Stones in the gallbladder - causes, symptoms and treatment

The gallbladder is the organ in which the bile produced by the liver accumulates. The latter is necessary for the digestion of food.If necessary, it is thrown into the duodenum. Bile is a complex substance that has a large amount of bilirubin and cholesterol.

Stones in the gallbladder are formed due to stagnation of bile, during which the cholesterol is retained in the bladder and precipitates. This process is called the process of formation of "sand" - microscopic stones. If you do not eliminate the "sand", the stones adhere to each other, forming concrements. Stones in the ducts of the bile and in the gall bladder form for a long time. This takes 5-20 years.

Stones in the gallstones can for a long time not behave themselves, but it is still not recommended to start the disease: a stone can injure the wall of the gallbladder and inflammation will spread to neighboring organs (patients often suffer from gastritis, ulcers, pancreatitis). What to do if there are stones in the gall, and how to treat this problem without surgery, we will consider in this article.

How are stones formed in the gallbladder?

The gall bladder is a small sac, it contains 50-80 ml of bile - a liquid that the body needs to digest fats and maintain normal microflora. If the bile stagnates, its components begin to precipitate and crystallize. Thus, stones are formed, which in the course of time increase in size and quantity.

Moreover, one of the mostcommon causes of the disease are considered:

1. Severe inflammation in the gallbladder.
2. Reduces the contractility of the gallbladder, because of which stagnation of bile occurs.
3. When bile contains a large amount of calcium, cholesterol, bile pigment, it is a water insoluble bilirubin.
4. Most often, the woman's disease is caused by obesity, a large number of births, the reception of hormones - estrogens.
5. Heredity. The formation of stones in the gallbladder is due to a genetic factor. If parents suffered from an illness, their child also has a risk of developing pathology.
6. Medicamentous treatment - Cyclosporine, Clofibrate, Octreotide.
7. Diet. Fasting or long intervals between meals can cause gallstones. Restricting yourself to the consumption of liquid is not recommended.
8. Stones in the gallbladder can arise due to diabetes, hemolytic anemia, because of Caroli syndrome, Crohn's disease, liver cirrhosis.
9. As a consequence of the transferred operation, in which the lower part of the intestine is removed.
10. Alcohol. Abuse of it provokes stagnation in the bladder. Bilirubin crystallizes and calculi appear.

As you know, bile consists of various components, so the stones may differ in composition. The following types of stones are distinguished:

1. Cholesterol- have a rounded shape and a small diameter (about 16-18 mm);
2. Calcareous- contain a lot of calcium and are rare;
3. Mixed- differ in a layered structure, in some cases they consist of a pigmented center and a cholesteric shell.

In addition, in the gall bladder, bilirubin stones may be formed that have a small value and are localized both in the bag and in the ducts. However, stones are often mixed. On average, their sizes range from 0.1 mm to 5 cm.

Symptoms of gallstones

The clinical picture of symptoms with the appearance of stones in the gallbladder is quite diverse. Symptomatology depends on the composition, amount and location of stones. Most patients with single large stones located directly in the gallbladder, often do not even know about their disease. This condition is called latent (latent) form of CSF.

As for specific features,Stones in the gallbladder make themselves felt by such symptoms:

• pain in the right hypochondrium (projection of the liver and bile ducts) - intensity from unexplained discomfort to hepatic colic;
• dyspeptic syndrome - manifestations of digestive disorders - nausea, bloating, unstable stool;
• an increase in body temperature is a consequence of the attachment of a secondary bacterial infection.
• if the stone descends into the bile duct, the pain is localized in the lower abdomen, into the groin, and gives into the femoral part.

In 70% of people this disease does not cause any unpleasant sensations at all, a person begins to feel discomfort only when the stones have already grown and clogged the bile duct and a typical manifestation - biliary colic, this is an attack of acute pain with periodic blockage of the gallbladder duct. This attack of acute pain, that is, colic, can last from 10 minutes to 5 hours

Diagnostics

The doctor-gastroenterologist is engaged in diagnostics. The diagnosis is established through the patient's complaints and some additional studies.

For the beginning of the patient, ultrasound of the abdominal cavity is done. - the main and most effective method of diagnosis of 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-traumatism), security, accessibility and the possibility of repeated execution.

If the situation is more serious, then doctors resort to cholecystocholangiography (X-ray examination with the introduction of contrast medium).

Effects

The course of cholelithiasis can be complicated by the following conditions:

• phlegmon wall of the gallbladder;
• biliary fistula;
• Mirizzi syndrome (compression of the common bile duct);
• perforation of the gallbladder;
• biliary pancreatitis;
• acute and chronic cholecystitis;
• edema of the gallbladder;
• intestinal obstruction;
• cancer of the gallbladder;
• acute purulent inflammation (empyema) and gall bladder gangrene.

In general, the presence of a stone in the bladder is not dangerous until it clogs the bile duct. Small stones usually come out by themselves, and if their size is comparable to the diameter of the duct (about 0.5 cm), then with the passage of pain - colic. The grain "slipped" further into the small intestine - the pain disappears. If the stone is so large that it sticks, then this situation already requires immediate medical intervention.

