- Diagnosis of pathology
- How to remove liver stones
- The gallstone disease is a disease of the hepatobiliary system that leads to the formation of gallstones in the liver ducts( intrahepatic cholelithiasis), in the common bile duct( choledocholithiasis) or in the gallbladder( cholecystolithiasis).
Usually, with intrahepatic lithiasis, stones are found not only in liver tissues, but also in the bile and general hepatic duct, however, concrements can only occur in the lobar and segmental bile ducts. In Western countries, stones in the liver are a rare phenomenon. Of all patients with CSF, only 0.6-1.3% have concrements in the gland itself, in East Asian countries this figure reaches 45%.
In Eastern Asia, intrahepatic lythiasis is a primary disease, and in Western Europe patients, 95-97% of the concrements migrate to the ducts from the gall bladder. It was also found that in women older than 40 years, stones are formed twice as often as men.
appear The formation of concrements in the liver is due to the physicochemical and physiological properties of the environment. If it is impossible to dissolve the organic or inorganic compounds that are in the bile, the suspended substances precipitate. It is believed that the formation of sediment occurs as a result of metabolic disorders, which can be congenital and acquired( poor nutrition, destructive processes, poisoning).
In the liver and in the biliary tract, stones can form with a sedentary lifestyle, due to food, fever, climatic conditions. An obligatory condition for the formation of a calculus is a violation of the secretory and resorptive activity of the organ, stasis of bile or inflammatory processes.
It is believed that due to the strictures of the biliary ducts in the gland bile duct stagnation occurs, motor ductility is broken and atony develops, which leads to the formation of an abscess, biliary cirrhosis, sepsis. If there is a violation of bile secretion, the concentration of dissolved substances in the bile increases, but they can not be removed, since there is no component that must bind them, as a result, they precipitate.
In case of inflammation, liver secretion stagnates, and this also leads to precipitation, changes in solubility of salts and deterioration of protective colloids. In the concretions, the nucleus and the layering are distinguished. The core of any stone is an organic or colloidal substance( slipped epithelium, leukocytes, thick mucus, fibrin, protein precipitate, bacteria), over which inorganic compounds are layered over time.
The composition of the stone formation determines its strength( it can be soft, like caked sand or very hard)
At first the stones are small, the size of crystals or grains of sand, but gradually they are covered with salts and increase. Even small solitary formations can disrupt the flow of bile, and once ingested into the gland duct, they can clog it, which will provoke a disturbance in the digestive process and an inflammatory reaction.
Stones in the liver in humans can be formed from bile pigment, calcium salts, cholesterol. They can be round, oval, in the form of a polygon. Their color depends on the composition, for example, cholesterol stones are yellow, and bilirubin brown or black( as in the photo below).The size of the formation can be up to 3 cm. Stones in the liver grow relatively slowly, they increase by about 10 mm in six months.
Most often, cholesterol stones are formed, extremely rare are formed from phosphorus or calcium carbonate. For the formation of cholesterol stones it is necessary to observe three factors: excess cholesterol in the bile, its precipitation in the form of crystals and disruption of the liver.
Due to bile acids and phospholipids, cholesterol in the bile is in a dissolved state, if there are not enough cholesterol-containing factors, it precipitates. Sometimes the lithogenicity of bile becomes due to increased secretion of cholesterol, which happens with obesity, hypothyroidism, diabetes, pregnancy, fatty hepatosis.
To start the process of stone formation in the liver any pathology that leads to a disruption of the metabolism in the liver is capable. It can be obesity, inflammatory processes both in the liver itself and other organs, for example, the bladder, urinary tract, pancreas. Appear pigmented stones in the gland, if the patient quickly destroy red blood cells( thalassemia or sickle-cell anemia).Stones in the liver can grow because of the increased content in the diet of harmful cholesterol( consumption of fried, fatty, smoked food), alcohol abuse, hormonal disorders.
Symptoms of the disease
It's not always that people who have concrements in the liver know about their existence. In 10% of cases, the stones are discovered accidentally, for example, during a routine examination or treatment on another matter, and their owners do not even know if there are stones in the liver. But most patients still have symptoms of stones in the liver, which indicate a violation of the gland.
With a disturbed outflow of hepatic secretions, the stones increase in size and overlap the lumen, which leads to hepatic colic and progressive jaundice. Intrahepatic lythiasis can occur in acute and chronic form. In acute course, there are hepatic colic, which are very painful. They are caused by the movement of the calculus along the duct of the gland or the obstruction of the lumen of the duct.
The disease can be manifested by pain in the epigastric region, jaundice and increased body temperature
If the stones in the liver, the pain is usually worse during inspiration, it radiates to the right shoulder blade, the waist. The patient appears chills, vomiting. With broken excretion of bilirubin, the urine becomes dark, and the feces are light, the skin acquires a yellowish shade and begins to itch. In the chronic course of the pathology, a person after two hours, after taking fat or heavy food, feels a rasporyanie or aching pain in the right hypochondrium.
In some cases, a bitter taste develops in the mouth, nausea may be disturbing. On the violation of the gland is also indicated dyspeptic syndrome, icterus, pruritus. Intrahepatic cholelithiasis is indicated by periodically arising icterus and fever, bitterness and dryness in the mouth, increase and thickening of the lobe of the liver in which the calculus is located, as well as its soreness.
Diagnosis of pathology
To determine the presence of stones in the liver is difficult. When setting a preliminary diagnosis, the doctor relies not only on clinical symptoms, but also on the presence of lesions of the gallbladder or its ducts, congenital hemolytic jaundice, prolonged cholangitis after removal of the gallbladder( if there are no stones in the biliary tract).To confirm the diagnosis, intravenous cholangiography, laparoscopy, or even operating cholangiography is performed.
