Cholelithiasis (also called cholelithiasis ) - A disease which is characterized by the appearance of stones in the biliary tract. In particular, the formed stones in the gallbladder (referring to cholecystolithiasis ) And bile ducts (in this case develops choledocholithiasis ).
The appearance of stones in the development of gallstone disease is due to the deposition of insoluble components of bile. These components are cholesterol . calcium salt . cholochrome s As well as certain types of proteins . Also, in some cases, found the net in terms of the chemical composition of calculi. Stones, are formed in the bladder and bile ducts, divided into cholesterol . pigment As well as rare, which is calcium carbonate . When it comes to mixed stones, they usually consist of cholesterol by 70%.
It is believed that cholelithiasis It is one of the most common problems in gastroenterology.
As the medical statistics, in recent years the number of cases has increased significantly cholelithiasis Thus, in 25 years the number of patients with gallstone disease increased approximately 2, 8 times.
Symptoms cholelithiasis mainly manifested in humans on average, and in the elderly. However, you can get sick from this disease at any age. The disease occurs even in newborn babies. Among the total number of patients is dominated by women but also men gallstones are formed frequently.
Causes of gallstones
Until now, the mechanisms that lead to the formation of the stones are not fully disclosed. Accepted provide three stages of education: step saturation . Crystallization and subsequent growth . Considered the most important stage of saturation bile cholesterol. The bile cholesterol dissolved through a complex chemical process, which is defined by other lipids bile.
Experts identify some of the reasons due to which a person may develop gallstones. The main reasons for the manifestation of the disease should be noted bile stasis, metabolic disorders and infectious factor.
Violation of cholesterol metabolism in the body and, consequently, increased levels of cholesterol in the bile and blood leads to gallstones. Studies indicate that the development of gallstones is often observed in obese people. With obesity lithogenicity bile rises due to a too high level of cholesterol secretion.
One of the important factors affecting the occurrence of gallstones is the food. People who are prone to this ailment, recommended special diet cholelithiasis, including cholesterol as low as possible and more products with dietary fiber. In addition to obesity factors contributing to stone formation is considered physical inactivity and old age person. There are also studies that suggest that gallstone disease is more common in men and women who are suffering diabetes . atherosclerosis .
In women, one of the precipitating factors is childbearing. During the growth of the fetus is a compression of the gall bladder, so that there is stagnation of bile. In the last stages of pregnancy bile saturated with cholesterol, which also contributes to the formation of stones. Gallstone disease is often manifested in women after the second pregnancy.
Cholesterol stones are often formed in the presence of a person other diseases of the gall bladder or the gastrointestinal tract. The concentration of cholesterol increases when irritable bowel syndrome . dysbacteriosis .
Therefore, gallstone disease is polyetiological disease caused by different factors, the totality of which eventually leads to the formation of gallstones.
Symptoms of gallstones
Gallstone disease manifests itself in humans is very different symptoms. Experts distinguish several different forms of the disease. It Latent . dyspeptic . pain torpid and paroxysmal pain form.
When the period ends with the latent form of the disease, the patient may initially be noted manifestation of dyspeptic disorders. After some time, he already appears moderate pain, and later people are concerned about the periodic attacks biliary colic . But not always gallstone disease is developing for this scheme.
Stones in the gallbladder or the ducts are not always trigger the clinical manifestations of the disease. Sometimes the presence of a calculus in the fundus of the gallbladder causes no tangible manifestation of symptoms. The duration of the latent form of the disease can vary from 2 to 11 years.
In the transition to the form of diarrheal disease in a patient already marked general dyspepsia, which often occur in diseases of the gastrointestinal tract. In the right hypochondrium and epigastric marked heaviness in the mouth periodically appears dryness and bitterness. Possible attacks Heartburn Constant belching . abdominal distention and unstable chair . At the same time the patient feels ill after consuming fatty and spicy foods. These symptoms occur in this stage of disease development regularly.
