Causes of cholelithiasis in women. Special diet for the treatment of gallstone disease without surgery

Stones in the gallbladder, unfortunately, are common. Many people face this ailment. Gallstone disease can cause pancreatitis, cholangitis, cholecystitis and other diseases. Gallstone disease affects mainly women. With age, the likelihood of stone formation increases.

Gallstone disease (GSD) is a disease of the gastrointestinal tract, characterized by the formation and growth of solid calculi in the gallbladder. The disease occurs in three stages:

1. Physicochemical. At the first stage, processes occur that predict the formation of stones. The cholesterol level rises in the bile.
2. Latent. Stage symptoms do not appear, similar to the first. But the stones are already present in the bladder, irritate the mucous membrane, and scratch. An inflammatory process begins in the gallbladder and ducts.
3. Clinical. At the stage, the symptoms of the disease, taken for seizures, are fully manifested.

Stones formed in the organ with the course of the disease fall into the bile ducts and can clog them. What is happening causes complications in the work of the gallbladder. The patient has biliary colic, called an attack of gallstone disease.

Causes of occurrence

The key to the normal functioning of the digestive tract is proper nutrition. are formed when metabolism is disturbed or an infection enters the body. There are many causes of diseases. Physicians studying disorders in the gastrointestinal tract have identified certain risk factors. The presence of factors often determines the appearance of the disease:

• Sedentary lifestyle.
• Genetic predisposition.
• Wrong lifestyle, alcohol consumption.
• Eating disorders, starvation, obesity.
• Diseases of the gastrointestinal tract.

The disease often manifests itself in women during pregnancy. Due to the factors accompanying the expectation of a child, the level of cholesterol, the main constituent of stones, rises. The process contributes to the stagnation of bile in the bladder. The likelihood of illness increases if you drink hormonal drugs.

Symptoms of the disease

The first two stages of the disease are asymptomatic. The patient does not know what becomes the carrier of gallstones. Symptoms appear when. Bitterness in the mouth, pain in the right hypochondrium, heaviness are considered the first signs of the presence of violations. Nausea, flatulence, belching develop.

A small stone is able to pass through the ducts directly into the duodenum. Then the formation leaves the body along with the feces. In such cases, the attack goes away on its own, without treatment.

If the stone is large, it is a sure sign of the danger of getting stuck in the ducts. This threatens with severe complications requiring treatment. If the ducts are blocked, the pain does not go away, it is shown to immediately consult a doctor. With exacerbation of gallstones, inflammation of the gallbladder occurs. Without prescribing treatment, the patient develops third-party diseases of the gastrointestinal tract:

• Acute pancreatitis.
• Obstructive jaundice.
• Cholecystitis.
• Liver abscess.

In order to avoid undesirable consequences, you do not need to ignore the symptoms of the disease. It is important to start treatment on time. In the early stages of the disease, treatment increases the likelihood of a complete recovery with the least investment of time and effort for the patient.

Diagnosis of the disease

A gastroenterologist is involved in the diagnosis and treatment of a patient with gallstone disease. The doctor collects anamnesis and visual examination, examines the patient's predisposition to the disease. Accurate diagnosis is extremely important, early symptoms are similar to other diseases of the gastrointestinal tract, for example, gastritis and pancreatitis.

To clarify the diagnosis, a number of additional studies are assigned, including laboratory and instrumental methods. Ultrasound is considered the main method of instrumental diagnostics in determining gallstones. The method helps to determine the presence of stones, find out the size and location.

Based on the data obtained, the doctor establishes an accurate diagnosis. An important role in diagnosis is played by the study of the patient's lifestyle, genetic predisposition. Observing a detailed picture of the course of the disease, the doctor prescribes the appropriate treatment.

Treatment methods

Depending on the degree of the course and severity, methods of treatment of gallstone disease are determined. When treating most diseases, doctors try to do with conservative methods. Surgical intervention can lead to undesirable consequences for the functioning of the human body. If the disease becomes severe, therapeutic treatment does not work, the doctor decides to treat the disease with an operation.

Is it possible to do without surgery

Many patients question the possibility of effective treatment of the disease without surgery - and they are wrong. The opportunity to do without surgery is worth taking advantage of. The correct method of treatment can only be prescribed by a doctor after studying the patient's medical history, taking into account possible factors and risks. Self-medication is dangerous.

Treatment of gallstone disease without surgery is prescribed if the size of the stones is up to three centimeters. Gallbladder disease has been sufficiently studied by gastroenterologists. Based on research, a number of treatment methods have been developed. Diet, as a means of treatment, is widely used as a component of techniques, also acting as a full-fledged method of treating gallstones.

Treatment without surgery

Therapeutic treatments include medication and lithotripsy. Compliance with a strict diet is important. Sanatorium treatment is recognized as a positive way to cure the disease. Not all patients have the opportunity to use the mentioned method.

The conditions of spa treatment help to provide the patient with a regimen aimed at normalizing the work of the gastrointestinal tract. A similar technique is used for patients with diagnoses: gastritis, stomach ulcer, chronic pancreatitis. An important role is played by climatic conditions, prescribed regular walks for the patient. The foregoing is aimed at enhancing the patient's activity. The patient takes mineral waters, follows a diet. For people suffering from disorders of the gastrointestinal tract, a special menu is drawn up. The patient is prescribed mineral baths and physiotherapy.

The main task of treatment is the release of the gallbladder and ducts from stones, an important role is played by lithotripsy. The term denotes a non-contact procedure for the purpose of independent passage of formations through the ducts. The method is used for stones in the gallbladder up to three centimeters. The danger of the procedure is due to the possibility of blockage of the ducts by passing crushed stones. Along with lithotripsy, drugs are prescribed to help dissolve stones. For patients, ursodeoxycholic acid preparations are prescribed.

