A common pathology characterized by the formation of stones in the gallbladder or bile ducts is called. The formation of stones can be caused by the deposition of bile pigments, cholesterol, calcium salts, as well as lipid metabolism disorders. The disease is accompanied by pain in the right hypochondrium, biliary colic, and jaundice.

According to statistics, the disease occurs in approximately 13% of the adult population of the planet. The disease can develop in both men and women, but among representatives of the fair half of society it occurs twice as often.

The leading cause of pathology is the formation of stones due to lipid metabolism disorders. In addition, the occurrence of the disease may be due to:

• unbalanced diet, abuse of fatty foods;
• hormonal imbalance;
• inactive lifestyle;
• anomalies that occur in the gallbladder;
• various liver lesions;
• spinal injuries;
• pregnancy;
• fasting;
• genetic predisposition;
• presence of diabetes mellitus;
• diseases of the small intestine.

Women are more susceptible to the disease. This is explained by the technique contraception, pregnancy and childbirth. Moreover, the disease is more often diagnosed in older people. The highest incidence is observed among the Japanese and Indians.

Symptoms of the disease

There are stones made from cholesterol, bile pigments and mixed ones.

• An increase in unconjugated bilirubin is the cause of the formation of stones from bile pigments. They contain calcium salts and bilirubin.
• As for pigmented stones, they are small in size, often up to 10 mm and black or grayish in color.
• The composition of cholesterol stones: insoluble cholesterol and various impurities. There are both single and multiple. They are black or grey.
• Mixed stones are most common. They contain: cholesterol, calcium salts and bilirubin. They are yellowish-brown and always multiple.

Symptoms of the pathology do not appear immediately in more than 60% of cases. Gallstone disease can be asymptomatic for several years.

Gallstones are usually detected accidentally during an ultrasound examination. Symptoms can only appear if stones move through the cystic canal, which provokes blockage and the development of an inflammatory process.

Signs to watch out for

Since the pathology practically does not manifest itself over a long period, it is important to respond in a timely manner to signs that may indicate the presence of stones in the gallbladder. Often, we don’t particularly react to the appearance of heaviness in the stomach; we attribute it to a heavy dinner. Do not underestimate this sensation, as it can signal urolithiasis.

In addition, the first manifestations of pathology include: discomfort and pain after a meal, nausea, heartburn, vomiting, diarrhea or constipation, yellowness of the sclera and skin.

A lot of time passes from the moment stones begin to form until the first manifestations of pathology. According to some studies, the average duration of the asymptomatic course of the disease is ten years. If there is a predisposition to stone formation, this period may be reduced to several years.

For some, the formation of stones, on the contrary, is very slow - they grow throughout life and this does not manifest itself at all. Such stones are often discovered after death.

It is difficult for pathologists to establish an accurate diagnosis based on the first manifestations. The appearance of nausea, vomiting and stool disturbances may accompany other gastrointestinal ailments. To clarify the diagnosis, an ultrasound examination of the abdominal cavity is prescribed. It is with its help that one can detect both an increase in the size of the gall bladder and the presence of stones in its cavity.

Stages

There are several stages of cholelithiasis: the stage of disturbance of the physicochemical properties of bile, latent or hidden, and the stage of the appearance of symptoms of the disease.

The first stage practically does not manifest itself at all. The diagnosis is established only by examining bile. Crystals or “snowflakes” of cholesterol are found in it. When conducting biochemical analysis There is an increase in cholesterol content and a decrease in concentration bile acids.

The second stage also does not manifest itself in any way. But at this stage there are already stones in the gallbladder. The diagnosis can be made using ultrasound. Symptoms, in particular biliary colic, appear only at the last stage. At this stage, there are complaints of strong, paroxysmal or sharp pains. The duration of the painful syndrome is from two to six hours. The attack usually occurs in the evening.

The patient complains of pain in the right hypochondrium, spreading to the right cervical region. Often pain syndrome occurs after eating fatty, spicy foods, as well as after physical exercise.

The appearance of pain can also be caused by the consumption of carbonated drinks, eggs, cream, alcoholic drinks, and cakes. In addition to pain in the right hypochondrium, there may be complaints of increased temperature, chills, and increased sweating.

Ignoring the symptoms of gallstone disease is fraught with the development of the last stage or stage of complications.

What are the complications of gallstone disease? Lack of therapy is fraught with the development of serious diseases: acute cholecystitis, hydrocele of the gallbladder, perforation or rupture of the gallbladder, liver abscess, gallbladder cancer, empyema, reactive hepatitis, acute cholangitis, biliary fistulas, paravesical abscess, cicatricial strictures, secondary biliary cirrhosis.

Help with an attack of biliary colic

If severe pain appears in the right hypochondrium, chills, fever, subtle bloating and arrhythmia, measures must be taken. The attack itself lasts, as a rule, half an hour, after which the pain becomes aching. After about three hours, the pain goes away.

The occurrence of an attack is provoked by stones that move along the bile ducts into the intestines. It is the size of the stones that determines the intensity of the pain.

Often, to relieve pain, the administration of M-anticholinergic blockers (help eliminate spasms) is prescribed - Atropine 0.1% - 1 ml IM or Platifillin 2% - 1 ml IM.

If anticholinergic drugs are ineffective, antispasmodics are used. In this case, intramuscular administration of Papaverine 2% - 2 ml or Drotaverine (No-shpy) 2% - 2 ml is prescribed.

Baralgin or Pentalgin 5 ml IM is prescribed as a pain reliever. If the pain is severe and cannot be relieved by anything, use Promedol 2% - 1 ml.

How to diagnose cholelithiasis?

In order to identify pathology, in addition to questioning, examination, palpation of the abdomen and blood sampling for general and biochemical blood tests, the following is prescribed:

• ultrasound examination;
• radiography;
• cholecystography;
• computed tomography;
• endoscopic cholangiopancreatography.

Features of treatment

Treatment of pathology involves preventing the movement of stones, litholytic therapy (crushing stones), as well as normalizing metabolic processes. The main direction of treatment for the asymptomatic stage of the disease is diet.

What should the diet be like? You need to eat food in small portions, at least five times a day. The temperature of cold dishes is 15 degrees (not lower), and hot dishes are not higher than 62 degrees Celsius.

Patients are prohibited from consuming: alcoholic beverages, legumes, fatty and spicy foods, dairy products (cream, fat milk, sour cream), fatty varieties meat and fish, canned food, mushrooms, freshly baked bread, spices, coffee, chocolate, strong tea.

It is allowed to eat low-fat cheeses, dried bread, baked vegetables (potatoes, carrots), fresh vegetables (tomatoes, cucumbers, cabbage, green onions, parsley), low-fat varieties meat (veal, rabbit, beef, chicken) stewed or boiled, cereals, noodles, sweet ripe berries and fruits, compotes, low-fat yoghurts and low-fat cottage cheese.

Drug dissolution of stones

Drug therapy for the disease is effective in the following cases: if the stones consist of cholesterol, if they do not exceed five millimeters, if the patient is not obese and the age of the stones does not exceed three years. In order to dissolve the stones, the use of Ursofalk or Ursosan is prescribed - 8-13 mg per kilogram of body weight per day. The average duration of a therapeutic course is a year.

Surgery for gallstone disease

The operation is performed if the stones are large and also in cases where drug therapy has not brought positive results. The main types of cholecystectomy (surgery to remove the gallbladder) include:

• standard cholecystectomy;
• laparoscopic cholecystectomy.

The first method has been used for a long time. It is based on abdominal surgery(with an open abdominal cavity). However, in Lately it is used less and less. This is due to frequent postoperative complications.

The laparoscopic technique is based on the use of a special device – a laparoscope. This method is much more effective than the first. Laparoscopic cholecystectomy does not require large incisions. In addition, small scars remain after the operation. Another advantage of such an operation is the rapid restoration of performance. And most importantly, complications after surgery are rare.

Useful information in the article "."

How to carry out prevention?

In order to prevent the development of this pathology, it is recommended to lead an active and healthy lifestyle, eat right, play sports, and stop drinking alcohol and smoking.

To understand what diet is necessary for non-surgical treatment of gallstone disease, it is important to know the features and causes of the disease.

What is cholelithiasis

As a result of a failure of metabolic processes in the body, stones (calculi) form, which can be located in the gallbladder or in its ducts.

Provoking factors are:

1. Stagnation of bile, which occurs due to decreased motility and weak contraction of the gallbladder,
2. The composition of bile, which changes as a result of inflammatory diseases and consumption of foods rich in cholesterol.

In size and shape, stones can range from small crystals to concretions of more than two centimeters.

Gallstone disease - diet

According to their composition, stones are divided into:

1. Cholesterol - formed when excess cholesterol appears in the bile, have yellow and small size. Characteristic of 90% of people with gallstone disease.
2. Bilirubin - formed against the background of liver disease or destruction of blood cells, have a dark brown color. They can be found in the gallbladder and bile ducts; they occur in 5% of patients.
3. Calcium - arise as a result of the action of bacteria that destroy protein and amino acids. A precipitate consisting of calcium salts is formed. Stones Brown, are more often located in the biliary tract, occurring in 3% of patients.
4. Mixed.

