Gallstone disease: the dangers of non-treatment. How an attack of gallstone disease manifests itself: characteristic symptoms and treatment Gallstone disease symptoms and treatment in adults

The benefits of spa treatment

In case of chronic cholelithiasis, treatment is prescribed in sanatorium-resort institutions. This method gives good results and prolongs periods of remission. For cholelithiasis, the second and third sanatorium regime is used, which includes:

general climatotherapy;
therapeutic group physical education;
use of mineral water;
balneotherapy (mud therapy has an effective effect);
various therapeutic baths (mineralized and herbal).

Sanatorium- spa treatment is soft but effective way non-surgical treatment of gallstone disease. The results of this treatment are:

reduction of pain syndromes;
improvement of general well-being;
decrease inflammatory processes digestive system, gallbladder;
stabilization of pancreatic function;
reduction of lipid oxidation;
improving the functioning of the intestinal tract;
change in bile density.

This type of treatment is used only in the remission stage and in the absence of pain. Sanatorium-resort treatment is not used for acute forms of cholecystitis, especially purulent ones.

Features of diet therapy

The peculiarity of diet therapy is the regulation of metabolism, especially cholesterol metabolism. To do this, reduce calories and limit the consumption of simple carbohydrates and animal fats. Food for gallstone disease should be simple, balanced and as healthy as possible.

The following food products are excluded:

egg yolk;
offal;
fatty meats and fish;
animal fats.

The exception is butter; it is recommended to consume it up to 10 grams. in a day. Prohibited foods also include herbs containing a lot of acid - sorrel and spinach. You should avoid eating spicy seasonings, beans and baked goods. All of these foods are difficult to digest and contribute to the exacerbation of the disease.

Changing your diet is fundamental to treating the disease without surgery. According to medical recommendations, diet No. 5 is used.

The main points of the diet are:

fractional meals;
exclusion of harmful foods;
consumption of foods enriched with magnesium salts.

Portioned food consumption improves the functioning of the bile-excretory system.

Nutritionists recommend consuming various cereals, especially green and ordinary buckwheat, and whole grain oatmeal. The diet should contain a sufficient amount of fruits and vegetables, it is recommended to include dairy products. And the consumption of mineral water (alkaline) is an integral part of the therapeutic diet.

Dietary food processing should be carried out in the following ways:

boiling;
baking in the oven;
steaming.

First breakfast:

cottage cheese casserole (120 gr.);
oatmeal (150 gr.) with butter (10 gr.);
Herb tea.

Second breakfast – fruit of your choice (apple, pear, apricot).

vegetable soup (400 gr.);
a piece of baked poultry;
steamed vegetables (zucchini, carrots) –120 gr.;
dried fruits compote.

Afternoon snack – fruit compote with crackers.

fish baked with vegetables (250 gr.);
decoction of rose hips and strawberry leaves.

Before bed – natural yogurt (200 grams).

Option No. 2

First breakfast:

buckwheat porridge (200 grams);
natural yogurt with fresh berries (100 grams);
tea without sugar, you can add honey.

Second breakfast – steamed dried apricots (several pieces).

boiled veal (100 grams);
beet and carrot salad seasoned with vegetable oil (200 grams);
Herb tea.

Afternoon snack – baked apple or pumpkin.

steamed fish cutlets (150 gr.);
boiled rice (100 grams);
drink with echinacea and rose hips.

Before bed - a glass of low-fat kefir.

Based on this approximate diet menu, simply select dishes, excluding junk food from your diet, and create a list of products for every day that will meet therapeutic diet №5.

Why is it necessary to follow a diet after gallbladder removal?

Many people who have had their gallbladder removed do not understand why they need a diet, because the gallbladder is no longer there! And there are no stones either... Why do you need to eat differently?

Let me explain: you have had the consequence removed - the stones and the bubble in which they are formed, and the disease - metabolic disorder - has not gone away, you continue to live with her. Now stones can form in the bile ducts, which is much more dangerous. And the correct one balanced diet, which we usually call a diet, gradually normalizes metabolism and you will get rid of cholelithiasis forever.

Moreover, if in the presence of a gallbladder, the bile in it became concentrated, which gave it the opportunity to exhibit disinfectant properties and kill pathogenic microbes, now it enters directly into the duodenum- constantly, having no place to accumulate. This bile cannot help digest large amounts of food, since there is no reservoir where it accumulated - the bladder has been removed.

It is for this reason that it is recommended fractional meals 5-6 times throughout the day and give up irrational consumption of fatty foods. Yes, fat is needed, but in small quantities. You also need to drink a lot of water - at least 1.5 liters, which will dilute the bile. And adhere to the list of permitted and prohibited foods for cholelithiasis (you remember - the disease has not gone away!), which is given above.

I hope that the article was useful for you and helped you understand such a complex phenomenon as cholelithiasis, its symptoms and causes, surgical treatment and nutrition for the formation of gallstones.

Be healthy! We eat rationally and correctly!

Cholelithiasis (other name cholelithiasis ) is a disease characterized by the formation of stones in the bile ducts. In particular, stones form in the gallbladder (we are talking about cholecystolithiasis ) and in the bile ducts (in this case, choledocholithiasis ).

The formation of stones during the development of cholelithiasis occurs due to the precipitation of insoluble components of bile. These components are, calcium salts , bile pigments , as well as certain types proteins . Also, in some cases, stones that are pure in terms of chemical composition are found. Stones that form in the bile ducts and bladder are divided into cholesterol , pigment , as well as rare ones, which amount to . If we are talking about mixed stones, they usually consist of 70% cholesterol.

In women, one of the provoking factors is bearing a child. As the fetus grows, the gallbladder contracts, resulting in bile stagnation. In the last stages of pregnancy, bile is saturated with cholesterol, which also contributes to the formation of stones. Gallstone disease most often occurs in women after their second pregnancy.

Cholesterol stones often form when a person has other diseases of the gallbladder or gastrointestinal tract. Cholesterol concentration increases with irritable bowel syndrome , dysbacteriosis .

Consequently, cholelithiasis is a polyetiological disease caused by various factors, the combination of which ultimately leads to the formation of stones in the gall bladder.

Symptoms of gallstone disease

Gallstone disease manifests itself in humans very different symptoms. Experts distinguish several different forms of the disease. This latent , dyspeptic , painful torpid And paroxysmal pain forms.

