Stone bile. Gallbladder stones: symptoms and treatment without surgery

Stones in the gallbladder, treatment with folk remedies for such a pathological condition is permissible strictly after consultation with a gastroenterologist. Self-medication is fraught with complications. The primary appearance of biliary colic - attacks of acute pain on the right side, a signal to immediately seek help.

Only a doctor, having assessed the current state (having carried out appropriate diagnostic measures), is able to “give the go-ahead” to the use of folk remedies in the fight against gallstone pathology.

The duration of the attacks varies by an impressive time interval of 5-10 minutes - several hours. In the female body, the risks of acquaintance with cholelithiasis (a secondary name for gallstone disease) are up to three times higher.

With age, the rate of development of pathology increases. After 70 cholelithiasis 35% of women and up to 20% of men are affected.

In cases where there are no complications, the therapy is conservative, after agreement with the doctor, it is allowed to connect folk remedies. Severe forms require surgical intervention.

How and why stones form

The gallbladder (GB) is a "reservoir" for bile produced by the liver, which is involved in the body's process of splitting fats. The liver has no lunch breaks, and the production of bile is a daily process, about a liter every day.

Water is a key component, however, there are other substances in the composition:

• bile acids, pigments
• mineral salts
• cholesterol

Leaving the hepatocyte (stable liver cells), bile is initially grouped in the bile capillaries, which lead to the intrahepatic bile ducts - tubular formations located between the lobes of the liver. Then it enters the excretory hepatic ducts, and then flows into the gallbladder, where it is stored until the “start” of the digestive process.

In a healthy body, bile acids, which are part of bile, do not allow cholesterol to accumulate excessively. The resulting excess dissolves in acids, excreted by the body along with bile.

Violations of the synthesis, chemical composition of bile, gallbladder, infection, lead to “imbalance”, an equilibrium state between the amount cholesterol and the volume of bile acids is under threat. The concentration of lecithin, bile acids decreases, and the amount of cholesterol produced by the liver increases.

Cholesterol deposits gradually accumulating on the walls of the mucous membrane of the gallbladder crystallize and form “grains of sand”. Over time, being pressed, such a crystallization center “transforms”, other components of bile (mucus, epithelium) are layered on it, small stones (calculi) are formed.

If you miss the moment and do not take the necessary competent therapeutic measures in time, then the stones grow, periodically provoking attacks of acute pain, and the risks of complications increase:

• inflammation of the gallbladder, up to a purulent form
• rupture of the gallbladder
• peritonitis
• peritoneal abscess
• duct blockage
• jaundice
• liver pathology
• risk of pancreatic cancer

In addition to cholesterol, the following types of stones are classified:

• Pigmented (bilirubin) - the formation is due to excessive breakdown of hemoglobin in conditions of various types of anemia (hemolytic, sickle cell), as well as other hematological pathologies. In addition to the formation of this type of stones, the involvement of the factor of infection of the gallbladder has been proven.
• Lime - consist of salt crystals.

Diagnosis of one-component stones is infrequent, a mixed version of calculus deposits is much more “popular”.

Structurally distinguish:

• layered
• crystalline

By consistency:

• solid
• waxy

In form, almost any shape.

The size varies in a wide range from 0.5-2 mm to 1.5-2 cm, weighing up to 50-60 grams. It is also problematic to concretize the probable number, since sometimes one large stone stretches the entire cavity of the gallbladder, and in other cases the number is measured in tens or even hundreds.

In addition to attacks of biliary colic, the following forms of manifestation of cholelithiasis are classified:

• Latent - asymptomatic, capable of lasting for a long time, since there are no characteristic manifestations.
• Dyspeptic - indicators are the appearance on the right of a feeling of heaviness, a feeling of heartburn, an unstable stool. Likely catalysts - fried, spicy food, uncontrolled intake of food.
• Painful - aching, irregular pains are disturbed, usually in the epigastric, hypochondral regions.

Why stones form

Basic reasons:

• infection (inflammation) of the gallbladder
• disturbed metabolism
• stagnation of bile, change in composition (the proportion of cholesterol increases)

List of risk factors:

• Overweight (obesity)
• Excessive consumption of animal fats, supersaturated with cholesterol.
• - in a diabetic, the level of triglycerides, fats that support the body's energy reserve is overestimated. This is a weighty negative argument in favor of the appearance of stones.
• Heredity, if close relatives are “familiar” with cholelithiasis, then you are at risk.
• A high rate of female sex hormones (estrogen) leads to an increase in cholesterol values, a deterioration in the motility of the gallbladder, which increases the body's tendency to form stones. In women, the risks are higher, especially if you are pregnant, taking contraceptives, or undergoing hormone therapy.
• Age, the older the person, the higher the risk of developing cholelithiasis.
• Ignoring all the basics of a healthy diet - uncontrolled eating. A balanced diet, together with a competent diet, are the most important preventive arguments for gallstone pathology.
• Starvation, rapid weight loss.
• Mechanical factor: tumors, adhesions, swelling of the walls of the gallbladder, cyst, kink, narrowing of the bile duct.

The disease progresses with the calculous form of cholecystitis, the size of the stones rapidly increases, complications arise.

Clinical picture

Pain on the right side, in the hypochondrium, is a fundamental symptom, however, the symptomatic pattern can be supplemented by:

• nausea
• bitterness in the mouth
• weakness
• chills
• flatulence
• heat
• yellowing of the skin, white of the eye

Diagnostics

• Abdominal x-ray
• Endoscopic retrograde cholangiopancreatography - helps to identify stones in the ducts
• Endoscopic ultrasonography

How to treat cholelithiasis

A competent choice of therapeutic tactics will increase the chances of restoring the impaired functionality of the “cluttered with stones” gallbladder and ducts, moreover, in a conservative way.

Medical points of view on this issue diverge, and many consider the prevailing surgical methods of confronting cholelithiasis.

The problematic situation lies in the secrecy of gallstone pathology, which for a long time can not declare itself in any way. stones are discovered either by chance, during a planned ultrasound, or when the pathological process has “dispersed” - the pebbles have increased, causing an attack of colic.

Conservative treatment

Dissolution of stones with drugs (litholytic therapy), the basis of which is bile acids - ursodeoxycholic (Ursochol, Ursosan, Ursofalk), as well as chenodeoxycholic (Chenosan, Henofalk). Usually, drugs are prescribed at the same time, since each has its own task. One contributes to the dissolution of stones, and the second allows the solid cholesterol crystal to “translate” into a liquid state.

Indications for appointment:

• the patient categorically refuses the operation, and other methods are contraindicated
• cholesterol nature of stones, size range 5-15 mm, stone filling does not exceed 50% of the total volume of the gallbladder
• no GI motility disorders
• duct flow is good

It is required to stop taking other drugs that provoke the formation of stones:

• estrogen
• antacids
• cholestyramine

Contraindications:

• pathology of the gastrointestinal tract

The required doses, the duration of the course, are selected by the doctor individually, and the treatment is long, can stretch for months, from 6-20. To control the dynamics of the therapeutic process will allow regular (every six months) ultrasound, it is imperative to maintain a healthy lifestyle, follow dietary recommendations. However, unfortunately, this technique has a downside:

• positive results can be expected only at the initial stage of cholelithiasis
• with a long course, litholytic therapy is ineffective - the calculi “overgrown” with deposits of calcium salts
• the frequency of relapses goes off scale, reaching 70%, at the end of the course, prophylactic administration, lower maintenance doses will be required
• treatment is relatively expensive, and more than one doctor will not undertake to guarantee the absence of similar problems in the future

Indications:

• single (2-3), cholesterol, small 5-10 mm, without lime impurities
• free bile ducts
• Contraindications:
• poor blood clotting

Possible complications:

• From vibration, fragments may damage the walls of the gallbladder.
• The risk of blockage of the duct increases, then an urgent operation is required, and this is much worse than the planned intervention of the surgeon, the preparation for which is more thorough.

Cholelitholysis - stones in the gallbladder or bile ducts are dissolved with a special organic "solvent" (methyl tert-butyl ether), which enters through the skin and liver tissue through a thin catheter.

Advantages:

• calculi of any kind, quantity, not only cholesterol,
• permissible at different stages (latent, dyspeptic, painful)
• high percentage of efficiency, after several procedures (within a month), about 90% of stones are “liquidated”

Flaws:

• increased degree of trauma
• lack of a guaranteed result - re-education is likely

Surgical intervention by a surgeon is indicated in cases of large calculi, frequent exacerbations accompanied by unbearable attacks of biliary colic, and a number of dangerous complications.

If you are familiar with acute calculous cholecystitis firsthand, then the risks (surgical, anesthetic) inherent in any operation become significantly lower than the risk of possible complications.

Moreover, a planned operation (carefully prepared), and the intervention of a surgeon against the background of an aggravated inflammatory or destructive process in the wall of the gallbladder are two diametrically opposed things.

Of course, if there is even the slightest possibility of avoiding “going under the scalpel”, then conservative therapy is recommended. However, when the threat to health is extremely high, ignoring the operation is a reckless act.

Operation types

Traditional classical, called open cholecystectomy- removal of the gallbladder along with stones.

Unfortunately, having removed the bladder, negative symptoms (pain on the right side, bitterness in the mouth) characteristic of cholelithiasis can remain.

The lithogenicity of bile remains, and since the storage reservoir is removed, it begins to fill the intestines uncontrollably. The metabolism of bile acids collapses, irritation of the mucous membrane increases. The risks of pathologies of the gastrointestinal tract - esophagitis, enteritis increase.

Laparoscopic cholecystolithotomy- not the entire gallbladder is removed, but that part of the bladder where the stones are contained. The frequency of relapses is high - in the case of destabilization of the motor function of the gallbladder, after 3-4 years, the problem of cholelithiasis again becomes relevant.

Laparoscopic cholecystectomy- for penetration inside, on the right side of the abdominal cavity, under the ribs, a small incision is made.

The laparoscope evaluates the current state, location and size of the gallbladder, which is pulled up to the incision made.

A secondary incision is made at the base of the bubble. Next, a soft tube is inserted into the gallbladder, into which a choledochoscope is inserted.

Large stones are crushed into small ones, removed, and then, at the end of all manipulations, the device is removed from the gallbladder, the bladder incision is “darned” with absorbable threads. The skin incision is leveled with medical glue.

A clear picture of the actions performed is displayed on the monitor.

Advantages over open gallbladder removal:

• Low risks of hernias
• Less recovery period
• No noticeable scars
• Below cost

Contraindications

• large size stones
• operations on other organs of the gastrointestinal tract
• gallbladder abscess
• heart problems

Folk methods

The attending physician can competently answer the question of the appropriateness of using home prescriptions in your (specific) situation.

Self-medication, in an attempt to avoid surgery, without consultation is categorically unacceptable.