The prescription of treatment with or without surgery will depend on the severity of the disease, the size of the stones and their number in the patient.

The development of cholelithiasis is caused by:

• errors in nutrition (lack of diet), non-compliance with food intake, overeating, fasting, predominance of refined and fatty foods in the diet, excessive consumption of alcoholic beverages;
• lack of physical activity, sedentary work;
• congenital disorders of the structure of internal organs, as well as heredity;
• diseases leading to hormonal imbalance ( diabetes, thyroid disease), pregnancy;
• inflammatory diseases of internal organs involved in the formation and excretion of bile.

How does gallstone disease manifest?

During crystal fallout and primary education gallstone disease does not manifest itself in any way.

Manifestation of cholelithiasis

The first symptoms appear when the formed stones begin to irritate the gallbladder from the inside and interfere with the outflow of its contents:

• sudden sharp pain due to colic, or It's a dull pain under the rib, with right side, which can radiate to the back and shoulder blade, and passes within a short time;
• feeling of nausea, vomiting (with colic), feeling of bitterness, heartburn;
• flatulence, diarrhea;
• slight increase in temperature,

Important to remember! In the absence of treatment, in case of errors in nutrition (diet), as well as without necessary operation gallstone disease leads to serious health problems which can be fatal. For example, intestinal obstruction, obstructive jaundice, cirrhosis of the liver, rupture of the bile duct, rupture of the walls of the bladder itself, bleeding, cancer.

How to treat gallstone disease without surgery

Surgical intervention for cholelithiasis is indicated when large cluster stones, or with single stones larger than 2 cm. In this situation, the gallbladder is completely removed, which promotes recovery in 95% of patients.

In other cases, treatment without surgery is possible:

1. Hardware treatment. For a small number of stones less than 2 cm in size, it is possible to use ultrasound or electromagnetic waves. Using appropriate equipment, a shock wave is directed at the stones, which deforms and causes their destruction. The resulting small fragments are excreted in bile. For the best effect, bile acid preparations are prescribed in parallel. The lithotripsy procedure is painless.
2. Drug treatment. If there are cholesterol stones less than 2 cm in size, they may dissolve when taking medications orally. These include drugs containing ursodeoxycholic and chenodeoxycholic acids. The course of treatment is a year or more. Tablets are taken in a daily dose of 15 mg/kg in 2-3 doses, always as prescribed by a doctor, as they have a number of contraindications.
3. Not drug treatment.

As additional measures treatment with mineral water is used. It can be carried out at home or at resorts, but only as prescribed by a doctor. Low mineralization water promotes the formation of bile, improves its composition, and reduces cholesterol levels.

Water of medium mineralization has a choleretic effect, which has a positive effect on blood circulation and the functioning of liver cells. The course of treatment is about three weeks.

in the presence of a disease such as cholelithiasis, treatment without surgery is possible, but in this case diet is a prerequisite for recovery

Need to take one glass of mineral water three times a day, warm (42-45°C). For a stomach with low acidity, take water 10-20 minutes before meals, with high acidity take it 1.5 hours before meals, with normal acidity take it an hour before meals. Several courses of treatment with water rich in minerals can be carried out per year.

In any case, in the presence of a disease such as cholelithiasis, treatment without surgery is possible, but in this case, diet is a prerequisite for recovery. Mostly assign table number 5, the doctor can adjust the consumption of certain products depending on the severity of the disease.

Cholelithiasis. Treatment without surgery with special diets

When treating cholelithiasis with diet you need to eat often and in small portions. This technique causes a constant outflow of bile, eliminates its stagnation and the formation of new stones, reduces the symptoms of the disease, and makes it possible to carry out treatment without surgery.

A diet balanced in fats, proteins and carbohydrates allows you to normalize the composition of bile. An attack of severe pain can be caused by eating too hot or, conversely, too cold food, so it is necessary to take it in a warm, comfortable form for the stomach.

Be sure to chew thoroughly. Avoiding late dinners and not having food in your stomach before bed helps you avoid pain. Organize a weekly fasting day. The amount of liquid you drink should be sufficient, about eight glasses a day.

The diet involves excluding the following foods from the diet:

What foods are not harmful for cholelithiasis?

Cooking methods are boiling, baking, sometimes stewing. Broth for soups should be based on vegetables. Excessive salt consumption is unacceptable. Products must be thoroughly chopped or pureed.

The diet should include a variety of cereals

• meat (lean chicken, rabbit, lean beef, etc.),
• lean river fish, squid,
• various porridges (buckwheat, barley, oatmeal, rice, millet),
• black bread (preferably dried), crackers,
• dairy products (cottage cheese, cheese, kefir), limited butter,
• egg, several times a week,
• various vegetable oils,
• vegetables, fruits, dried fruits.
• fruit compotes.

Menu for the day

Note! When severe pain occurs, when cholelithiasis worsens, It is recommended to drink water and other liquids for several days. Refusal to eat allows the gallbladder to restore its function and rest without stress.

The components of the dishes on the menu can be changed, subject to the basic principles of the diet

It is necessary to contact a doctor who will prescribe treatment and exclude surgery. After three days, you can switch to a special gentle diet.

Menu for the day:

• Breakfast. Porridge cooked with milk (semolina, oatmeal or buckwheat), with the addition of olive oil, weak tea (can be with milk).
• Lunch. Dishes made from cottage cheese (for example, pudding), non-acidic fruits.
• Dinner. The first is any soup with vegetable broth (rassolnik, borscht) or milk soup. The second is lean meat (beef stroganoff, meatballs), vegetable side dish (mashed potatoes, stewed zucchini). Third - dried fruit compote or fruit jelly.
• Afternoon snack. Weak tea, insipid biscuits (biscuits), crackers, crispbread.
• Dinner. Steamed fish, vegetable cutlets (carrot, carrot-apple), tea.
• Second dinner. A glass of kefir, preferably drunk two hours before bedtime.

This kind of food must be preserved long time, up to two years. The components of the dishes on the menu can be changed, subject to the basic principles of the diet.

Traditional methods of treatment for cholelithiasis

The use of folk remedies is an auxiliary method that cannot completely replace therapeutic methods of treatment. The course of taking tinctures and decoctions must be long in order to achieve the desired effect.

It is also possible to treat cholelithiasis without surgery through diet and following all doctor’s recommendations. Many herbs have a number of contraindications; their use must be approved by a doctor.

Dandelion roots are an excellent choleretic agent.

To prepare infusions and decoctions, herbs and herbs are used that have already proven themselves and give positive results.

As a choleretic agent A collection of equal parts of chaga and dandelion roots is used. The components are crushed, then two teaspoons of raw materials are poured with boiling water (2 cups). Infusion time is three hours. It should be taken during an exacerbation, half an hour before meals, up to four times a day, a tablespoon.

In case of chronic disease It is beneficial to take chaga oil. It is obtained using olive oil. Begin to take half a teaspoon once a day, over time increasing the single dose to 4 tablespoons. The course of treatment is alternated with breaks.

An effective remedy is decoction made from dill seeds. To prepare it, take two tablespoons of raw materials and fill them with two glasses of water. It is necessary to bring the broth to a boil in a water bath and leave for 15 minutes. After cooling, strain through cheesecloth and serve warm. The course of administration is four times a day, for three weeks, half a glass.

This disease can be asymptomatic for a long time.

Sunflower roots are also widely used as a folk remedy.. A full course of treatment requires seven glasses of crushed roots.

First, one glass of prepared roots is boiled for five minutes in three liters of water. The broth is cooled, it should be stored in a cool place, use one liter per day.

After three days, the remaining roots from the decoction are again boiled in three liters of water, but for ten minutes. Then after three days they are boiled for twenty minutes. After nine days of use, the sunflower roots are replaced with new raw materials. Thus, treatment takes about two months.

Important to remember! This disease can be asymptomatic for a long time. It can manifest itself unexpectedly with attacks of acute pain, or it can be discovered during examination of other organs.

In people diagnosed with cholelithiasis, treatment without surgery is allowed. Diet, folk remedies and moderate physical activity can cope with the disease, provided it is detected in the early stages.

What foods are prohibited for cholelithiasis, what is possible and what is not allowed, the associate professor explains:

Who is at risk and what can cholelithiasis lead to:

Is it possible to get rid of cholelithiasis without surgery and what needs to be done for this:

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Treatment of cholelithiasis

Causes of gallstone disease

A disease in which stones form in the gallbladder and its ducts. The formation of stones most often occurs in the bladder itself and much less often in the ducts and bladder at the same time. This is a disease of the digestive system of an metabolic nature, characterized by the formation of stones in the hepatic bile ducts (intrahepatic cholelithiasis), in the common bile duct (choledocholithiasis) or in the gallbladder (cholecystolithiasis).

Gallstone disease is a fairly common disease, it is found in 20% of all autopsies in Europe, and after 40 years this figure reaches 25%, and after 70 years - 50%. This pathology is more common in women than in men.