When the period of the latent form of the disease ends, the patient may initially note the manifestation of dyspeptic disorders. After some time, he already develops a moderate pain syndrome, and later the person is already bothered by periodic attacks biliary colic . But gallstone disease does not always develop exactly according to the described scheme.

Stones in the gall bladder or ducts do not always provoke clinical manifestations of the disease. Sometimes the presence of one stone in the bottom of the gallbladder does not cause noticeable symptoms. The duration of the latent form of the disease can range from 2 to 11 years.

When moving to the dyspeptic form of the disease, the patient already experiences general dyspeptic disorders, which often manifest themselves in gastrointestinal diseases. There is a feeling of heaviness in the area of the right hypochondrium and epigastrium; dryness and bitterness periodically appear in the mouth. Possible seizures, constant belching , And unstable chair . In this case, the patient feels unwell after eating fatty and spicy foods. Such symptoms occur regularly at this stage of the disease.

In the painful torpid form of cholelithiasis, a person does not experience pronounced attacks of pain. Sometimes there is a dull and aching pain in the epigastrium, a feeling of severe heaviness in the right hypochondrium. More intense pain occurs after violations of the nutritional rules for gallstone disease. In addition, the pain becomes intense after strong shaking, significant physical exertion, unpleasant emotions, or changes in weather conditions. The pain often radiates to the right shoulder and right shoulder blade. Some people get overwhelmed frequent nausea, heartburn, bloating, constant feeling of malaise. Symptoms of gallstone disease in women are characterized by increased pain during menstruation. This form of the disease can even last several decades, accompanied in the absence of adequate therapy by attacks of biliary colic or acute.

The painful paroxysmal form is also called biliary colic . It proceeds in waves: against the background of a normal state, a severe attack of colic suddenly occurs. Moreover, such attacks can appear both after a few days and after several years. The pain of biliary colic is very sharp, stabbing or tearing. It is localized in the right hypochondrium or in the epigastric region. In this case, the person suffers severe pain, cannot find a suitable body position, and even screams in pain.

Sometimes such attacks appear for no reason, but very often they are provoked by fatty or spicy foods, other deviations from the diet, as well as drinking alcohol, physical or emotional stress. Women often suffer from colic during menstruation and during pregnancy. Pain with biliary colic often radiates under the right shoulder blade, into the collarbone and supraclavicular region, neck, right shoulder, and behind the sternum. In more rare cases, the pain radiates to the heart area and can be mistaken for an attack. Often during pain there is nausea and vomiting of bile, which does not bring relief to the patient. If during an attack of biliary colic a person suffers from uncontrollable vomiting, this may indicate that the pancreas was also involved in the pathological processes.

The most severe attacks of colic occur in those people who have small stones in the gall bladder. People suffering from biliary colic have a bitter taste in their mouth, they may suffer from heartburn, and they cannot tolerate fried and fatty foods.

Diagnosis of cholelithiasis

Making a diagnosis in the case of cholelithiasis, as a rule, does not cause any particular difficulties if the patient develops an attack of biliary colic. It is more difficult to diagnose the disease in the presence of vague pain, dyspeptic symptoms, or symptoms of pathology of other gastrointestinal organs. One of the most important moments During the diagnostic process, a correct medical history is required, from which the doctor can learn about all the features of the course of the disease.

In the diagnostic process, an informative method is laboratory testing of blood, as well as feces and urine.

Sometimes patients with suspected gallstones are prescribed duodenal intubation. Carrying out biochemical research bile allows you to evaluate the properties of bile, which to some extent depend on the presence pathological process in the biliary tract. However, due to the possibility of exacerbation of the disease after duodenal intubation, X-ray and ultrasonographic research methods are now more often used to confirm the diagnosis. To fully verify the correctness of the diagnosis, an ultrasound is performed, as well as the method of oral cholecystography and infusion cholegraphy. The modern method of cholangiography allows you to obtain images of the bile ducts after direct injection of a contrast agent into them. This is done through endoscopy, piercing abdominal wall. During the research it is also used CT scan and magnetic resonance imaging.

Treatment of cholelithiasis

In order for the treatment of cholelithiasis to have the most noticeable effect, it is important to approach the principles of therapy differently in patients of different ages, on different stages diseases. The presence or absence of complications should also be taken into account. For all patients who have been diagnosed with gallstones, it is important proper nutrition with cholelithiasis.

If a patient has an exacerbation of the disease, an attack of biliary colic, he should not eat at all for one or two days in order to ensure a gentle regime for the pancreas. Next, you should eat exclusively boiled, pureed, low-fat foods.

In case of an acute attack of the disease, the patient is prescribed medications with an analgesic effect. In especially severe cases, it is possible to prescribe narcotic analgesics, as well as administer antispasmodic drugs intravenously. If during the diagnostic process the development of inflammation in the biliary tract was discovered, complex therapy turn on . If gallstone disease is accompanied by, it is advisable to take enzyme preparations -, festal , Creona .

It is also possible to prescribe drugs that improve liver function - hepatitis , . If only single, floating gallstones are found, treatment may consist of attempting to dissolve them. Drugs that help dissolve stones are used chenodeoxycholic or ursodeoxycholic acids .

For the dissolution of stones to be successful, it is important that the normal functions of the gallbladder are preserved and that there is no inflammation in the bile ducts and gallbladder. These drugs help reduce cholesterol synthesis, reduce its excretion in bile, and help separate cholesterol crystals from stones and excrete them in bile.

Such treatment can last more than six months. During the treatment period, it is important for the patient to follow a diet that includes a minimum of cholesterol and plenty of fluids. However, such treatment is contraindicated for pregnant women, since the drugs may cause Negative influence for the fruit.

Shock wave cholelithotripsy - This modern technique treatment of cholelithiasis, which consists of crushing stones. A sound wave is used for this. For crushing to be successful, the size of the stone should not be more than 3 cm in diameter.

Surgery for gallstone disease involves complete removal gallbladder. Today, laparoscopic cholecystectomy is mainly used for this. This method of removing the gallbladder is much less traumatic, postoperative period lasts for a much shorter period of time. This operation can be done if the goal is to remove stones from the gallbladder.

For stones in the bile duct, a combined operation is performed: the gallbladder is removed using the laprascopic method, and stones are removed from the bile ducts using an endoscope and sphincterotomy.