The doctor controls the method of treatment with the help of ultrasound examinations. Additionally, the use of herbal medicine is introduced. The attending physician adjusts the diet for cholelithiasis. Lifestyle changes in cholelithiasis are the main component of effective non-surgical treatment.

Diet for gallstone disease

For a full recovery, the patient will need to change their lifestyle. Compliance with individual dietary rules is important for cholelithiasis. It does not matter whether surgery was performed or treatment was prescribed without surgery, diet plays a huge role in the recovery process. There is a list of popular diets for patients with cholelithiasis, common and effective from the list - No. 5.

Features of the fifth table

M.I. Pevzner, the founder of domestic diet therapy, in 1929 developed a method of dietary nutrition. Based on the methods, a table of treatment tables was created. The scientist's approach to nutrition is widely used in spa treatment. There are fifteen diets in total. For patients with dysfunction of the gallbladder, diet No. 5 is recommended. The patient's diet is prescribed by the attending physician, determining the period of adherence. Following a diet is also shown at home, having studied the acceptable food and cooking rules.

The diet aims at a normal intake of protein and carbohydrates, with a measurable decrease in fat intake. The energy value of the diet does not exceed 2500 kcal per day. A similar diet is prescribed for patients diagnosed with chronic pancreatitis, gastritis, and liver dysfunction.

The patient is assigned fractional meals. It is recommended to take food in small doses, without burdening the digestive system. Meals are five to six a day. Food processing is an important element in the diet. It is recommended to eat food chopped or pureed. This prevents the production of excess bile, reduces the likelihood of colic.

Food should not be fried or smoked. It is advisable to cook steamed dishes, boil. It is permissible to bake or stew dishes. Shown to eat a minimum of salt (10 grams). The daily consumption of plain purified water is increased to two or more liters per day.

Do's and don'ts

The patient will have to completely adjust the menu. You will need to study the list of foods to exclude from the diet. Alcohol can provoke spasms of the bladder and ducts, causing colic. Remove products that overload the liver and gallbladder, contributing to the production of bile and gas. Products that irritate the digestive tract, overload the human digestive system, are removed from the menu. Forbidden to use:

• Sweet pastries.
• Mushrooms.
• Fatty dairy products.
• Cabbage, legumes.
• Smoked, salted, fatty fish.
• Fatty meat, sausages.
• Coffee, strong tea.
• Spices, herbs, onions, garlic.

The list is much longer. It includes foods containing an abundance of animal fats, oils, smoked meats, and spicy foods. Strong tea for gallstone disease is prohibited, it is permissible to drink tea with milk or weakly brewed drinks. As an analogue of tea, compotes and rosehip broth are used. Recommended food is rich in fiber, which improves digestion, pectins, which reduce inflammation, lipotropic substances that dissolve fats. A beneficial effect on the body is produced by products containing magnesium, which relieves spasms of the gallbladder.

You need to eat foods:

• Rusks and bran bread.
• Lean meat.
• Diet vegetable soup.
• Low-fat and slightly salted fish.
• Low-fat dairy products.
• Nuts, dried fruits and seeds.
• Vegetables containing pectin.

From fruits it is allowed to use pomegranates, bananas. Baked apples, jelly, marmalade are allowed. Iodine-infused seafood helps bind cholesterol. Vitamin D prevents salt deposition. Fish oil helps empty the gallbladder. The permitted product is cheese, but in limited use.

Compliance with the rules of the diet can have a beneficial effect on the work of the gallbladder, on the functioning of the body as a whole. Eating healthy foods improves the functioning of the gastrointestinal tract, preventing many diseases. helps to strengthen the immune system, improve overall health.

Traditional methods of treatment

In traditional medicine, selected recipes are developed, supported by qualified doctors. Many of the descriptions use beets. The vegetable needs to be chopped and cooked to a syrupy consistency. Drink the broth three times a day for half a glass. It is allowed to use beet juice, either alone or with radish juice. Beets are believed to help dissolve stones.

There are a huge number of honey-based decoctions. Radish, horseradish, birch sap and other means are added to the recipes. Treatment with honey has a choleretic effect, the product helps to improve digestion.

Various medicinal herbs are widely used in traditional medicine recipes. A decoction of celandine and mint has a healing effect. Add corn silk, sage, chamomile and other herbs. Often, decoctions need to be infused and taken in a tablespoon several times a day, baths are made with the elite, others drink like tea.

A known method of treatment and prevention of gallstone disease with kombucha. Japanese kombucha contains an acid that helps break down stones.

Homemade recipes are allowed to be used only after consulting a doctor. Professional advice will help you avoid the unwanted consequences of self-medication. For the treatment and prevention of gallstone disease, useful food is indicated. Prepared without excessive use of spices and salt. It is important to exclude harmful, fatty foods that negatively affect the digestive tract.

They can be caused by a wide variety of pathological conditions. But most often they are provoked by diseases of organs directly related to the production and excretion of bile - the liver, gallbladder and biliary tract. Statistics show that the first place in this category of diseases is gallstone disease (GSD), which affects up to 25% of women and 10% of men of mature age.

Causes of gallstone disease

"Stones in the gall" - this is how patients most often characterize their illness and they are right. Stones (calculi in a scientific way) are formed mainly in the gallbladder and consist of bile components - calcium salts - mixed in various proportions.

Scientists believe that stone formation occurs for three main reasons:

1. Stagnation of bile. This is due to the appearance of a mechanical obstacle to the normal outflow of bile - cicatricial narrowing, hypertrophy of the mucous membrane of the ducts or their muscle layer, tumors.
2. Inflammation of the wall of the gallbladder. An active infectious process causes increased necrosis of the cells of the mucous membrane, which break off and become nuclei of precipitation, on which the components of the future stone settle.
3. Metabolic disorders, namely cholesterol, phospholipids and bile acids. In this case, it is the imbalance between these substances that is important, and not an increase in the concentration of any of them.

