Gallstone disease: symptoms and treatment

Gallstone disease (SCI) is a pathological process accompanied by the formation of concrements in the gallbladder.

The second name of the disease is calculous cholecystitis. Since the SCI affects the body of the digestive tract (gallbladder), its treatment is usually handled by a gastroenterologist.

Features of gallstones

Concrements are the main manifestation of cholelithiasis. They consist of calcium, cholesterol and bilirubin, and can have different sizes. At a small size, it is a question of the so-called "sand" in the gallbladder, but if the formations are large, they are considered full stones (concrements).

Such formations may increase in size over time. So, from a small grain of sand, a stone can appear in dimensions of 1 cm or more. The concrement can have a different shape - from a round or oval to a polyhedron outline. The same applies to the density of stones. There are quite strong concrements, but there are also very fragile, capable of crumbling from one touch.

The surface of the stone can be smooth, spiked or porous (in cracks). These features are characteristic of all stones, regardless of their location. However, it is often found in the gall bladder. Such an anomaly is called cholelithiasis, or calculosis of the gallbladder. Less common stones are found in the bile ducts. This disease is called choledocholithiasis.

instagram viewer

Concrements in the gallbladder can be either single or multiple. They can be dozens, and even hundreds. However, it should be remembered that the presence of even one calculus can cause serious damage to health. And dangerous complications often result from small, rather than large gallstones.

Causes of stone formation

If for any reason the quantitative balance of the components that make up the bile is disturbed, solid structures - flakes are formed. As they grow, they merge to form stones. Often the disease develops due to the accumulation of excessively large amounts of cholesterol in the bile. In this case, bile is called lithogenic.

Hypercholesterolemia can result from:

obesity;
the abuse of fatty foods containing large amounts of cholesterol;
decrease in the number of specific acids entering bile;
decrease in the number of phospholipids, preventing hardening and settling of bilirubin and cholesterol;
stagnation of bile.

Bile stasis may be mechanical or functional. If it is a question of the mechanical nature of a given deviation, factors such as:

tumors;
adhesions;
inflections of the gallbladder;
enlargement of adjacent organs or lymph nodes;
scar formation;
inflammatory processes, accompanied by swelling of the wall of the organ;
strictures.

Functional failures are associated with impaired motor activity of the gallbladder itself. In particular, they arise in patients with hypokinetic dyskinesia of bile ducts. In addition, the development of cholelithiasis can be a consequence of disorders in the work of the biliary system, infectious and allergic diseases, pathologies of the autoimmune nature,

Classification

Gallstone disease is divided into several stages:

Physicochemical or proof. This is the initial stage of the development of cholelithiasis. During its course gradual changes in the composition of bile occur. There are no special clinical manifestations at this stage. It is possible to detect the initial stage of CLD during a biochemical study of the composition of bile.
The phase of latent (latent) stone construction. At this stage, concrements in the gall bladder or its ducts are just beginning to form. The clinical picture is also not typical for this phase of the pathological process. Identification of cholelithiasis can only be done during instrumental diagnostic procedures.
Stage, when the symptomatology of the disease begins to manifest itself brighter and heavier. In this case, we can talk about the development of acute calculous cholecystitis, or to ascertain the fact of its transition into a chronic form.

In separate sources one can see a four-stage gradation of cholelithiasis. The last, fourth, phase of the disease is characterized as such, in which accompanying complications of the pathological process develop.

Types of gallstones

Stones localized in the gallbladder can have different chemical composition. By this criterion they are divided into:

Cholesterol. Cholesterol - one of the components of bile, but with its overabundance can be formed concrements. This substance enters the human body together with food, and evenly distributed across its cells, contributing to its full functioning. If there is a violation of the process of assimilation of cholesterol, it begins to accumulate in bile, forming stones. Cholesterol stones have a round or oval shape, and can reach from 1 to 1.5 centimeters in diameter. Their location often becomes the bottom of the gallbladder.
Bilirubin. Bilirubin is a product of the breakdown of hemoglobin. Stones that are formed with its excess in the body are also called pigmented. Bilirubin calculi in size are inferior to cholesterol, but there may be more in number. In this case, they affect not only the bottom of the gallbladder, but also are able to localize in the biliary tract.