Diet, nutrition for gallstone disease

Treatment of this disease is impossible without strict adherence to certain nutritional principles. Diet for gallstones can effectively relieve frequent occurrence unpleasant symptoms of gallstone disease.

Its main principle is to limit foods that contain cholesterol. People with gallstones should not eat cheese, brains, egg yolk, liver, sausages, pork, full-fat dairy products, duck and goose.

If the patient has a presence, then he needs to exclude easily digestible carbohydrates from the menu.

It is important to eat foods containing protein regularly. A diet for gallstone disease involves eating fish, poultry, rabbit, and low-fat cottage cheese. To reduce the cholesterol content in foods, they should be boiled, but the broth should not be drunk. Food should be consumed baked, boiled, or stewed. If meat is baked, the skin must be removed before eating it.

Vegetable salads are seasoned with kefir, olive oil. You cannot eat fresh bread: it is better to take a slightly stale piece of bread or cracker. It is important to increase your regular fiber intake by introducing as many vegetables into your diet as possible. You should not limit your daily intake of liquid drinks, as they help remove toxins from the body and also support normal metabolic processes.

The diet for gallstones excludes the inclusion of soda, ice cream, and chocolate in the diet. Fatty foods put a significant strain on the gallbladder. You should eat in relatively small portions, dividing the total daily diet into 6-7 meals.

Prevention of gallstone disease

In order to prevent the development of cholelithiasis, it is important to promptly eliminate all causes that contribute to the disruption of metabolic processes and stagnation of bile. People prone to the formation of gallstones, as well as those who suffer from other gastrointestinal diseases, should pay special attention to their diet, excluding, if possible, foods that are prohibited from being consumed on a special diet. It is necessary to eliminate constipation, not wear tight belts, and ensure a daily active lifestyle.

Due to the fact that cholesterol synthesis in the body occurs from glucose, it is important not to abuse sugar, as well as products containing it.

Due to the fact that intensive growth of stones occurs mainly at night, you should try to empty your gallbladder before going to bed. To do this, about two hours before bedtime, you can consume choleretic products - tea or kefir with honey, mineral water.

If a patient is diagnosed with a latent course of the disease, he should visit a gastroenterologist at least once a year.

Complications of gallstone disease

If, during the development of cholelithiasis, inflammation, infection is added to it, or a blockage develops in the bile ducts due to the movement of stones, then the clinical picture of the disease changes significantly. If the duct or neck of the gallbladder is blocked, gradual development may occur. hydrocele of the gallbladder . In this case, the person suffers from a severe attack of pain, and after some time the doctor can feel the enlarged gallbladder. If a patient develops dropsy, then sharp attacks of pain are gradually replaced by a feeling of heaviness in the right hypochondrium. There is no increase in body temperature or changes in laboratory research blood. But when the infection is attached, it already develops gallbladder empyema . With this diagnosis, a sharp deterioration in the patient’s condition occurs: he is overcome by pain, chills, and there is a significant increase in body temperature.

If the entrance to the gallbladder is completely blocked by a stone, the outflow and entry of bile becomes impossible. As a result, the bubble atrophies over time.

Sometimes a certain movement of stones allows bile to enter the duodenum. At the same time, a person develops jaundice . The consequence of stagnation of bile in the liver is; Also, a complication of cholelithiasis can be inflammation of the bile ducts, causing cholangitis .

If the process becomes chronic, then this is fraught with the manifestation of irreversible changes: , cholangiohepatitis , hepatic-renal failure . As complications of a progressive disease, it is also possible to develop biliary peritonitis , . Such conditions must be urgently treated exclusively by surgery.

The most common complication of cholelithiasis is destructive cholecystitis , gallbladder perforation .

A serious complication of prolonged presence of stones can be the development gallbladder cancer . Rarely occurs cholelithiasis .

List of sources

Ilchenko A.A. Diseases of the gallbladder and biliary tract. Guide for doctors. Moscow: MIA, 2011;
Gallstone disease / S. A. Dadvani [et al.]. - M.: Vidar-M Publishing House, 2000;
Leuschner U. Practical guide to diseases of the biliary tract. M.: publishing House GEOTAR-MED. 2001;
Kozyrev, M. A. Diseases of the liver and biliary tract: textbook. allowance / M. A. Kozyrev. - Minsk: Bel. navuka, 2002.

The number and size of gallstones are very diverse: sometimes it is one large stone, but more often there are multiple stones, numbering in the tens, sometimes in the hundreds. They vary in size from chicken egg to millet grain and less. Stones may vary according to chemical composition. Cholesterol, lime and bile pigments participate in their formation. Consequently, metabolic disorders in the body, bile stagnation and infection play an important role in the process of stone formation. When bile stagnates, its concentration increases, creating conditions for the crystallization of cholesterol contained in it and removed from the body with it. It has been scientifically established that excessive and irregular nutrition, as well as insufficient mobility, contribute to the creation of conditions for the formation of gallstones. Most common reasons, causing the appearance of biliary colic (the main manifestation of cholelithiasis) are the consumption of alcohol, spicy fatty foods, and excessive physical activity.

A common metabolic disease in which, due to disruption of the processes of bile formation and bile excretion, stones form in the gall bladder. Small stones (microliths) sometimes also form in the intrahepatic bile ducts, especially in elderly men and patients with cirrhosis of the liver. Once in the gallbladder, microliths can serve as a basis for the deposition of cholesterol on them and the formation of large cholesterol stones. In addition to cholesterol stones, there are pigment (bilirubin), calcareous, mixed and combined types of stones. Stone-carrying is possible without clinical manifestations; It is often discovered by chance at autopsy. Gallstones occur at any age, and the older the patient, the higher the incidence of the disease. In women, cholelithiasis and stone carriage are observed several times more often than in men.

Gallstone disease is often accompanied by chronic cholecystitis. With multiple stones, bedsores form in the gallbladder, which can lead to ulceration and perforation of its walls.

Classification

In cholelithiasis there are stages: physico-chemical (changes in bile), latent (asymptomatic stone carriage), clinical (calculous cholecystitis, biliary colic).
The following are distinguished: clinical forms gallstone disease: asymptomatic stone carriers, calculous cholecystitis, biliary colic.
Gallstone disease can be complicated or uncomplicated.

The main manifestation of cholelithiasis is biliary, or hepatic, colic, which is manifested by attacks of very severe pain in the right hypochondrium. At the same time, they spread and radiate to the right shoulder, arm, collarbone and scapula or to the lower back with right side bodies. The most severe pain occur when blockage of the common bile duct occurs suddenly.