Usually three reasons "work" at once, although only one can prevail. But in any case, once started, stone formation never stops.

Symptoms of gallstone disease

Gallstone disease is insidious - for a long time it has an asymptomatic course. With a successful combination of circumstances, stones in the gallbladder are sometimes found during a prophylactic examination or in the presence of other diseases for which such a diagnostic measure as an ultrasound of the abdominal organs is indicated.

However, most often, gallstones are detected only when it manifests itself, which occurs if the stone is infringed either in the neck of the gallbladder or in the duct extending from the organ. In this case, pain usually appears after abundant feasts, during which a large amount of food is consumed, provoking an increased release of bile - fatty, spicy. Sometimes an attack is provoked by:

• physical activity that changes intra-abdominal pressure;
• psychoemotional stress, causing spasm of the muscles of the cystic duct;
• driving on a bumpy road, capable of physically moving a still stationary stone.

Chronic calculous cholecystitis

The constant presence of stones in the gallbladder and stagnation of bile create favorable conditions for the existence of chronic inflammation. It is they who explain the fact that after colic the patient's condition rarely completely normalizes. Usually at this time, the patient notes the presence of:

• pulling pains under the ribs on the right;
• their strengthening after taking fatty or fried foods, spices;
• bloating;
• diarrhea that occurs after dieting disorders;
• and heartburn.

If untreated, chronic calculous cholecystitis can lead to complications such as:

• choledocholithiasis - displacement of stones from the gallbladder into the common bile duct;
• cholangitis - the transition of inflammation from the bladder to the ducts (a rather severe complication);
• cicatricial strictures of the common bile duct - narrowing of its lumen due to scarring of the foci of inflammation in it;
• internal biliodigestive fistulas - the formation of a through hole between the wall of the duct and the wall of the intestine;
• dropsy of the gallbladder is a change in an organ that completely turns it off from digestion: the gallbladder is filled with mucous contents, bile does not penetrate into it.

Acute cholecystitis

This is one of the most common complications of gallstone disease. It occurs when the microflora is highly aggressive, trapped in the gallbladder, where at this moment there is stagnation of bile. Symptoms of acute cholecystitis are somewhat similar to biliary colic: pains of the same localization and intensity, also radiating to the right side of the body, nausea and repeated vomiting. However, there are also differences - the temperature, depending on the stage of the disease, rises from a slight fever (37-38 ° C) to very high numbers. The abdomen becomes sharply painful, with the transition of inflammation to the peritoneum, a protective tension arises.

The main and most dangerous complication of acute cholecystitis is peritonitis - inflammation of the peritoneum, which sharply aggravates the course of any disease of the abdominal organs and has high mortality rates.

Diagnostics

With biliary colic, the diagnosis is usually not in doubt. Typical complaints and data on the factors that provoked the attack suggest that it is the gallbladder that is "guilty" of the pain. The use of ultrasound and cholecystocholangiography puts an end to the question of diagnosing gallstone disease.

Doctors use the same methods in cases with cholecystitis. However, laboratory research methods also help here, with the help of which it is possible to identify the presence of an inflammatory process in the body. By linking the characteristic clinical picture with the data of analyzes and instrumental methods of research, a reliable diagnosis can be made almost always.

Treatment of gallstone disease

Whatever the supporters of alternative methods of treatment say (herbalists, psychics and other healers), the only method of complete healing of the patient is surgical. Once it has arisen, gallstone disease never passes without a trace. Therefore, only the removal of the gallbladder can completely relieve the patient of the disease.

However, at the peak of biliary colic and in milder forms of cholecystitis, doctors do not practice surgical treatment of the disease. In the first case, it is enough to use antispasmodics - baralgin, no-shpa, papaverine, in order to quickly relieve a person of pain. In acute cholecystitis, a cold heating pad is also used on the right hypochondrium, a strict diet is established without products provoking the release of bile, and antibiotics are used to destroy microbes. In the early days, it is possible to prescribe intravenous infusions of appropriate solutions to relieve intoxication.

In severe cases of acute cholecystitis, an emergency cholecystectomy is indicated. This is done to eliminate the threat of peritonitis, in which the patient's chances of survival tend to zero. The operation is carried out either by the laparoscopic method (microsurgical instruments are introduced into the abdominal cavity through punctures) or through a conventional incision.

Gallstone disease is not a sentence, but a reason for special attention to your health. Avoiding errors in the diet, constant monitoring of the state of the gallbladder, and, if necessary, removing it in a planned manner, can completely relieve a person of its unpleasant symptoms. The main thing is not to bring yourself to a serious condition, when even the best surgeons in the world will not give guarantees of healing.

Is it worth removing the gallbladder and how to treat gallstone disease? You will find the answers in this video review:

Bozbey Gennady, medical commentator, emergency doctor

An attack of gallstone disease is a condition caused by a violation of the outflow of bile due to blockage of the gallbladder and / or bile ducts by calculi. found in every 5th woman and every 10th man. Up to 60% of people with stones in the gallbladder do not experience unpleasant symptoms, but the likelihood of an attack of the disease in them increases annually by 2-3%. What is the danger of exacerbation of gallstone disease and what are the principles of first aid? To answer this, you must first familiarize yourself with the causes of the pathology.

Bile is a mixture of bile acids, pigments, phospholipids, and cholesterol. The action of a negative factor provokes the precipitation of a solid sediment, gradually turning into calculi (stones). This can be observed against the background of metabolic disorders, inflammatory diseases of the organs of the biliary system. In the first case, the concentration of bile acids and cholesterol in bile increases. In the second, its physical and chemical properties change. Depending on the predominant component, cholesterol and pigment calculi are distinguished. In rare cases, there are calcifications (stones with a large amount of calcium).

