Diseases of the gallbladder

The gallbladder, as an isolated organ, is still dependent onwork of the liver and performs an additional function for the storage and further withdrawal of bile into the intestine. Therefore, gallbladder disease always accompanies pathological disorders in the hepatic tissue, and it is impossible to cure it if the hepatocytes work correctly.

Pathological changes in the gallbladder are caused by: inflammation in the wall, altered motility, congestion and thickening of bile, a mechanical obstruction in the bile ducts. The triggered process has not only a local effect, but also leads to a general digestion failure:

• stops excretion of toxic substances from food, the environment, and medicines from the body;
• disrupted the functioning of the pancreas and intestines;
• increases the likelihood of inflammation of the stomach and duodenum;
• an inoperable gallbladder reduces immunity and the body's ability to eliminate infection.

What are the tasks of the gallbladder?

The biliary ducts( bile ducts) are located inside the liver, in the central part of the lobules together with the vessels, they collect the secret developed. According to the withdrawal system, they carry it to the gallbladder. This body contains 40-70 ml of liquid, it has a saccular structure with a rather thin wall.

In it are layers:

• slimy - formed by large folds of high epithelium;
• muscular - from smooth muscle bundles with a basic circular direction;
• serous - protects the organ from the outside.

In the inner shell there are glands that secrete mucus, the hormone anticholecystokinin, able to absorb water from the bile, amino acids, salts. Thus, the composition and viscosity of the contents are regulated.

An inferior duct approaches the intestine along with the pancreatic duct. Here the muscles form a single sphincter, called according to the author of Oddi. After ingestion of food into the intestine, the gallbladder contracts and throws out bile at the same time as the pancreatic juice.

In an adult, 0.5-1 L of bile is produced in 24 hours. In addition to water: bile acids, mucus, proteins and amino acids, inorganic substances, bilirubin, cholesterol, phospholipids, vitamins A, B, C, D.

Some of these substances are excreted in feces, the other - digested in the intestine and enters the bloodstream. Bile neutralizes acid reaction of gastric juice, activates the work of digestive enzyme systems, protects the intestinal mucosa from the growth of harmful bacteria, promotes peristalsis and the removal of toxic substances, slags, from the body.

The main diseases of the bile excretory system

The most common pathology of biliary organs are:

• inflammations - cholecystitis( calcareous and calculous walls of the bladder) and cholangitis( excretory ducts);
• dyskinesia of bile ducts( reduction of DZHVP is used);
• cholelithiasis( SCI, writing "cholelithiasis" is erroneous, although it is often used in practice);
• cancer.

Diseases of the gallbladder lead to organ dysfunction followed by signs of digestive failure, so the main symptoms are the same, different in flow and intensity of manifestation.

The main causes of

Problems with the gallbladder in humans are caused by infection and stagnation in the bladder and ducts. These factors reinforce each other: bile congestion forms convenient conditions for infectious agents, and the inflammation that arises in response further strengthens the stasis( immobility) of the bile. Hence the causes of combined lesions( cholecystitis + stones in the bladder) in most patients.

Infection with microorganisms, parasites, helminths that come from the intestine, from the blood from chronic foci( in men with prostatitis, sinusitis, in women with adnexitis), from the liver. More often in bile detect staphylococcus, E. coli, streptococci, enterococci, proteus, Pseudomonas aeruginosa, lamblia, ascarids.

The predisposing factor is excess weight( obesity) - causes an increase in the concentration of cholesterol in the bile. Cholesterol - the main component of stones, so its growth leads to the development of CSW.

The cause of gallbladder disease in women can be a hormonal effect. Sex hormones increase the excretion of cholesterol. Pregnancy in the last trimester by compression causes stagnation of bile.

Congestive events are provoked:

• by irregular diet, if a person has forced long breaks, with inept attempts to lose weight using diets;
• in the elderly, with increased deposition of cholesterol;
• diabetes, when the metabolism and production of fatty components in the liver is disturbed;
• is an allergic predisposition;
• by the presence of developmental anomalies altering the anatomical structure, the size of the bladder and ducts( bends, deformations, curvature);
• by disturbed innervation - leads to uncoordinated contraction of muscle fibers and impedes the passage of bile;
• concomitant diseases of the pancreas and liver.

These factors can be attributed to internal( endogenous) problems of the gallbladder. There are also external( exogenous) reasons with which not every organism is able to cope without losses. These include:

• contact with toxic substances in chemical plants;
• low physical activity in combination with chronic atonic constipation;
• increased stress load, expressed emotional feelings;
• Drug use( Clofibrate, Ceftriaxone, Octreotide, diuretics, statins) and oral contraceptives.

Signs of the pathology of the gallbladder and biliary tract

Regardless of the etiology and mechanism of development, the symptoms of gallbladder diseases are accompanied by similar manifestations. Pain syndrome - differs in intensity and nature. Its features are taken into account in the diagnosis and choice of treatment for the gallbladder.