In case of cholelithiasis, caused by a violation of the metabolism of cholesterol and bile acids, cholesterol stones are formed; In the event of a violation of the metabolism of bilirubin, pigment or bilirubin stones are formed, which consist mainly of calcium bilirubinate. Less commonly, stones form from calcium carbonate or phosphorus.

Classification of cholelithiasis

• gallstones with acute cholecystitis;
• gallstones with chronic cholecystitis;
• gallstones without cholecystitis (cholecystolithiasis);
• common bile duct stones with cholangitis;
• common bile duct stones with cholecystitis;
• common bile duct stones without cholangitis and cholecystitis.

Stages:

• I - physical and chemical;
• II - stage of latent stone bearing;
• III - stage clinical manifestations(calculous cholecystitis).

The role of bile acids in the body is multifaceted. The most important properties of cholates:

• bactericidal effect (in bile, which contains sufficient quantity bile acids, no microorganisms) ;
• stimulation of intestinal peristalsis (in in case of reduction in the bile level of cholates, obstipation syndrome develops with prolonged constipation);
• emulsification of fats, in case of insufficiency they develop steatorrhea;
• stimulation fermentovir functions of the pancreas (in case of insufficient supply of enzymes to the intestines, exocrine pancreatic failure) ;
• stabilization of bile, due to insufficient content of bile cholates, cholesterol crystallization and stone formation occur;
• stimulation of choleresis.

During meals, the secretion of bile acids increases; bile is not sufficiently saturated with cholesterol. At night , when it happens cholesterol synthesis, its content in bile increases, and bile acids decrease, which stimulates the development of cholelithiasis. In some cases education lithogenic bile may be due to increased secretion of cholesterol, which is observed in obesity and metabolic syndrome. Genetic background also matters. poor nutrition, disorder of the hepatic-intestinal circulation of bile components.

Causes of gallstone disease:

• bile stagnation
• obesity
• metabolic disease
• infectious diseases
• pregnancy
• hormonal disorders
• sedentary lifestyle
• reception oral contraceptives

Symptoms of gallstone disease:

• pain in the right hypochondrium
• bitterness in the mouth
• nausea
• belching
• heartburn
• flatulence
• vomit
• jaundice (rare)

Stones that are contained at the bottom of the gallbladder (silent zone) do not create an obvious clinical picture until they enter the neck, cystic duct, or inflammation occurs. A stone in the neck of the gallbladder occupies its outlet and thereby causes the development of biliary and hepatic colic. Cervical obstruction may be temporary if the stone returns to the gallbladder. A stone of 0.5 cm can pass into the duodenum and be excreted from the body in feces. However, remaining in the common bile duct, it causes mechanical or obstructive jaundice.

In this case, the bile is always infected and cholelithiasis is accompanied by inflammation of the mucous membranes of the biliary tract.

The main sign of stone migration is pain. It is more typical for exacerbation of chronic calculous cholecystitis. This is biliary (liver) colic. An attack of colic is provoked by fatty foods, spicy seasonings, salted and pickled foods, sudden physical activity, infections, negative emotions, menstruation.

The pain often occurs suddenly, at night, is localized in the right upper quadrant of the abdomen, less often in the epigastric region, and is characterized by irradiation to the right scapula and subscapularis. Sometimes the pain radiates to the sacrum, the region of the heart, provoking an attack of angina. The pain is caused not so much by mechanical irritation of the mucous membrane and inflammation of the gallbladder, but by overstretching of its walls due to increased intravesical pressure and spastic contraction of the bladder sphincter. Less commonly, the pain can be dull, constant, periodic, and often accompanied by nausea and vomiting, which does not bring relief.

During an attack of pain, the abdomen is swollen, the anterior abdominal wall is tense, especially in the projection of the gallbladder. In older people, tension in the anterior abdominal wall and pain may not be present.

Characterized by sharp pain on palpation of the abdomen in the right hypochondrium. As the pain decreases, it is possible to palpate the painful liver and enlarged gall bladder.

How to treat cholelithiasis?

It is carried out both by medication and by surgery. Therapeutic and preventive measures for gallstone disease depend on the stage of the disease:

• Stages I and II are a therapeutic problem (as is chronic acalculous cholecystitis),
• at stage III it is required surgical intervention.

If there are no indications for surgical intervention, then specialists usually resort to conservative treatment. This treatment is based on the use of drugs based on ursodeoxycholic acid, with the help of which the stones dissolve. Treatment medications also includes drugs that normalize the function of the bile ducts and duodenum, and drugs aimed at reducing inflammation in the mucous membrane and suppressing pathogenic flora.

In stage I, the patient is prescribed a general hygienic regime, systematic physical activity, rational split meals (diet No. 5), and adequate correction of functional disorders of the digestive system is necessary.

Drug treatment should be aimed at stimulating the synthesis and secretion of bile acids (cholates) and inhibiting cholesterol synthesis. To achieve the first goal, phenobarbital and zigsorine are recommended. Usually, after this, the biochemical composition of bile improves: the cholate content increases, the cholesterol content decreases (the cholate-cholesterol index is normalized). Lyobil can be added to this complex.

In stage II, patients are shown drugs of ursodeoxycholic acid - ursofalk, ursosan. The drugs help break down stones and restore the physical and chemical composition of bile. This therapy is indicated for patients with serious concomitant pathologies, those for whom surgical intervention is at high risk (with ischemic heart disease, arterial hypertension, diabetes mellitus, chronic pulmonary heart disease, chronic obstructive pulmonary diseases, etc.).

In stage III, treatment is usually surgical. Open or, more often, laparoscopic cholecystectomy is used. Today, to remove stones from the bile ducts, the technique of endoscopic retrograde cholepancreatoscopy is used, during which, if necessary, sphincterotomy and stone extraction from the common bile duct are performed. If the stone cannot be removed, then this is done by percutaneous choledochotomy.

Indications for surgical intervention:

• absolute:
  • acute cholecystitis and other surgical complications;
  • frequent recurrent biliary colic;
  • non-functioning (“disabled”) gallbladder;
  • choledocholithiasis;
  • pancreatitis;
  • suspected gallbladder cancer;
• relative:
  • chronic calculous cholecystitis with symptoms;
  • contraindications to drug litholysis.

Contraindications for conservative treatment of cholelithiasis:

• complications of gallstone disease, including acute and chronic cholecystitis;
• the gallbladder is “disabled”;
• frequent relapses of biliary colic;
• pregnancy;
• severe obesity;
• concomitant diseases (peptic ulcer, chronic pancreatitis, diabetes mellitus, Crohn's disease, ulcerative colitis);
• chronic diarrhea;
• gallbladder cancer (suspected);
• pigmented or calcified stones;
• any common bile duct stones larger than 15 mm;
• multiple stones occupying more than 50% of the gallbladder lumen;
• inability to take medications for a long time (6-24 months).

Surgical treatment lasts 4-10 days (depending on the type of operation - open or
laparoscopic cholecystectomy), drug litholysis lasts on average 12-18 months.
Treatment effectiveness criteria:

• splitting of stones (in the case of drug litholysis or shock wave lithotripsy),
• elimination of symptoms of cholelithiasis (after cholecystectomy),
• no complications of cholelithiasis.

Another direction in the treatment of patients is shock wave lithotripsy. Shock wave therapy (cholelithotripsy) is performed for a small number of stones and a functioning gallbladder. The stones are crushed into small elements and excreted in the feces. The procedure is performed under general anesthesia or spinal anesthesia. However, 35% of patients after such an intervention develop transient biliary colic, and 2% develop pancreatitis. Before and after such therapy, therapy with ursodeoxycholic acid is also indicated. After successful lithotripsy, ursodeoxycholic acid is prescribed at a dose of 500-750 mg per day for a year. Without maintenance therapy with ursodoxycholic acid, 50% of patients experience recurrence of gallstones over the next 5 years.

TO conservative methods Treatments also include diet and physical therapy. Physiotherapy uses UHF, diathermy, and inductometry. However, these procedures can only be performed in the absence of symptoms of exacerbation.

What diseases can it be associated with?

Treatment of gallstone disease at home

A clinical examination is necessary once a year; after successful drug litholysis, ultrasound monitoring of relapse is indicated gallstones Once every 6 months, in case of relapse - re-treatment.

Treatment of cholelithiasis at home involves following all medical instructions. Particular attention should be paid to diet, eat small and frequent meals, and avoid long periods of fasting. Eliminate fatty, cholesterol-rich foods, eat more fruits, vegetables and foods rich in fiber. Drink a lot of juices and mineral waters. Frequent visits to the bathhouse are also recommended.

Moderate physical activity is required to prevent bile stagnation.

Sanatorium-resort treatment is indicated for stable remission - in Morshyn, Truskavets, Mirgorod, Kuyalnik and Transcarpathia.

What drugs are used to treat cholelithiasis?