Stones in the gallbladder can have a different degree of calcium saturation. It depends on it how clearly it will be possible to see the tumor on the screen of the ultrasound machine or on the roentgenogram. In addition, the degree of saturation of stones with calcium also determines the choice of therapeutic methods. If the stone is calcified, it means that the medicamental means to cope with it will be much more difficult.

Depending on the size of gallstones are:

Small. The dimensions of such neoplasms do not exceed 3 cm in diameter. With single stones localized in the area of the bottom of the gallbladder, no specific clinical symptoms in the patient manifest themselves.
Large. These are the stones whose diameter exceeds 3 cm. They prevent a normal outflow of bile, and can cause bouts of biliary colic, or other unpleasant symptoms.

Not only species, but also the size of concrements can influence the choice of therapeutic tactics in the LCF. Large stones, as a rule, are not subjected to drug dissolution. They are also not crushed by ultrasound, since such a therapeutic approach is unlikely to produce the expected results.

In this case, cholecystectomy is performed - an operation to remove the gallbladder along with the stones in it. If the calculi are small, more gentle methods of treatment are considered.

In some cases, the attention of physicians can also be concentrated on the location of neoplasms. Stones located in the area of the bottom of the gallbladder rarely disturb the patient, because they are not characteristic of any clinical picture.

If the calculi are localized in the immediate vicinity of the neck of the diseased organ, this can cause bile duct obstruction. In this case, the patient will be disturbed by unpleasant symptoms, manifested by pain syndrome in the right hypochondrium and digestion disorders.

Symptoms and signs of cholelithiasis

Gallstone disease is a pathological process that can for a long time run absolutely asymptomatically. This especially applies to the initial stages of the disease, when the calculi are too small, and therefore do not clog the bile ducts, and do not injure the wall of the bladder.

The patient can not guess for a long time about the presence of the disease, that is, to be a latent stone-breaker. When neoplasms reach rather large sizes, the first alarming signs of the pathological process in the gall bladder appear. They can manifest themselves in different ways.

The first symptoms of cholelithiasis, which occur before the appearance of pain in the right upper quadrant, include:

feeling of heaviness in the stomach after eating;
bouts of nausea;
slight yellowing of the skin (mechanical jaundice).

Such a clinical picture arises due to a violation of the process of outflow of bile. Under the influence of such a malfunction, there are deviations in the functioning of the organs of the digestive tract.

The most common symptoms and signs of CSW include:

Pain in the right hypochondrium, which signal the development of biliary colic. The duration of an attack can last from 10 minutes to several hours, with the pain can be acute, unbearable, and give to the right shoulder, other areas of the abdomen or back. If the attack does not take place within 5-6 hours, the patient may develop serious complications.
An increase in body temperature, indicating the development of acute cholecystitis - a disease that is a frequent companion of the CLS. Intensive inflammation of the gallbladder leads to an active release of toxic substances into the blood. If there are frequent bouts of pain after biliary colic, and they are accompanied by a fever, this indicates the development of acute cholecystitis. If the temperature rises are temporary, and the thermometer marks reach 38 ° C, this may indicate the occurrence of cholangitis. But, nevertheless, the temperature is not an obligatory sign of the CSW.
Development of jaundice. This anomaly arises because of prolonged stagnant processes due to a violation of the outflow of bile. First of all, the eye sclera turns yellow, and only then the skin covers. In people with fair skin this symptom is more noticeable than in swarthy patients. Often, along with the yellowing of the skin and the eye proteins in patients changes color and urine. It acquires a darker shade, which is associated with the release of large amounts of bilirubin by the kidneys. With calculous cholecystitis, jaundice is only an indirect but not an obligatory symptom. In addition, it can become a consequence of other diseases - cirrhosis, hepatitis, etc.
Acute response of the body to fat intake. Under the influence of bile there is a splitting and absorption of lipids in the blood. If the stones are located near the cervix or bile duct, they simply block the bile path. As a consequence, it can not normally circulate in the intestine. A similar anomaly causes the appearance of diarrhea, nausea, flatulence, dull pain in the abdomen. But these symptoms are not specific manifestations of CSF, because they are found in most GI diseases. Intolerance to fatty foods can occur at different stages of development of cholelithiasis. However, even a large calculus, if it is located on the bottom of the diseased organ, is not an obstacle to the outflow of bile. Consequently, fatty foods will be digested and digested quite normally.