An attack of biliary colic is accompanied by nausea and repeated vomiting with an admixture of bile in the vomit, which does not alleviate the condition of the patients. Sometimes reflex pain appears in the heart area. Biliary colic usually occurs with an increase in body temperature, which lasts from several hours to 1 day.

Between attacks, patients feel practically healthy, sometimes they feel dull pain, a feeling of heaviness in the right hypochondrium, and nausea. There may be a decrease in appetite and dyspeptic disorders.

With prolonged blockage of the common bile duct, bile from the liver is absorbed into the blood, jaundice occurs, which requires appropriate treatment in a hospital setting.
The most reliable confirmation of the diagnosis of cholelithiasis is the results x-ray examination with the introduction of radiopaque liquid into the bile ducts.

IN clinical manifestations cholelithiasis, functional disorders of the extrahepatic biliary tract are of significant importance, both in the early period before the formation of stones, and in the presence of such. Gallstone disease is a fairly common disease, especially in women, accompanied by a number of complications and sequential processes.
The size and number of gallstones vary in different cases. The most voluminous are single, solitary stones (monoliths), and the weight of the stone can reach 25-30 g; gallstones usually have a round, ovoid shape, common bile duct stones resemble the end of a cigar, and intrahepatic duct stones can be branched. Small stones, almost grains of sand, can number several thousand in one patient.

The main components of stones are cholesterol, pigments (bilirubin and its oxidation products) and lime salts. All these substances can be combined in various proportions. From organic matter they contain a special colloidal substance of a protein nature that forms the skeleton of the stone, and among inorganic ones, in addition to lime salts (carbon dioxide and phosphoric acid), iron, copper, magnesium, aluminum and sulfur were found in gallstones. For practical purposes, it is enough to distinguish three types of stones based on their chemical composition: cholesterol, mixed and pigment.

Cholesterol, radial stones consist almost exclusively (up to 98%) of cholesterol; they are white, sometimes slightly yellowish, round or oval in shape, ranging in size from a pea to a large cherry.
Mixed stones, cholesterol-pigment-calcareous, multiple, faceted, occur in tens, hundreds, even thousands. These are the most common, most common stones. In the section, you can clearly see a layered structure with a central core, which is a soft black substance consisting of cholesterol. In the center of mixed stones, fragments of epithelium are sometimes found, foreign bodies(blood clot, dried roundworm, etc.), around which stones falling out of the bile are layered.
Pure pigment stones are of two types: a) observed in cholelithiasis, possibly with a plant diet, and b) observed in hemolytic jaundice. These pure pigment stones are usually multiple, black in color, and turn green in the air; they are found in the bile ducts and gallbladder.

Causes of cholelithiasis (gallbladder stones)

The development of gallstone disease is a complex process associated with metabolic disorders, infection and stagnation of bile. Undoubtedly, heredity also plays a role. Metabolic disorders contribute to disruption of bile eicolloidity. The stability of the bile colloidal system, its surface activity and solubility depend on the composition and correct ratio of bile ingredients, primarily bile acids and cholesterol (the so-called cholate-cholesterol index). An increase in the concentration of cholesterol or bilirubin in bile can contribute to their loss from solution. The prerequisites for increasing the concentration of cholesterol and decreasing the content of cholates in bile are created when bile stagnates. Infection promotes stone formation by inhibiting the synthesis of bile acids by liver cells. All these mechanisms, closely related to each other, lead to the development of the disease, which is facilitated by neuro-endocrine and metabolic disorders. Hence, the more frequent development of gallstone disease among people with obesity, poor lifestyle, its frequent association with other metabolic diseases (atherosclerosis, diabetes), as well as the frequent occurrence of the disease during repeated pregnancy.

Great importance in the formation of gallstones, there appears to be an abnormal composition of the bile produced by the liver (dyscholia), which contributes to the loss of difficultly soluble components of bile, as well as a violation general exchange substances with blood overload with cholesterol (hypercholesterolemia) and other products of slow metabolism. Infection leading to disruption of the integrity of the epithelium of the gallbladder mucosa with its desquamation, foreign bodies inside the gallbladder, easily causing deposition of lime and other components of bile, are rather only secondary, more rare factors stone formation. Excessive secretion of bilirubin by bile during massive hemolysis is also important.

Impaired liver activity and changes in metabolism are based on unfavorable environmental influences in the form of excessive poor nutrition and lack of physical work. Neuroendocrine factors affecting the function of the liver cell and tissue metabolism, as well as the emptying of the gallbladder, are also of great importance.
Gallstone disease is often combined with obesity, gout, the presence of kidney stones, sand in the urine, atherosclerosis, hypertension, diabetes, i.e., it is observed in numerous conditions occurring with: hypercholesterolemia.

The disease most often manifests itself between the ages of 30 and 55 years, and in women it is 4-5 times more common than in men. Gallstones in inflammation of the gallbladder and hemolytic jaundice can be observed at an earlier age. Gallstone disease, of course, often manifests itself clinically for the first time during pregnancy or in the postpartum period: pregnancy is also accompanied by normal conditions physiological hypercholesterolemia and increased function of liver cells, which creates best conditions for fetal development and milk production by the mammary gland. Particularly significant disturbances in metabolic and vegetative processes can be expected when the physiological rhythm of the reproductive function is disrupted due to repeated abortions or premature births without subsequent lactation, etc., when a delay in emptying of the gallbladder is possible due to altered activity of the nervous system. Family cases of cholelithiasis, especially frequent in mother and daughter, are most often explained by the influence of the same environmental conditions mentioned above.

It has long been known that foods rich in cholesterol (fatty fish or meat, caviar, brains, butter, sour cream, eggs) contribute to the formation of stones, of course, if oxidative-enzymatic processes are disrupted.

Recent experimental studies have also discovered the effect of vitamin A deficiency on the integrity of the epithelium of the gallbladder mucosa; Its desquamation contributes to the precipitation of salt and other precipitation.

Currently, great importance in the loss of cholesterol in bile is attributed, as indicated, to the abnormal chemical composition of bile, in particular, the lack of bile (as well as fatty) acids, which can be seen as a dysfunction of the liver cell itself.

Infections and bile stasis are of known importance in gallstone disease. Of the diseases suffered, special attention was paid to typhoid fever, since it is known that typhoid bacillus can affect the bile ducts, excreted in bile.