There are several factors that increase your risk of gallstones. Namely:

• Errors in the diet. The predominance of animal fats, long-term complete parenteral nutrition (bypassing the gastrointestinal tract). The likelihood of gallstones increases by 30% during fasting, rapid weight loss.
• Diseases of the biliary system. Most often, chronic cholecystitis. With cirrhosis of the liver, the risk of calculus formation increases 10 times.
• Endocrine pathologies. The formation of calculi is often found in individuals with uncorrected hypothyroidism. Patients with diabetes mellitus suffer from cholelithiasis 3 times more often than those who do not have this endocrine disease.
• Obesity, high triglyceride content. 2 out of 10 people with metabolic syndrome (a complex of metabolic changes) develop symptoms of an attack of gallstones over time.
• Taking a drug that affects the composition of bile, the motility of the biliary tract. For example, ceftriaxone.
• Female gender, age. Women suffer from gallstones 2 times more often than men. With age, the difference in morbidity is smoothed out. The main category of patients is people over 40 years old.
• Pregnancy. Concrements are formed in 5-12% of cases of gestation, but often after childbirth they disappear spontaneously. The risk is greater for 2 and subsequent pregnancies.
• Taking estrogen regardless of gender. With hormone replacement therapy in postmenopausal women, the risk of gallstones increases by 3.7 times.
• Weighed down heredity. People who have blood relatives with gallstone disease are 4-5 times more susceptible to the disease.

Pathogenesis of an attack of gallstone disease

An attack of the gallbladder is caused by a blockage of its neck / or excretory ducts by migrating calculi. But the pathogenesis is not limited to this. Symptoms can be based on several processes at once. Types of manifestations of gallstone disease and mechanisms of their occurrence:

• (biliary pain). The most frequent variant of the manifestation of the disease (75% of cases). It is based on the wedging of a stone into the neck of the gallbladder, the entry of calculus into the bile ducts (cystic and general), followed by their reflex spasm. Because of this, bile cannot enter the duodenum, leading to an increase in pressure in the biliary tract.
• ... It occurs in 10% of episodes of clinically severe gallstone disease. Usually occurs as a complication of blockage of the neck of the gallbladder, cystic duct. The provocateurs are bacterial infection (50-85% of cases) and lysolecithin, a bile derivative that is chemically aggressive for previously damaged parts of the biliary tract.
• Cholangitis. Inflammation of the bile ducts. The provoking factors are the same as above.
• Acute biliary pancreatitis. Inflammation of the pancreas. It is associated with the throwing of bile into the pancreatic duct, lymphogenous spread of infection from the biliary system.

Causes causing an attack

Increased production of bile, spasm of the gallbladder and excretory ducts can cause migration of stones. Provoking factors:

Sharp movements, shaking, driving;

Binge eating;

Eating food that stimulates the secretion of bile (especially fatty and spicy foods);

Stress (due to smooth muscle spasm).

Symptoms

Most often, an attack of calculous cholecystitis begins with biliary colic. If it is associated with food intake, then it occurs 1-1.5 hours after eating. Colic often bothers at night, a few hours after falling asleep. Symptoms of an attack of gallstone disease:

• Pain syndrome. Sharp, pronounced. It is localized in the right hypochondrium with extension to the epigastrium (the area of ​​the stomach projection). Can give under the right shovel, between the shoulder blades, thoracic spine, neck, right shoulder. The pain grows in waves, then becomes constant, bursting. Lasts from a few minutes to several hours. Can lead to painful shock.
• Dyspeptic syndrome. Possible nausea, vomiting. Emptying the stomach does not bring relief. Due to the reflex slowdown of intestinal motility, the stomach is slightly swollen.
• Vegetative disorders. Sweating, increased or slowed heart rate, changes in blood pressure (more often a decrease).
• Hyperthermia. Body temperature usually does not exceed 38 ° C.

Typical bilious colic is so pronounced that the patient rushes about in bed. He is constantly looking for a comfortable position in which the discomfort will diminish. Breathing becomes shallow as each movement of the chest increases the pain. Colic usually disappears on its own (if a small stone could pass into the duodenum) or after taking antispasmodics.

If the colic has not disappeared after 6 hours, the development of acute cholecystitis is first of all suspected. The pain is similar to biliary pain. Inflammation of the gallbladder, cholangitis, pancreatitis may be indirectly indicated by hyperthermia from 38 ° C. The condition may worsen to high fever (39 ° C) with chills. At later stages, jaundice joins.

Important! Progressive deterioration, a hard "board-like" abdomen may indicate a rupture of the gallbladder with the development of peritonitis - inflammation of the sheets of the peritoneum. This condition is life threatening and requires immediate intervention by a surgeon.

Diagnostics

The primary establishment of the cause of colic is based on the study of complaints, examination data. In emergency situations, this is enough for a medical specialist to urgently relieve an attack of gallstone disease and prevent pain shock. Laboratory and instrumental research methods help to finally confirm the diagnosis. The main ones are:

• Ultrasound of the abdominal organs. It is possible to visualize stones, change the contractility of the gallbladder.
• Clinical blood test. Signs of bacterial inflammation are often observed: acceleration of ESR, an increase in the number of leukocytes.
• Blood chemistry. Signs of bile stagnation. The level of bilirubin increases due to the direct fraction, the activity of alkaline phosphatase, ALT, AST increases.

If necessary, ERCP (endoscopic retrograde cholangiopancreatography) is performed. This is X-ray imaging of the bile and pancreatic ducts using endoscopic administration of contrast agents. More often, such a study is combined with therapeutic manipulations, for example, by dissecting the mouth of the duodenal papilla. ERCP is performed without exacerbation of gallstone disease, therefore, an attack of the disease is a direct contraindication to the procedure.

Abdominal myocardial infarction can mimic an attack of biliary colic. To avoid a diagnostic error, it is best to immediately contact a medical specialist.

What should be done in case of an attack of gallstone disease?