If we talk about the general symptoms of CSW, then it can be quite diverse. There are different in intensity and nature of abdominal pain, digestive disorders, nausea, sometimes with attacks of vomiting. But since the clinic of the disease is typical for many pathologies of the gastrointestinal tract, experienced doctors always prescribe ultrasound of the gallbladder to understand the cause of the patient's malaise.

Diagnostics

If there was a symptomatology characteristic of biliary colic, it is necessary to immediately contact a specialist. First of all, a physical examination and anamnesis are conducted, based on finding out which symptoms the patient suffers from.

With palpation of the abdomen, the tension and soreness of the skin in the muscles of the abdominal wall are noted in the immediate vicinity of the diseased gall bladder. In addition, the doctor observes that the patient has yellowish spots on the skin, which are caused by a violation of lipid metabolism, yellowing of the eye sclera and skin.

But physical examination is not the main diagnostic procedure. This is a preliminary examination, which gives the doctor the basis for referring the patient to certain studies. In particular:

Clinical blood test. In the presence of an inflammatory process in the gallbladder, a moderate increase in ESR and a pronounced leukocytosis will be seen in the test results.
Blood chemistry. When deciphering the data the doctor noted an increased level of cholesterol and bilirubin against the background of anomalous activity of alkaline phosphatase.
Cholecystography. This diagnostic technique helps to accurately study the condition of the gallbladder. During the procedure, the organ is enlarged and lime inclusions appear on its walls. With the help of cholecystography, calcareous stones located inside the diseased organ are found.
Ultrasound of the abdominal cavity is the most informative diagnostic technique for suspected development of cholelithiasis. In addition to identifying neoplasms, specialists note deformation of the gallbladder wall. Also, negative changes in the motor function of the diseased organ are recorded. Well visible on ultrasound and signs characteristic of cholecystitis.

A thorough examination of the condition of the gallbladder is also possible with an MRI or CT scan. No less informative diagnostic technique, during which violations in the circulation of bile are detected, is scintigraphy. A method of retrograde endoscopic cholangiopancreatography is also widely used.

Complications

The formation of concrements in the gallbladder is fraught with not only a violation of the motor function of the diseased organ. LCM can have a very negative impact on the functioning of other organs, especially those that are in close proximity to the HP.

Thus, the edges of the stones can injure the walls of the bladder, causing the development of inflammatory processes in them. In especially severe cases, neoplasms clog the entrance and exit from the bile, thereby making it difficult to outflow the bile. With such deviations begin to occur stagnant processes, leading to the development of inflammation. This process can take from several hours to several days, but sooner or later it will necessarily make itself felt. The vastness of the lesion and the intensity of the pathological phenomenon can be different.

So, it is possible the formation of a small edema of the gallbladder wall, or its destruction. The consequence of this dangerous process is the rupture of the diseased organ. This complication of cholelithiasis directly threatens the patient's life.

The spread of the inflammatory process to the organs of the abdominal cavity is fraught with the development of peritonitis. Complications of this condition can be an infectious-toxic shock or multiple organ failure. With its development, serious malfunctions occur in the functioning of the heart, kidneys, blood vessels and even the brain.