When pain torpid form gallstones distinct episodes of pain a person is not observed. Sometimes it appears dull and aching epigastric pain, a sense of strong gravity in the right upper quadrant. The more intense the pain occur after food violations in cholelithiasis. In addition, the pain becomes intense after severe shaking, tangible physical activity, unpleasant emotions, changing weather conditions. The pain often radiates to the right shoulder and right shoulder blade. Some people are overcome by frequent nausea, heartburn, bloating, constant feeling of malaise. Symptoms of gallstones in women characterized by increased pain during the menstrual period. This form of the disease can last even a few decades, accompanied by the absence of adequate therapy attacks of biliary colic or acute cholecystitis .
Painful paroxysmal form also called biliary colic . It flows in waves: in the background of the normal state there is a sudden severe attack of colic. However, such attacks can manifest as a few days and a few years later. The pain of biliary colic is very sharp, stabbing or tearing. It is localized in the right hypochondrium or epigastrium. This man suffered severe torture, can not find the right position of the body, even screaming in pain.
Sometimes these attacks occur for no reason, it often provokes them oily or spicy food, and other deviations from the diet, and alcohol intake, physical or emotional stress. Women often suffer from cramps during the menstrual period, during pregnancy. The pain of biliary colic is often placed under the right shoulder blade, collarbone and supraclavicular region, neck, right shoulder and chest. In more rare cases, the pain gives to the heart and can be mistaken for an attack angina . Often the pain is celebrated during nausea, vomiting bile, which the patient does not bring relief. If the attack of biliary colic person suffers from uncontrollable vomiting, it may indicate that the pathologic processes has been involved as the pancreas.
The most severe attacks of colic have been reported in people who have gall stones are small. In people suffering from biliary colic, noted in his mouth the bitter taste, they may be torturing heartburn, flatulence They do not tolerate fried and fatty foods.
Complications of cholelithiasis
If in the process of developing gallstones is joined by inflammation, infection or blockage develops in the biliary tract as a result of movement of stones, the clinical picture of the disease varies considerably. When clogged duct or gallbladder neck possible gradual development hydrocholecystis . This person suffering from a severe attack of pain, but after a while the doctor can feel the increased gall bladder. If the patient develops an edema, the sharp attacks of pain are gradually replaced by a feeling of heaviness in the right upper quadrant. It is not marked rise in body temperature or changes in laboratory blood test. But the accession of infection has been developing gallbladder empyema . With this diagnosis, a sharp deterioration in the patient's condition: he was overcome by pain, fever, there is a significant increase in body temperature.
If there is a complete blockage of the entrance to the gall bladder stone, and it is impossible to drain the flow of bile. As a result, the bubble will atrophy over time.
Sometimes a certain movement of the stones hit promotes bile into the duodenum. At the same time a person develops jaundice . The consequence of the stagnation of bile in the liver is hepatomegaly; as a complication of gallstone disease may be cholangitis, provocative cholangitis .
If the process becomes chronic, it is fraught with the manifestation of irreversible changes: cirrhosis . holangiogepatita . renal and hepatic failure . As a complication of progressive disease may also develop bile peritonitis . pancreatonecrosis . These states urgently need to be treated exclusively surgically.
The most common complication of cholelithiasis becomes destructive cholecystitis . ruptured gallbladder .
A serious complication of long presence of stones may be the development of gallbladder cancer . Rarely gallstone ileus .
Diagnosis of gallstone disease
The diagnosis in the case of gallstone disease usually does not cause particular difficulties, if the patient develops an attack of biliary colic. It is more difficult to diagnose the disease in the presence of vague pain, dyspeptic symptoms, or symptoms of other diseases of the digestive tract. One of the most important moments in the diagnostic process is the correct history, from which the doctor can learn about all the features of the current malaise.
During the informative method of diagnosis is a laboratory examination of blood and feces and urine.
Sometimes patients with suspected gallstones appoint holding duodenal intubation . Clinical chemistry bile to evaluate the properties of bile, which to some extent dependent on the presence of a pathological process in the biliary tract . However, due to the possibility of disease exacerbation after the duodenal sounding now increasingly used radiographic and ultrasonographic research methods that allow you to confirm the diagnosis . To fully verify the accuracy of the diagnosis, ultrasound is performed, and the method of infusion and oral holetsistografii cholegraphy . The modern method of cholangiography allows you to take pictures of the biliary tract after direct injection of contrast medium into them . This is done by endoscopy, puncturing the abdominal wall . The study also used computed tomography and magnetic resonance imaging .