Typical biliary colic (not to be confused with mild dyspepsia with errors in nutrition) is an absolute indication for calling an ambulance. The condition may require urgent surgery. The main task is to prevent complications before the arrival of a team of specialists. First aid for an attack of gallbladder colic:

• Provide bed rest;
• Stop food intake;
• Give an antispasmodic, avoiding exceeding the dosage (mebeverine, drotaverine, papaverine);
• Cover with a blanket for chills;
• Monitor the patient constantly, as he may faint from pain.

Attention! Despite the recommendations in some sources, it is impossible to independently warm up the right hypochondrium and take a hot bath. Under an attack of colic, other diseases can be disguised in which such procedures are dangerous. With gallstones, it is forbidden to give choleretic drugs.

How can you relieve an attack of gallstone disease yourself? If this is typical biliary pain, then it is better to follow the above measures and wait for a doctor.

Prevention

Biliary colic prevention measures are based on dietary and lifestyle adjustments. Namely:

• Compliance with a diet. Frequent fractional meals 4-5 times a day in small portions. Exclusion of fatty, fried, spicy foods, marinades. The restriction includes products that stimulate the production of bile: garlic, coffee, egg yolks, carbonated drinks. The diet should be especially strictly observed after an attack of gallstone disease. Do not eat for 12 hours after colic.
• Balanced physical activity. Avoid physical inactivity, heavy lifting.
• Eliminate sources of stress. This also includes the observance of the regime of work and rest.

Conclusion

Colic with gallstone disease is a condition that requires the intervention of a specialist. Even if they managed to stop it on their own, it can recur at any time and lead to life-threatening complications. If stones in the gallbladder are an asymptomatic ultrasound finding, a planned visit to a gastroenterologist and a surgeon is mandatory. Otherwise, sooner or later they will cause an attack of gallstone disease.

Cholelithiasis (cholelithiasis or, as it is incorrectly called, cholelithiasis) is a disease associated with impaired metabolism of cholesterol and bilirubin, resulting in the formation of stones (stones) in the gallbladder (cholecystolithiasis) and / or in the bile ducts (choledocholithiasis).

This disease is in third place in terms of prevalence after cardiovascular disease and diabetes mellitus. It is more common in economically developed countries in persons whose work is associated with stressful situations and leading a sedentary lifestyle.

How gallstones form

The gallbladder is a reservoir for bile produced by the liver. The movement of bile along the biliary tract is provided due to the coordinated activity of the liver, gallbladder, common bile duct, pancreas, duodenum. This ensures the timely flow of bile into the intestines during digestion and its accumulation in the gallbladder on an empty stomach.

The formation of stones in it occurs due to changes in the composition and stagnation of bile (dyscholia), inflammatory processes, motor-tonic disorders of bile secretion (dyskinesia).

There are cholesterol (up to 80-90% of all gallstones), pigmented and mixed stones.

The formation of cholesterol stones is facilitated by the oversaturation of bile with cholesterol, its precipitation, the formation of cholesterol crystals. With impaired motility of the gallbladder, crystals are not excreted into the intestine, but remain and begin to grow.

Pigmented (bilirubin) stones appear as a result of increased breakdown of red blood cells in hemolytic anemia.

Mixed stones are a combination of both shapes. Contains calcium, bilirubin, cholesterol.

They occur mainly in inflammatory diseases of the gallbladder and biliary tract.

Causes of gallstone disease

1. Inflammation of the biliary tract (cholecystitis, cholangitis).
Infection plays a role in the formation of calculi. Bacteria are able to convert bilirubin, which is soluble in water, into insoluble bilirubin, which precipitates.

2. Endocrine disorders:
- diabetes;
- hypothyroidism (insufficient secretion of thyroid hormones);
- violation of estrogen metabolism, with various gynecological diseases, taking hormonal contraceptives, pregnancy.
There is a violation of the contractile function of the gallbladder, bile stagnation.

3. Violation of cholesterol metabolism:
- atherosclerosis;
- gout;
- obesity.
When cholesterol levels rise, conditions are created for the formation of stones.

4. Hyperbilirubinemia - an increase in the level of bilirubin with an increase in its content in bile:
- hemolytic anemia.

5. Hereditary predisposition.

6. Fasting, irregular nutrition cause disruption of the normal function of the gallbladder.

7. Excessive consumption of foods rich in animal fats, cholesterol. This promotes a shift in the reaction of bile to the acidic side, which leads to the formation of stones.

Symptoms of gallstone disease

For a long time, the disease can be asymptomatic and become a finding during ultrasound examination. With the migration of stones, the addition of an infection in the gallbladder and ducts, symptoms appear. Symptoms of gallstone disease depend on the location of the stones, their size, the activity of inflammation, as well as damage to other digestive organs.

When stones leave the gallbladder and move along the bile ducts, an attack of biliary colic occurs. An attack is provoked by errors in nutrition, especially the abuse of fatty foods, vibration, stressful situations. The pain is sudden, sharp in the upper abdomen, in the right hypochondrium, radiates to the right shoulder blade, right shoulder. Often, pain in gallstone disease is accompanied by nausea, vomiting that does not bring relief, and dry mouth. Concerned about itching.

The appearance of yellowness of the sclera and skin, darkening of urine and discoloration of feces is possible.

The duration of a painful attack is from several minutes to several hours, the pain subsides on its own or after anesthesia.

Symptoms of biliary colic do not always have a classic manifestation, they can often resemble other diseases: right-sided pneumonia, acute appendicitis, especially if it is not typical of its position, liver abscess, renal colic - with urolithiasis, acute pancreatitis.

It can manifest as cholecystocardial syndrome, when heart pain is the only symptom of gallstone disease.

To establish an accurate diagnosis, when the first signs of the disease appear, an urgent need to consult a doctor - therapist, family doctor.

Examination for gallstone disease

Instrumental diagnostic methods.