From medicinal herbs, it is required to be perceived as an auxiliary measure in the fight against cholelithiasis. Herbal collection, subject to proper use, will provide secondary assistance to the gastrointestinal tract - it will reduce the intensity of the pain syndrome, slow down the progression of the inflammatory process, and probably reduce the size of the calculi.

However, the main argument of the disease is that the stones in the gallbladder will remain, they cannot be overcome with herbs alone. It is necessary to realize the seriousness of such a pathological situation and possible negative consequences.

Wash thoroughly, peel 1 kg of black radish roots, squeeze out the juice. Take a third of an hour after eating, 20 ml. The portioning is gradually increased to 50 ml., among the contraindications are stomach ulcers, acute stages of kidney disease.

The number and size of gallstones are very diverse: sometimes it is one large stone, but more often - multiple stones, numbering in tens, sometimes hundreds. They range in size from a chicken egg to millet grain and less. Stones may vary in chemical composition. Cholesterol, lime and bile pigments are involved in their formation. Consequently, metabolic disorders in the body, bile stasis and infection play an important role in the process of stone formation. When bile stagnates, its concentration increases, conditions are created for the crystallization of cholesterol contained in it and excreted 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. The most common causes of biliary colic (the main manifestation of cholelithiasis) are the use of alcohol, spicy fatty foods, excessive exercise.

A common metabolic disease in which, due to a violation of the processes of bile formation and bile secretion, the formation of stones in the gallbladder occurs. Small stones (microliths) are sometimes also formed in the intrahepatic bile ducts, especially in older men and patients with cirrhosis of the liver. Once in the gallbladder, microliths can serve as a basis for cholesterol to settle on them and form large cholesterol stones. In addition to cholesterol stones, there are pigmented (bilirubin), calcareous, mixed and combined types of stones. Stone carrying is possible without clinical manifestations; often it is accidentally discovered at autopsy. Gallstones occur at any age, and the older the patient, the higher the frequency of the disease. In women, gallstone disease and stone carrying are observed several times more often than in men.

Cholelithiasis 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, stages are distinguished: physicochemical (changes in bile), latent (asymptomatic stone-carrying), clinical (calculous cholecystitis, biliary colic).
• There are the following clinical forms of cholelithiasis: asymptomatic stone carrying, calculous cholecystitis, biliary colic.
• Gallstone disease can be complicated and uncomplicated.

The main manifestation of cholelithiasis is biliary, or hepatic, colic, which is manifested by bouts of very severe pain in the right hypochondrium. At the same time, they spread and give to the right shoulder, arm, collarbone and shoulder blade or to the lower back on the right side of the body. The most severe pain occurs when the 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 patients. Sometimes there are reflex pains in the region of the heart. 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 pains, a feeling of heaviness in the right hypochondrium, and nausea. There may be a decrease in appetite, 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 gallstone disease is the results of an X-ray examination with the introduction of a radiopaque fluid into the bile ducts.

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

The main components of the stones are cholesterol, pigments (bilirubin and its oxidation products) and lime salts. All these substances can be combined in various proportions. From organic substances, they contain a special colloidal substance of a protein nature, which forms the skeleton of a stone, and from inorganic, in addition to lime salts (carbonic and phosphate), iron, copper, magnesium, aluminum and sulfur were found in gallstones. For practical purposes, it is enough to distinguish three types of stones according to their chemical composition: cholesterol, mixed and pigmented.

1. Cholesterol, radiar stones consist almost exclusively (up to 98%) of cholesterol; they are white, sometimes slightly yellowish in color, round or oval in shape, ranging in size from a pea to a large cherry.
2. Mixed stones, cholesterol-pigment-lime, multiple, faceted, found in tens, hundreds, even thousands. These are the most common, most common stones. On the cut, one 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 the epithelium, foreign bodies (blood clot, dried roundworm, etc.) are sometimes found, around which stones falling out of bile are layered.
3. Pure pigment stones are of two types: a) observed in cholelithiasis, possibly with plant nutrition, and b) observed in hemolytic jaundice. These pure pigment stones are usually multiple, black in color, turn green when exposed to air; they are found in the bile ducts and in the gallbladder.

Causes of gallstone disease (stones in the gallbladder)

The development of gallstone disease is a complex process associated with metabolic disorders, infection and bile stasis. Undoubtedly, heredity also matters. Metabolic disorders contribute to the violation of bile eicolloidality. 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 reducing the content of cholates in bile are created during stagnation of bile. The infection promotes stone formation by inhibiting the synthesis of bile acids by the 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 cholelithiasis among people with obesity, an unhealthy lifestyle, its frequent association with other metabolic diseases (atherosclerosis, diabetes), as well as the frequent occurrence of the disease during repeated pregnancy.

Of great importance in the formation of gallstones is, apparently, the abnormal composition of the bile produced by the liver (dyscholia), which contributes to the loss of hardly soluble components of bile, as well as a violation of the general metabolism with an overload of blood 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 the deposition of lime and other components of bile, are rather only secondary, more rare factors in stone formation. Excessive bile secretion of bilirubin in massive hemolysis is of the same importance.

At the heart of violations of the liver and changes in metabolism are the adverse effects of the external environment in the form of excessive malnutrition, lack of physical work. Of great importance are the neuroendocrine factors that affect the function of the liver cell and tissue metabolism, as well as the emptying of the gallbladder.
Gallstone disease is often combined with obesity, gout, the presence of kidney stones, sand in the urine, atherosclerosis, hypertension, diabetes, that is, it is observed in numerous conditions that occur: with hypercholesterolemia.

The disease most often manifests itself between the ages of 30 and 55, and women are 4-5 times more likely than men. Gallstones with inflammation of the gallbladder and hemolytic jaundice can be observed at an earlier age. Cholelithiasis, of course, often manifests itself clinically for the first time during pregnancy or in the postpartum period: pregnancy is accompanied, under normal conditions, by physiological hypercholesterolemia and increased liver cell function, which creates the best conditions for fetal development and milk production by the mammary gland. Particularly significant disturbances of metabolic and vegetative processes can be expected in violation of the physiological rhythm of the function of childbearing during repeated abortions or premature births without subsequent lactation, etc., when a delay in the emptying of the gallbladder is also possible due to altered activity of the nervous system. Family cases of gallstone disease, 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, in violation of oxidative-enzymatic processes.

Experimental studies of recent times have also found 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 attached, as indicated, to the abnormal chemical composition of bile, in particular, the lack of bile (and also fatty) acids, which can be seen as a violation of the function of the liver cell itself.

Known value in cholelithiasis have infections and stagnation of bile. Of the transferred diseases, special attention was paid to typhoid fever, since it is known that typhoid bacillus can affect the biliary tract, excreted with bile.

Stagnation of bile contributes, in addition to a sedentary lifestyle, excessive fullness, pregnancy, clothing that squeezes the liver or restricts the movement of the diaphragm, prolapse of the abdominal organs, mainly the right kidney and liver; at the same time, an inflection of the bile ducts, especially the cystic one, located in the lig. hepato-duodenale. With swelling of the duodenal mucosa and scarring of ulcerative processes in it, the mouth of the common bile duct can be compressed, which leads to stagnation of bile. Catarrh resulting from a gross violation of the diet sometimes contributes to stagnation of bile and infection of the biliary tract. Usually, however, in addition to the mechanical factor, the action of the above liver-exchange factor is also noted.

The greatest importance in the origin of cholelithiasis should be given to a violation 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 by higher nervous activity, for which the great importance of conditioned reflex connections for normal bile secretion speaks.

At the same time, the receptor fields of the biliary tract, already 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 cortical-visceral diseases.

Exchange-endocrine disorders play only a secondary role, subject to functional changes in the nervous regulation. With an initial lesion of adjacent organs and infectious causes, a violation of the activity of the hepatic-biliary system, leading to cholelithiasis, also occurs in a neuroreflex way.

Separate signs of gallstone disease, especially the signs accompanying biliary colic, characteristic of gallstone dyspepsia, etc., owe their intensity and variety, primarily to the abundant innervation of the gallbladder and biliary tract, and are undoubtedly mainly neuroreflex in nature.

Symptoms, signs of gallstone disease (stones in the gallbladder)

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

Complications of gallstone disease

Complications of gallstone disease

• biliary colic.
• Cholecystitis.
• Acute pancreatitis.
• Fistula of the gallbladder, mechanical intestinal obstruction.
• Obstructive jaundice.
• Cholangitis and septicemia or liver abscess.
• perforation and peritonitis.

Cholelithiasis is characterized by a 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 biliary tract, intestinal obstruction and phlegmonous cholecystitis. Often, the disease takes a latent (latent) course, and stones are found 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, obstruction of the biliary tract and their infection are described primarily separately, although very often the phenomena of obstruction and infection are combined.

Stones can get stuck in their movement at various points along the path of bile flow, causing special characteristic clinical symptoms. Most often it is necessary to observe blockage of the cystic and common bile duct.

A typical manifestation of the disease is an attack of biliary, or hepatic, colic. The pains come on suddenly, but sometimes they are preceded by nausea. Colic usually begins at night, more often 3-4 hours after an evening meal, especially fatty foods, drinking alcohol; accompanied by a rise in temperature (sometimes with chills), tension in the abdominal muscles, stool retention, bradycardia, vomiting, and bloating. Possible temporary anuria, in the presence of coronary disease - the resumption of anginal attacks. In the duodenal contents, a large number of cholesterol crystals, sometimes small stones are found. In some cases, stones can be found in the stool 2-3 days after the attack. In some cases, colic is repeated often, in others - rarely, proceeding in the form of gallstone dyspepsia.

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

Diagnosis and differential diagnosis of cholelithiasis (gallstones)

The diagnosis of cholelithiasis is made on the basis of complaints of patients, anamnesis and the course of the disease. In the anamnesis, indications of the dependence of complaints on fatty and starchy foods, their connection with pregnancy, the fullness of patients (in the past), the presence of cases of cholelithiasis in the family (in the mother of the patient, sisters) under the same external living conditions are especially important.

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

As for the differential diagnosis, in various stages of cholelithiasis one has to keep in mind a number of diseases. With gallstone dyspepsia, it is necessary to exclude, first of all, gastric and duodenal ulcers, chronic appendicitis, colitis and many other causes of gastric and intestinal dyspepsia. Erased signs of gallstone dyspepsia, described in detail above, allow clinically clarifying the diagnosis.

Hepatic colic has to be differentiated from a number of diseases.