Stagnation of bile is promoted, in addition to a sedentary lifestyle, by excessive obesity, pregnancy, clothing that compresses the liver or restricts the movement of the diaphragm, prolapse abdominal organs, mainly right kidney and liver; in this case, bending of the bile ducts, especially the cystic ducts, located in the lig may occur. hepato-duodenal. When the mucous membrane of the duodenum swells and ulcerative processes in it become scarred, the mouth of the common bile duct may be compressed, which leads to stagnation of bile. Catarrhs that arise as a result of a gross violation of the diet sometimes contribute to stagnation of bile and infection of the biliary tract. Usually, however, in addition to the mechanical factor, the effect of the above-mentioned hepatic-metabolic factor is also noted.

The greatest importance in the origin of cholelithiasis should be given to disruption of the nervous regulation of various aspects of the activity of the liver and biliary tract, including the gallbladder, with their complex innervation device. The formation of bile, its entry into the gallbladder and its release into the duodenum is finely regulated by autonomic nerves, as well as higher nervous activity, which is evidenced by the great importance of conditioned reflex connections for normal bile secretion.

At the same time, the receptor fields of the biliary tract, even with functional disorders of the biliary function, give rise to pathological signaling to the cerebral cortex. Thus, in the pathogenesis of cholelithiasis, it is possible to establish individual links that are also characteristic of other cortico-visceral diseases.

Metabolic-endocrine disorders play only a secondary role, subordinate to functional changes in nervous regulation. With initial damage to adjacent organs and infectious causes disruption of the hepatobiliary system, leading to cholelithiasis, also occurs through the neuroreflex pathway.

Certain signs of cholelithiasis, especially the signs accompanying biliary colic, characteristic of gallstone dyspepsia, etc., owe their intensity and diversity primarily to the abundant innervation of the gallbladder and bile ducts and are, undoubtedly, mainly neuroreflex in nature.

Symptoms, signs of cholelithiasis (gallbladder stones)

The clinical picture of cholelithiasis is extremely varied and difficult to describe briefly. Uncomplicated gallstone disease is manifested by gallstone dyspepsia and biliary, or hepatic, colic.

Complications of gallstone disease

Biliary colic.
Cholecystitis.
Acute pancreatitis.
Gallbladder fistula, mechanical intestinal obstruction.
Obstructive jaundice.
Cholangitis and septicemia or liver abscess.
Perforation and peritonitis.

Gallstone disease is characterized chronic course, leading to disability of patients and even threatening their lives during certain periods of the disease in the presence of certain complications, especially as a result of blockage of the bile ducts, intestinal obstruction and phlegmonous cholecystitis. Often the disease takes a hidden (latent) course, and stones are discovered only at the autopsy of patients who died from another cause.

Of the complications of cholelithiasis, almost as numerous as, for example, complications of peptic ulcer of the stomach and duodenum, blockage of the bile ducts and their infection are described first of all separately, although very often the phenomena of blockage and infection are combined.

During their movement, stones can get stuck at various points along the path of bile movement, causing special characteristic clinical symptoms. Most often, we observe blockage of the cystic and common bile duct.

A typical manifestation of the disease is an attack of biliary, or hepatic, colic. The pain occurs suddenly, but is sometimes preceded by nausea. Colic usually begins at night, usually 3-4 hours after an evening meal, especially fatty foods, or drinking alcohol; accompanied by a rise in temperature (sometimes with chills), tension in the abdominal muscles, stool retention, bradycardia, vomiting, and bloating. Temporary anuria is possible, if present coronary disease- resumption of anginal attacks. There are a large number of cholesterol crystals in the duodenal contents, sometimes small stones are found. In some cases, stones can be detected in feces 2-3 days after the attack. In some cases, colic recurs frequently, in others - rarely, occurring in the form of gallstone dyspepsia.

With biliary colic, complications are possible, of which the most dangerous are blockage of the neck of the gallbladder by a stone; as a result of the stone laying an artificial path into the intestine (fistula), severe infection of the biliary apparatus occurs with the development of ulcers, biliary peritonitis and sepsis. Gallstone disease favors the development malignant neoplasms biliary system.

Diagnosis and differential diagnosis of cholelithiasis (gallbladder stones)

The diagnosis of cholelithiasis is made on the basis of patient complaints, medical history and course of the disease. In the anamnesis, it is especially important to indicate the dependence of complaints on fatty and floury foods, their connection with pregnancy, obesity of patients (in the past), the presence of cases of cholelithiasis in the family (the patient’s mother, sisters) under the same external living conditions.

When examining patients, the possibility of cholelithiasis is indicated by the presence of at least mild jaundice, skin pigmentation (liver spots, chloasma), cholesterol deposition in the skin (cholesterol nodes - xanthelasmas - in the thickness of the eyelids near the nose). Often, patients have overdeveloped subcutaneous fat. However, cholelithiasis also affects people with normal and low weight, especially in connection with biliary tract infection. As a result of severe cholelithiasis and its complications, patients can suddenly lose weight and even acquire a cachectic appearance. The cholesterol level in the blood may fall below normal, although cholelithiasis is often accompanied by elevated blood cholesterol levels. Direct evidence of the presence of a stone can be provided by cholecystography, the results of which are positive with modern technology in 90% of patients; The detection of microliths in the duodenal contents is also important.

Concerning differential diagnosis, then in various stages of cholelithiasis one has to take into account a number of diseases. In case of gallstone dyspepsia, it is necessary to exclude first of all a gastric and duodenal ulcer, chronic appendicitis, colitis and many other causes of gastric and intestinal dyspepsia. The erased signs of gallstone dyspepsia, described in detail above, make it possible to clinically clarify the diagnosis.

Hepatic colic must be differentiated from a number of diseases.