• - 2 capsules 3 times a day for 2 weeks.
• - 120-240 mg in 2-3 doses.
• - 480 mg 2 times a day, duration of treatment - 5-14 days.
• - 250-500 mg at a time, interval between doses is 6 hours.
• - at a dose of 200 mg per day (50 mg in the morning and at lunch and 100 mg in the evening), the course of treatment is from 3 to 6 weeks.
• Zixorin - 300-500 mg per day (100 mg in the morning and 200-300 mg in the evening), course of treatment - 3-6 weeks.
• - 400-600 mg 3 times a day after eating, for 3-4 weeks.
• or - at a dose of 8-12 mg/kg; if cholesterol stones are no more than 15 mm and preserved contractile function gallbladder, then they are recommended to be consumed 2 times a day (for example, 500 mg in the morning and 250 mg in the evening); the course of treatment is 6-18-24 months.

Treatment of gallstone disease with traditional methods

Folk recipes treatment of cholelithiasis effectively prevent bile stagnation. Before using any of the recipes, you should consult with your doctor so as not to aggravate the disease.

Depending on the size and number of stones, drinking a variety of vegetable juices may help reduce them. It can be beetroot, cucumber, carrot or pumpkin juice. You need to drink half a glass 2-3 times a day.

• Lingonberry leaves: pour a glass of boiling water over 1 tablespoon of leaves, leave for 30 minutes and strain. Take 4 times a day, two tablespoons.
• Olive oil: take for 3 weeks 30 minutes before meals.
• Oats: pour 1 cup of oats with one liter of boiling water and cook over low heat until ¼ of the liquid has evaporated. Take this infusion 1 glass 3 times a day.
• Dill: 2 tbsp. pour dill seeds with 2 cups of boiling water, bring to a boil, leave for no more than 5 minutes and strain. Drink the infusion little by little throughout the day.
• Black radish juice with honey: mix juice and honey in equal proportions. Take 3 tablespoons once a day.

Traditional medicine recommends the following herbs for gallstone disease: horsetail, immortelle, mint, fennel, wormwood, meadow geranium, calamus. You can brew herbs either individually or mix several types.;

total bilirubin and its fractions;

ALT, AST, basic phosphatase, glutamyl transpeptidase;

total cholesterol and LDL cholesterol triadylglycerols, beta - lipoproteins , HDL cholesterol ;

general urinalysis, coprogram;

blood type, Rh factor.

To clarify the diagnosis, use X-ray, ultrasonic, thermographic And laparoscopic research methods.

On a plain X-ray of the abdominal organs, it is sometimes possible to see a shadow of stones in the gall bladder or a shadow of an enlarged gall bladder, limited swelling of intestinal loops in the right half of the abdominal cavity, limited mobility right dome of the diaphragm. Application cholecystography or cholecystocholangiography in the acute phase of chronic cholecystitis is usually non-informative. More data is provided by sonography of the liver, biliary tract, and gallbladder.

Treatment of other diseases starting with the letter - g

The information is for educational purposes only. Do not self-medicate; For all questions regarding the definition of the disease and methods of its treatment, consult your doctor. EUROLAB is not responsible for the consequences caused by the use of information posted on the portal.

- This pathological process, in which the gallbladder and ducts form stones (stones ). Due to the formation of gallstones, the patient develops gallstones.

In order to understand the nature of gallstone disease, it is necessary, first of all, to understand how formation and transportation occur . Human liver cells produce from 500 ml to 1 liter of bile every day. Bile is required for food processing, especially .

Bile from the liver (from the bile capillaries) first ends up in the hepatic ducts, after which it enters the duodenum through the common hepatic bile duct. The process of passage of bile into the duodenum from this duct occurs with the help of a muscle called “ sphincter of Oddi " If the duodenum is empty, the sphincter closes and bile flows. IN in this case Stretching of the gallbladder may occur. There may be an accumulation of bile in it, which can be stored there for a long time.

Features of gallstones

Gallstones (stones ) are the main manifestation of gallstone disease. These formations consist of bile components: the stone contains , calcium , . The size of the stones can vary: they can be the size of grains of sand, or they can be large formations, several centimeters in diameter. A stone grows over a certain time: for example, from the size of a grain of sand in six months a stone can grow up to 1 cm. Stones have different shapes: there are oval, rounded stones, formations in the form of a polyhedron, etc. The strength of stones also varies: there are both very strong stones and fragile ones that crumble when touched. Cracks and thorns are sometimes observed on the surface of stones, but it can also be smooth. The most common stones are in the gall bladder. This condition is usually called cholelithiasis or calculosis gallbladder. In more rare cases, a person develops choledocholithiasis , that is, stones appear in the bile ducts of the liver. Stones form in the bile ducts either one at a time or several dozen at a time. Sometimes their number is in the hundreds. But even one stone can provoke a serious complication of the disease. In this case, small stones are considered more dangerous.

Causes of gallstone disease

Today there is no single accurate theory that would explain the cause and process of the appearance of gallstones. The most likely causes of this disease are considered to be disturbances in the body's metabolic processes, inflammation that occurs in the area of ​​the gallbladder wall, congestion in the bile ducts, as well as other phenomena. As a rule, the main reasons why a person develops symptoms of gallstone disease are an unhealthy lifestyle in general and poor nutrition in particular. Other factors are also important: insufficient activity, overeating or irregular eating, sedentary work can provoke the development of gallstone disease. In women, the disease occurs more often than in men, and women who have had several births are most susceptible to cholelithiasis.

Symptoms of gallstone disease

Due to the likelihood of stagnation in the gallbladder, this is where stones form most often. In some cases, symptoms of gallstone disease do not appear for a long period of time after the stones have formed. Stones sometimes do not affect the function of the gallbladder, so a person may not even suspect that he has stones.

However, very often stones that appear in the gallbladder provoke spasms or cause expansion of the gallbladder. In this case, the symptoms of cholelithiasis are manifested by painful attacks. The pain, which is localized under the right costal arch, can be short-lived or long-lasting, with pain varying in intensity. If the inflammatory process in the wall of the gallbladder does not manifest itself, then the pain may disappear without any consequences. In this case, such phenomena are usually called hepatic or biliary. colic .

With cholelithiasis, pain sometimes radiates to the area of ​​the shoulder blades, especially under the right shoulder blade. Sometimes the pain radiates to the heart area. At the same time, it sometimes appears : The rhythm of heart contractions is disrupted. Pain often appears after a person has eaten something spicy or fatty. To digest such foods, bile is needed, therefore, contractions of the gallbladder occur. Sometimes vomiting may occur.

If there is acute inflammation gallbladder, the pain may continue without subsiding for several days or even weeks. The temperature sometimes rises a little. It is important to consider that some subsidence of pain is not always a sign that inflammation is subsiding. We can talk about the cessation of the inflammatory process only when the pain is completely absent for several days, and at the same time the person’s body temperature normalizes.

If there is chronic inflammation, then pain in the right hypochondrium appears periodically, it can be both severe and aching. The person also feels discomfort in this area.

When developing as a consequence of the disease, the symptoms of gallstone disease are complemented by the manifestation of strong pain in the upper abdomen, near the navel. Sometimes the pain may radiate to the lower back, and the patient also experiences frequent vomiting.

Diagnosis of cholelithiasis

The main research method in the process of diagnosing cholelithiasis is ultrasonography abdominal cavity. The patient is also prescribed cholangiography , cholecystography . The ultrasound method has significantly improved the accuracy of diagnosis. It is very important that this study is carried out by a specialist who has experience in identifying such diseases and their characteristics. So, it happens that the contents of the intestine and other anatomical structures are mistaken for stones. There is a possibility that stones will not be detected during the examination; it is especially difficult to determine their presence in the bile ducts.

Treatment of cholelithiasis

Today, treatment of gallstone disease often consists of cholecystectomy , that is, removal of the gallbladder in which stones are found. Removal of the gallbladder does not have a decisive effect on human life.

If the stones are freely located in the cavity of the gallbladder and they consist exclusively of cholesterol, and their size does not exceed 2 cm, then sometimes the stones are dissolved. This procedure is performed using chenodeoxycholic And ursodeoxycholic acids It is important to take into account that in this case the treatment lasts at least a year, and very often after some time the fireplaces re-form in patients. However, the method can be quite effective. Stones are also destroyed using the power of a special wave created by special generators. In this case, it is important that the stones contain only cholesterol, their number does not exceed three, and their size is no more than two centimeters. There are also a number of contraindications for this method of treatment: inflammation of the gallbladder, pancreas, liver, , abdominal vessels, etc.

Today, cholelithiasis is also treated using a method called laparoscopic cholecystectomy. Such surgical intervention is less traumatic and is performed by punctures of the abdominal wall and insertion of microsurgical instruments through the punctures. This method also has some disadvantages. First of all, the gallbladder cannot be removed this way in every case. If the structure of this zone is atypical, traditional cholecystectomy should be used. Also, this method of treatment cannot be used in the presence of adhesions and severe inflammation in the gallbladder.

The doctors

Medicines

Prevention of gallstone disease

As a preventive measure for cholelithiasis, it is important to eliminate all risk factors for its occurrence. You should try to lead a healthy lifestyle and adhere to the principles proper nutrition, prevent obesity. If a person has already been diagnosed with gallstone disease, then he should constantly undergo examinations and consultations with a specialist.