1. With renal colic, pain is localized below, in the lumbar region, and radiates to the groin, genitals and leg; often there is dysuria, anuria, blood in the urine, and sometimes sand; the vomiting is not so persistent, the febrile reaction is less common. We must not forget that both colic can be observed simultaneously.
2. With food poisoning, the 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.
3. In acute appendicitis, pain and tension of the abdominal wall (muscular protection) are localized below the navel, the pulse is more frequent, etc.
4. Duodenal ulcers and periduodenitis, due to their 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.
5. Myocardial infarction can give a similar picture, especially since pain and infarction can only be localized in the right upper quadrant of the abdomen (“status gastralgicus” due to acute congestive liver). The history of patients, electrocardiographic changes, etc., resolve the issue. Angina pectoris and even myocardial infarction can be caused by biliary colic. Nitroglycerin, according to some authors, also facilitates an attack of gallstone disease.
6. Acute hemorrhagic pancreatitis is characterized by more pronounced general phenomena (see when describing this form).
7. Intestinal colic is characterized by periodic pain with rumbling and is sometimes accompanied by diarrhea.
8. 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.
9. Tabetic crises give less intense pain, vomiting with them is more abundant, the temperature is not elevated, there are neurological signs of dorsal tabes.
10. With lead colic, the pains are localized in the middle of the abdomen, they are spilled, they calm down with deep pressure; the abdomen 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 ascaris stuck in the ducts or echinococcus bladder. The analysis of feces and the presence of other symptoms of ascaris invasion or echinococcal disease helps to establish the diagnosis.

Enlarged gallbladder with dropsy, it can be mixed with hydronephrosis, pancreatic cyst; the gallbladder is characterized by respiratory mobility and lateral displacement; the anterior echinococcal cyst of the liver is differentiated from hydrocele of the bladder according to the rest of the signs characteristic of echinococcal disease.

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

Forecast and working capacity of cholelithiasis (stones in the gallbladder)

The prognosis of cholelithiasis is difficult to formulate in a general form, the course of the disease is so diverse. In most cases, the disease proceeds with recurrent pain attacks and dyspepsia and, with the right regimen, is not prone to progression and does not significantly shorten life expectancy. Such is the course of cholelithiasis in most sanatorium-and-spa patients. In patients in the therapeutic departments of hospitals, a more persistent course with complications is usually observed; finally, in patients with 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 disabled or their ability to work is limited. In milder cases of cholelithiasis with a predominance of spastic or dyskinetic phenomena in the gallbladder area, without pronounced symptoms of cholecystitis, patients should be recognized as limited able-bodied in the presence of significant severity and persistence of nervous disorders and frequent, mostly non-infectious, subfebrile condition. They cannot perform work associated with significant physical stress. With the development of severe complications of cholelithiasis, patients are completely disabled.

Prevention and treatment of gallstone disease (stones in the gallbladder)

To relieve a painful attack intravenously, intramuscularly, antispasmodics (drotaverine hydrochloride, papaverine hydrochloride) and analgesics (metamisole sodium, promedol) are administered. If it is still not possible to eliminate the attack and the jaundice does not go away, one has to resort to surgical treatment. To remove stones, lithotripsy is used - their crushing with the help of a shock wave.

Patients with gallstone disease must strictly observe the diet and diet, do not abuse alcohol.

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

To prevent the development of the inflammatory process in the mucous membrane of the gallbladder, timely treatment of infectious diseases is necessary. 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 are more frequent, and most importantly, severe complications (hydrops of the gallbladder, cholangitis, pancreatitis, etc.) can develop, the treatment of which is very difficult.

For the prevention of gallstone disease, a hygienic general regimen, sufficient physical activity and proper nutrition, as well as the fight against infections, disorders of the gastrointestinal tract, elimination of bile stasis, and elimination of nervous shocks are important. For people leading a sedentary lifestyle, it is especially important to avoid overeating, systematically take walks in the fresh air, and play light sports.

Treatment of gallstone disease at various stages of its development is not the same. However, regardless of temporary urgent measures, patients, as a rule, must observe 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 biliary tract, ascending from the intestine or metastasizing from distant foci, as well as eliminating difficult experiences. It is necessary to recommend fractional nutrition (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 the stagnation of bile (for example, a tight belt); with severe ptosis, wearing a bandage is necessary. Constipation should be controlled by diet, enemas, and mild laxatives.

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

In cholelithiasis, it is usually necessary to limit patients both in terms of total caloric intake of food, and in relation to meat, fatty dishes, especially smoked foods, canned food, snacks, and alcoholic beverages. 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 a violation 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 the physicochemical properties of food, but also its individual tolerance.

During the period of sharp exacerbations of the disease, a meager diet is prescribed: tea, rice and semolina porridge on the water, kissels, white unbread crackers. Only gradually add fruits (lemon, applesauce, compotes), cauliflower, other mashed 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 vegetable puree; Provence oil is given as a medicine with tablespoons on an empty stomach. Patients for years should avoid those dishes that cause them attacks of colic or dyspepsia, namely: pies, cream cakes and pastry in general, saltwort, 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 must avoid excitement, hypothermia, constipation, etc., in a word, all those irritations which, according to their experience, lead with particular constancy to the return of colic, to a large extent, probably due to the zones of prolonged excitation created in the cerebral cortex. Taking drugs that strengthen the inhibitory process in higher nervous activity, distraction, and similar other methods should be used to prevent another attack even when exposed to the usual provoking factors.

In the treatment of cholelithiasis, one of the first places is occupied by sanatorium treatment, which is indicated after the passage of acute attacks (not earlier than 1-2 months) for most 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 place of residence of patients for dietary and physiotherapy. In sanatorium treatment, complete rest, proper general regimen, nutrition, measured walks, topical application of mud to the liver area, which relieves pain and accelerates the cure of residual inflammatory processes, and drinking mineral waters are beneficial. Of the mineral waters, hot bicarbonate-sulphate-sodium (for example, the Zheleznovodsk Slavyanovsky spring with water at a temperature of 55 °), hydrocarbonate-sodium sources of Borjomi and others are used, which contribute to a 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-coniferous baths are also used, which act favorably on the nervous system.

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

Of the medicines, bile acids (decholine) can be important, which make it possible to ensure a normal ratio of bile acids and cholesterol and thereby counteract stone formation; herbal preparations rich in anti-spasmodic, anti-inflammatory, laxative ingredients; preparations from plants with choleretic properties (holosas extract from rosehip berries, infusion of sandy immortelle-Helichrysum arenarium and many others), choleretic and laxative salts - magnesium sulfate, artificial Carlsbad salt, etc.

Treatment of biliary colic consists in the vigorous application of heat to the area of ​​the liver in the form of heating pads or compresses; if the patient does not tolerate heat, ice is sometimes applied. Assign painkillers: belladonna, morphine. Usually vomiting does not allow oral medication, 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 increase spasms of the sphincter of Oddi and thereby increase blood pressure. bile ducts.

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

Within 5-6 days after the attack, it is necessary to monitor whether the stone is excreted in the stool. In the prevention of a seizure, rest, the prohibition of bumpy driving, an appropriate diet with restriction of fatty and spicy foods, fractional nutrition with sufficient fluid intake and elimination of constipation are important.

In case of infection of the biliary tract, sulfazin and other sulfonamide drugs are used in an average dose, penicillin (200,000-400,000 units per day), hexamine, "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, campolone, blood transfusion, etc.

With obstructive jaundice, the same drugs are prescribed that improve the condition of the liver, and in addition, ox bile, vitamin K inside parenterally (against hemorrhagic diathesis).
Urgent surgical treatment is indicated for gangrenous cholecystitis, perforated peritonitis, intestinal obstruction on the basis of a stone (simultaneously with treatment with penicillin). Surgical intervention is subject to limited accumulations of pus with empyema of the gallbladder, subdiaphragmatic abscess, purulent cholecystitis, blockage of the common bile duct by a stone, dropsy of the gallbladder, purulent cholangitis. More often, an operation 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 in order to avoid recurrence of stone formation or inflammatory-dyskinetic phenomena, as well as spa treatment.

In some cases, it should be only conservative, in others, it must be surgical. Foods rich in cholesterol and fats (brains, eggs, fatty meats), rich meat soups, spicy and fatty foods, lard, smoked meats, canned food, rich confectionery, alcoholic beverages should be excluded from nutrition. Allowed dairy products, fruit and vegetable juices, vegetables, vegetarian soups, boiled meat, fish and pasta, cereals, berries, butter and vegetable oil, preferably corn. It is necessary to advise patients to eat moderately, regularly and often, with plenty of drink, giving preference to mineral waters (Essentuki No. 20, Borzhom, etc.).

Assign various choleretic drugs. Karlovy Vary salt, magnesium sulfate, sodium sulfate, allochol, cholecine, cholenzim, oxafenamide, cholagol, flamin, cholelitin, etc. are very effective. colic sometimes it is necessary to prescribe pantopon or morphine, always with atropine, since morphine preparations can cause spasm of the sphincter of Oddi. In the presence of symptoms of an "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 a persistent course of the disease, with frequent relapses of biliary colic that occur despite active treatment, with blockage of the gallbladder, perforation of the bladder, and the formation of biliary fistulas. Operative treatment of cholelithiasis should be timely.

Chronic calculous cholecystitis- This is a disease in which stones form in the cavity of the gallbladder, which subsequently cause inflammation of the walls of the gallbladder.

Cholelithiasis refers to common diseases - occurs in 10-15% of the adult population. In women, this disease occurs 2-3 times more often than in men. Cholecystitis is an ancient human disease. The first gallstones were discovered during the study of Egyptian mummies.

Anatomy and physiology of the gallbladder

The length of the gallbladder is from 5 to 14 centimeters, and the capacity is 30-70 milliliters. In the bladder, the bottom, body and neck are distinguished.

The wall of the gallbladder consists of mucous, muscular, and connective tissue membranes. The mucosa consists of epithelium and various glandular cells. The musculature is made up of smooth muscle fibers. At the neck, the mucous and muscular membranes form a sphincter that prevents the release of bile at the wrong time.

The bladder neck continues into the cystic duct, which then merges with the common hepatic duct to form the common bile duct.
The gallbladder is located on the lower surface of the liver so that the wide end of the gallbladder (bottom) slightly extends beyond the lower edge of the liver.

The function of the gallbladder is to store, concentrate bile and excrete bile as needed.
The liver produces bile and, as unnecessary, bile accumulates in the gallbladder.
Once in the bladder, bile is concentrated by absorption of excess water and trace elements by the epithelium of the bladder.

The secretion of bile occurs after eating. The muscular layer of the bladder contracts, increasing the pressure in the gallbladder to 200-300 mm. water column. Under the action of pressure, the sphincter relaxes, and bile enters the cystic duct. The bile then enters the common bile duct, which opens into the duodenum.

The role of bile in digestion

Bile in the duodenum creates the necessary conditions for the activity of enzymes in the pancreatic juice. Bile dissolves fats, which contributes to the further absorption of these fats. Bile is involved in the absorption of vitamins D, E, K, A in the small intestine. Bile also stimulates the secretion of pancreatic juice.

Causes of the development of chronic calculous cholecystitis

Fixed Factors:

• Floor. Most often, women get sick due to the use of contraceptives, childbirth (estrogens, which are elevated during pregnancy, increase the absorption of cholesterol from the intestines and its abundant excretion with bile).
• Age. Persons aged 50 to 60 years are more likely to suffer from cholecystitis.
• genetic factors. These include - family predisposition, various congenital anomalies of the gallbladder.
• ethnic factor. The greatest number of cases of cholecystitis is observed in Indians living in the southwestern United States and in the Japanese.