1. Ultrasound of the abdominal organs is the main and most effective method for diagnosing gallstone disease. Reveals the presence of stones in the gallbladder, thickening of the walls of the gallbladder, its deformation, expansion of the bile ducts.
Its main advantages are non-invasiveness (non-trauma), safety, accessibility and the possibility of repeated administration.

2. X-ray examination of the abdominal cavity - to detect X-ray-positive carbonate stones.

3. Endoscopic retrograde cholangiopancreatography (with suspicion of stones in the bile ducts).

4. In controversial cases, magnetic resonance cholangiography is used, it allows you to accurately assess the state of the biliary tract thanks to two- and three-dimensional images; computed tomography.

Laboratory research.

1. Total bilirubin and its fractions, transaminases. Examined to assess the functional state of the liver.

2. Lipidogram. Determine the level of cholesterol, triglycerides. When they increase, it is necessary to carry out therapy aimed at reducing these indicators, for the prevention of stone formation.

A surgeon's examination is required to select a treatment tactics.

Treatment of gallstone disease.

With gallstone disease, surgical and conservative treatment is used.

Drug treatment of gallstone disease

The conservative method is used in the presence of cholesterol gallstones (X-ray negative) up to 15 mm in size with preserved contractility of the gallbladder and patency of the cystic duct.

Contraindications for drug dissolution of gallstones:

Acute inflammatory diseases of the gallbladder and biliary tract;
- stones with a diameter of more than 2 cm;
- liver disease, diabetes mellitus, gastric ulcer and duodenal ulcer, chronic pancreatitis;
- inflammatory diseases of the small and large intestines;
- obesity;
- pregnancy;
- "disabled" - non-functioning gallbladder;
- pigmented or carbonate stones;
- cancer of the gallbladder;
- multiple calculi, which occupy more than 50% of the gallbladder volume.

Use drugs ursodeoxycholic acid, the action of which is aimed at dissolving only cholesterol stones, the drug is taken within 6 to 24 months. But the likelihood of relapse after dissolving the stones is 50%. The dose of the drug, the duration of admission is determined only by a doctor - a therapist or gastroenterologist. Conservative treatment is possible only under medical supervision.

Shock-wave cholelithotrepsy - treatment by crushing large stones into small fragments using shock waves, followed by taking bile acid preparations (ursodeoxycholic acid). The recurrence rate is 30%.

Cholelithiasis can be asymptomatic or asymptomatic for a long time, which creates certain difficulties in identifying it in the early stages. This is the reason for late diagnosis, at the stage of already formed gallstones, when the use of conservative methods of treatment is limited, and the only method of treatment remains surgical.

Surgical treatment of gallstone disease

Patients should undergo elective surgery before or immediately after the first biliary colic. This is due to the high risk of complications.

After surgical treatment, it is necessary to observe an individual dietary regimen (frequent, fractional meals with restriction or exclusion of individually intolerable foods, fatty, fried foods), adherence to work and rest, physical education. Eliminate alcohol consumption. It is possible to have a spa treatment after the operation, provided that the remission is stable.

Complications of gallstone disease.

When an infection is attached, acute cholecystitis, empyema (significant accumulation of pus), cholangitis (inflammation of the bile ducts) develop, which in turn can lead to the development of peritonitis. The main symptoms are sharp, intense pain in the right hypochondrium, chills, fever, severe weakness, impaired consciousness.

Choledocholithiasis (stones in the bile duct) with the development of obstructive jaundice. After one of the attacks of biliary colic, itchy skin, yellowness of the sclera and skin, discolored feces, darkening of urine appear.

With prolonged blockage of the cystic duct and the absence of infection, dropsy of the gallbladder occurs. Bile is absorbed from the bladder, but the mucous membrane continues to produce mucus. The bubble increases in size. It is manifested by attacks of biliary colic, subsequently the pain subsides, the severity remains in the right hypochondrium.

Against the background of prolonged gallstone disease, gallbladder cancer often occurs,
acute and chronic pancreatitis develops. With prolonged blockage of the intrahepatic bile ducts, secondary biliary cirrhosis develops. Large stones of the gallbladder hardly migrate, but they can lead to the formation of a fistula between the gallbladder and the duodenum. As a result of the stone falling out of the bladder, it begins to migrate and can lead to the development of intestinal obstruction.

Untimely removal of the gallbladder (cholecystectomy) is one of the reasons for the development of postcholecystectomy syndrome.

Complications pose a threat to the patient's life and require an immediate examination by a surgeon and hospitalization in a surgical hospital.

Prevention of gallstone disease.

Even after a successful operation, relapses occur in 10% of cases. Lifestyle changes are necessary to prevent the development of new calculi. Classes in the gym, active rest, promote the outflow of bile, eliminate its stagnation. It is necessary to gradually normalize body weight, this will reduce cholesterol hypersecretion.

Patients who have to take estrogens, clofibrate, ceftriaxone, octreotide for a long time should undergo an ultrasound examination to detect changes in the gallbladder in a timely manner. If the level of cholesterol in the blood rises, statins are recommended.

Diet for gallstone disease

Limit or exclude from the diet fatty, high-calorie, cholesterol-rich dishes, especially with a hereditary predisposition to cholelithiasis. Food should be frequent (4-6 times a day), in small portions, which helps to reduce the stagnation of bile in the gallbladder. The food should contain a sufficient amount of dietary fiber, due to vegetables and fruits. You can add food bran (15 g 2-3 times a day). This reduces the lithogenicity (tendency to stone formation) of bile.

Doctor's consultation on gallstone disease

Question: what is the name of the disease, cholelithiasis or cholelithiasis?
Answer: according to the international classification of diseases, the name "cholelithiasis" does not exist, there is only cholelithiasis.