Constant aching pain, sometimes bursting type localized in the hypochondrium to the right. More often associated with chronic inflammation, dyskinesia of the hypotonic type. Increase after eating fried and fatty foods, alcohol. Ordinary analgesics are not removed.

In acute cholecystitis and biliary colic attacks, the pains are of an intense cutting nature, irradiate into the back, the right collarbone, and the shoulder. Sometimes patients indicate a burning sensation in the right side. Special difficulties in diagnosis cause the ability of pain to increase with breathing and irradiate to the heart area.

With prolonged course of inflammation, the solar plexus is involved in the process, then a "solar" syndrome with intense burning pains in the navel region that give off during breathing in the back is formed.

Among other manifestations, it should be noted:

• fever with chills in acute inflammation or to low figures in chronic;
• dyspepsia in the form of nausea, vomiting with bitterness, belching;
• disorder of intestinal motility, which is manifested by transient diarrhea and constipation;
• permanent bloating;
• moderate weight loss;
• loss of appetite;
• feeling of bitterness and dryness in the mouth;
• increased irritability, insomnia;
• skin itching.

With the disturbed intake of bile into the intestine with overlapping of the duct with stone, tumor, adhesions, the absorption of its components into the blood takes place. Due to the accumulation of direct bilirubin and its release, the appearance of symptoms of mechanical jaundice in case of problems with the gallbladder:

• urine becomes intensely yellow, then darkens even more;
• discoloration of feces causes a gray stool color;
• reveals the icterus of the sclera and skin.

Jaundice can be considered a complication indicating the spread of inflammation to the hepatic tissue. The patient's condition worsens after heavy physical exertion, shaken transport, vibration, undercooling, emotional emotions.

Features of the manifestation of diseases in childhood

In children, the symptoms of gallbladder disease are most often associated with dyskinesia of the outflow tract, giardiasis cholecystitis, appear against the background of viral hepatitis. The gallstone process and tumors are rare. Congenital anomalies also refer to infrequently detected pathology.

There is regurgitation, nausea with vomiting, the stomach is swollen, the stool is unstable, the feces lightens. In older children, pain is associated with eating fried foods, chips, soda water, fast food. The child becomes restless, capricious, irritability rises, does not sleep well. School children complain of fatigue and weakness.

Characteristics of the main pathologies of the biliary system

Diseases are related to each other by pathogenesis and often occur together with other diseases of the gastrointestinal tract. But we will analyze the most characteristic features for each nosology.

Cholecystitis

To the acute and chronic inflammation of the gallbladder, women over 40, with excess weight and nutritional errors are more likely. Statistics record prevalence in almost 1/10 of the adult population( according to some, 20%).

Most cases are caused by simultaneous presence in the bladder of stones( calculous cholecystitis).But in men, the stoneless form is more often manifested. A prolonged inflammatory process develops in the inner shell of the organ, leads to scarring, thinning of the wall, loss of functions.

For existing stones, favorable conditions are created in the formation of pressure sores and a breakthrough into the abdominal cavity. For the reasons described, a bladder lesion in typhoid and paratyphoid fever should be added. Severe inflammation in the form of gangrene is accompanied by meltdown of the wall, peritonitis, intoxication of the whole organism.

Dyskinesia of biliary tract

The disease is classified as functional impairment. It is more characteristic of children, people of the neurological nature of the character. The disease is associated with impaired muscle tonus of the gallbladder wall or outflow ducts.

By nature is divided into 2 types: hyperkinetic and hypokinetic. At the first basic symptoms are paroxysmal pains, at the second - dyspeptic displays.
Treatment of the gallbladder in such cases requires preliminary clarification of the nature of the disorders.

Cholangitis

The disease is caused by inflammation of the bile ducts. It is rarely isolated, more often complicates the course of chronic cholecystitis, remains in the patient after removal of the gallbladder due to cholelithiasis.

There are different types of pathogenesis and clinic:

• obstructive( with mechanical obstruction inside the duct);
• bacterial;
• recurrent;
• is secondary sclerosing if caused by the effects of inflammation.

Gallstone disease

The disease is associated with the pathology of bilirubin and cholesterol metabolism. In the thick bile, first precipitate salts, colloidal substances, then they are glued together and form stones. Localized stones can be inside the hepatic passages, in the gall bladder and in branched ducts.

The most susceptible to risk factors are middle-aged and overweight women, often giving birth, blonde. Symptoms in the form of an attack of colic arise at the time of "getting stuck" and moving the stone along the ducts. Before this, the disease can last for a long time asymptomatically or be accompanied by signs of inflammation.

Gallbladder cancer

Disease is considered the outcome of a prolonged inflammatory process in the bladder. Distinguish by the types of malignant growth: adenocarcinoma, squamous solid and cancer, mucosal tumor.

