeoxycholic acid. This technique is effective only for single cholesterol calculi. If the patient has no contraindications, such therapy is prescribed for a course of one and a half years.
2. Extracorporeal shock wave lithotripsy is a conservative method for the treatment of cholelithiasis, which involves the use of a shock wave, which leads to the destruction of gallstones. Such a wave is created with the help of special medical devices. Such treatment of cholelithiasis is carried out only with small cholesterol calculi (up to 3 cm). The procedure practically does not cause pain and is quite easily tolerated by patients. Pieces of stones are excreted from the body during bowel movements.
3. Diet. This is one of the foundations of a successful recovery and removal of unpleasant symptoms. Throughout the course of diet therapy, it is necessary to follow the rules of fractional nutrition. Food should be taken 4-6 times a day in small portions. Fatty, spicy, fried, spicy dishes, smoked meats, pickles, carbonated and alcoholic drinks, chocolate are necessarily excluded from the diet. The patient should give up fatty meats and hot spices. A healthy diet for cholelithiasis is based on the use of dairy products and plant products. It is necessary to add wheat bran to the menu.

Cholecystectomy is the most popular surgical treatment for gallstones. It is carried out in 2 ways:

• classic;
• laparoscopic.

Only the surgeon can determine which type of operation is appropriate for each individual case. Cholecystectomy is mandatory for:

1. Numerous neoplasms in the gallbladder. At the same time, the exact number and size of stones do not play any role. If they occupy at least 33% of the area of ​​the diseased organ, cholecystectomy is mandatory. It is not possible to crush or dissolve such a quantity of stones.
2. Frequent bouts of biliary colic. Pain with this deviation can be quite intense and frequent. They are removed with the help of antispasmodic drugs, but sometimes such treatment does not bring relief. In this case, doctors resort to surgical intervention, regardless of the number of calculi and their diameter.
3. The presence of stones in the bile ducts. Obstruction of the biliary tract is a serious threat to the health of the patient, and significantly worsens his well-being. The outflow of bile is disturbed, the pain syndrome becomes more intense and obstructive jaundice develops. In such a situation, surgery is indispensable.
4. Biliary pancreatitis. - an inflammatory process that develops and proceeds in the tissues of the pancreas. The pancreas and gallbladder are connected by one bile duct, so a violation in the work of one organ entails negative changes in the work of another. In some cases, calculous cholecystitis leads to a violation of the outflow of pancreatic juice. Destruction of organ tissues can lead to serious complications, and directly threatens the life of the patient. The problem must be solved exclusively by surgery.

A mandatory operation is also necessary when:

1. peritonitis. Inflammation of the abdominal organs and tissues of the peritoneum itself is a dangerous condition that can lead to death. The pathological process can develop when the gallbladder ruptures and bile contaminated with pathogenic microorganisms enters the abdominal cavity. In this case, the operation is aimed not only at removing the affected organ, but also at thorough disinfection of adjacent organs. Delaying the operation can lead to death.
2. Stricture of bile ducts. The narrowing of the canal is called a stricture. An intense inflammatory process can lead to such violations. They lead to stagnation of bile and its accumulation in the tissues of the liver, although the gallbladder can be removed. During surgery, the efforts of the surgeon are aimed at eliminating strictures. The narrowed area can be widened, or the doctor can create a bypass for bile, through which it is excreted directly into the rectum. It is impossible to normalize the situation without surgical intervention.
3. Accumulation of purulent contents. When a bacterial infection attaches to the tissues of the gallbladder, pus accumulates in them. A collection of pus within the gallbladder itself is called an empyema. If the pathological contents are collected outside of it, without affecting the abdominal organs, in this case we are talking about the development of a paravesical abscess. Such anomalies lead to a sharp deterioration in the patient's condition. During the operation, the gallbladder is removed and the abscess is emptied, followed by careful treatment with antiseptics to prevent peritonitis.
4. Biliary fistulas are pathological openings located between the gallbladder (less commonly, its ducts) and adjacent hollow organs. For such a deviation, any specific clinical picture is uncharacteristic, but it can significantly disrupt the outflow of bile, leading to its stagnation. In addition, they can cause the development of other diseases and digestive disorders. During the operation, pathological openings are closed, which helps to prevent unwanted complications.