With renal colic, pain is localized lower in the lumbar region and radiates to the groin, genitals and leg; dysuria, anuria, blood in the urine, and sometimes sandy discharge are often observed; vomiting is less persistent and feverish reactions are less common. We must not forget that both colics can occur at the same time.
At food poisoning manifestations begin suddenly with profuse food vomiting, often diarrhea, in the form of an outbreak of a number of diseases; there is no characteristic dyspepsia in the anamnesis.
At acute appendicitis pain and tension in the abdominal wall (muscular protection) are localized below the navel, the pulse is more frequent, etc.
Duodenal ulcers and periduodenitis, due to the anatomical proximity to the gallbladder, are especially often mixed with biliary colic. A detailed analysis of the pain syndrome, pain points and x-ray examination helps to establish the diagnosis.
Myocardial infarction can give a similar picture, especially since pain during a heart attack can be localized only in the right upper quadrant of the abdomen (“status gastralgicus” due to acute congestive liver). The issue is resolved by the patient's medical history, electrocardiographic changes, etc. Angina pectoris and even myocardial infarction can be caused by biliary colic. Nitroglycerin, according to some authors, also alleviates an attack of cholelithiasis.
Acute hemorrhagic pancreatitis is characterized by more pronounced general phenomena (see description of this form).
Intestinal colic is characterized by periodic pain with rumbling and sometimes accompanied by diarrhea.
Mesenteric lymphadenitis (usually tuberculous) when located in the right upper quadrant is sometimes accompanied by pericholecystitis and periduodenitis without affecting the gallbladder itself, but is often mistakenly recognized as chronic cholecystitis.
Tabetic crises produce less intense pain, vomiting is more profuse, the temperature is not elevated, and there are neurological signs of tabes dorsalis.
With lead colic, the pain is localized in the middle of the abdomen, is diffuse, and calms down with deep pressure; the stomach is usually retracted and tense; blood pressure is increased; the gums have a typical lead border.

As stated above, biliary colic is almost always caused by stones, but in rare cases it can be caused by an roundworm or echinococcus vesicle stuck in the ducts. Analysis of stool and the presence of other symptoms of ascarid infestation or hydatid disease help establish the diagnosis.

An enlarged gallbladder with dropsy can be mixed with hydronephrosis, a pancreatic cyst; the gallbladder is characterized by respiratory mobility and lateral displacement; anterior hydatid cyst of the liver is differentiated from hydrocele by other signs characteristic of hydatid disease.

It is necessary to differentiate febrile cholecystitis, obstructive stone jaundice, cholangitis pseudomalarial fever, secondary biliary cirrhosis of the liver, gallstone ileus, etc. from other diseases that may resemble the corresponding complication of cholelithiasis.

Prognosis and working ability of cholelithiasis (gallbladder stones)

The prognosis of cholelithiasis is difficult to formulate in a general form, the course of the disease is so varied. In most cases, the disease occurs with periodically recurring painful attacks and dyspepsia and, with the right regimen, is not prone to progression and does not significantly shorten life expectancy. This is the course of gallstone disease in most sanatorium-resort patients. In patients in the therapeutic departments of hospitals, a more persistent course with complications is usually observed; finally, in patients surgical departments The most serious complications of cholelithiasis are noted, giving a relatively high mortality rate.

With frequent exacerbations of cholelithiasis and severe inflammatory phenomena (fever, leukocytosis), which are not inferior to treatment, patients are completely unable to work or their ability to work is limited. In milder cases of cholelithiasis with a predominance of spastic or dyskinetic phenomena in the area of the gallbladder, without pronounced symptoms of cholecystitis, patients should be recognized as having limited ability to work if there is significant severity and persistence nervous disorders and frequent, mostly non-infectious, low-grade fever. They cannot perform work involving significant physical stress. With the development of severe complications of cholelithiasis, patients are completely disabled.

Prevention and treatment of cholelithiasis (gallbladder stones)

To relieve a painful attack, antispasmodics (drotaverine hydrochloride, papaverine hydrochloride) and analgesics (metamizole sodium, promedol) are administered intravenously or intramuscularly. If the attack still cannot be eliminated and the jaundice does not go away, you have to resort to surgical treatment. To remove stones, lithotripsy is used - crushing them using a shock wave.

Patients with cholelithiasis must strictly adhere to their diet and diet, and not abuse alcohol.

Patients with chronic diseases gallbladder and bile ducts with insufficient bile secretion and a tendency to constipation, a diet with a high content of magnesium, calcium, carotene, and vitamins B and A is recommended. If bile enters the intestines in insufficient quantities, then the consumption of animal fats should be limited. It is also recommended to consume more honey, fruits, berries, raisins, and dried apricots.

To prevent the development of the inflammatory process in the mucous membrane of the gallbladder, it is necessary timely treatment infectious diseases. In cases where cholelithiasis is combined with inflammation of the mucous membrane of the gallbladder (chronic cholecystitis), the disease is much more severe. Attacks of biliary colic occur more often, and most importantly, severe complications can develop (dropsy of the gallbladder, cholangitis, pancreatitis, etc.), the treatment of which is very difficult.

To prevent cholelithiasis, a general hygienic regimen, sufficient physical activity and proper nutrition are important, as well as the fight against infections, dysfunctions of the gastrointestinal tract, elimination of bile stagnation, and elimination of nervous shock. For people leading a sedentary lifestyle, it is especially important to avoid overeating, systematically take walks in the fresh air, and engage in light sports.

Treatment of cholelithiasis at different stages of its development varies. However, regardless of temporary urgent measures, patients, as a rule, must adhere to a general and dietary regimen for years and decades, periodically undergo spa treatment in order to counteract metabolic disorders, cholesterolemia, to increase the activity of liver cells, to strengthen the nervous regulation of bile-hepatic activity. Of great importance is the fight against stagnation of bile, infection of the gallbladder and bile ducts, ascending from the intestines or metastasizing from distant foci, as well as eliminating difficult experiences. It is necessary to recommend split meals (more often and little by little), as it is the best choleretic agent. The daily amount of drinking should be plentiful to increase secretion and dilute bile. It is important to eliminate all causes that contribute to bile stagnation (for example, a tight belt); with severe ptosis, it is necessary to wear a bandage. Constipation should be combated by prescribing diet, enemas and mild laxatives.

Dietary nutrition is very important in the treatment of gallstone disease. In acute attacks of biliary colic, a strict gentle regimen is necessary. Concomitant lesions of the gastrointestinal tract or other diseases (colitis, constipation, diabetes, gout) should be taken into account.

In case of cholelithiasis, it is usually necessary to limit patients both in terms of the total caloric intake of food and in relation to meat, fatty dishes, especially smoked foods, canned food, snacks, as well as alcoholic drinks. Egg yolks and brains, especially rich in cholesterol, should be excluded from food, and butter should be sharply limited . The diet should be predominantly vegetarian with a sufficient amount of vitamins, for example, vitamin A, the lack of which in the experiment leads to disruption of the integrity of the epithelium of the mucous membranes and, in particular, to the formation of gallstones. Much attention is paid to the culinary processing of food, and fried meat, strong sauces, broths, and some seasonings should be avoided. It is necessary to take into account not only physicochemical characteristics food, but also individual tolerance to it.