Neoplasm of the gallbladder is characterized by a high degree of malignancy, early spread of metastases, rapid germination in neighboring organs.

Treatment of diseases of the gallbladder

Therapy of diseases of the biliary tract and bladder requires clarification of the main causes of pathology. Timely decision-making on the surgical removal of the organ can save the patient from many unpleasant problems, but it can not be considered truly cured, because for the rest of his life a person will have to monitor food, take special preparations to support digestion.

Diet

Patients with obesity need to limit caloric content, spend unloading days. Therapeutic diet according to the list of acceptable dishes and foods belongs to the table number 5.The patient is categorically contraindicated:

• fried and smoked dishes( are replaced with boiled, steamed, stewed);
• all kinds of alcohol, carbonated water;
• spicy seasonings, pickles, marinades, canned food;
• greasy culinary products with cream;
• beans.

shown drink rather weak green tea, rose hips broth, fruit juice in breeding, dairy products with reduced fat index, cereals, meat and fish dishes from the low-fat varieties.

Medication therapy

Inflammation requires the use of antibacterial agents. Used antibiotics with broad-spectrum class of the semi-penicillin( Amoksiklav) cephalosporins and III IVpokoleniya( Ceftriaxone), fluoroquinolone derivatives( moxifloxacin, gatifloxacin).

Specific treatment courses with respect slots assigned when detecting parasites in the bile( furazolidone, Erythromycin, hloksila, Vermoxum, Kombantrin, Trichopolum, Fazizhin).For the removal of spasmodic pains are shown: Atropine, Platifillin, No-shpa, drugs must be injected. Attacks of cholelithiasis are removed by Nalbuffin, Ketanov, Promedol.

In patients with hypotonia, cholecystokinetics are used. Hepatoprotectors( Heptral, Essentiale) are prescribed to prevent reactive inflammation in the liver.

When concomitant diseases of the pancreas and lesions of the stomach may require enzymatic means( Pancreatin, Creon, Festal, enzistal, Panzinorm, Penzital, Mezim, Gastenorm, Pangrol) and drugs that inhibit the secretory function( Almagell, Omez, Maalox, Kontrolok, Kvamatel).In the treatment of dyskinesia

necessary to provide protective regime, anti-anxiety drugs from less strong plant( tincture motherwort, Novopassit) to sedative tablets( Seduxen).In such cases, physiotherapy procedures are shown - galvanic collar, diadynamic currents, inductothermy.

The methods of stone crushing( lithotripsy) in recent years have developed a negative attitude. All apparatuses together with stones damage the walls of the organ, aggravate the severity of the course of the disease, cause perforation.

With a persistent pain syndrome, frequent attacks require rapid removal of the bladder( cholecystectomy).Treatment of a cancerous tumor is not complete without removal of the gallbladder, partial resection of the liver, nearby lymph nodes. Combined therapy( cytostatics + irradiation) is prescribed.

tactics and types of application Cholagogue

How to treat gall bladder drugs with choleretic properties useful for patients to know to avoid buying unnecessary products. Depending on the purpose, different groups of funds are used.

To stimulate bile( choleretics) in liver cells, medicines are needed that are capable of:

• directly activate parenchymal cells of the liver;
• stimulate receptors on the mucosa of the small intestine;
• to increase the osmotic ratio between bile and blood, which increases the transition to the bile ducts of water and electrolytes;
• increase the flow rate of bile through the pathways to prevent inflammation;
• increase the concentration of bile salts in the bile to prevent precipitation of cholesterol.

Synthetic and vegetative choleretics are used in the treatment. These include: Khologol, Allochol, Festal, Holenzim, Nikodin, Tsikvalon, Oksafenamid, Odeston. Folk remedies: grass immortelle, hips, tansy, mint.

The subgroup of hydrocholeretics increases the volume of bile at the expense of the water part, restricts the back absorption of water and electrolytes, which increases the fluidity of the bile. These include natural mineral waters: Smirnovskaya, Essentuki( differ in the degree of mineralization), Jermuk, Izhevskaya, Slavyanovskaya.

Group of cholekinetics - increases muscular tension of the gallbladder with a simultaneous decrease in the tone of the biliary tract, exerts a laxative effect. Known drugs: Xylitol, Sorbitol, magnesium sulfate, Carlsbad salt, Berberine.

Drugs from ursodeoxycholic acid help normalize the outflow of bile in lymphoblasts( Ursofalk, Ursolizin, Ursosan, Holudexan, Cholespasmolytics - relieve biliary tract spasm

Used for spasmodic pains, hyperkinetic dyskinesia: Atropine, belladonna extract, Platifillin, Nitroglycerin.the right combination of funds depending on the task of therapy.

In order to prevent gallbladder diseases, it is necessary to struggle with excess weight, to exclude smoking and receptionalcohol, adhere to proper nutrition, even in the presence of congenital anomalies, attentive attitude to one's own health allows to prevent the development of pathology