Radiation methods are also used in diagnostics:
During the last two studies, it is possible to remove small stones, take a biopsy, install a stent.
- MRI( magnetic resonance cholangiography);
- ERCP( endoscopic retrograde cholangiopancreatography);
- CHCHKH( percutaneous transhepatic cholangiography).
How to remove stones from the liver
During the exacerbation of cholelithiasis, drugs that relieve pain and improve the quality characteristics of bile are prescribed. With renal colic, analgesics( metamizole), cholepspizmolytics( No-Shpa, Papaverin) and holinality( Atropine) are administered. Medical recommendations without exacerbation will depend on the stage of the disease. There are three stages of cholelithiasis.
The first stage of the
Physicochemical. The liver secret contains too much cholesterol and few bile acids and phospholipids. Clinical manifestations of the disease are absent, and the diagnosis is made based on the analysis of duodenal contents. The first stage can develop for several years.
Therapeutic measures consist in understanding the causes of bile lithogenicity, systematic physical loading, fractional rational nutrition, normalization of gastrointestinal functions, elimination of stagnation of hepatic bile are prescribed, if necessary, drug therapy is indicated.
After the termination of the drug course in the gland, the concrements
can form again. The second stage is
It proceeds asymptomatically, but the process of calculus formation has already begun. Transition of the disease in the second stage may be due to bile stasis, mucosal damage, inflammation, increased bubble permeability for bile acids, impaired intestinal hepatic movement of bile acids.
The diagnosis is based on the results of ultrasound and cholecystography. Predicting factors such as female sex, age over 40 years, hemolytic anemia, high weight, diabetes, pregnancy, long-term medication( nicotinic acid or clofibrate) are also considered. Stones containing calcium can be seen even on a review radiograph.
In the latent stage, patients are advised to adhere to a rational diet, prefer vegetarian and fiber-rich foods, move more, do not allow weight gain. Also prescribed drugs that can dissolve the calculus.
The third stage of
is characterized by the appearance of clinical signs. At first the patient is troubled by heartburn, abdominal pain, flatulence, stool disruption. Then there is colic( severe pain, nausea, vomiting).The next form of pathology painful, when there is a constant pressing pain in the right hypochondrium.Pain in the liver region
In the absence of treatment, the disease develops before the angina pectoris( pain is felt in the heart area) and the syndrome of the Stahn syndrome, when the LAS goes along with the diaphragmatic hernia and diverticulosis of the large intestine.
Treatment of stones in the liver can be non-surgical, including minimally invasive measures and surgical. With non-surgical treatment, bile acids are prescribed. Drug treatment only works if cholesterol concretes are formed in the liver.
Drugs containing ursodeoxycholic or chenodeoxycholic bile acid( Urofalk, Ursosan) are prescribed. Drugs should be taken for a long time( 1-2 years) and during the first three months of monthly examination.
In addition to daily medication, dietary recommendations should be followed and alcohol should be completely discarded. If there is no positive dynamics within six months, then the treatment tactics should be reviewed. Often patients can not take the remedy for a long time, because it can cause side effects in the form of nausea or headache.You can not take bile acids to pregnant women, patients with obesity, kidney or stomach disease.
Minimally invasive methods include lithotripsy, during which the stone is destroyed by laser or ultrasound. If the calculi are small, ultrasound is used. Vibration affects the stones, which leads to their destruction, and then they are eliminated naturally( cleansing the ducts is not required).The procedure is carried out without anesthesia. Large stones are crushed with a laser.
Endoscopic cholangioscopy with lithotripsy is ineffective in 40% of cases, as patients have strictures of the intrahepatic ducts
. The operation is done under anesthesia, as it requires a puncture of the abdominal wall so that the laser beam can penetrate the stone. Also, stones can be removed from the liver with laparoscopy. In the abdominal wall, several punctures are made to introduce the necessary equipment. Then carbon dioxide is introduced to improve the visibility of the internal organs. The doctor examines the affected areas with an endoscope and removes stones from the hepatic ducts with special instruments.
During surgery to remove the calculus from the liver, choledochotomy, sphincteroplasty, choledochitis, stenting of ducts, removal of part of the gland( with significant fibrotic changes, multiple abscesses, the presence of cholangiocarcinoma) can be performed.
If there are stones in the liver, the patient must necessarily follow a diet. You need to eat small portions, but often( 5-6 times a day).This will prevent stagnant processes in the liver and bile will be completely expelled into the gallbladder, and then into the duodenum. It is also necessary to ensure the thermal sparing of the digestive organs( food should be 15-60 0С).
From the diet, you need to remove fatty, salty, fried dishes, rich broths, smoked meats, marinades, alcohol, coffee, chocolate, since it is after heavy meals that hepatic colic often occurs. It is necessary to abandon foods that contain a lot of bad cholesterol( by-products, butter, sausages, cheese, yolk, caviar and seafood, canned goods, fatty sour cream, cream).This will not make the stones disappear, but will prevent their growth.
It is recommended to eat more green vegetables, dairy products, cereals in case of LCB.Meat and fish should be dietary, and bread - yesterday. All dishes should be cooked for a couple or boiled. Traditional medicine can be used only in the absence of complications and indications for surgery. They use decoctions and infusions of herbs that have a sedative, choleretic, anti-inflammatory effect.. Traditional medicine recommends drinking the collections, which include strawberries, birch leaves, mint and celandine, St. John's wort, dog rose, dandelion, buckthorn, wormwood, oregano and chicory.
What to do if there are symptoms of stones in the liver, the doctor will determine after a physical examination and receive the results of blood and urine tests. At the initial stage of the disease, diet and the administration of bile acids are usually prescribed, in some cases, crushing stones with ultrasound or a laser. If the patient arrives in an acute condition, then a surgical operation is performed.