Diet, nutrition for gallstone disease

In order to prevent further formation of stones during cholelithiasis, the patient should adhere to the principles of rational, healthy eating, and also comply with specially developed for patients with this disease. Main feature dietary nutrition which should be used in the treatment of cholelithiasis is to ensure correct cholesterol metabolism . To do this, it is important to reduce the calorie content of food by removing a certain amount of fats and carbohydrates from your daily diet, and also stop eating foods that contain a lot of cholesterol. First of all, the latter concerns liver, egg yolk, fatty fish and meat, lard and a number of other products. The diet for gallstone disease should not include dishes from these products.

Helps remove excess cholesterol from the body magnesium salts . Therefore, in dietary ration There should be those products that have a high content of magnesium salts. The diet for gallstone disease should include apricots, oatmeal and buckwheat.

Cholesterol in bile must be contained in dissolved form. To do this, you should increase the level of alkali in the bile. In this case, it is important to include foods in the diet plant origin, alkaline mineral waters, dishes and products with high content(it is in butter and other dairy products). In addition, the diet for gallstone disease includes many vegetable dishes. It is important to note that all dishes must be steamed, baked, or boiled. You should eat six times a day, and the portions should not be too large.

You should salt your food in moderation; you should limit rich baked goods.

Experts included sausages, smoked products, sauces, fried foods, animal fats, legumes, spices and spices, cream cakes and pastries, coffee, cocoa, and chocolate among the products prohibited for patients with cholelithiasis. Patients should follow such a diet for several years.

Complications of gallstone disease

The appearance of stones is fraught not only with disruption of organ functions, but also with the occurrence of inflammatory changes in the gallbladder and nearby organs. So, because of the stones, the walls of the bladder can be injured, which, in turn, provokes inflammation. If the stones pass through the cystic duct with bile from the gallbladder, the flow of bile may be obstructed. In the most severe cases, stones can block the entrance and exit of the gallbladder, becoming lodged in it. With such phenomena, stagnation of bile occurs, and this is a prerequisite for the development of inflammation. The inflammatory process can develop over several hours and over several days. Under such conditions, the patient may develop an acute inflammatory process of the gallbladder. In this case, both the degree of damage and the rate of development of inflammation can be different. Thus, both slight swelling of the wall and its destruction and, as a consequence, rupture of the gallbladder are possible. Such complications of cholelithiasis are life-threatening. If inflammation spreads to the abdominal organs and peritoneum, then the patient develops peritonitis . As a result, multiple organ failure may become a complication of these phenomena. In this case, disruption of the functioning of blood vessels, kidneys, heart, and brain occurs. At severe inflammation and the high toxicity of microbes multiplying in the affected wall of the gallbladder, infectious-toxic shock can appear immediately. In this case, even resuscitation measures do not guarantee that the patient will be able to be brought out of this state and death will be avoided.

List of sources

• Gallstone disease / S. A. Dadvani [et al.]. - M.: Vidar-M Publishing House, 2000.
• Grigorieva I. N., Nikitin Yu. P. Lipid metabolism and cholelithiasis. - Novosibirsk, 2005.
• Ilchenko A. A. Gallstone disease. - M., 2004.
• Guide to Gastroenterology / ed. F.I. Komarov, A.L. Grebenev. - M.: Medicine, 1995. - T.2.

Cholelithiasis is a pathology characterized by the formation of stones ( stones) in the gallbladder. This disease is also called cholelithiasis or calculous cholecystitis. It is very common throughout the globe, found in all countries and among representatives of all races. Gallstone disease is a pathology digestive tract, and its treatment is usually carried out by gastroenterologists.

In medicine, it is customary to distinguish between several variants of cholelithiasis. Firstly, stone-carrying occurs, which is not always classified as a pathological condition. A number of experts even suggest considering it separately from calculous cholecystitis itself. Stone-carrying is the process of formation of stones in the gall bladder, which is not accompanied by any symptoms or disorders. It occurs in almost 15% of the population, but is not always detected. Often, stones are unexpectedly discovered during a preventative ultrasound or x-ray examination.

The second variant of the disease is gallstone disease itself with all its symptoms and manifestations. Gallstones can cause a variety of problems, most of which are related to the digestive process. Finally, the third variant of this pathology is biliary colic. These are sharp pains that usually appear in the right hypochondrium. In fact, colic is only a symptom of the disease. However, most patients are unaware of their illness or do not seek medical attention until this symptom appears. Because biliary colic is an acute condition that requires urgent medical attention, it is sometimes considered a separate syndrome.

The prevalence of gallstone disease is not the same at different ages. In children and adolescents, this pathology is rarely detected, since the formation of stones takes quite a long time. As you age, the risk of stone formation increases, as does the risk of severe complications.

The prevalence of calculous cholecystitis by age is as follows:

• 20 – 30 years– less than 3% of the population;
• 30 – 40 years– 3 – 5% of the population;
• 40 – 50 years– 5 – 7% of the population;
• 50 – 60 years– up to 10% of the population;
• Over 60 years old– up to 20% of the population, and the risk increases with age.

It has also been noted that women suffer from gallstones significantly more often than men, approximately in a ratio of 3 to 1. The female population of North America currently has the highest incidence of gallstones. According to various sources, it ranges from 40 to 50%.

There are several theories about the causes of this disease. Most experts are inclined to believe that calculous cholecystitis is the result of exposure to a whole complex various factors. On the one hand, this is confirmed by statistical data, on the other hand, it does not explain the appearance of stones in those people who are not influenced by these factors.

In many cases, cholelithiasis is indicated surgery– removal of the gallbladder along with stones. This pathology occupies an important place in surgical hospitals. Despite the risk serious complications, which exists in cholelithiasis, the mortality rate from it in developed countries is not high. The prognosis of the disease usually depends on timely diagnosis and proper treatment.

Causes of gallstone disease

Gallstone disease itself has one specific cause - stones ( stones), which are located in the gallbladder. However, the mechanism and reasons for the formation of these stones may be different. To better understand them, you should understand the anatomy and physiology of the gallbladder.

The gallbladder itself is a small hollow organ with a volume of 30–50 ml. In the abdominal cavity it is located in the upper right part, adjacent to the lower ( visceral) surface of the liver. It borders the duodenum, the liver itself, the bile duct, and the head of the pancreas.

The structure of the gallbladder consists of the following parts:

• Bottom– the upper part adjacent to the liver from below.
• Body– the central part, limited by the side walls of the bubble.
• Neck- the lower, funnel-shaped part of the organ, which passes into the bile duct.

The bile duct itself is a narrow tube through which bile flows from the bladder into the duodenum. In the middle part, the bile duct unites with the common hepatic duct. Just before it enters the duodenum, it merges with the excretory duct of the pancreas.

The main function of the gallbladder is the storage of bile. Bile itself is formed by liver cells ( hepatocytes) and flows from there along the common hepatic duct. Since bile is necessary specifically for the digestion of fats after meals, there is no need for its constant supply to the intestines. That is why it accumulates “in reserve” in the gallbladder. After eating, the smooth muscles in the walls of the gallbladder contract and rapid release occurs. large quantity bile ( which the liver itself is not capable of, since bile is formed in it gradually at the same speed). Thanks to this, fats are emulsified, they are broken down and absorbed.

Bile is a fluid produced by hepatocytes, the cells of the liver. Its most important components are cholic and chenodeoxycholic acids, which have the ability to emulsify fats. These acids contain a compound called cholesterol ( fat soluble cholesterol). Bile also contains compounds called phospholipids, which keep cholesterol from crystallizing. When the concentration of phospholipids is insufficient, so-called lithogenic bile begins to accumulate. In it, cholesterol gradually crystallizes and combines into stones - gallstones themselves.

Bile also contains the pigment bilirubin. It is formed from hemoglobin after the breakdown of red blood cells ( red blood cells are destroyed from “old age” in 120 days). Bilirubin enters the blood and is transported to the liver. Here it is conjugated ( contacts) with other substances ( into the bound fraction of bilirubin) and is excreted in bile. Bilirubin itself is toxic and can irritate some tissues in high concentrations ( itching in the skin, irritation of the membranes of the brain, etc.). When there is an excessive concentration of bilirubin in the blood and bile, it can form compounds with calcium ( calcium bilirubinate), which form the stones. Such stones are also called pigment stones.

Common causes and mechanisms of formation of gallstones on this moment not found. However, there is an extensive list of various factors and associated disorders that greatly increase the risk of stone formation. Since none of them leads to cholelithiasis in 100% of cases, they are usually called predisposing factors. In practice, a patient with cholelithiasis almost always has a combination of several of these factors.