During periods of sharp exacerbations of the disease, a meager diet is prescribed: tea, rice and semolina porridge with water, jelly, white uneatable crackers. Only gradually add fruits (lemon, applesauce, compotes), cauliflower, other pureed vegetables, a little milk with tea or coffee, yogurt, low-fat broth or vegetable soup, etc. From fats, fresh butter is allowed in the future in a small amount, with breadcrumbs or with vegetable puree; Provencal oil is given as a medicine in tablespoons on an empty stomach. For years, patients should avoid those foods that cause them attacks of colic or dyspepsia, namely: pies, cakes with cream and in general butter dough, solyanka, pork, fatty fish, cold fatty snacks, especially with alcoholic drinks, etc.

The regimen of patients with cholelithiasis should not, however, be limited only to a properly selected diet and rational eating habits; patients should avoid excitement, hypothermia, constipation, etc., in a word, all those irritations that, in their experience, with particular consistency lead to the return of colic, to a large extent, probably due to the zones of prolonged excitation created in the cerebral cortex. Reception medicines, strengthening the inhibitory process in higher nervous activity, distraction, similar other methods should be used in order to prevent another attack even when exposed to habitual provoking factors.

In the treatment of cholelithiasis, one of the first places is occupied by sanatorium-resort treatment, which is indicated after acute attacks have passed (not earlier than 1-2 months) for the majority of patients with uncomplicated cholelithiasis without signs of a pronounced decline in nutrition. Patients are sent mainly to Zheleznovodsk, Essentuki, Borjomi, etc., or to sanatoriums at the patients’ place of residence for diet and physiotherapy. At spa treatment Complete rest, correct general regimen, nutrition, measured walks, local application of mud to the liver area, which relieves pain and accelerates the healing of residual inflammatory processes, and drinking mineral waters, have a beneficial effect. From mineral waters, hot hydrocarbonate-sulfate-sodium springs are used (for example, the Zheleznovodsk Slavyanovsky spring with water at a temperature of 55°), hydro-carbonate-sodium springs Borjomi, etc., which promote better separation of more liquid bile and the cure of gastrointestinal catarrhs, as well as better loosening the intestines and diverting blood from the liver. Mineral or salt-pine baths are also used, which have a beneficial effect on the nervous system.

Under the influence of climate, mineral waters, hydrotherapy procedures, local application dirt and, finally, an appropriate dietary regimen, the metabolism changes in a favorable direction, the inflammatory phenomena subside, the bile becomes less viscous and is easier to remove from the biliary tract, and the normal nervous regulation of the activity of the hepatobiliary system is largely restored.

Of the medications, bile acids (decholine) may be important, allowing for a normal ratio of bile acids and cholesterol and thereby counteracting stone formation; herbal preparations rich in anti-spasmodic, anti-inflammatory, laxative ingredients; preparations from plants with choleretic properties (holosas extract from rose hips, infusion of immortelle Helichrysum arenarium and many others), choleretic and laxative salts - magnesium sulfate, artificial Carlsbad salt, etc.

Treatment of biliary colic consists of vigorous application of heat to the liver area in the form of heating pads or compresses; if the patient cannot tolerate heat, ice is sometimes applied. Painkillers are prescribed: belladonna, morphine. Usually, vomiting does not allow giving medications orally, and most often it is necessary to inject 0.01 or 0.015 morphine under the skin, preferably with the addition of 0.5 or 1 mg of atropine, since morphine, apparently, can intensify spasms of the sphincter of Oddi and thereby increase the pressure in the bile ducts.

Novocaine also relieves colic ( intravenous administration 5 ml of 0.5% solution), papaverine. Many patients experience bloating during an attack; in these cases, warm enemas are prescribed; For persistent constipation, siphon enemas are used. Vomiting can be calmed by drinking hot black coffee or swallowing ice cubes.

For 5-6 days after the attack, it is necessary to monitor whether the stone is passed with stool. In preventing a seizure, rest, prohibition of bumpy driving, an appropriate diet with a limit on fatty and spicy foods, small meals with sufficient fluid intake and elimination of constipation are important.

For infection of the biliary tract, sulfazine and other sulfonamide drugs are used in an average dose, penicillin (200,000-400,000 units per day), methenamine, “non-surgical drainage” of the biliary tract in combination with agents that increase the body’s resistance and improve the condition of the liver: intravenous infusion of glucose, ascorbic acid, Campolon, blood transfusion, etc.

For obstructive jaundice, the same drugs that improve the condition of the liver are prescribed, and in addition, ox bile, parenteral vitamin K (against hemorrhagic diathesis).
Urgent surgical treatment is indicated for gangrenous cholecystitis, perforated peritonitis, intestinal obstruction due to stones (simultaneously with treatment with penicillin). Surgical intervention Limited accumulations of pus are subject to empyema of the gallbladder, subdiaphragmatic abscess, purulent cholecystitis, blockage of the common bile duct with a stone, hydrocele of the gallbladder, purulent cholangitis. More often, surgery is performed to remove the gallbladder (cholecystectomy) or to open and drain the gallbladder or common bile duct. After the operation, the correct general and dietary regimen is also necessary to avoid relapse of stone formation or inflammatory-dyskinetic phenomena, as well as sanatorium-resort treatment.

In some cases it should only be conservative, in others it must be surgical. From your diet you should exclude foods rich in cholesterol and fats (brains, eggs, fatty meats), rich meat soups, spicy and fatty foods, lard, smoked meats, canned food, baked goods, alcoholic drinks. Allowed are dairy products, fruit and vegetable juices, vegetables, vegetarian soups, boiled meat, fish and pasta, cereals, berries, butter and vegetable oil, preferably corn. Patients should be advised to eat moderately, regularly and often, with plenty of fluids, giving preference mineral waters(Essentuki No. 20, Borzhom, etc.).