• Food . Increased consumption of animal fats and sweets, as well as hunger and rapid weight loss can cause cholecystitis.
• Obesity. The amount of cholesterol in the blood and bile increases, which leads to the formation of stones
• Diseases of the gastrointestinal tract. Crohn's disease, resection (removal) of part of the small intestine
• Medications. Estrogens, contraceptives, diuretics (diuretics) - increase the risk of cholecystitis.
• Hypodynamia (fixed, sedentary lifestyle)
• Decreased tone of the muscles of the gallbladder

How are stones formed?

First phase- violation in bile of the ratio of cholesterol and solvents (bile acids, phospholipids).
In this phase, there is an increase in the amount of cholesterol and a decrease in the amount of bile acids.

An increase in cholesterol occurs due to a malfunction of various enzymes.
- decreased hydroxylase activity (affects cholesterol lowering)
- decreased activity of acetyl transferase (converts cholesterol to other substances)
- increased breakdown of fats from the fatty layer of the body (increases the amount of cholesterol in the blood).

The decrease in fatty acids occurs for the following reasons.
- Violations of the synthesis of fatty acids in the liver
- Increased excretion of bile acids from the body (impaired absorption of fatty acids in the intestine)
- Violation of intrahepatic circulation

Second phase - bile saturated with cholesterol forms a stasis of bile (stagnation of bile in the bladder), then the process of crystallization occurs - forming crystals of cholesterol monohydrate. These crystals stick together and form stones of various sizes and compositions.
Cholesterol stones may be single or multiple and are usually round or oval in shape. The color of these stones is yellow-green. The sizes of stones vary from 1 millimeter to 3-4 centimeters.

Bile pigment stones are formed due to an increase in the amount of unbound, water-insoluble bilirubin. These stones are composed of various polymers of bilirubin and calcium salts.
Pigment stones are usually small in size up to 10 millimeters. Usually there are several pieces in the bubble. These stones are black or grey.

Most often (80-82% of cases) there are mixed stones. They consist of cholesterol, bilirubin and calcium salts. By the number of stones are always multiple, yellow-brown.

Symptoms of gallstone disease

Symptoms appear only if the stone moves through the cystic canal, which leads to its blockage and inflammation.

Depending on the stage of cholelithiasis, the symptoms presented in the next section of the article are also distinguished.

Clinical stages of gallstone disease

2. Latent stage.
At this stage, there are no complaints from the patient. There are already stones in the gallbladder. Diagnosis can be made by ultrasound.

3. The stage of onset of symptoms of the disease.
- Biliary colic is a very severe, paroxysmal and sharp pain that lasts from 2 to 6 hours, sometimes more. Attacks of pain usually appear in the evening or at night.

The pain is in the right hypochondrium and spreads to the right shoulder blade and right cervical region. Pain occurs most often after a rich, fatty meal or after a lot of physical activity.

Products after taking, which may cause pain:

• Cream
• Alcohol
• cakes
• Carbonated drinks

Other symptoms of the disease:

• Increased sweating
• Chills
• Increase in body temperature up to 38 degrees Celsius
• Vomiting bile that does not bring relief

At this stage, complications such as:
Acute cholecystitis This disease requires immediate surgical intervention.

Hydrocele of the gallbladder. There is a blockage of the cystic duct by a stone or narrowing to a complete blockage of the duct. The release of bile from the bladder stops. Bile is absorbed from the bladder through the walls, and a serous-mucous secret is secreted into its lumen.
Gradually accumulating, the secret stretches the walls of the gallbladder, sometimes to a huge size.

Perforation or rupture of the gallbladder leads to the development of biliary peritonitis (inflammation of the peritoneum).

hepatic abscess. Limited accumulation of pus in the liver. An abscess forms when a section of the liver is destroyed. Symptoms: high temperature up to 40 degrees, intoxication, liver enlargement.
This disease is treated only surgically.

gallbladder cancer. Chronic calculous cholecystitis greatly increases the risk of cancer.

Diagnosis of gallstone disease

Conversation with a doctor
The doctor will ask you about your complaints. Reveal the causes of the disease. He will dwell in particular detail on nutrition (after taking, what foods do you feel bad about?). Then he will enter all the data into the medical record and then proceed to the examination.

Inspection
The examination always begins with a visual examination of the patient. If the patient at the time of examination complains of severe pain, then his face will express suffering.

The patient will be in a supine position with the legs bent and brought to the stomach. This position is forced (reduces pain). I would also like to note a very important sign, when the patient is turned over to the left side, the pain intensifies.

Palpation (palpation of the abdomen)
With superficial palpation, flatulence (bloating) of the abdomen is determined. Hypersensitivity in the right hypochondrium is also determined. There may be muscle tension in the abdomen.

With deep palpation, an enlarged gallbladder can be determined (normally, the gallbladder is not palpable). Also, with deep palpation, specific symptoms are determined.
1. Murphy's symptom - the appearance of pain during inspiration at the time of probing the right hypochondrium.

2. Ortner's symptom - the appearance of pain in the right hypochondrium, when tapping (percussion) on the right costal arch.

Ultrasound of the liver and gallbladder
On ultrasonography, the presence of stones in the gallbladder is well determined.

Signs of the presence of stones on ultrasound:
1. Presence of solid structures in the gallbladder
2. Mobility (movement) of stones
3. Ultrasonographic hypoechoic (visible as a white gap in the picture) trace below the stone
4. Thickening of the walls of the gallbladder more than 4 millimeters

Abdominal x-ray
Clearly visible stones, which include calcium salts

Cholecystography- study using contrast for better visualization of the gallbladder.

CT scan- performed in the diagnosis of cholecystitis and other diseases

Endoscopic cholangiopancreatography- used to determine the location of a stone in the common bile duct.

The course of chronic calculous cholecystitis
The asymptomatic form of cholecystitis lasts a long time. From the moment of detection of stones in the gallbladder within 5-6 years, only 10-20% of patients begin to develop symptoms (complaints).
The appearance of any complications indicates an unfavorable course of the disease. In addition, many complications are treated only surgically.

Treatment of gallstone disease

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

Diet for gallstone disease

Prohibited Products:

Alcoholic drinks
- legumes, in any kind of preparation
- high-fat dairy products (cream, full-fat milk)
- any fried food
- meat from fatty varieties (goose, duck, pork, lamb), lard
- fatty fish, salted, smoked fish, caviar
- any kind of canned goods
- mushrooms
- fresh bread (especially hot bread), croutons
- spices, spices, salinity, pickled products
- coffee, chocolate, cocoa, strong tea
- salty, hard and fatty types of cheese

Cheeses can be eaten, but low-fat

Vegetables should be consumed in boiled, baked form (potatoes, carrots). It is allowed to use finely chopped cabbage, ripe cucumbers, tomatoes. Green onion, parsley to use as an addition to dishes

Meat from non-fat varieties (beef, veal, rabbit), as well as (chicken and turkey without skin). Meat should be consumed boiled or baked. It is also recommended to use minced meat (cutlets)

Vermicelli and pasta allowed

Sweet ripe fruits and berries, as well as various jams and concoctions

Drinks: not strong tea, not sour juices, various mousses, compotes

Butter (30 grams) in dishes

Low-fat types of fish are allowed (perch, cod, pike, bream, perch, hake). It is recommended to use the fish in boiled form, in the form of cutlets, aspic

You can use whole milk. You can also add milk to various cereals.
Not sour cottage cheese, non-sour fat-free yogurts are allowed

Effective treatment of cholecystitis, when symptoms are present, is possible only in a hospital setting!

Drug treatment of biliary colic (pain symptom)

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

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

Method of direct destruction of stones
The method is based on the direct injection of a strong stone dissolver into the gallbladder.

Extracorporeal shock wave lithotripsy- crushing stones using the energy of shock waves generated outside the human body.

This method is carried out using various devices that produce different types of waves. For example, waves created by a laser, an electromagnetic installation, an installation that produces ultrasound.

Any of the devices is installed in the projection of the gallbladder, then waves from various sources act on the stones and they are crushed to small crystals.

Then these crystals are freely excreted along with bile into the duodenum.
This method is used when the stones are no larger than 1 centimeter and when the gallbladder is still functioning.
In other cases, in the presence of symptoms of cholecystitis, surgery is recommended to remove the gallbladder.

Surgical removal of the gallbladder

The first type has been used for a long time. The standard method is based on abdominal surgery (with an open abdominal cavity). Recently, it has been used less and less due to frequent postoperative complications.

The laparoscopic method is based on the use of a laparoscope apparatus. This apparatus consists of several parts:
- high magnification video cameras
- different kinds of tools
Advantages of the 2nd method over the first:
1. Laparoscopic surgery does not require large incisions. The incisions are made in several places and are very small.
2. The seams are cosmetic, so they are practically invisible
3. Health is restored 3 times faster
4. The number of complications is ten times less

Prevention of gallstone disease

Secondary prevention is to prevent complications. The main method of prevention is the effective treatment of chronic cholecystitis described above.

Why is gallstone disease dangerous?

Gallstone disease is dangerous, first of all, with the following complications:

• Gallbladder perforation. A perforation is a rupture of the gallbladder. It can be caused by the movement of stones or too much contraction ( spasm) smooth muscle of the organ. In this case, the contents of the organ enter the abdominal cavity. Even if there was no pus inside, the bile itself can cause serious irritation and inflammation of the peritoneum. The inflammatory process extends to intestinal loops and other neighboring organs. Most often, in the cavity of the gallbladder there are opportunistic microbes. In the abdominal cavity, they multiply rapidly, realizing their pathogenic potential and leading to the development of peritonitis.
• Empyema of the gallbladder. An empyema is a collection of pus in a natural body cavity. With calculous cholecystitis, the stone often gets stuck at the level of the bladder neck. At first, this leads to dropsy - the accumulation of mucous secretion in the cavity of the organ. The pressure inside increases, the walls stretch, but may contract spastically. This leads to severe pain - biliary colic. If such a clogged gallbladder becomes infected, the mucus turns into pus and empyema occurs. Usually pathogens are bacteria from the genera Escherichia, Klebsiella, Streptococcus, Proteus, Pseudomonas, less often Clostridium and some other microorganisms. They can be ingested through the bloodstream or travel up the bile duct from the intestines. With the accumulation of pus, the patient's condition worsens greatly. The temperature rises, headaches intensify ( due to absorption of waste products into the blood). Without urgent surgery, the gallbladder ruptures, its contents enter the abdominal cavity, causing purulent peritonitis. At this stage ( after the break) the disease often ends in the death of the patient, despite the efforts of doctors.
• Reactive hepatitis. The inflammatory process from the gallbladder can spread to the liver, causing inflammation. The liver also suffers from a deterioration in local blood flow. Typically, this problem unlike viral hepatitis) passes quite quickly after removal of the gallbladder - the main center of inflammation.
• Acute cholangitis. This complication involves blockage and inflammation of the bile duct. In this case, the outflow of bile is disturbed by a stone stuck in the duct. Since the bile ducts are connected to the ducts of the pancreas, pancreatitis can also develop in parallel. Acute cholangitis occurs with severe fever, chills, jaundice, severe pain in the right hypochondrium.
• Acute pancreatitis. Usually occurs due to lack of bile ( that is not released from the clogged bladder) or blockage of the common duct. Pancreatic juice contains a large amount of strong digestive enzymes. Their stagnation can cause necrosis ( death) of the gland itself. This form of acute pancreatitis poses a serious threat to the patient's life.
• Biliary fistulas. If gallstones do not cause severe pain, the patient may ignore them for a long time. However, the inflammatory process in the organ wall ( directly around the stone) is still evolving. The destruction of the wall and its “soldering” with neighboring anatomical structures gradually occur. Over time, a fistula may form, connecting the gallbladder with other hollow organs. These organs can be the duodenum ( most often), stomach, small intestine, large intestine. There are also options for fistulas between the bile ducts and these organs. If the stones themselves do not bother the patient, then fistulas can cause air accumulation in the gallbladder, violations of the outflow of bile ( and intolerance to fatty foods), jaundice, vomiting of bile.
• Paravesical abscess. This complication is characterized by the accumulation of pus near the gallbladder. Usually, an abscess is delimited from the rest of the abdominal cavity by adhesions that have arisen against the background of an inflammatory process. From above, the abscess is limited to the lower edge of the liver. The complication is dangerous by the spread of infection with the development of peritonitis, impaired liver function.
• Scar strictures. Strictures are places of narrowing in the bile duct that prevent the normal flow of bile. In cholelithiasis, this complication may occur as a result of inflammation ( the body responds with excessive formation of connective tissue - scars) or as a consequence of an intervention to remove stones. Either way, strictures can persist even after recovery and seriously affect the body's ability to digest and absorb fatty foods. In addition, if stones are removed without removing the gallbladder, strictures can cause bile stasis. In general, people with these duct narrowings are more likely to relapse ( repeated inflammation of the gallbladder).
• Secondary biliary cirrhosis. This complication can occur if gallstones prevent the flow of bile for a long time. The fact is that bile enters the gallbladder from the liver. Its overflow causes stagnation of bile in the ducts in the liver itself. It can eventually lead to the death of hepatocytes ( normal liver cells) and their replacement with connective tissue that does not perform the necessary functions. This phenomenon is called cirrhosis. The result is serious violations of blood clotting, impaired absorption of fat-soluble vitamins ( A, D, E, K), accumulation of fluid in the abdominal cavity ( ascites), severe intoxication ( poisoning) organism.

Can calculous cholecystitis be cured without surgery?

The main advantages of surgical treatment of calculous cholecystitis are:

• Radical solution to the problem. Removal of the gallbladder guarantees the cessation of pain ( biliary colic), since colic appears due to contractions of the muscles of this organ. In addition, there is no risk of recurrence ( repeated exacerbations) gallstone disease. Bile can no longer accumulate in the bladder, stagnate and form stones. It will go directly from the liver to the duodenum.
• Patient safety. Today, endoscopic removal of the gallbladder ( cholecystectomy) is a routine operation. The risk of complications during surgery is minimal. Subject to all the rules of asepsis and antisepsis, postoperative complications are also unlikely. The patient recovers quickly and can be discharged ( in consultation with the attending physician) a few days after the operation. After a few months, he can lead the most normal life, apart from a special diet.
• Ability to treat complications. Many patients go to the doctor too late, when complications of calculous cholecystitis begin to appear. Then surgical treatment is simply necessary to remove pus, examine neighboring organs, and adequately assess the risk to life.

Nowadays, there are several ways of non-surgical treatment of calculous cholecystitis. This is not about symptomatic treatment. muscle spasm relief, pain relief), namely, getting rid of stones inside the gallbladder. The main advantage of these methods is the preservation of the organ itself. With a successful result, the gallbladder is freed from stones and continues to perform its functions of accumulating and dosed bile secretion.

There are three main methods of non-surgical treatment of calculous cholecystitis:

• Medical dissolution of stones. This method is perhaps the safest for the patient. For a long time, the patient must take drugs based on ursodeoxycholic acid. It promotes the dissolution of stones containing bile acids. The problem is that even to dissolve small stones, it is necessary to take the medicine regularly for several months. If we are talking about larger stones, the course can be delayed for 1 - 2 years. However, there is no guarantee that the stones will dissolve completely. Depending on the individual characteristics of metabolism, they may contain impurities that will not dissolve. As a result, the stones will decrease in size, the symptoms of the disease will disappear. However, this effect will be temporary.
• Ultrasonic crushing of stones. Today, crushing stones with the help of ultrasonic waves is a fairly common practice. The procedure is safe for the patient, easy to perform. The problem is that the stones are crushed into sharp fragments, which still cannot leave the gallbladder without injuring it. In addition, the problem of stagnation of bile is not solved radically, and after a while ( usually several years) stones can form again.
• Laser stone removal. It is used quite rarely due to the high cost and relatively low efficiency. Stones are also subjected to a kind of crushing and fall apart. However, even these parts can injure the mucous membrane of the organ. In addition, there is a high risk of recurrence ( re-formation of stones). Then the procedure will have to be repeated.

When is surgery needed for gallstone disease?

Cholecystectomy involves the complete removal of the bladder along with the stones it contains. With an uncomplicated course of the disease, it guarantees a solution to the problem, since the bile formed in the liver will no longer accumulate and stagnate. The pigments simply won't be able to form stones again.

There are many indications for cholecystectomy. They are divided into absolute and relative. Absolute indications are those without which serious complications can develop. Thus, if the operation is not performed when there are absolute indications, the life of the patient will be endangered. In this regard, doctors in such situations always try to convince the patient of the need for surgical intervention. There are no other treatments available or they will take too long and increase the risk of complications.

Absolute indications for cholecystectomy in cholelithiasis are:

• A large number of stones. If gallstones ( regardless of their number and size) occupy more than 33% of the organ volume, cholecystectomy should be performed. It is almost impossible to crush or dissolve such a large number of stones. At the same time, the organ does not work, since the walls are very stretched, they contract poorly, stones periodically clog the neck area and interfere with the outflow of bile.
• Frequent colic. Attacks of pain in cholelithiasis can be very intense. Remove them with antispasmodic drugs. However, frequent colic suggests that drug treatment is not successful. In this case, it is better to resort to the removal of the gallbladder, regardless of how many stones are in it and what size they are.
• Stones in the bile duct. When the bile ducts are blocked by a stone from the gallbladder, the patient's condition worsens greatly. The outflow of bile stops completely, the pain intensifies, obstructive jaundice develops ( due to the free fraction of bilirubin).
• Biliary pancreatitis. Pancreatitis is an inflammation of the pancreas. This organ has a common excretory duct with the gallbladder. In some cases, with calculous cholecystitis, the outflow of pancreatic juice is disturbed. The destruction of tissues in pancreatitis endangers the life of the patient, so the problem must be urgently solved by surgical intervention.

Separately, it should be noted the surgical treatment of complications of acute cholecystitis. In this case, we are talking about the spread of the inflammatory process. Problems with the gallbladder are reflected in the work of neighboring organs. In such situations, the operation will include not only the removal of the gallbladder with stones, but also the solution of the resulting problems.

Surgical treatment without fail may also be necessary for the following complications of gallstone disease:

• Peritonitis. Peritonitis is an inflammation of the peritoneum, the membrane that covers most of the abdominal organs. This complication occurs when the inflammatory process spreads from the gallbladder or perforation ( gap) of this organ. Bile, and often a large number of microbes, enters the abdominal cavity, where intense inflammation begins. The operation is necessary not only to remove the gallbladder, but also to thoroughly disinfect the abdominal cavity as a whole. It is impossible to postpone surgical intervention, since peritonitis is fraught with the death of the patient.
• Bile duct strictures. Strictures are called narrowing of the canal. Such narrowing can be formed due to the inflammatory process. They obstruct the outflow of bile and cause stagnation in the liver, although the gallbladder itself can be removed. Surgery is needed to remove strictures. As a rule, the narrowed area is expanded or a bypass is made for bile from the liver to the duodenum. Apart from surgery, there is no effective solution to this problem.
• accumulation of pus. Purulent complications of gallstone disease occur when an infection enters the gallbladder. If pus accumulates inside the organ, gradually filling it, such a complication is called empyema. If pus accumulates near the gallbladder, but does not spread through the abdominal cavity, they speak of a paravesical abscess. The patient's condition with these complications is greatly deteriorating. The risk of spreading the infection is high. The operation includes removal of the gallbladder, emptying the purulent cavity and thoroughly disinfecting it to prevent peritonitis.
• Biliary fistulas. Gallbladder fistulas are pathological openings between the gallbladder ( less commonly by biliary tract) and neighboring hollow organs. Fistulas may not cause acute symptoms, but they disrupt the natural flow of bile, digestion, and predispose to other diseases. The operation is performed to close pathological openings.

How to treat gallstone disease with folk remedies?

Possible effects of medicinal plants in gallstone disease are:

• Relaxation of smooth muscles. Some medicinal plants relax the muscular sphincter of the gallbladder and the smooth muscles of its walls. This relieves pain attacks usually caused by spasm).
• Decreased bilirubin level. Elevated levels of bilirubin in bile especially if it's been stuck for a long time) may contribute to the formation of stones.
• outflow of bile. Due to the relaxation of the sphincter of the gallbladder, the outflow of bile occurs. It does not stagnate, and crystals and stones do not have time to form in the bubble.

Thus, the effect of the use of folk remedies will be predominantly preventive. Patients with abnormal liver function or other factors predisposing to gallstone disease will benefit from periodic treatment. This will slow down the formation of stones and prevent the problem before it occurs.

For the prevention of gallstone disease, you can use the following folk remedies:

• radish juice. Black radish juice is diluted with honey in equal proportions. You can also cut a cavity in a radish and pour honey into it for 10-15 hours. After that, a mixture of juice and honey is consumed 1 tablespoon 1-2 times a day.
• barberry leaves. Green leaves of barberry are thoroughly washed with running water and filled with alcohol. For 20 g of crushed leaves, 100 ml of alcohol is needed. Infusion lasts 5 - 7 hours. After that, the tincture is drunk 1 teaspoon 3-4 times a day. The course lasts 1 - 2 months. It can be repeated after six months.
• Rowan tincture. 30 g of rowan berries pour 500 ml of boiling water. Insist 1 - 2 hours ( while the temperature drops to room temperature). Then the infusion is taken half a glass 2-3 times a day.
• Mummy. Shilajit can be taken both for the prevention of stone formation, and for cholelithiasis ( if the diameter of the stones does not exceed 5 - 7 mm). It is diluted in a ratio of 1 to 1000 ( 1 g mummy per 1 liter of warm water). Before meals, drink 1 glass of solution, three times a day. This tool can be used no more than 8 - 10 days in a row, after which you need to take a break of 5 - 7 days.
• Mint with celandine. Equal proportions of the dry leaves of these herbs are consumed as an infusion. For 2 tablespoons of the mixture, 1 liter of boiling water is needed. Infusion lasts 4 - 5 hours. After that, the infusion is consumed 1 glass per day. Sediment ( grass) is filtered before use. It is not recommended to store the infusion for more than 3 - 4 days.
• Highlander snake. To prepare a decoction, you need 2 tablespoons of dry chopped rhizome, pour 1 liter of boiling water and cook for 10-15 minutes over low heat. 10 minutes after turning off the fire, the broth is decanted and allowed to cool ( usually 3 - 4 hours). The decoction is taken 2 tablespoons half an hour before meals twice a day.