It is believed that the risk of gallstones is directly related to exposure to the following factors:

• Cirrhosis of the liver. With alcoholic cirrhosis of the liver, changes occur in the composition of the blood. As a result, increased production of bilirubin is possible, and there is a higher likelihood of pigment stones forming.
• Crohn's disease. Crohn's disease is an inflammatory lesion of the digestive tract with a presumably autoimmune mechanism of development. The inflammatory process can develop on various areas Gastrointestinal tract, but the intestines are most often affected. The disease is chronic and occurs with long periods of remission ( subsidence of symptoms). It has been statistically noted that patients with Crohn's disease are more likely to develop gallstones.
• Lack of plant fiber in food. Plant fibers found mainly in vegetables and a number of grain crops. The lack of these products in the diet disrupts the functioning of the intestines, and the excretion of feces worsens. Intestinal dysfunction also affects the contractility of the gallbladder. There is a high risk of bile stagnation, which predisposes to the formation of stones.
• Resection ( deletion) ileum. Removal of part of the ileum is sometimes done if there are suspicious formations in it ( tumors), rarely – polyps, diverticula or after abdominal injuries. Since a significant part is absorbed here nutrients, its removal affects the functioning of the digestive system as a whole. The risk of developing gallstones in such patients is thought to be increased.
• Taking hormonal contraceptives (COOK). It is noted that excess estrogen ( female sex hormones) is generally a predisposing factor to cholelithiasis. The effect of combined oral contraceptives ( COOK) is usually based precisely on an increase in the amount of estrogen. This may partly explain the higher prevalence of gallstone disease among women. In addition to COCs, excess estrogen can be observed in hormone-producing tumors and a number of gynecological diseases.
• Some hematological diseases. The pigment bilirubin, which often forms stones, is formed from hemoglobin. Hemoglobin enters the blood after the breakdown of red blood cells. Normally, the body destroys a certain number of old cells. However, in a number of pathologies, hemolysis can occur - the simultaneous destruction of red blood cells in large quantities. Hemolysis can be triggered by infections, toxins, disorders at the bone marrow level and a number of other reasons. As a result, red blood cells break down faster, releasing more hemoglobin and producing excess bilirubin. Accordingly, the risk of gallstone formation increases.
• Infectious process. Can play a certain role infectious processes at the level of the bile ducts. Most often, opportunistic microorganisms from the intestines act as infectious agents ( Escherichia coli, enterococci, clostridia, etc.). Some of these microbes produce a special enzyme, beta-glucuronidase. Getting into the bile in the cavity of the bladder, these enzymes contribute to the binding of bilirubin into stones.
• Sclerosing cholangitis. Sclerosing cholangitis is a pathology in which, against the background chronic inflammation The lumen of the bile duct gradually narrows. Because of this, the outflow of bile is disrupted, it stagnates in the bladder, and favorable conditions arise for the formation of stones. Thus, with this pathology, a violation of the outflow of bile precedes the formation of stones. First, the patient will develop jaundice and digestive disorders, and only then - colic due to the growth of stones and spastic contraction of the bladder walls.
• Some pharmacological drugs. Taking a number of medications ( especially long lasting) can affect the functioning of the liver and, through it, the composition of bile. As a result, bilirubin or cholesterol will precipitate and form stones. This feature has been observed in some drugs containing estrogens ( female sex hormones), somatostatin, fibrates.

In addition, the likelihood of gallstones forming and the rate at which they grow can be influenced by a number of factors beyond a person's control. For example, women are at higher risk than men and older people are at higher risk than young people. Heredity also plays a role. It is believed that the average growth rate of stones is 1–3 mm per year, but during pregnancy it can increase sharply, causing an exacerbation of cholelithiasis. Thus, a large number of pregnancies in a woman ( including abortions) predisposes to the formation of gallstones.

Classification of cholelithiasis

There are several options for classifying cholelithiasis, which are based on different criteria. The main classification can be called the division of stone carriers and gallstone disease itself. Both of these terms imply the presence of gallstones. However, in the first case, with stone carriers, the patient does not have any manifestations, symptoms or signs of the disease at all. Gallstone disease refers to the same condition, but at a stage when there are different clinical manifestations. At first they may be very minor, but gradually progress.

Among other classifications of cholelithiasis, it should be noted that it is divided according to the type of stones, their number, size and location, as well as the course of the disease. In each case, the disease will have its own characteristics, and therefore may require a different approach to treatment.

According to the chemical composition of stones, they are distinguished the following types cholelithiasis:

• Cholesterol. Cholesterol is a normal component of bile, but excess can lead to the formation of stones. This substance enters the body with food and must be absorbed normally in order to contribute to various physiological processes. Impaired absorption leads to its increased concentration in bile. Cholesterol stones are usually round or oval, reach 1–1.5 cm in diameter and are often located at the bottom of the gallbladder.
• Bilirubin ( pigment). The basis of these stones is the pigment bilirubin, which is formed after the breakdown of hemoglobin. Stones usually form when its content in the blood is high. Pigment stones are smaller than cholesterol stones. Usually there are more of them, and they can be found not only in the gallbladder, but also enter the bile ducts.

Also, gallstones have varying degrees of calcium saturation. This largely determines how well they are visible on ultrasound or radiography. In addition, the degree of calcium saturation influences the choice of treatment method. Calcified stones are more difficult to dissolve with medication.

In general, the classification of the disease according to the chemical composition of stones is rather of scientific interest. In practice, the manifestations of the disease will be similar, and it is almost impossible to distinguish these types by symptoms. However, the composition of the stones indicates concomitant disorders in the body, which also need to be corrected. In addition, as noted above, the method of medicinal dissolution of stones is not suitable in all cases.

According to the number of stones, individual stones are distinguished accordingly ( less than 3) and multiple ( 3 or more) stones. In principle, the fewer stones, the simpler the treatment should be. However, here great importance They also have their sizes. The manifestations of the disease with single or multiple stones are the same. Differences appear only with ultrasound examination, which visualizes stones.

It is customary to distinguish the following types of stones by size:

• Small ones. The size of these stones does not exceed 3 cm. If the stones are single and located in the bottom of the bladder, the patient usually does not have acute symptoms.
• Large ones. Large stones with a diameter of more than 3 cm often disrupt the flow of bile and cause biliary colic and other severe manifestations of the disease.

The size of the stones may influence the choice of treatment tactics. Large stones are usually not dissolved, and crushing them with ultrasonic waves is unlikely to have a good effect. In these cases, surgical removal of the bladder along with its contents is recommended. For small stones, alternative, non-surgical treatment methods can be considered.

Sometimes attention is also paid to the location of gallstones. Stones located at the bottom of the gallbladder are less likely to cause any symptoms. Stones located in the cervical area can clog the bile duct and cause bile stagnation. Accordingly, they are more likely to cause any symptoms associated with pain or digestive disorders.

There are also the following forms of cholelithiasis itself:

• Latent form. In this case, we are talking about stone-bearing, which does not manifest itself in any way and is discovered, as a rule, by accident.
• Symptomatic uncomplicated form. This form is characterized various symptoms from the digestive system or pain in the form of typical biliary colic. In other words, typical manifestations for this pathology are present.
• Symptomatic complicated form. In this case, the patient experiences not only symptoms characteristic of cholelithiasis, but also signs of damage to other organs. This may include atypical pain, liver enlargement, etc.
• Atypical form. As a rule, this form of the disease includes unusual manifestations of cholelithiasis. For example, pain syndrome can sometimes occur not in the form of biliary colic, but imitate the pain of appendicitis ( in the right lower abdomen) or angina ( chest pain). In these cases, making a correct diagnosis is difficult.

During the diagnostic process, it is very important to find out exactly what form of the disease the patient is suffering from. A detailed classification according to all of the above criteria will allow us to more clearly formulate the diagnosis and prescribe more correct treatment.

Stages of gallstone disease

Like any disease, gallstone disease goes through several stages in its development. Each of these stages is directly related to such characteristics of the disease as clinical course, size of stones, presence of complications, etc. Thus, the conditional division of the disease into stages is based on various classifications listed above.

During gallstone disease the following stages can be distinguished:

• Physico-chemical stage. At this stage, there are no stones in the gall bladder yet, but the patient has the prerequisites for their appearance. There is a disruption in the formation of normal bile. The liver begins to produce lithogenic bile, rich in cholesterol, or the patient experiences increased secretion of bilirubin. In both cases, direct preconditions for the formation of stones are created. Sometimes this stage is also called pre-disease. It is very difficult to detect disturbances in the formation of bile. Actually, there are no stones in the gall bladder yet, but special tests are needed to identify physicochemical changes. A bile sample can be obtained by probing, but it is not prescribed to patients without any pathologies as a preventive or diagnostic method. Sometimes the procedure is prescribed to those patients who have diseases that predispose them to the formation of stones ( hemolytic anemia, high cholesterol, liver disease, etc.). However, in general, the disease is not diagnosed at the pre-disease stage.
• Stone-carrying. At the stone-carrying stage, stones of various sizes may be found in the gallbladder ( even large ones), but there are no symptoms of the disease. Stones can be detected by ultrasound or x-ray, but these diagnostic methods also usually not prescribed during a preventive examination. Thus, cholelithiasis at this stage is usually diagnosed by chance.
• Clinical stage. The onset of the clinical stage almost always coincides with the first attack ( first ever biliary colic). Patients may already suffer from vague pain in the right hypochondrium or periodic bowel movements. However, they do not always consult a doctor about this. With colic, the pain is very severe, so it usually becomes the reason for a full examination. The clinical stage is characterized by periodic colic, intolerance to fatty foods and other typical symptoms. Diagnosing the disease during this period is usually not difficult.
• Complications. The stage of complications with cholelithiasis can occur quite quickly. In some patients, literally on the second or third day after the first colic, the temperature rises, constant dull pain in the abdomen and other symptoms occur, which are rare in an uncomplicated course of the disease. In fact, the onset of this stage depends on the movement of stones and the entry of pathogens into the gallbladder. In many patients it never occurs. The stage of clinical complications can last for years and end with a successful recovery ( removal or dissolution of stones).