Stones in the gallbladder: treatment without surgery

Identification of gallstones does not always imply mandatory surgical intervention, in most cases treatment without surgery is indicated. But uncontrolled self-treatment at home is fraught with blockage of the bile ducts and an emergency hit on the operating table to the on-duty surgeon.

Therefore, it is better not to use questionable cocktails from categorically prohibited cholagogue and herbal oils, which are recommended by some traditional healers, but to make an appointment for a consultation with the gastroenterologist.

Forconservative treatment of cholelithiasisthe following medicines are prescribed:

1. Preparations that promote the normalization of the composition of bile (ursofalk, lobil);
2. Enzyme preparations, which improve the digestive process, in particular - processes of lipid digestion (creon).
3. With pain caused by contraction of the gallbladder, patients are recommended various muscle relaxants (platifillin, drotaverin, no-spa, metacin, pyrenicin).
4. Stimulants of bile acid secretion (phenobarbital, zixorin).

Modern conservative treatment, allowing to preserve the organ and its ducts, includes three main methods: dissolution of stones drugs, crushing stones with ultrasound or laser and percutaneous cholelitholysis (invasive method).

Dissolution of stones (litholytic therapy)

Dissolution of gallstones with drugs helps to cure gallstones without surgery. The main drugs used to dissolve stones in the gallbladder are ursodeoxycholic acid (Ursosan) and chenodeoxycholic acid (Henofalk).

Litholithic therapyshown in the following cases:

1. The stones are small (5 to 15 mm) and fill no more than 1/2 of the gallbladder.
2. The contractile function of the gallbladder is normal, the patency of the bile ducts is good.
3. The stones have a cholesteric nature. The chemical composition of the stones can be determined with the help of duodenal sounding (duodenum) or oral cholecystography.

Ursosan and Henofalk reduce in the bile the level of substances that promote the formation of stones (cholesterol) and increases the level of substances that dissolve stones (bile acids). Litholytic therapy is effective only in the presence of small cholesterol stones, in the early stages of the disease. Dose and duration of drug intake is determined by a doctor based on ultrasound data.

Stone crushing (extracorporeal lithotripsy)

Extracorporeal shock wave lithotripsy (pulverization) is a technique based on the generation of a shock wave, leading to crushing of the stone into a multitude of grains of sand. Currently, this procedure is used as a preparatory stage before oral litholytic therapy.

Contraindicationsare:

1. Blood clotting disorders;
2. Chronic inflammatory diseases of the digestive tract (cholecystitis, pancreatitis, ulcer).

TOside effectsultrasonic lithotripsy include:

1. Risk of blockage of the bile duct;
2. Damage to the walls of the gall bladder by shards of stones as a result of vibration.

Indication for ESWL is the absence of violation of patency of the biliary tract, single and multiple cholesterol stones with a diameter of not more than 3 cm.

Percutaneous transhepatic cholelitholysis

It is used rarely since it refers to invasive methods. In the gallbladder, through the skin and tissue of the liver, a catheter is introduced, through which 5-10 ml of a mixture of special preparations are dripped. The procedure should be repeated, for 3-4 weeks you can dissolve up to 90% of the concrements.

You can dissolve not only cholesterol, but also other types of gallstones. The number and size of the stones do not matter. In contrast to the previous two, this method can be used not only in persons with asymptomatic cholelithiasis, but also in patients with severe clinical manifestations of the disease.

Operation to remove gall stones

Nevertheless, it is worthwhile to understand that one can not do without surgical treatment when:

• frequent biliary colic;
• "Disconnected" (lost contractility) bubble;
• large concretions;
• frequent exacerbations of cholecystitis;
• complications.

In most cases, surgery to remove gallstones is recommended for patients who have a disease accompanied by frequent relapses, attacks of severe pain, large stones, high body temperature, various complications.

Operative treatment can be laparoscopic and open (cholecystolithotomy, cholecystectomy, papillosphincterotomy, cholecystostomy). The variant of operative intervention is determined for each patient individually.

Food

Usually, the diet is prescribed as soon as the first signs of stones in the gallbladder appeared. It is specially developed for such patients, it is called - a therapeutic diet number 5, it must be adhered to constantly.

With stones in the bile, the use of such products is not recommended:

• fat meat;
• various smoked products;
• margarine;
• spicy seasonings;
• hard-boiled eggs;
• strong coffee;
• canned meat and fish;
• pickled products;
• broths: meat, fish and mushrooms;
• fresh bread and yeast pastries;
• carbonated drinks;
• alcohol.

The food is prepared by cooking or baking, at the same time you need to eat often - 5-6 times a day. Diet with stones in the gallbladder should contain a maximum of vegetables and vegetable oils. Vegetables due to vegetable protein stimulate the cleavage of excess cholesterol, and vegetable oils improve peristalsis of the intestine, contribute to the reduction of the bladder, and thus, prevent the accumulation of bile in it.

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