To prevent stagnation of bile with the help of blind probing, pharmacological preparations or some natural mineral waters can be used. Water or medicine should be drunk on an empty stomach, after which the patient lies on his right side, placing it under the right hypochondrium ( on the area of ​​the liver and gallbladder) warm heating pad. You need to lie down for 1 - 2 hours. During this time, the sphincter will relax, the bile duct will expand, and the bile will gradually come out into the intestines. The success of the procedure is indicated by dark stools with an unpleasant odor after a few hours. It is advisable to consult with your doctor about the method of blind probing and its expediency in each specific case. After the procedure, you need to follow a low-fat diet for several days.

Thus, folk remedies can successfully prevent the formation of gallstones. At the same time, the regularity of treatment courses is important. It is also advisable to undergo preventive examinations with a doctor. This will help to detect small stones ( using ultrasound) in case folk methods do not help. After the formation of stones, the effectiveness of traditional medicine is greatly reduced.

What are the first signs of gallstone disease?

Usually, gallstone disease manifests itself for the first time as follows:

• Heaviness in the abdomen. A subjective feeling of heaviness in the abdomen is one of the first manifestations of the disease. Most patients complain about it when they see a doctor. The severity is localized in the epigastrium ( under the pit of the stomach, in the upper abdomen) or in the right hypochondrium. It can appear spontaneously, after physical exertion, but most often - after eating. This feeling is due to stagnation of bile and an increase in the gallbladder.
• Pain after eating. Sometimes the first symptom of the disease is pain in the right hypochondrium. In rare cases, it is biliary colic. It is a severe, sometimes unbearable pain that can radiate to the right shoulder or shoulder blade. However, often the first attacks of pain are less intense. It is rather a feeling of heaviness and discomfort, which, when moving, can turn into stabbing or bursting pain. Discomfort occurs an hour and a half after eating. Especially often pain attacks are observed after taking a large amount of fatty foods or alcohol.
• Nausea. Nausea, heartburn, and sometimes vomiting can also be the first manifestations of the disease. They also usually appear after eating. The connection of many symptoms with food intake is explained by the fact that the gallbladder normally releases a certain portion of bile. It is needed for emulsification ( a kind of dissolution and assimilation) fats and activation of certain digestive enzymes. In patients with gallstones, bile is not excreted, food is digested worse. Therefore, nausea occurs. Backward reflux of food into the stomach leads to belching, heartburn, gas accumulation, and sometimes vomiting.
• Stool changes. As mentioned above, bile is necessary for the normal absorption of fatty foods. With uncontrolled secretion of bile, prolonged constipation or diarrhea may occur. Sometimes they appear even before other symptoms typical of cholecystitis. In later stages, the stool may become discolored. This means that the stones clogged the ducts, and bile is practically not excreted from the gallbladder.
• Jaundice. Yellowing of the skin and sclera of the eyes is rarely the first symptom of gallstone disease. It usually occurs after digestive problems and pain. Jaundice is caused by stagnation of bile not only at the level of the gallbladder, but also in the ducts inside the liver ( where bile is produced). Due to a violation of the liver, a substance called bilirubin accumulates in the blood, which is normally excreted with bile. Bilirubin enters the skin, and its excess gives it a characteristic yellowish tint.

It is usually difficult to make a correct diagnosis based on the first symptoms and manifestations of gallstone disease. Nausea, vomiting and indigestion can also occur with disorders in other organs of the digestive system. To clarify the diagnosis, an ultrasound is prescribed ( ultrasound procedure) of the abdominal cavity. It allows you to detect a characteristic increase in the gallbladder, as well as the presence of stones in its cavity.

Can calculous cholecystitis be treated at home?

• Acute forms of the disease. In the acute course of calculous cholecystitis, a serious inflammatory process develops. Without proper patient care, the course of the disease can become very complicated. In particular, we are talking about the accumulation of pus, the formation of an abscess or the development of peritonitis ( inflammation of the peritoneum). In the acute course of the disease, hospitalization should not be postponed, since the above-mentioned complications can develop within 1 to 2 days after the first symptoms.
• The first signs of the disease. It is recommended that patients who present with symptoms and signs of calculous cholecystitis be admitted to the hospital for the first time. There they will do all the necessary research within a few days. They will help to figure out what kind of disease the patient has, what his condition is, whether there is a question of urgent surgical intervention.
• Accompanying illnesses. Cholecystitis can develop in parallel with other health problems. For example, in patients with chronic heart failure, diabetes mellitus or other chronic diseases, it can cause an exacerbation and a serious deterioration in the condition. To carefully monitor the course of the disease, it is recommended to put the patient in the hospital. There, if necessary, he will be quickly provided with any assistance.
• Patients with social problems. Hospitalization is recommended for all patients who cannot receive urgent care at home. For example, a patient with chronic cholelithiasis lives very far from the hospital. In the event of an exacerbation, it will not be possible for him to quickly provide qualified assistance ( usually about surgery.). During transportation, serious complications may develop. A similar situation arises with older people who have no one to look after at home. In these cases, it makes sense to operate even a non-acute process. This will prevent an exacerbation of the disease in the future.
• Pregnant women. Calculous cholecystitis in pregnancy carries a higher risk for both mother and fetus. In order to have time to provide assistance, it is recommended to hospitalize the patient.
• Patient's wish. Any patient with chronic cholelithiasis can voluntarily go to the hospital for the surgical removal of gallstones. This is much more profitable than operating on an acute process. Firstly, the risk of complications during surgery and in the postoperative period is reduced. Secondly, the patient himself chooses the time ( vacation, scheduled sick leave, etc.). Thirdly, he deliberately excludes the risk of repeated complications of the disease in the future. The prognosis for such elective operations is much better. Doctors have more time to carefully examine the patient before treatment.

At home, the disease can be treated under the following conditions:

• chronic course of gallstone disease ( no acute symptoms);
• final diagnosis;
• strict adherence to the instructions of a specialist ( regarding prevention and treatment);
• the need for long-term medical treatment ( for example, non-surgical dissolution of stones can take 6 to 18 months);
• the possibility of caring for the patient at home.

Is it possible to play sports with gallstone disease?

One of the important conditions of the preventive regimen is the limitation of physical activity. This is necessary after the discovery of stones, during the acute stage of the disease, as well as during treatment. At the same time, we are talking not only about professional athletes, whose training requires all the strength, but also about everyday physical activity. At each stage of the disease, they can affect the development of events in different ways.

The main reasons for limiting physical activity are:

• Accelerated production of bilirubin. Bilirubin is a natural metabolic product ( metabolism). This substance is formed during the breakdown of hemoglobin - the main component of red blood cells. The more physical activity a person performs, the faster red blood cells break down and the more hemoglobin enters the blood. As a result, the level of bilirubin also rises. This is especially dangerous for people who have bile stasis or a predisposition to the formation of stones. The gallbladder accumulates bile with a high concentration of bilirubin, which gradually crystallizes and forms stones. Thus, people who already have cholestasis ( bile stasis), but the stones have not yet formed, heavy physical activity is not recommended for preventive purposes.
• Movement of stones. If the stones have already formed, then serious loads can lead to their movement. Most often, stones are located in the area of ​​the bottom of the gallbladder. There they can cause a moderate inflammatory process, but do not interfere with the outflow of bile. As a result of physical activity, intra-abdominal pressure rises. This is reflected to some extent in the gallbladder. It is compressed, and the stones can set in motion, moving to the neck of the organ. There, the stone gets stuck at the level of the sphincter or in the bile duct. As a result, a serious inflammatory process develops, and the disease acquires an acute course.
• Progression of symptoms. If the patient already has digestive disorders, pain in the right hypochondrium or other symptoms of gallstone disease, then physical activity can provoke an exacerbation. For example, pain due to inflammation can turn into biliary colic. If the symptoms are caused by the movement of stones and blockage of the bile duct, then they will not disappear after the cessation of exercise. Thus, there is a chance that even a single exercise ( running, jumping, lifting weights, etc.) can lead to urgent hospitalization and surgery. However, we are talking about people who already suffer from a chronic form of the disease, but do not comply with the regimen prescribed by the doctor.
• Risk of complications of gallstone disease. Calculous cholecystitis is almost always accompanied by an inflammatory process. At first, it is caused by mechanical trauma to the mucous membrane. However, many patients also develop an infectious process. As a result, pus may form and accumulate in the bladder cavity. If, under such conditions, intra-abdominal pressure rises sharply or the patient makes a sharp bad turn, the swollen gallbladder may burst. The infection will spread throughout the abdominal cavity, and peritonitis will begin. Thus, sports and physical activity in general can contribute to the development of serious complications.
• Risk of postoperative complications. Acute cholecystitis often has to be treated surgically. There are two main types of operations - open, when an incision is made in the abdominal wall, and endoscopic, when removal occurs through small openings. In both cases, after the operation, any physical activity is contraindicated for some time. With open surgery, healing takes longer, more sutures are placed, and the risk of divergence is higher. With endoscopic removal of the gallbladder, the patient recovers faster. As a rule, full-fledged loads are allowed to be given only 4-6 months after the operation, provided that the doctor does not see other contraindications for this.

• daily walks for 30 - 60 minutes at an average pace;
• gymnastic exercises without sudden movements with limited load on the abdominal press;
• swimming ( not for speed) without diving to great depths.

Is pregnancy dangerous with gallstone disease?

The prevalence of this problem during pregnancy is explained as follows:

• Metabolic changes. As a result of hormonal changes, the metabolism in the body also changes. This can lead to accelerated stone formation.
• Motility changes. Normally, the gallbladder stores bile and contracts, releasing it in small portions. During pregnancy, the rhythm and strength of its contractions are disturbed ( dyskinesia). As a result, bile stasis can develop, which contributes to the formation of stones.
• Increased intra-abdominal pressure. If a woman already had small gallstones, then the growth of the fetus can lead to their movement. This is especially true in the third trimester, when the growing fetus pushes up the stomach, colon, and gallbladder. These organs are compressed. As a result, the stones located near the bottom of the bubble ( at the top of it), can enter the bile duct and block it. This will lead to the development of acute cholecystitis.
• Sedentary lifestyle. Pregnant women often neglect walking or elementary physical exercises, which contribute, among other things, to the normal functioning of the gallbladder. This leads to stagnation of bile and acceleration of the formation of stones.
• Diet change. Changing food preferences can affect the composition of the microflora in the intestine, worsen the motility of the bile ducts. If at the same time the woman had a latent ( asymptomatic) form of gallstone disease, the risk of exacerbation greatly increases.