Question: What medications, folk remedies, spa treatment remove stones from the gallbladder?
Answer: There are no such drugs. All choleretic agents for cholelithiasis should be taken strictly as directed and under the supervision of a physician. Self-medication in such a situation is not safe due to the high risk of complications. With elective cholecystectomy (surgery to remove the gallbladder), the mortality rate is 0.5%, and with cholecystectomy for acute cholecystitis (and these are complications of self-medication), the mortality rate reaches 20%. Spa treatment in the presence of stones in the gallbladder is contraindicated.

Question: Should a patient be observed after surgery for gallstone disease, with which specialist, for how long and with what drugs to carry out postoperative treatment?
Answer: Patients after surgical treatment are observed by a family doctor, a therapist. Dispensary examination, ultrasound examination of the abdominal organs, control of lipid profile, liver tests are annually carried out. Based on the examination data, diagnostic studies, the doctor recommends a set of necessary therapeutic and recreational measures to prevent the development of a relapse of the disease.

Physician therapist Vostrenkova I.N.

Video about the causes, symptoms and treatment of gallstone disease

Gallstone disease is also called cholelithiasis. The gallbladder or ducts belonging to it enter a pathological state in this disease due to the formation of calculi in them. These are stony deposits, popularly called stones. But, of course, it is wrong to compare them with natural stones. They did not come from the outside, but independently formed and deposited inside a person for several reasons. Cholelithiasis is dangerous and carries serious health problems, pain, complications, and gives rise to secondary pathologies. The sooner you pay attention to the symptoms and go to a doctor who diagnoses and starts treating the disease, the more surely it will be possible to avoid surgical intervention to remove calculi and the consequences of their formation.

Nature has arranged the human body in the wisest way. Everything in it is a single well-coordinated system, which, if it functions normally, does not cause problems and reasons to think about your health. But when a person feels pain, this is a signal of trouble, some kind of malfunction, which the body sends to the brain so that it can take action that can get rid of the problem.

Important! The main and first symptom of gallstone disease, doctors call pain, namely, abrupt colic, which are localized in the right side under the ribs. But this is a sign of an already urgent operational situation, when the stones moved and created a disease-causing focus. It all begins at the stage of small formations, with bitterness in the mouth, heaviness, spreading throughout the abdomen, starting from the right, and a transient feeling of nausea.

Bitterness in the mouth is one of the first signs of gallstone disease.

For what reason, stones suddenly appear in a well-functioning normally functioning body, and why they accumulate in the gallbladder.

The main reason is the violation of metabolic processes. The exchange of calcium, protein, bilirubin, cholesterol, and so on is impaired. Participants in these metabolic processes, which do not dissolve in bile, accumulate in it. There they, fastening to each other, turn into a monolithic compound, which hardens over time under the pressure of more and more particles arriving and sticking to it.

Important! When microscopic particles form calculi, they can reach truly enormous sizes, compared to the size of their receptacle - the gallbladder - five centimeters.

Statistically, the formation of gallstones occurs in every seventh person, and women are susceptible to this pathology twice as much as men. Their bodies have more estrogen, which inhibits the release of hormones from bile.

Estrogens - hormones that stimulate stagnation of bile in the gallbladder

In addition to a slowed-down bile outflow, low mobility, a predominantly static lifestyle, in which all metabolic processes are inhibited, can provoke the growth of stones. Also, the constant use of fatty foods creates cholesterol accumulations, greatly increasing the likelihood of stone formation.

The calculi are divided into four varieties, depending on the components.

On a note! While the formations are small (and they are from 0.1 mm), they lie quietly at the bottom of the gallbladder, and the owner does not even know about their existence.

If he (or she) is lucky, he will be able to feel bitterness, heaviness and nausea after eating at the early stage of stone formation, while they have not yet become overgrown with deposits, have not reached large sizes and have not moved along narrow ducts, causing unbearable pain.

Signs and diagnosis

So, when a stone or several from the gallbladder decides to go out (under the pressure of bile), it goes along the only available path - the bile duct. The mouth of the duct is narrow, and the paradox is that a small stone that could pass through it without problems will remain at the bottom of the bubble until it grows to a certain size. Only then its volume and mass will interfere with the bile contents, and it will try to "press" on the calculus, driving it out.

What happens to the duct when a solid object with a volume greater than the width of the passage enters it? Of course, the duct will become clogged.

1. Pain when leaving calculus the patient experiences two things at once. The first is trauma to the walls of the duct when large solid masses move along it.
2. Second - violation of the outflow of bile due to blockage of the course... Bile, which continuously flows from the liver into the "reservoir" of the gallbladder (it is produced in the liver), is forced to remain there, having no outlet in the intestines, in order to fulfill its function - to help in the digestive process - and be excreted from the body. Stretching of the walls of the bladder, which grows as bile accumulates in it, leads to very strong painful sensations under the rib on the right, throughout the abdomen, even in the right arm, thigh, collarbone and right side of the back.

   Pain in the right hypochondrium is a symptom of the acute phase of cholelithiasis

3. Nausea begins, not associated with food intake, developing into vomiting.
4. The skin may turn yellow.
5. The temperature rises.

   High body temperature is one of the symptoms of the acute phase of gallstone disease

Among themselves, doctors call this situation "rockfall". If it has begun, the pains may still stop and have a recurrent nature, but they will intensify and become more frequent until they become incessant.

Important! With a complete blockage of the outflow of bile, without providing assistance to the patient, the pancreas will soon become inflamed (it will begin pancreatitis), the gallbladder itself (the name of the pathology - cholecystitis), and also formed obstructive jaundice with all the consequences.

Diagnostic methods

Until the patient suffers from pain in the form of colic, it is rather difficult to establish a diagnosis of gallstone disease "by eye". After all, nausea and heaviness in the abdomen are symptoms of many diseases, not even related to the gastrointestinal tract. Bitterness in the mouth can also not be an isolated pathology. Even the colic on the right does not yet indicate one hundred percent on LCB. How do you know about the presence of stones? With ultrasound.

