Gallstone disease( cholelithiasis, gallstones) - Causes, symptoms and treatment. MF.

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

This disease is the third most common disease after cardiovascular disease and diabetes mellitus. It is more common in economically developed countries for people whose work is associated with stressful situations and leading a sedentary lifestyle.

How the stones form in the gallbladder

The gallbladder is a reservoir for the bile produced by the liver. Movement of bile on the bile ducts is provided by coordinated activity of the liver, gallbladder, common bile duct, pancreas, duodenum. This ensures timely delivery of bile to the intestine during digestion and its accumulation in the gallbladder on an empty stomach.

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

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

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

Pigmented( bilirubin) stones appear as a result of enhanced decay of erythrocytes in hemolytic anemia.

Mixed stones are a combination of both forms. Contain calcium, bilirubin, cholesterol.

occur mainly in inflammatory diseases of the gallbladder and bile ducts.

Causes of cholelithiasis

1. Inflammation of bile ducts( cholecystitis, cholangitis).
Infection plays a role in the formation of concrements. Bacteria are able to convert bilirubin, soluble in water, to insoluble, which precipitates.

2. Endocrine disorders:
- diabetes mellitus;
- hypothyroidism( insufficient secretion of thyroid hormones);
- a violation of the exchange of estrogens, with various gynecological diseases, the intake of contraceptive hormonal drugs, pregnancy.
There is a violation of the contractile function of the gallbladder, stasis of bile.

3. Cholesterol metabolism disorder:
- atherosclerosis;
- gout;
is obesity.
When the level of cholesterol is increased, conditions are created for the formation of stones.

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

5. Hereditary predisposition.

6. Fasting, irregular eating cause a violation of the normal function of the gallbladder.

7. Excessive consumption of animal-rich fats, cholesterol, food. This helps to shift the reaction of bile to the acid side, which leads to the formation of stones.

Symptoms of cholelithiasis

For a long time the disease can be asymptomatic and become a finding in ultrasound. When migrating stones, joining the infection in the gallbladder and ducts, symptoms appear. Symptoms of cholelithiasis depend on the location of the stones, their size, the activity of inflammation, as well as the damage to other digestive organs.

When the stones leave the gallbladder and move them along the bile ducts, an attack of biliary colic occurs. Provoke an attack of error in nutrition, especially the abuse of fatty foods, vibration, stressful situations. The pain is sudden, sharp in the upper half of the abdomen, in the region of the right hypochondrium, it gives into the right scapula, the right shoulder. Often the pain with cholelithiasis is accompanied by nausea, vomiting, not bringing relief, dry mouth. Dermatitis itching.

There may be jaundice in sclera and skin, darkening of urine and discoloration of feces.

The duration of a pain attack from several minutes to several hours, the pain subsides independently or after anesthesia.

Symptoms of biliary colic do not always have a classical variant of manifestation, they often can resemble other diseases: right-sided pneumonia, acute appendicitis, especially if not typical, liver abscess, renal colic in case of urolithiasis, acute pancreatitis.

May be manifested by cholecystocardial syndrome, when the pain in the heart is the only symptom of cholelithiasis.

To establish an accurate diagnosis, when the first signs of the disease appear, you need to urgently go to the doctor - therapist, family doctor.

Examination for cholelithiasis

Instrumental diagnostic methods.

1. Ultrasound of the abdominal cavity organs is the main and most effective method of diagnosing cholelithiasis. Detects the presence of stones in the gallbladder, thickening of the gallbladder walls, its deformation, expansion of the bile ducts.
Its main advantages are non-invasiveness( non-irrationality), security, accessibility and the possibility of repeated execution.

2. Radiographic examination of the abdominal cavity - for the detection of X-ray positive carbonate stones.

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

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

Laboratory research.

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

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

Obligatory examination of the surgeon - to choose the tactics of treatment.

Treatment of cholelithiasis.

In cholelithiasis, surgical and conservative treatment is used.