Exacerbation of gallstone disease during pregnancy is especially dangerous for the following reasons:

• high risk of rupture due to increased intra-abdominal pressure;
• high risk of infectious complications ( including purulent processes) due to weakened immunity;
• fetal intoxication due to the inflammatory process;
• malnutrition of the fetus due to poor digestion ( food is absorbed worse, as bile does not enter the duodenum);
• limited treatment options not all drugs and treatments that are commonly used for gallstone disease are suitable for pregnant women).

In the absence of complications of gallstone disease, the prognosis for the mother and child remains favorable. If the patient turned to a specialist too late, and the inflammatory process began to spread in the abdominal cavity, the question of extracting the fetus by caesarean section may be raised. At the same time, the prognosis worsens somewhat, since we are talking about a technically complex surgical intervention. It is necessary to remove the gallbladder, remove the fetus, carefully examine the abdominal cavity to prevent the development of peritonitis.

What are the types of calculous cholecystitis?

From the point of view of the main manifestations of the disease(clinical form)There are the following types of calculous cholecystitis:

• stone carrier. This form is latent. The disease does not show up. The patient feels great, does not experience any pain in the right hypochondrium, or problems with digestion. However, the stones have already formed. They gradually increase in number and size. This will happen until the accumulated stones begin to disrupt the functioning of the organ. Then the disease will begin to manifest. Stone carriers can be detected during a preventive ultrasound examination. It is more difficult to notice stones on a plain x-ray of the abdomen. When a stone carrier is found, there is no question of an emergency operation. Doctors have time to try other treatments.
• Dyspeptic form. In this form, the disease is manifested by a variety of digestive disorders. It can be difficult to suspect cholecystitis at first, since there are no typical pains in the right hypochondrium. Patients are concerned about heaviness in the stomach, in the epigastrium. Often after a large meal especially fatty foods and alcohol) there is an eructation with a taste of bitterness in the mouth. This is due to violations of bile secretion. Also, patients may have problems with the stool. In this case, an ultrasound examination will help confirm the correct diagnosis.
• biliary colic. In fact, biliary colic is not a form of gallstone disease. This is a common specific symptom. The problem is that in the acute stage of the disease, severe pain attacks often appear ( every day and sometimes more). The effect of antispasmodic drugs is temporary. Gallbladder colic is caused by painful contraction of smooth muscles in the walls of the gallbladder. They are usually observed with large stones, overstretching of the organ, ingress of a stone into the bile duct.
• Chronic recurrent cholecystitis. The recurrent form of the disease is characterized by repeated bouts of cholecystitis. The attack is manifested by severe pain, colic, fever, characteristic changes in blood tests ( increases the level of leukocytes and the erythrocyte sedimentation rate - ESR). Relapses occur when unsuccessful attempts at conservative treatment. Medicines temporarily bring down the inflammatory process, and some medical procedures can temporarily improve the outflow of bile. But as long as there are stones in the gallbladder cavity, the risk of recurrence remains high. Surgery ( cholecystectomy - removal of the gallbladder) solves this problem once and for all.
• Chronic residual cholecystitis. This form is not recognized by all experts. It is sometimes spoken of in cases where an attack of acute cholecystitis has passed. The patient's temperature decreased, and the general condition returned to normal. However, the symptoms remained moderate pain in the right hypochondrium, which is aggravated by palpation ( palpation of this area). Thus, we are not talking about a complete recovery, but about the transition to a special form - residual ( residual) cholecystitis. As a rule, over time, the pain disappears or the disease worsens again, turning into acute cholecystitis.
• angina pectoris form. It is a rare clinical form of calculous cholecystitis. Its difference from others is that the pain from the right hypochondrium spreads to the region of the heart and provokes an attack of angina pectoris. Heart rhythm disturbances and other symptoms of the cardiovascular system may also be observed. This form is more common in patients with chronic ischemic heart disease. Biliary colic in this case plays the role of a kind of "trigger". The problem is that due to an attack of angina pectoris, doctors often do not immediately detect the main problem - the actual calculous cholecystitis.
• Saint's syndrome. It is a very rare and poorly understood genetic disorder. With it, the patient has a tendency to form stones in the gallbladder ( actually calculous cholecystitis), which appears to be due to the absence of certain enzymes. In parallel, diverticulosis of the colon and diaphragmatic hernia are observed. This combination of defects requires a special approach in treatment.

The detection of stones (calculi) in the gallbladder often becomes an unpleasant surprise. After all, their presence indicates the development of cholecystolithiasis or gallstone disease and raises the question of the advisability of a visit to a surgical clinic.

In recent decades, this disease, characteristic of middle-aged and elderly people, has significantly rejuvenated. One fifth of patients with cholecystolithiasis have not yet celebrated their thirtieth birthday.

The resulting stones differ in number (single or multiple), chemical composition (black and brown pigmented, cholesterol, mixed, complex), size and location (they can move from the bladder to the bile ducts).

Symptoms of gallstone disease

In some patients, even large gallstones do not manifest themselves in any way, they usually turn out to be an unexpected finding on x-ray or ultrasound examination for completely different reasons (asymptomatic form). For others, very small calculi significantly complicate everyday life, causing them:

• paroxysmal pains of varying severity (from barely perceptible to intense colic, called biliary) in the right hypochondrium and epigastric zone, sometimes they radiate to the right arm, back or right collarbone;
• bitter taste in the mouth;
• nausea;
• belching bitter or airy;
• vomiting;
• bloating.

Sometimes the disease manifests itself atypically. Instead of the characteristic pains in the abdomen, there are pains in the left side of the chest and behind the sternum, similar to a cardiovascular disease -.

Often, patients themselves note a clear connection between the occurrence of signs of the disease with the use of fatty foods, stress, physical overstrain, or with a trip in transport on a bumpy road.

Long-term presence of stones leads to the fact that they constantly injure the delicate mucous membrane of the gallbladder, causing inflammation - calculous cholecystitis. Its development is accompanied by the appearance of fever, excessive fatigue, loss of appetite. The disease is not infectious, therefore, such patients do not pose an epidemiological danger to the surrounding people.

The reasons

Scientists believe that the process of stone formation is triggered by a combination of the following key conditions:

• oversaturation of bile with calcium, cholesterol or bile pigment - water-insoluble bilirubin;
• the presence of inflammation in the gallbladder;
• a decrease in the contractility of the bladder, accompanied by stagnation of bile.

And the emergence of these conditions, in turn, contribute to:

• female (although the number of sick men is now steadily increasing);
• frequent childbirth;
• taking estrogens - female hormones (including during the IVF procedure);
• burdened heredity;
• cold climate;
• treatment with certain drugs (clofibrate, cyclosporine, octreotide, etc.);
• high-calorie diet with a lack of fiber;
• rapid weight loss;
• some diseases (hemolytic anemia, diabetes mellitus, Crohn's disease, cirrhosis of the liver, Caroli's syndrome, etc.);
• transferred operations (removal of the lower part of the ileum, vagotomy, etc.).

Diagnostic procedures

The transferred attack of biliary colic should be a powerful incentive for a subsequent examination and an indispensable trip to the doctor. After all, 70% of it is repeated. It is better to know your “enemy” and start fighting it faster than to bring the matter to serious complications (empyema - suppuration of the gallbladder, the transition of inflammation to nearby organs, blockage of the bile ducts with stones, secondary biliary cirrhosis, cicatricial changes in the ducts, gallbladder cancer and etc.), requiring the life-saving intervention of a surgeon.

In addition, the symptoms described can occur with more harmless functional disorders (for example, with spasm of the muscular valve - the sphincter of Oddi, located at the very entrance of the common bile duct to the duodenum).

Modern diagnostic studies needed to detect stones in the gallbladder may include:

• a qualified examination of the doctor (when probing the abdomen in special areas and gallbladder points, pain is detected);
• Ultrasound is the main method that detects up to 95% of stones, assessing their location, size, condition of the walls and size of the gallbladder;
• x-ray studies:
  • survey radiography (only calcified stones with calcium inclusions can be seen);
  • cholecystography (allows you to detect radiologically contrasting stones, assess the condition and function of the bladder);
  • computed or magnetic resonance imaging (used in unclear situations);
  • endoultrasound (examination with an endoscopic device with an ultrasonic nozzle clarifies not only the condition of the bladder, but also the ductal system, pancreas, major duodenal papilla);
  • ERCP (excludes stones and other formations in the ducts);
  • hemogram (in case of acute inflammation in the bladder, an increase in leukocytes, their fractions - neutrophils, and an increase in ESR are detected).

Treatment

Identification of stones does not always imply a mandatory operation. But uncontrolled self-treatment in this case is fraught with blockage of the bile ducts and an emergency hit on the operating table to the first available surgeon. Therefore, it is better not to drink liters of dubious cocktails from strictly prohibited choleretic herbs and vegetable oils, which are recommended by some "healers" from the people, but to sign up for a consultation with a gastroenterologist or surgeon.

Treatment of gallbladder stones can be either conservative or surgical.

The complex of drug therapy may include:

• drugs that relieve biliary colic: antispasmodics (no-shpa, papaverine, etc.), non-narcotic (analgin, baralgin, etc.) and narcotic (morphine, etc.) analgesics;
• antibiotics (with the development of cholecystitis - clarithromycin, etc.);
• means for dissolving stones (ursodeoxycholic and chenodeoxycholic acids, but there are strict indications for their appointment, which can only be determined by a qualified specialist).

Taking litholytic (dissolving stones) drugs can lead to complications, so the patient must be under vigilant medical supervision for this entire period (it can last up to 2 years).

Some patients are prescribed extracorporeal shock wave lithotripsy (stone crushing).

Surgical treatment is indispensable for:

• frequent biliary colic;
• "Disabled" (lost contractility) bubble;
• large stones;
• frequent exacerbations;
• complications.

Modern technology helps to remove the bladder without the traditional incision of the abdominal wall (laparotomy) through small punctures (laparoscopic cholecystectomy) in it.

Prevention

Prevention of the formation of gallstones is reduced to the elimination of all possible factors predisposing to the disease (excess weight, unbalanced diet, etc.). To prevent the formation of new stones, litholytic drugs are recommended for most patients after surgery.

Which doctor to contact

If you experience pain in the right hypochondrium or accidental detection of stones, you should contact a gastroenterologist. Conservative treatment includes diet, so consulting a nutritionist is helpful. In some cases, there are indications for surgery. The approach to each patient with cholelithiasis is individual, so there is no point in contacting a specialist remotely, a full personal examination and questioning of the patient is necessary.