The division of the disease into stages in most cases is not serious clinical significance. It relies on the processes that occur in the body, but does not greatly influence the choice of diagnostic or treatment method. In principle, the more advanced the disease, the more difficult it is to treat. But sometimes uncomplicated cholecystitis can create many problems with treatment.

Symptoms and signs of gallstone disease

In principle, cholelithiasis can be very for a long time proceed without any symptoms or manifestations. This is explained by the fact that the stones in the early stages are small, do not clog the bile duct and do not injure the walls. The patient may not even suspect that he has this problem for a long time. In these cases, they usually talk about stone-carrying. When gallstone disease itself makes itself felt, it can manifest itself in different ways.

Among the first symptoms of the disease, one should note heaviness in the abdomen after eating, stool disturbances ( especially after eating fatty foods), nausea and mild jaundice. These symptoms may appear even before severe pain in the right hypochondrium - the main symptom of cholelithiasis. They are explained by unexpressed disturbances in the outflow of bile, which makes the digestion process worse.

Most characteristic of cholelithiasis following symptoms and signs:

• Pain in the right hypochondrium. The most typical manifestation of cholelithiasis is the so-called gallstone ( biliary, hepatic) colic. This is an attack of acute pain, which in most cases is localized at the intersection of the right costal arch and the right edge of the rectus abdominis muscle. The duration of an attack can vary from 10–15 minutes to several hours. At this time, the pain can be very severe, radiating to the right shoulder, back or other areas of the abdomen. If the attack lasts more than 5 - 6 hours, then you should think about possible complications. The frequency of attacks may vary. Often, about a year passes between the first and second attack. However, in general, they become more frequent over time.
• Temperature increase. An increase in temperature usually indicates acute cholecystitis, which often accompanies cholelithiasis. An intense inflammatory process in the area of ​​the right hypochondrium leads to the release of active substances into the blood that contribute to a rise in temperature. Prolonged pain after colic accompanied by fever almost always indicates acute cholecystitis or other complications of the disease. Periodic increase in temperature ( wavy) with a rise above 38 degrees may indicate cholangitis. However, in general, fever is not a mandatory symptom of gallstone disease. The temperature may remain normal even after severe, prolonged colic.
• Jaundice. Jaundice occurs due to stagnation of bile. The pigment bilirubin is responsible for its appearance, which is normally secreted with bile into the intestines, and from there is excreted from the body with feces. Bilirubin is a natural metabolic product. If it ceases to be excreted in the bile, it accumulates in the blood. This is how it spreads throughout the body and accumulates in tissues, giving them a characteristic yellowish tint. Most often, the sclera of the eyes turn yellow in patients first, and only then the skin. In fair-skinned people, this symptom is more noticeable, but in dark-skinned people, unexpressed jaundice can be missed even by an experienced doctor. Often, simultaneously with the appearance of jaundice in patients, the urine also darkens ( dark yellow, but not brown color ). This is explained by the fact that the pigment begins to be released from the body through the kidneys. Jaundice is not a mandatory symptom of calculous cholecystitis. Also, it does not appear only with this disease. Bilirubin can also accumulate in the blood due to hepatitis, liver cirrhosis, some hematological diseases or poisoning.
• Fat intolerance. IN human body bile is responsible for emulsification ( dissolution) fats in the intestines, which is necessary for their normal breakdown, absorption and assimilation. With cholelithiasis, stones in the cervix or bile duct often block the path of bile to the intestines. As a result, fatty foods are not broken down normally and cause intestinal disturbances. These disorders may manifest as diarrhea ( diarrhea), accumulation of gases in the intestines ( flatulence), mild abdominal pain. All these symptoms are nonspecific and can occur with various diseases Gastrointestinal tract ( gastrointestinal tract). Intolerance to fatty foods can also occur at the stone-carrying stage, when other symptoms of the disease are still absent. At the same time, even a large stone located at the bottom of the gallbladder may not block the flow of bile, and fatty foods will be digested normally.

In general, the symptoms of cholelithiasis can be quite varied. There are various stool disorders, atypical pain, nausea, and periodic bouts of vomiting. Most doctors are aware of this variety of symptoms, and just in case, they prescribe an ultrasound of the gallbladder to exclude cholelithiasis.

How does an attack of cholelithiasis manifest itself?

An attack of cholelithiasis usually means biliary colic, which is the most acute and typical manifestation of the disease. Stone carriage does not cause any symptoms or disorders, and patients usually do not attach importance to mild digestive disorders. Thus, the disease proceeds latently ( is hidden).

Biliary colic usually appears suddenly. Its cause is a spasm of smooth muscles located in the walls of the gallbladder. Sometimes the mucous membrane is also damaged. Most often this happens if the stone moves and gets stuck in the neck of the bladder. Here it blocks the outflow of bile, and bile from the liver does not accumulate in the bladder, but flows directly into the intestines.

Thus, an attack of cholelithiasis usually manifests itself as characteristic pain in the right hypochondrium. At the same time, the patient may experience nausea and vomiting. Often an attack occurs after sudden movements or exertion, or after eating a large amount of fatty food. Once during an exacerbation, stool discoloration may be observed. This is explained by the fact that pigmented ( painted) bile from the gallbladder. Bile from the liver flows only in small quantities and does not give intense color. This symptom called acholia. In general, the most typical manifestation of an attack of cholelithiasis is characteristic pain, which will be described below.

Pain due to cholelithiasis

Pain due to cholelithiasis differs at different stages. With stones, there is no pain as such, but some patients complain of discomfort in the upper abdomen or in the right hypochondrium. Sometimes it can be caused by a buildup of gases. At the stage of clinical manifestations of the disease, more accentuated pain appears. Their epicenter is usually located in the area of ​​the right costal arch, 5–7 cm from the midline of the abdomen. However, atypical pain is sometimes possible.

The most common form of gallstone pain is biliary colic. It occurs suddenly, and patients often feel that the cause of the pain is muscle spasm. The pain gradually increases and usually reaches its peak after 30 to 60 minutes. Sometimes colic goes away faster ( in 15 – 20 minutes), and sometimes lasts several hours. The pain is very strong, the patient cannot find a place for himself and cannot take a comfortable position so that the pain goes away completely. In most cases, it is when biliary colic occurs that patients turn to a doctor for qualified help, even if they previously ignored all the symptoms of the disease.

Pain from biliary colic can radiate to the following areas:

• lower right abdomen ( can be confused with appendicitis);
• “in the pit of the stomach” and in the area of ​​the heart;
• to the right shoulder;
• into the right shoulder blade;
• in the back.

Most often it is the spread ( irradiation) pain, but sometimes there is almost no pain in the right hypochondrium. Then it is difficult to suspect biliary colic during examination.

Often pain occurs when pressing on the corresponding area or when tapping on the right costal arch. It should be remembered that pain in the right hypochondrium ( and even biliary colic) do not always indicate the presence of gallstones. They can be observed with cholecystitis ( inflammation of the gallbladder) without the formation of stones, as well as with biliary dyskinesia.

Gallstone disease in children

In general, cholelithiasis in children is extremely rare and is rather an exception to the rule. The fact is that it usually takes a long time for stones to form. Cholesterol crystals or bilirubin compact and form a stone slowly. In addition, hypercholesterolemia itself is rare in children. They are not subject to many of the predisposing factors that affect adults. First of all, these are fatty and heavy foods, physical inactivity ( sedentary lifestyle), smoking and alcohol. Even if these factors are present, children's body copes with them much better than an adult. Thus, the likelihood of developing gallstones in children is greatly reduced. The current prevalence of calculous cholecystitis ( among children with gastrointestinal diseases) is no more than 1%.

In most children, cholelithiasis manifests itself differently than in adults. Biliary colic occurs rarely. More often observed clinical picture (symptoms and manifestations) gastritis, peptic ulcer, colitis and other gastrointestinal diseases. An acute inflammatory process rarely complicates the course of the disease. Fat intolerance, stool disorders, nausea and vomiting are common.

Confirmation of the diagnosis and treatment of pathology is not very different from those in adults. Cholecystectomy ( gallbladder removal) is required quite rarely. Sometimes surgical correction of bile duct abnormalities is necessary.

Gallstone disease during pregnancy

Gallstone disease in women during pregnancy is a very common problem. All such cases can be divided into two large groups. The first category includes patients who already have gallstones ( stone-bearing stage). In them, the disease most often passes into an acute stage under the influence of various factors that arise specifically during pregnancy. The second group includes patients in whom the intensive process of stone formation begins precisely during pregnancy ( that is, at the time of conception there were no stones yet). There are also a number of prerequisites for this.