Treatment of gallstone disease
To treatment of gallstones has been the most significant effect, it is important for the different approach to the principles of therapy in patients of all ages, at different stages of the disease. It should also take into account the presence or absence of complications. For all patients who were found gallstones, it is important to proper nutrition in cholelithiasis.
If a patient has acute illness, attack of biliary colic, it should take no food for a day or two to ensure gentle treatment for pancreatic cancer. Further, should eat only boiled, mashed, low-fat food.
During an acute attack the patient's prescribed medicines with analgesic effect. In severe cases, you can assign narcotic analgesics, as well as the introduction of antispasmodic drugs intravenously. If during the diagnosis was found to the development of inflammation in the biliary tract, in the course of complex therapy included antibiotics . If cholelithiasis is accompanied pancreatitis , Expedient receiving enzyme preparations - mezima . Festal . Creon .
Perhaps the appointment of drugs that improve the functioning of the liver - essentiale . hepatitis . karsila . If found only a single floating gallstones, treatment may consist in an attempt to their dissolution. As drugs which promote dissolution of the stones used drugs henodezoksiholevoy or ursodeoxycholic acids .
To dissolve stones is successful, it is important to have saved the normal functions of the gallbladder, there was no inflammation in the bile ducts and gall bladder. These drugs may reduce the synthesis of cholesterol, reduce its excretion in the bile, promote the separation of cholesterol crystals from the stones and the removal of bile.
This treatment can last more than six months. During treatment the patient is important to follow a diet that will include a minimum of cholesterol and plenty of fluids. However, pregnant women such treatment is contraindicated, since drugs can have a negative effect on the fetus.
Shockwave cholelithotrity - A modern method of treatment of gallstones, which consists of crushed stone. It uses sound wave. To be successful crushing, stone size should not be more than 3 cm in diameter.
Surgery when gallstones involves complete removal of the gallbladder. Today it is mainly used for laparoscopic cholecystectomy. This technique is removal of the gallbladder is much less traumatic, post-operative period is much shorter period of time. Such an operation can be done if the goal is to remove the stones from the gallbladder.
When the stones in the bile duct is carried out combined operation: using lapraskopicheskogo method to remove the gallbladder and bile duct from the extraction of stones is carried out using an endoscope and sphincterotomy.
Diet for gallstones
Treatment of the disease is impossible without strict compliance with certain principles of nutrition. Diet for gallstones can effectively get rid of the frequent occurrence of unpleasant symptoms of gallstones.
Its basic principle is to limit foods that contain cholesterol. People with gallstones should not eat cheese, brains, egg yolk, liver, sausages, pork, fatty dairy products, meat, duck and goose.
If the patient is the presence of overweight Then it should be excluded from the menu digestible carbohydrates.
It is important to regularly eat foods containing protein. Diet for gallstones suggests eating fish, meat, poultry, rabbit, low fat cottage cheese. To reduce the cholesterol content in the products, they must be boiled, but the broth drink. The food should be consumed in baked, boiled, stewed. If baked meat, the skin before its use should be removed.
Vegetable salads dressed with yogurt, olive oil. Do not eat fresh bread is better to take a little piece of stale bread or crackers. It is important to increase the regular intake of fiber by introducing into the diet as much as possible vegetables. Do not restrict the everyday use of liquid beverages, as they contribute to the output of toxins from the body and maintains normal metabolism.
Diet for gallstones excludes the inclusion in the diet soda, ice cream, chocolate. Fatty meals significantly load the gallbladder. Eating should be a relatively small portions, dividing the total daily diet for 6-7 meals.
Prevention of cholelithiasis
To prevent the development of gallstones, it is important to quickly eliminate all the causes that contribute to disruption of metabolic processes and the stagnation of bile.