Every tenth inhabitant of our planet is diagnosed with stones in the gallbladder. They differ in size. Sometimes there is only one stone in the bubble, but more often there are several of them, and of different shapes. This pathology, as a rule, is detected at the next preventive examination. In this case, the question arises: "A stone in the gallbladder - to remove or not?". It is not possible to give a definite answer to it. Pathology may not manifest itself for a long time, but it is not recommended to start it. The stone can injure the walls of the organ, and the inflammation can spread to other areas. In this article, we will talk in more detail about the causes of this pathology and the methods of treatment offered by modern medicine.

general information

The gallbladder is a small reservoir with liquid contents, which is localized next to the liver. The latter continuously produces bile. It constantly accumulates in the bladder, which, when emptied, throws it into the duodenum. Bile contributes to the active digestion of food. It consists of fairly complex chemicals, as well as cholesterol and bilirubin. With prolonged cholesterol gradually begins to precipitate, and then deposited on the so-called protein scaffolds. Such a process entails the formation of microscopic stones, which over time can increase in size and merge with each other. In this case, we are usually talking about gallstone disease.

The formation of a calculus in the gallbladder is a fairly long process, taking from 5 to about 20 years. Experts distinguish between the following types:

• Cholesterol. They differ in a rounded shape and a small diameter up to 18 mm.
• Lime. They contain a lot of calcium, are extremely rare.
• Mixed. Characterized by a layered structure.

The type of stones depends primarily on human nutrition. For example, in Europe, 90% of all diagnosed gallstones are of a cholesterol nature. In Japan until 1945, calcareous forms predominated. However, over time and with the transition of the Japanese to the "Western" diet, the proportion of cholesterol stones began to grow.

It is noteworthy that on the African continent, this kind of pathology is confirmed extremely rarely, which cannot be said about our country. In Russia, 12 people out of 100 are diagnosed annually with 600,000 people; in the United States, these figures are much higher. In America, about 1.2 million people undergo surgery every year.

The reasons

Under normal conditions, in absolutely healthy people, bile in the bladder is in a liquid state and does not contribute to the formation of stones. However, experts call a number of factors that affect the change in its initial properties. As a result, stones are formed.

• Inflammation of the wall of the sac.
• Metabolic disorders due to hypodynamia, stagnation of bile, diseases of an infectious nature.
• hereditary predisposition.
• Diseases of the liver.
• Food. Due to the use of cholesterol-containing products, the concentration of this substance gradually increases and stones form.
• Diet. Starvation often causes the development of gallstone disease.
• Changes at the hormonal level. An excess of female sex hormones is usually observed during pregnancy, the use of oral contraceptives.
• Age. The body of older people quite often cannot cope with the load on the liver, which leads to the formation of pathology.
• Stress.
• The use of alcoholic beverages.

What are the symptoms of a gallbladder stone?

How to relieve an attack of pain? What medications should be taken for this? Before understanding these issues, it is necessary to tell what kind of signs indicate the formation of stones.

Many people with this pathology are often unaware of it. Symptoms most often appear a few years after the onset of its formation.

Biliary colic appears suddenly. The pain in this case is characterized by a constant character, localized mainly in the region of the right hypochondrium. Spasms can last from 15 minutes to approximately four hours. If after this time the pain discomfort does not go away, inflammation of the gallbladder can be suspected.

Also, patients note the presence of a pronounced dyspeptic syndrome (problems with stools, nausea, bloating). Some people have a fever. This symptom most often indicates the addition of a secondary bacterial infection.

Survey plan

If you have been diagnosed with a stone in the gallbladder, only a qualified specialist can tell you how to treat and what to do next. When primary symptoms appear, it is recommended to seek advice from a gastroenterologist. Diagnosis of this pathology involves a conversation with a doctor, the study of specific complaints of the patient, the collection of anamnesis.

If gallstones are suspected, instrumental diagnostic methods are mandatory. By means of the most common radiograph, it is usually not possible to consider the pathology. Patients are recommended cholecystography, which uses x-rays along with a contrast agent.

Ultrasound is considered an even more accessible diagnostic method. It allows you to identify stones, determine their size and shape, as well as mobility.

What to do if a pathology is detected?

If a gallstone has been diagnosed, treatment methods should be comprehensive. Modern medicine, depending on the nature of the pathology and the severity of the inflammatory process, offers several approaches to therapy:

• Diet (principles of proper nutrition).
• Lifestyle correction (normalization of sleep and rest, physical activity).
• conservative therapy.
• Non-surgical removal of stones.
• Surgical intervention (if, for example, a stone in the gallbladder is 32 mm).

What to do first? All patients without exception with such a diagnosis are advised to reconsider their usual lifestyle. It is necessary to give up all bad habits (smoking, alcohol abuse) and try to adhere to the right lifestyle. Patients should increase physical activity to enhance the burning of fat in the body and the excretion of cholesterol. For these purposes, it is not at all necessary to go to the gym and take on serious exercises. It is quite enough to walk after work, attend yoga classes or exercise therapy.

Let's talk about nutrition

Bile and cholesterol are inextricably linked. This is due to the fact that an excess of these substances can provoke the formation of gallstones. 80% of cholesterol is constantly produced by the liver. The rest comes with food. Cholesterol is extremely important for the synthesis of sex hormones, normal digestion and absorption of vitamins. However, its excess leads to heart attacks. By controlling the level of cholesterol with food, you can avoid the occurrence of such a pathology as a gallstone in the gallbladder.

The diet in this disease is based on a decrease in the intake of animal fats and excessively high-calorie foods. As practice shows, vegetarians practically do not have to face such a problem. Patients with this diagnosis are advised to avoid high-fat animal foods (pork, saturated broths, fried meats, etc.). Smoked meats, canned foods, lard are also banned. The diet should be diversified with vegetables and fruits, lean meat and fish are allowed in small quantities, as well as lactic acid products. The best breakfast is oatmeal on the water with fresh berries or cottage cheese, for lunch you can bake chicken fillet with vegetables, and for dinner you can make a light vegetable salad with fish cutlets. Dishes are steamed or stewed.

Food is recommended to be taken in small portions, but often (4-5 times a day). All those who take a break between meals for more than 14 hours have an increased likelihood of developing this kind of pathology. In addition, the risk group includes women who are constantly losing weight and those who like to refuse a full breakfast. The lack of regular nutrition leads to the fact that a deficiency of certain acids appears in the gastrointestinal tract. Excess cholesterol is not broken down and falls out, that is, a stone is formed in the gallbladder.

The diet involves a complete rejection of alcohol and coffee. Just half a cup of this stimulating drink a day provokes unnecessary and even useless bladder contraction.

As for the fair sex, those ladies who daily include citrus fruits, grains and legumes in their diet are less at risk of developing pathology.

Conservative treatment

Diet alone is usually not enough to resolve a gallstone. How to dissolve it medically? Therapeutic treatment, first of all, should be aimed at reducing unpleasant symptoms. Here we are talking about the so-called biliary colic. The severe pain accompanying it is due to intense muscle spasm in the area of ​​stone localization. In this case, a vicious circle is often observed. The spasm provokes severe pain discomfort. Pain, through a neuro-reflex effect on all surrounding tissues, only intensifies the spasm. In this case, therapy should simultaneously pursue two goals: the removal of spasm and the elimination of pain.

Specialists prescribe various antispasmodic drugs to reduce the pain discomfort that accompanies a gallstone. How to treat pathology, what dosage of the drug to choose, only the doctor decides. As a rule, the attack is removed by an injection of Papaverine or Dibazol. In acute attacks of biliary colic, intramuscular injection of "No-shpy" or "Euphyllin" is recommended. Of course, any of these drugs has its own contraindications, so the choice of one or another drug is carried out only after examining the patient.

Antispasmodics are often administered simultaneously with painkillers. Baralgin is especially effective.

If it is not possible to reduce symptoms with the help of the above drugs, stronger drugs are prescribed in combination (Tramal + Atropine).

Very often, due to nausea, the patient cannot drink the medicine. In this kind of situation, drugs are administered with an enema. As a rule, a combination of "Euphyllin", "Analgin" and belladonna is used.

Medical therapy is also actively used to dissolve the gallstone. How to withdraw it in this case? The calculus can literally be dissolved with the help of drugs ursodeoxycholic (Ursosan, Ursohol, Ursofalk) and chenodeoxycholic acids (Henohol, Chenofalk, Chenodiol).

Who is this treatment suitable for? First of all, the calculi in the gallbladder should be of a cholesterol nature, their size should not exceed 15 mm, and the contractility of the bladder should be normal. The course of treatment usually lasts from 6 to approximately 24 months. At this time, patients are advised to abandon drugs that promote stone formation and interfere with the normal absorption of drug constituents (for example, antacids).

Removal of stones without surgery

For this, shock wave lithotripsy is used - a technique in which a specialist “crushes” a stone in the gallbladder with ultrasound or a laser. The operation to remove the calculus is not suitable for all patients. It is recommended only if the number of stones does not exceed three pieces, they differ in cholesterol nature. Due to the fact that the procedure involves a direct physical impact, it is not suitable for patients with bleeding disorders.

In total, no more than seven therapy sessions are required. Stones are fragmented to particles of about 3 mm, and then independently pass along with bile. In practice, such treatment is usually combined with drug therapy. Common side effects include the following: the development of an inflammatory process.

A laser can also be used to remove a gallstone. The operation to remove the laser is carried out according to the same principle as ultrasound. However, with such a procedure, the likelihood of a burn of the mucous membrane is quite high. That is why its help is resorted to only in exceptional cases.

Surgical intervention

Surgery is highly effective for a problem such as a gallstone. The operation to remove an existing calculus can be carried out in two ways:

• Open cholecystectomy. This is a classic procedure and is recommended for large stones. During the operation, the doctor makes an incision in the abdominal cavity, then removes the gallbladder, drains if necessary. Drainage is the installation of special plastic tubes for the outflow of blood, biological fluids and wound exudate. A couple of days after surgery, the tubes are removed.
• Laparoscopy is now actively used in many areas of medicine. It is necessary to resort to her help with such a pathology as a stone in the gallbladder. The operation to remove stones is distinguished by its low trauma. Initially, the surgeon makes several punctures, through one of which carbon dioxide is supplied directly into the abdominal cavity itself. This is necessary so that the stomach increases in size, and in the resulting space it is easier to carry out manipulations. After that, the laparoscope itself is inserted directly through the trocar. It is a tube with a camera at the end. An optical cable with a light source can be attached to it. Such a device allows you to examine the organs from the inside, as the picture from the laparoscope is displayed on the computer screen. Micromanipulators are inserted through the remaining trocars to perform the operation itself.

Today, specialists, choosing from the options proposed above, most often give preference to the second. Laparoscopy is recommended if the gallstone is 2 cm. This type of operation has many advantages. These include the following: rapid recovery, no postoperative scarring, little blood loss.