Various choleretic drugs are prescribed. Carlsbad salt, magnesium sulfate, sodium sulfate, allohol, cholecin, cholenzyme, oxafenamide, holagol, flamin, cholelitin, etc. are very effective. For pain, antispastic and analgesic drugs are used: atropine, antispasmodic, belladonna, papaverine, platiphylline, etc. colic sometimes it is necessary to prescribe pantopon or morphine, always with atropine, since morphine drugs can cause spasm of the sphincter of Oddi. If you have symptoms " acute abdomen» The use of drugs is contraindicated.

In the presence of infection, antibiotics are used taking into account the sensitivity of the flora isolated from bile for 5-10 days; sulfa drugs.

Surgical treatment is carried out in cases of persistent disease, with frequent relapses of biliary colic that occur despite active treatment, with blockage of the gallbladder, perforation of the gallbladder, and the formation of biliary fistulas. Surgical treatment of cholelithiasis must be timely.

Gallstones need to be treated before they lead to complications.

Each method has its own application and contraindications, which, if ignored, can lead to serious consequences for human health. Application traditional methods Therapy is justified only to relieve an attack, as well as to prevent subsequent stone formation.

Radical treatment of the disease

Surgery for gallstone disease is the gold standard for treating this pathology. Its goal is to remove the container for stones, avoiding recurrences of biliary colic, as well as preventing the appearance of obstructive jaundice, cholangiogenic sepsis, and biliary peritonitis. Performed as planned, that is, before complications develop, the operation is safe - only 1 in 1000 people have a risk of dying. The chance of a complete recovery after the operation is about 95%.

Indications for the operation are:

the diameter of the stones is more than 1 cm;
“disabled” gallbladder;
multiple stones;
the patient has diabetes mellitus;
stones are formed by calcium salts, bilirubin or are of mixed origin;
stones (stones) are located in such a way that there is a high probability of blocking the bile ducts;
the patient travels a lot;
the walls of the gallbladder containing stones are inlaid with calcium salts - a “porcelain” gallbladder.

Warning! Of course, the operation cannot be performed on everyone - there are contraindications due to general condition.

In addition, the method as an independent method does not eliminate the cause of cholelithiasis. After cholecystectomy (the so-called operation to remove the bladder), stones can form in the liver ducts or the stump of the extrahepatic bile ducts. However, only surgical treatment of the pathology, subject to subsequent adherence to a diet, can permanently rid a person of gallstones.

The operation can be performed in two ways - abdominal and laparoscopic.

Abdominal surgery

This is a “big” operation in which general anesthesia A large incision is made on the front wall of the abdomen. As a result of this access, surgeons can thoroughly examine and palpate all bile ducts, perform local ultrasound or radiography with contrast to remove all existing stones. The method is indispensable for inflammatory and scarring processes in the area under the liver.

The disadvantages of this intervention are:

long recovery period after surgery;
greater chance of developing postoperative hernias;
cosmetic defect;
complications develop more often after surgery.

Laparoscopic method

The laparoscopy operation performed for cholelithiasis is an intervention under visual control using a fiber optic device connected to a monitor through several small incisions on the abdominal wall.

This is what gallbladder removal looks like on the monitor of a laparoscopic unit

The laparoscopic method has many advantages over abdominal surgery: the wound does not hurt so much and does not last so long, it does not limit breathing; intestinal paresis is not expressed; not such a strong cosmetic defect. Negative sides Laparoscopic cholecystectomy also has more contraindications to the operation. Thus, it cannot be performed not only in case of severe disorders of the heart, blood vessels and lungs, but also in the following cases:

obesity;
peritonitis;
late pregnancy;
acute pancreatitis;
obstructive jaundice;
fistulas between internal organs and bile ducts;
gallbladder cancer;
adhesive process in upper sections abdominal cavity;
acute cholecystitis, if more than 2 days have passed since the disease;
cicatricial changes in the hepatobiliary zone.

In 5% of cases, the difficulties of performing laparoscopic intervention are revealed only during the process. In this situation, you have to immediately switch to abdominal surgery.

Non-surgical treatment

Treatment of gallstone diseases can be carried out without surgery - using non-contact crushing of stones or dissolving them with medication.

Drug litholysis

In order to dissolve small stones, preparations of special bile acids, similar to those found in human bile, can be used. Such substances, taken in tablet form, reduce the absorption of cholesterol small intestine. As a result, less cholesterol enters the bile ducts, and due to the formation of liquid crystals with such acids, the cholesterol contained in the stones is partially dissolved.

Bile acid preparations are effective not only for dissolving stones, but also for preventing their formation:

with abnormal bile ducts;
for obesity;
after a course of a diet with reduced energy value;
after gastric surgery.

Bile acid preparations are contraindicated for:

disabled gallbladder;
pigment or carbonate stones;
if the stones occupy more than half the volume of the bladder;
during pregnancy;
if gallbladder carcinoma is diagnosed.

Warning! Medications are used to dissolve only cholesterol stones smaller than 2 cm in diameter, which are visible not only on ultrasound, but also on plain radiography. They are prescribed only by a gastroenterologist. The course of treatment is at least six months, but there is evidence that, even after completely dissolving, the stones recur in half of the cases.

Hardware dissolution of stones

Stones with a small diameter (up to 2 cm) can be crushed by a shock wave or laser beam directed at the gallbladder area, after which their fragments are removed naturally. Such operations are called “lithotripsy” (shock wave or laser) and are performed in a hospital. This is explained by the fact that after this procedure there is a high chance of complications associated with the wandering of small fragments of stones, which can only be treated surgically.

Warning! Lithotripsy is performed only with normal contractility of the gallbladder; it cannot be performed with cholecystitis. The procedure itself is practically painless, but removing stone fragments is very unpleasant.

Treatment of cholelithiasis with folk remedies has 2 goals:

stop an attack of biliary colic;
prevent further stone formation.

In order to avoid further stone formation, it is recommended to use the following recipes:

Squeeze juice from cucumber, carrots and beets, mix it in equal parts. Start by taking 1 glass of this juice, add another 200 ml per dose every month. Course – 6 months.
Drink 1 glass of freshly squeezed beet juice, which has been infused for 2-3 hours in the refrigerator, on an empty stomach.
Pour 1 tablespoon of immortelle flowers into 200 ml of boiling water, boil for half an hour in a water bath, cool for 45 minutes. Take 100 ml twice a day.
Dry the watermelon rinds in the oven, chop them, add water in a 1:1 ratio, and boil for half an hour. You should drink this decoction 200-600 ml per day, divided into 4-5 doses.