If the inflammation is too intense, and pathogenic microorganisms throw an excessive amount of toxins into the blood, the ITS can manifest immediately. Under such circumstances, even immediate resuscitation measures are not a guarantee of the patient's exit from a dangerous condition and prevention of a fatal outcome.

Treatment of cholelithiasis

Treatment of pathology can be conservative and surgical. As a rule, therapeutic methods are applied first. Among them are:

Dissolution of gallstones with the help of special medications. In particular, chenodeoxycholic and ursodeoxycholic acid. This technique is effective only for single cholesterol concretions. If the patient has no contraindications, such therapy is prescribed by the course for a year and a half.
Extracorporeal shock wave lithotripsy is a conservative method of treatment of SCI, implying the use of a shock wave, which leads to the destruction of gallstones. Such a wave is created with the help of special medical devices. Such treatment is performed only with cholesterol concrements of small sizes (up to 3 cm). The procedure almost does not cause pain and is easily tolerated by patients. Pieces of stones are removed from the body during defecation.
A diet. This is one of the bases of successful recovery and removal of unpleasant symptoms. During the whole course of diet therapy, you must follow the rules of fractional nutrition. Food should be taken 4-6 times a day in small portions. From the diet must be excluded fatty, sharp, fried, spicy dishes, smoked foods, pickles, carbonated and alcoholic beverages, chocolate. The patient should abandon fatty varieties of meat and spicy seasonings. Healthy nutrition with LAB is based on the use of dairy products and plant products. It is necessary to add wheat bran to the menu.

Especially popular today is the surgical treatment of cholelithiasis - cholecystectomy. It is carried out in 2 ways:

classical;
laparoscopic.

Only the surgeon can determine which type of operation is expedient to be carried out in each individual case. Cholecystectomy is mandatory with:

Numerous neoplasms in the gallbladder. At the same time, the exact number and size of concrements do not play any role. If they occupy, at least, 33% of the area of the diseased organ, cholecystectomy is mandatory. Neither shattering, nor dissolving such a number of concrements is not possible.
Frequent attacks of biliary colic. Pain for a given abnormality can be quite intense and frequent. They are removed with the help of spasmolytic drugs, but sometimes such treatment does not bring relief. In this case, doctors resort to surgical intervention, regardless of the number of concrements and their diameter.
Presence of stones in the bile ducts. Obturation of the biliary tract hides a serious threat to the health of the patient, and significantly worsens his state of health. The outflow of bile is broken, the pain syndrome becomes more intense and mechanical jaundice develops. In such a situation, one can not do without an operation.
Biliary pancreatitis. Pancreatitis is an inflammatory process that develops and proceeds in the tissues of the pancreas. The prostate and gall bladder are connected by a single bile duct, so a disturbance in the work of one organ entails negative changes in the work of the other. In some cases, calculous cholecystitis leads to a violation of the outflow of pancreatic juice. The destruction of the organ tissues can lead to serious complications, and directly threatens the patient's life. The problem should be solved exclusively surgically.

Mandatory operation is also necessary when:

Peritonitis. Inflammation of the abdominal organs and tissues of the peritoneum is a dangerous condition that can lead to death. The pathological process can develop with a rupture of the gallbladder and the ingestion of bile infested with pathogenic microorganisms into the abdominal cavity. In this case, the operation is aimed not only at removing the affected organ, but also on thorough disinfection of adjacent organs. Delay with surgery can lead to death.
Stricture of bile ducts. The narrowing of the channel is called stricture. To similar infringements the intensive inflammatory process can result. They lead to stagnation of bile and its accumulation in the tissues of the liver, although the gallbladder can be removed. With surgical intervention, the surgeon's efforts are aimed at eliminating the strictures. The narrowed section can be expanded, or the doctor creates a bypass for the bile, through which it is excreted directly into the rectum. Without surgical intervention, it is impossible to normalize the situation.
Accumulation of purulent contents. When the bacterial infection is attached to the tissues of the gallbladder, pus accumulates in them. The accumulation of pus inside the gallbladder itself is called empyema. If the pathological content is collected beyond its limits, without affecting the abdominal organs, in this case it is a question of the development of a paravezical abscess. Such anomalies lead to a sharp deterioration in the patient's condition. During the operation, the gallbladder is removed and the abscess is emptied, followed by careful antiseptic treatment to prevent peritonitis.
Bile fistulas - pathological holes localized between the gallbladder (less often - its ducts) and adjacent hollow organs. For such a deviation, any specific clinical picture is uncharacteristic, but it can significantly disrupt the outflow of bile, leading to its stagnation. In addition, they can cause other diseases and digestive disorders. During the operation, pathological holes are closed, which helps prevent unwanted complications.

In addition to the pathology, size and composition of the stones, the age of the patient and the presence of concomitant diseases play an important role in the choice of the therapeutic technique. When pharmacological drugs are intolerant, drug treatment for patients with SCI is contraindicated. In this case, the only correct way out of the situation is the operation.

But elderly people with diseases of the cardiovascular system, kidneys or other organs, surgical intervention can only do harm. In this case, doctors try to avoid this tactic of treatment.

As can be seen, the choice of the treatment method for CSF depends on many factors. Precisely, there is a need for surgery, can only the attending physician after carrying out all the necessary diagnostic measures.

Diet with cholelithiasis

The food should be fractional. Food should be taken in small portions 4-6 times a day. The temperature of food should not be less than 15 or more than 62 degrees Celsius. The banned products in the LCB include:

alcohol;
legumes in any form;
fatty dairy and sour-milk products;
roast;
sharp;
salty;
smoked;
fatty fish and meat;
caviar;
sweets;
canned food;
mushrooms in any form;
hot fresh bread, toast, toast;
spices, condiments;
marinade;
coffee;
chocolate products;
cocoa;
strong black tea;
hard or salty cheese.

And, on the contrary, doctors recommend giving preference:

dried bread made from 2 kinds of flour;
low-fat cheeses;
boiled, steamed or baked vegetables;
finely chopped white cabbage (in limited quantities);
baked or boiled lean meat;
different types of groats;
vermicelli and macaroni (within reasonable limits);
jam and jam;
sweet fruit and berries;
not strong tea;
sweet home-made juices;
mousses;
compote of dried fruits;
Cream butter, which must be added to various dishes in an amount not exceeding 30 grams per day;
low-fat varieties of fish (pike perch, pike, hake, etc.);
whole milk. It can be used both in its pure form, and can be used for cooking porridges.

Also skimmed cottage cheese and natural low-fat yogurts are allowed (preferably home-made).

Prognosis and prevention of CLD

To prevent the development of cholelithiasis, it is necessary, if possible, to avoid factors that can cause the development of hypercholesterolemia and bilirubinemia. It is also important to exclude stagnant processes in the gallbladder and its ducts. This is facilitated by:

balanced and adequate nutrition;
physical activity;
careful tracking of the body weight, and if necessary - its adjustment;
timely detection and complete cure of diseases of the biliary system.

Especially close attention to the circulation of bile and the level of cholesterol must be given to people who have a genetic predisposition to cholelithiasis.

If we talk about the prevention of biliary colic in detecting the disease, then patients must comply with a strict diet. They should carefully monitor their weight and use a sufficient amount of liquid (1.5 - 2 liters per day). To avoid the risk of movement of stones in the bile ducts, patients should avoid performing work that requires a long stay in an inclined position.

Prognosis for the development of cholelithiasis is different for all patients, because they directly depend on the rate of formation of calculi, their size and mobility. In most cases, the presence of concrements in the gallbladder leads to a number of unfavorable and serious complications. But if you perform a surgical procedure in a timely manner, the dangerous consequences of the disease can be prevented!