Stones in the gallbladder symptoms
stones in the gall bladder are fairly solid, dense formations. The number of stones in the in the gallbladder can be different - from one to many hundreds and even thousands. The size of the stones is also different: from a grain of sand and a pinhead to a plum and a hen's egg. The more stones in the gall bladder , the smaller they are. Most stones are located in the gallbladder, less often - in the biliary and hepatic ducts, in the intrahepatic bile ducts.
How to treat stones in folk ways, see here.
Causes of
The presence of of stones in the gallbladder and bile ducts causes and fecal disease.
Promotes the disease of dyskinesia biliary tract, gastritis, duodenitis, enteritis, colitis and other diseases of the gastrointestinal tract, but especially dangerous in this regard is cholecystitis - inflammation of the gallbladder.
for cholelithiasis is characterized by intense paroxysmal pains in the right upper quadrant, giving to the right shoulder blade, shoulder, neck, accompanied by vomiting, bitterness, dry mouth, skin itching, fever. Perhaps the development of jaundice. When palpation, pain is found in the right hypochondrium in the projection of the gallbladder.
Clinical forms of
According to the nature of the disease, distinguishes latent, dyspepsic, painful and painful torpid forms of .
1. Latent form of cholelithiasis is often observed in the presence of single, usually cholesteric stones. Patients feel normal, the presence of stones is determined by accident during an ultrasound study. The latent form of cholelithiasis is more common in older people and men.
2. The dyspeptic form of cholelithiasis is observed in approximately 1/3 of cases of cholelithiasis. For years, patients may experience occasional or persistent nausea, heaviness after eating, belching, bitterness in the mouth, dyspeptic disorders, which are usually associated with consuming fatty, fried or spicy foods, carbonated drinks. Local symptoms of the gallbladder's lesions are weak or absent for a long time. Very often all these manifestations are written off for dysbiosis, and more often than not it is actually present, but as a secondary pathology.
3. Painful paroxysmal form of cholelithiasis is the most common and is easily diagnosed. It is characterized by a recurring course: severe pain attacks occur unexpectedly and for no apparent reason, or after eating disorders, physical stress, etc.
4. The painful, torpid form of gallstone disease is distinguished by the absence or rarity of seizures. The pain is blunt, permanent or periodic. Under the influence of dietary disorders, physical exertion the pain intensifies, but does not reach the acuteness of typical colic. The pain intensification in most cases is short-lived. When exacerbation there is no increase in body temperature, the level of leukocytes in the blood and the rate of erythrocyte sedimentation remain normal.
By severity of the clinical course, 3 forms of cholelithiasis are isolated.
1. The mild form of of cholelithiasis is characterized by rare attacks of biliary colic( 1 to 5 times a year) lasting from 30 minutes to 1 hour( rarely more), a short-term fever without jaundice while maintaining the concentration and motor functions of the gallbladder. Seizures are easily removed with medication. In the period between attacks, pain syndrome and dyspepsia are poorly expressed.
2. The moderately severe form of cholelithiasis is characterized by a moderately persistent pain syndrome and periodic biliary colic attacks. Seizures occur 6-12 times a year lasting 3-6 hours or more, accompanied by fever, repeated vomiting, often jaundice. Fever, icteric staining of the sclera persists for 2-3 days after the attack. Significant changes in the biliary tract( cholangitis) and liver( hepatitis) are associated with symptoms of secondary pancreatitis. In the period between attacks, there is a moderately persistent pain syndrome, dyspeptic phenomena. It is possible to violate the concentration( the ability to make bile more concentrated, which allows the liver to produce it uninterruptedly) and motor function of the gallbladder, a moderate change in liver function, exocrine function of the pancreas.
3. The severe form of of cholelithiasis is characterized by frequent( 2-3 times a week) and prolonged biliary colic attacks. Attacks are removed only by repeated intake of strong painkillers. In the period between attacks there is a pronounced persistent pain syndrome, dyspeptic disorders, subfebrile temperature. Violated the concentration and motor functions of the gallbladder, liver function and exocrine function of the pancreas.
There are many reliable methods for detecting of cholelithiasis .But the main is the analysis of the general state of man.
The experienced gastroenterologist already at close examination can determine how great the problems of his patient are: whether the gallbladder is enlarged, the degree of its sensitivity, etc. But, of course, only careful analysis of the whole set of clinical symptoms and the results of auxiliary research methods makes it possible to put the rightdiagnosis.
To do this, performs an ultrasound examination of the gallbladder( US) and cholecystography of , which allows to detect changes in the gallbladder and the presence of stones. In addition, laboratory tests are performed: blood, urine, and sometimes cystic bile are taken( taken by the method of duodenal sounding).
1. Operative treatment
The stone removal operation should not frighten patients. Currently, these operations are performed at a good level in almost any hospital, and in some hospitals, laparoscopy is performed, i.e., a mini-operation with a point incision. After surgery, the patient quickly returns to normal lifestyle. For anesthesia, only high-quality drugs are used: they do not cause serious trouble to the body, its excretory systems, do not cause severe intoxication, in addition, their action can be suspended at any time. Therefore, if surgery is shown, if ultrasound and analyzes confirm the presence of stones, do not wait for complications. It is better to calmly, at a time when the exacerbation has passed, to go to the hospital, to prepare for the operation, and already after some half a month to feel healthy, able-bodied person, and not a "kamenositel" in the risk zone.