The development of cholelithiasis during pregnancy is influenced by the following factors:

• Mechanical compression of an organ. The growth of the fetus during pregnancy causes an increase in pressure in the abdominal cavity. Many organs move upward as they grow, and in the third trimester, when the fetus is at its maximum size, the pressure becomes maximum. Kinking the gallbladder and squeezing the biliary tract can trigger an attack of the disease. Most often this happens in cases where there are already stones in the gall bladder, but the woman does not know about it.
• Changes in hormonal levels. Pregnancy is associated with significant hormonal changes in a woman’s body. During this period, the concentration of a number of hormones in the blood increases, which contribute to the formation of stones. For example, the hormone estriol, among other beneficial effects, helps increase cholesterol levels in the blood. Progesterone, the concentration of which is also high, impairs motility ( reductions) walls of the gallbladder, which causes stagnation of bile. Under the influence of these hormones, as well as due to sedentary lifestyle life begins an intensive process of stone formation. Of course, it does not occur in all patients, but only in those who are predisposed to it ( there are other predisposing factors).
• Changes in diet. During pregnancy, many women experience changes in taste preferences and, as a result, changes in diet. An excess of foods rich in fats can provoke an attack, and the disease will move from stone-bearing to the stage of clinical manifestations. The mechanism of such exacerbation is quite simple. The gallbladder gets used to secreting bile in certain quantities. Regular intake of fatty foods requires more intense formation and secretion of bile. The walls of the organ contract intensely, and this leads to the movement of the stones present there.
• Taking certain medications. During pregnancy, patients various reasons A number of medications may be prescribed to promote the formation of gallstones. This may trigger an attack of illness.

It should be noted that the age of the expectant mother also plays a significant role. In young girls, cholelithiasis is rare, and therefore the risk of its exacerbation during pregnancy is lower. In adult women ( about 40 years or more) stone-bearing is more common. Accordingly, the risk of exacerbation of the disease during pregnancy is much higher.

Manifestations of cholelithiasis during pregnancy are generally not very different from those in other patients. The most typical acute pain is in the right hypochondrium ( biliary colic). If there is difficulty in the outflow of bile, darkening of the urine may occur ( it is saturated with bilirubin, which is not excreted in bile). It is also noted that toxicosis of pregnant women and a number of other complications of pregnancy are more common.

Diagnosis of cholelithiasis usually does not cause difficulties. Already in the first trimester of pregnancy, a competent doctor will conduct an ultrasound of the abdominal organs, which will reveal stone carriage. After this, an attack can be recognized even by typical symptoms. If the stones were not detected earlier, the diagnosis becomes somewhat more complicated. An atypical distribution of pain during an attack is possible, since many abdominal organs are displaced.

The most difficult stage is the treatment of patients with cholelithiasis during pregnancy. Many drugs that can help are not prescribed due to the risk to the fetus. However, during colic, in any case, pain is relieved with antispasmodics. Pregnancy is also not absolute contraindication for surgery and removal of the gallbladder along with stones. In these cases, they try to give preference endoscopic methods. In this case, there are no large seams left, which may subsequently come apart during childbirth. Patients with cholelithiasis are hospitalized for constant monitoring and more thorough examination. If possible, try to control exacerbations through diet and other preventive measures to perform the operation after childbirth ( eliminate the risk to the child). Non-surgical treatment of stones ( ultrasonic crushing or dissolution) is not used during pregnancy.

It should also be noted that various complications of cholelithiasis are more common in pregnant women. This is explained by weakened immunity during this period and frequent displacement of stones. Self-medication in these cases is unacceptable, since an acute inflammatory process provoked by stones can threaten the life of both the mother and the fetus.

Complications of gallstone disease

The formation of gallstones is slow process and usually takes more than one year. However, patients are advised to undergo prophylactic gallbladder ultrasound whenever possible to detect them on early stage. This is explained by the fact that the disease is fraught various complications, which are easier to prevent than to treat.

In most cases, complications of cholelithiasis arise due to the occurrence and spread of the inflammatory process in the abdominal cavity. The immediate cause is injury to the walls of the gallbladder by the sharp edges of the stones ( does not happen with all types of stones), blockage of the bile ducts and stagnation of bile. The most common surgical complications and disturbances in the digestive system.

With absence timely treatment cholelithiasis, the following complications are possible:

• Empyema of the gallbladder. Empyema is an accumulation of pus in the cavity of the gallbladder. This happens only if pyogenic microorganisms enter there. Most often these are representatives of the intestinal microflora - Escherichia, Klebsiella, Proteus. The stones clog the neck of the gallbladder, and a cavity is formed in which these microorganisms can freely develop. As a rule, the infection enters here through the bile ducts ( from the duodenum), but in rare cases it can also be carried with blood. With empyema, the gallbladder is enlarged and painful when pressed. An increase in temperature and a significant deterioration in general condition are possible. Empyema of the gallbladder is an indication for urgent removal of the organ.
• Wall perforation. Perforation is a perforation through the wall of an organ. As a rule, it occurs in the presence of large stones and high blood pressure inside the organ. Can cause gallbladder rupture exercise stress, sudden movement, pressure on the right hypochondrium ( for example, using a seat belt when braking). This complication is the most dangerous, since it causes the flow of bile into the free abdominal cavity. Bile is highly irritating and quickly causes inflammation of the sensitive peritoneum ( membrane covering the abdominal organs). Microbes can also enter the free abdominal cavity from the gallbladder cavity. As a result, there is serious condition– biliary peritonitis. The inflammation involves the right upper part of the abdominal cavity, but can spread to other areas. The main symptoms of perforation are the appearance of sharp severe pain, an increase in temperature, a rapid deterioration in general condition, increased heart rate and breathing. In this case, the patient can only be saved by large-scale surgery combined with intensive antibiotic therapy. However, even timely hospitalization of the patient does not provide a 100% guarantee of a successful recovery.
• Hepatitis. In this case we are not talking about viral hepatitis (which are the most common), but about the so-called reactive hepatitis. It is explained by the proximity of the inflammatory focus, stagnation of bile, and the spread of infection ( if there are microbes in the gallbladder). As a rule, such hepatitis responds well to treatment and goes away quickly after removal of the gallbladder. Its main symptoms are heaviness in the right hypochondrium and enlarged liver.
• Acute cholangitis. Acute cholangitis is inflammation of the bile ducts connecting the gallbladder and duodenum. As a rule, it is caused by the entry of a smaller stone into the duct itself and damage to the mucous membrane. Unlike cholecystitis, which can occur without acute symptoms, cholangitis is almost always accompanied by high fever, pain and jaundice.
• Acute pancreatitis. The excretory duct of the pancreas, before flowing into the duodenum, connects with the bile duct. If a small gallstone becomes lodged at the level of the common duct, bile may leak into the pancreas. This organ produces digestive enzymes that can break down proteins. These enzymes are normally activated by bile in the duodenum and break down food. Their activation in the cavity of the gland itself is fraught with destruction of organ tissue and an acute inflammatory process. Pancreatitis is manifested by severe girdle pain in the upper abdomen. As a rule, pain appears suddenly. This disease poses a serious threat to life and requires urgent surgical treatment.
• Fistula formation. A fistula is a pathological connection of one hollow organ to another. It is usually the result of a long-term inflammatory process with gradual destruction of the wall. Fistulas of the gallbladder can connect its cavity directly to abdominal cavity (clinically resembles perforation), intestines or stomach. In all these cases, serious digestive problems and periodic pain will occur.
• Cirrhosis of the liver. In this case we are talking about the so-called secondary biliary cirrhosis of the liver. Its cause is the accumulation of bile in the intrahepatic ducts, since it does not flow into the overfilled gallbladder. After some time, the liver cells stop functioning normally and die. In their place, connective tissue is formed, which does not perform the functions that hepatocytes performed ( liver cells). The main symptoms are bleeding disorders ( the liver produces substances necessary for this process), intoxication of the body with its own metabolic products, stagnation venous blood in the portal vein, which runs through the liver. Progression of the disease leads to hepatic coma and death of the patient. Despite the fact that liver cells are recovering well, treatment cannot be delayed. Cirrhosis is an irreversible process, and the only effective treatment is transplantation ( transfer) organ.
• Neoplasms of the gallbladder. Malignant neoplasms can appear in the gallbladder due to prolonged ( for many years) inflammatory process. The bile itself plays a certain role in this, with which some toxic substances can be released from the body. Gallbladder tumors can compress the bile ducts, duodenum, and grow into neighboring organs, disrupting their functions. Like all malignant neoplasms, they pose a direct danger to the patient’s life.

Due to the possibility of all these serious complications and a direct threat to the patient's life, in most cases doctors recommend cholecystectomy ( gallbladder removal) as the main method of treatment. Crushing gallstones with ultrasound or dissolving them does not always eliminate the risk of complications by 100%. Before use, you should consult a specialist.