Attention! Primary stones, which are not visible on ultrasound, at the initial stage, can be detected only when taking bile for biochemical analysis.

Ultrasound or fluoroscopy of the abdominal cavity (in the case of early diagnosis, the last procedure is with the introduction of contrast) will give an excellent result and help to detect even small stones.

And if for some reason these two types of studies are not available, today there is an alternative - a special study called choledochoscopy. On it, the doctor will see the calculi "with his own eyes", determine their size and location with an accuracy of a tenth of a millimeter, and also tell the patient how much it is necessary to operate on him in order to remove the stones.

Choledochoscope - a device for conducting choledochoscopy

On a note! The opinion of the surgeons about the stones is unambiguous - to remove in any case. Most physicians of therapeutics specialization believe that it is better not to touch the calculi in the bile as long as they are calm.

No symptoms - no cure? This is not entirely true. It is possible and necessary to treat calculi. More precisely, stones cannot be treated, but they can be crushed, dissolved, or removed in a less invasive way than surgery.

How to rid a patient of stones

Surgeons believe that it makes no sense to rid the patient of calculi by conservative methods. It takes a long time, is not always effective, is fraught with side effects, most importantly, the stones are likely to grow back.

That is, in principle, two ways are proposed. If calculi are found, but their size is small, and they do not give symptoms, it is recommended to ignore their presence, while observing a diet and controlling the size in order to notice their increase in time, which threatens the patient's health. This situation can last for years or even decades.

The second way, if the “rockfall” has begun, is to completely remove the entire gallbladder.

Is there life without a gallbladder? Today medicine answers: "yes", but its representatives in this matter are divided into two camps. Many people think that the gallbladder is not needed for a modern person. And although it is removed, together with the stones and ducts available there in emergency situations, for example, at the beginning acute cholecystitis which is about to grow into peritonitis, causing inflammation of the entire peritoneum, or with a complete blockage and developing rapidly pancreatitis, you can live without a gallbladder.

Moreover, the life and health of the patient will remain complete, subject to regular nutrition. No, you don't need special diets and strict regimens.

Regular nutrition is the key to the inconsequential removal of the gallbladder

On a note! Our primitive ancestors did not have refrigerators and supermarkets. They received food only when they successfully hunted, and this did not happen every day. And if they are fed up, accordingly, irregularly. But on the day of a successful hunt, they gorged themselves "for the future." For this, the gallbladder was needed - to store bile in a "reservoir" until the moment when it is needed to digest food (fats and proteins).

Since today a person can quite afford not to eat "for future use", bile can be released directly from the liver in small doses gradually, carrying out a continuous digestive process.

The second "camp" is categorically against the removal of the bladder without threatening the patient's life. They advocate that the gallbladder plays an essential role in the digestion process. It is true that the organ accumulates bile and throws it in portions into the intestine and stomach to ensure the digestion process. Without a bubble, bile will flow directly, its concentration will be more liquid, food will be digested less efficiently, which will eventually lead to gastrointestinal diseases.

Treatment methods

If we leave aside the surgical radical methods, there are still several opportunities to cope with calculi.

Table. Non-surgical methods of treating gallstones.

Way	Description
	First, a well-functioning power supply. The regime is strict, the diet is certain. No fat, spicy, smoked, fried, a minimum of protein products. This is necessary so that the calculi, if any, do not overgrow with new "details", and remain safe, lying at the bottom of the gallbladder.
	Secondly, drugs that dissolve stones. There are such funds, and they, albeit slowly, do their job. "Ursofalk", chenodeoxycholic acid and other drugs, with the help of which, with a certain patience and luck, you can get rid of calculi completely in a year. Yes, it is expensive and not always effective. The effect depends on many factors, not only on the size and number of stones. Moreover, while maintaining the previous lifestyle, the stones in patients will almost certainly form again after several years. And the likely complications after long-term use of these drugs are damage to liver cells.
	The third way to destroy stones is a shock wave. If the formations are single and medium-sized, they can be crushed and removed from the body naturally in small parts. This procedure is most often used today because it is minimally invasive, well tolerated, highly effective, and can even be performed on an outpatient basis.
	The method has a significant drawback - the stones are crushed using an ultrasonic installation into shards with sharp ends. At the exit, they are capable of damaging the shell. Therefore, after crushing, the above drugs are prescribed to dissolve the corners and smooth out the shapes in order to reduce complications.
	This method can be partially attributed to operational, since in order for the laser beam to directionally crush the stone, a puncture is made in the body. Here, too, there is a drawback - the possibility of mucosal burns.

In all cases except the first, the stones will almost certainly grow back. And the patient, exhausted by the struggle with calculi, will sooner or later agree to an operation to cut out the gallbladder.

On a note! In the case of surgery to remove the gallbladder, it is best to choose laparoscopy. With it, the anterior abdominal wall is pierced (that is, the tissues are not cut), and through these punctures the gallbladder with all its contents is removed. There are practically no traces, healing is quick.

Prevention and complications

The development of cholelithiasis is fraught with a number of complications.

What's the best thing to do? Not to have stones, or to have, but small, and try not to grow to the size when they have to be removed along with the bladder. To do this, it is necessary to engage in the prevention of gallstones.

Important! In the presence of small stones, it is impossible to take choleretic drugs in any form, even not only medications, but also phytopreparations. They will surely cause the migration of calculi and complications. Also, you can not use mineral water.

Compliance with personal hygiene is a measure of prevention of gallstone disease

In general, there is nothing terrible and difficult in observing these preventive measures. This is the norm of a healthy person's life, which he must adhere to if he does not want to have not only stones in the gallbladder, but also many other diseases. After all, maintaining health is not the highest price to pay for one day not to face a dilemma: to live with or without a gallbladder filled with stones.

Video - ZhKB: symptoms