Drug treatment for cholelithiasis

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

Contraindications for drug dissolution of gallstones:

- acute inflammatory diseases of the gallbladder and bile ducts;
- stones with a diameter of more than 2 cm;
- liver disease, diabetes, peptic ulcer and duodenal ulcer, chronic pancreatitis;
- inflammatory diseases of the small and large intestine;
- obesity;
- pregnancy;
- "disconnected" - non-functioning gallbladder;
- pigment or carbonate stones;
- gallbladder cancer;
- multiple concrements that occupy more than 50% of the volume of the gallbladder.

Ursodeoxycholic acid drugs are used, the action of which is aimed at dissolving only cholesterol stones, the drug is taken within 6 to 24 months. But the probability of recurrence after the dissolution of stones is 50%.The dose of the drug, duration of admission is determined only by a doctor - therapist or gastroenterologist. Conservative treatment is possible only under the supervision of a physician.

Shockwave cholelithotrepsy - treatment by crushing large concretions into small fragments with the help of shock waves, followed by the administration of bile acid preparations( ursodeoxycholic acid).The probability of relapse is 30%.

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

Surgical treatment of cholelithiasis

Patients should undergo scheduled surgery before the first biliary colic attack or immediately after it. This is due to the fact that the risk of complications is high.

After the operative treatment it is necessary to follow an individual diet regime( frequent, divided meals with restriction or exclusion of individually intolerable foods, fatty, fried foods), observance of the regime of work and rest, physical education. Eliminate the use of alcohol. Perhaps a sanatorium treatment after surgery, provided a stable remission.

Complications of cholelithiasis.

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

Choledocholithiasis( stones in the bile duct) with the development of mechanical jaundice. After one of the bile colic attacks, itching, icteric sclera and skin, discolored feces, darkening of the urine.

With prolonged blockage of the bladder duct and absence of infection, gall bladder edema occurs. Bile from the bladder is absorbed, but the mucous continues to produce mucus. There is an increase in the size of the bladder. Is manifested bouts of biliary colic, in the following the pain subsides, remains heaviness in the right hypochondrium.

Against the backdrop of prolonged cholelithiasis, gallbladder cancer often occurs,
develops acute and chronic pancreatitis. With prolonged blockage of the intrahepatic bile ducts, secondary biliary cirrhosis develops. Large gallstones practically do not migrate, but they can lead to fistula formation between the gallbladder and duodenum. As a result of the loss of the stone from the bladder, it begins to migrate and may lead to the development of intestinal obstruction.

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

Complications pose a threat to the life of the patient and require immediate examination of the surgeon and hospitalization in the surgical hospital.

Prevention of cholelithiasis.

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

Patients who are forced to take estrogen for a long time, clofibrate, ceftriaxone, octreotide must undergo ultrasound examination to detect changes in the gallbladder. With an increase in the level of cholesterol in the blood, the use of statins is recommended.

Diet for cholelithiasis

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

Consultation of the doctor for cholelithiasis

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

Question: Which medications, folk remedies, sanatorium treatment treat stones from the gallbladder?
Answer: There are no such medicines. All cholagogue funds for cholelithiasis should be taken strictly according to prescription and under the supervision of a doctor. Doing self-medication in this situation is not safe because of the high risk of complications. With a planned cholecystectomy( surgery to remove the gallbladder), the death rate is 0.5%, and with cholecystectomy for acute cholecystitis( and this complication of self-treatment), the mortality rate reaches 20%. Sanatorium treatment in the presence of gallstones is contraindicated by .

Question: Should a patient be observed after surgery for cholelithiasis, which specialist, how long and with what medicines should he undergo postoperative treatment?
Answer: Patients after surgical treatment are observed at the family doctor, the therapist. Every year there is a regular checkup, ultrasound examination of the abdominal cavity organs, control of the lipidogram, liver samples. Based on the examination data, diagnostic studies, the doctor recommends a set of necessary medical and recreational measures to prevent the recurrence of the disease.

Doctor therapist Vostrenkova IN