2. Therapeutic agents
In addition to surgical intervention, there are other therapies - therapeutic .First of all, these are drugs that should relieve an attack to provide urgent therapeutic help for biliary colic, to relieve a person of painful pain. For this purpose, various antispasmodics are administered.
The choice by a specialist physician of various drugs and the way they are administered( intravenously, intramuscularly, subcutaneously) depends on the strength of the attack and the condition of the patient. Most often, the attack is removed by injection of Platyphylline, Papaverin or Dibazol. In the period of an acute attack of biliary colic, intramuscular injection of No-shpa or Euphyllin is also effective. Naturally, each of these drugs has contraindications, so doctors choose the right drug only after examining the patient.
As a rule, antispasmodics are administered simultaneously with pain medication. Baralgin is especially effective( he relieves spasms and calms the pain).You can use analgesics or make an intravenous injection of Novocain.
If the attack is very severe and can not be removed with the help of the listed products, then "heavy artillery" is used: special strong preparations are introduced, for example, Tramal in combination with Atropine or other antispasmodics. In some cases, the use of nitroglycerin is effective. In hospital conditions, a right-sided paranephalic blockade is performed.
With severe vomiting, is administered by Cerucal( it regulates the motor function of the gastrointestinal tract, perfectly removes nausea and vomiting of a very different nature), you can also use Diphenhydramine, Aminazine or Pipolphen, but it is more advisable to use these drugs in combination. Drinking solutions of Regidron or Citroglucosolan are also prescribed.
If the attack is not very strong: there are no sharp pains, vomiting( only nausea), then you can do without injections. In this case, the doctor prescribes antispastic agents: 5-10 drops of 0.1% solution of Atropine, or Belladonna extract, Besalol, or Papaverin tablets, No-shps or Dibazol. Together with one of these drugs for complete relief of pain - a pill of Baralgina.
But often because of nausea it can be difficult to drink medicine. In this case, the drugs are administered with an enema - an effective and at the same time a safe way. For an enema, as a rule, a combination of Euphyllin, Belladonna and Analgin is taken.
After the pain stops and nausea recedes, the patient can be given a laxative, but not a saline. Saline laxatives have a pronounced cholagogic effect, and in the first days after an attack they should not be taken.
There is no appetite in patients, and there is no need to force them to eat. It is prescribed only a warm drink: sweet tea, cranberry( sweet) mors, compotes, warm water "Essentuki" № 4. Complete rest and strict bed rest is necessary.
So, the attack is removed. And, as you can see, there are many opportunities for this. It is important only to use them skillfully, on the one hand, to help a person as soon as possible - to relieve him of pain and to remove all other unpleasant symptoms, on the other - not to cause undesirable side medication.
But there is no less important task - to prevent the recurrence of attacks of , to maintain the state of health at a good level, to help the gallbladder and bile ducts work and to prevent the formation of new stones. Other means are used for this.
Some people naively and ignorantly do not listen to the opinion of the doctor, but try to help themselves, using a cheaper and simpler version of the usual cholagogue. They hope that the stones will come out on their own. In vain: this will not happen! Exit the stones can not, but to move from the "hard" place - easily. As a result, they will clog the bile duct - and a person can be on a hospital bed with an attack of biliary colic.
That's why with cholelithiasis without consulting a doctor it is very dangerous to take cholagogue preparations: allochol, cholenzim, berberine, lobil, and others. First you need to go through an ultrasound to determine if there are stones in the gall bladder or not. If the stones do not show up, it means that the pain syndrome gives cholecystitis and choleretic medications in this case will not bring harm.
Many people think that with cholelithiasis you can safely drink infusions and herbal medicinal herbs. But this is not so. Immortelle, corn stigmas, aloe, barberry, St. John's wort, oregano, rosehip, calendula and even valerian - all these plants also possess choleretic action and can pose a potential danger for people suffering from cholelithiasis, as they can cause an attack of hepatic colic.
3. Dissolution of stones
Medical litholysis( "lithos" - stone, "lysis" - dissolution) is a method of treatment of cholelithiasis, which began to be developed in the 70s of the last century. Initially, the dissolution of gallstones was carried out with the help of chenodeoxycholic acid, which with prolonged intake inhibits the synthesis of cholesterol in the body and promotes the dissolution of gallstones. But the use of chenodeoxycholic acid in therapeutic doses causes a large number of side effects, so at the present time ursodeoxycholic acid, which is also a hepatoprotector, is most often used as the drug for litholysis.
However, when using this acid as a "solvent" there are a number of limitations, namely: gallstones should be radiopaque( cholesterol);The gallbladder should function( the cystic duct must be passable);the fullness of the lumen of the gallbladder with stones should not exceed half, etc. In addition, dissolution with the help of bile acids is subject to stones with a density of no more than 70-100 units according to the Hounsfield scale.
Given these limitations, only 20% of the total number of patients with cholelithiasis can be used to dissolve stones. But even with the most careful selection, the therapeutic effect is not observed in all patients( from 25 to 50%).
General contraindications for dissolution of stones by any method:
• acute infectious diseases;
• acute diseases requiring in-patient treatment;
• pregnancy;
• complicated forms of cholelithiasis;
• disconnected gallbladder, etc.