In addition to the stage of pathology, the size and composition of stones, the age of the patient and the presence of concomitant diseases play an important role in choosing a therapeutic technique. With intolerance to pharmacological agents, drug treatment of cholelithiasis is contraindicated for the patient. In this case, the only correct way out of this situation will be an operation.

But for older people with diseases of the cardiovascular system, kidneys or other organs, surgery can only do harm. In this case, doctors try to avoid such treatment tactics.

As you can see, the choice of therapeutic technique for GSD depends on many factors. To say exactly whether there is a need for an operation can only be done by the attending physician after all the necessary diagnostic measures have been taken.

Diet for gallstone disease

Nutrition for cholelithiasis should be fractional. Food should be taken in small portions 4-6 times a day. Food temperature should not be less than 15 or more than 62 degrees Celsius. Prohibited products for gallstone disease include:

• alcohol;
• legumes in any form;
• fatty dairy and sour-milk products;
• roast;
• acute;
• salty;
• smoked;
• fatty varieties of fish and meat;
• caviar;
• sweets;
• canned food;
• mushrooms in any form;
• hot fresh bread, toast, croutons;
• spices, seasonings;
• marinade;
• coffee;
• chocolate products;
• cocoa;
• strong black tea;
• hard or salty cheese.

• dried bread made from flour of the 2nd grade;
• low-fat cheeses;
• boiled, steamed or baked vegetables;
• finely chopped white cabbage (in limited quantities);
• baked or boiled lean meat;
• different types of cereals;
• vermicelli and pasta (within reasonable limits);
• jams and preserves;
• sweet fruits and berries;
• weak tea;
• sweet homemade juices;
• mousse;
• dried fruit compote;
• butter, which must be added to various dishes in an amount of not more than 30 g per day;
• low-fat varieties of fish (perch, pike, hake, etc.);
• whole milk. It can be consumed both in its pure form and used for making cereals.

Fat-free cottage cheese and natural low-fat yoghurts are also allowed (home-made is better).

Forecast and prevention in cholelithiasis

To prevent the development of gallstone disease, it is necessary, if possible, to avoid factors that can cause the development of hypercholesterolemia and bilirubinemia. It is also important to exclude stagnant processes in the gallbladder and its ducts. This is facilitated by:

• balanced and complete nutrition;
• physical activity;
• careful monitoring of body weight, and, if necessary, its adjustment;
• timely detection and complete cure of diseases of the biliary system.

Especially close attention to bile circulation and cholesterol levels should be given to people who have a genetic predisposition to gallstone disease.

If we talk about the prevention of biliary colic when a disease is detected, then patients must follow a strict diet. They should carefully monitor their weight and consume a sufficient amount of fluid (1.5 - 2 liters per day). To avoid the risk of movement of calculi through the bile ducts, patients should avoid performing work that requires a long stay in an inclined position.

The prognosis for the development of cholelithiasis for all patients is different, since they directly depend on the rate of formation of stones, their size and mobility. In most cases, the presence of stones in the gallbladder leads to a number of adverse and severe complications. But if surgical intervention is carried out in a timely manner, the dangerous consequences of the disease can be completely prevented!

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 location 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.

Sometimes a person prone to diseases of the gallbladder accidentally provokes an attack of gallstone disease, being in an uncomfortable position for the gallbladder for a long time, having eaten a harmful product, washed down the dish with alcohol. 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.

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 10-15 minutes.

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:

• no-shpa;
• drotaverine;
• papaverine;
• antispasmodics of any order.

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 10-15 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 it is detected (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 bile ducts becomes more complicated. When stones get stuck, clogging the bile ducts, unpleasant phenomena occur:

• biliary cirrhosis of the liver;
• jaundice;
• cholecystitis ();
• 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:

• Crohn's disease;
• gout;
• diabetes.

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 depend 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:

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, you can forget about it 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.