How to recognize gallstone disease. Gallstone disease: symptoms, causes, diagnosis and treatment

Stones in gallbladder is a symptom of cholelithiasis, cholelithiasis. Bile contains components that can precipitate, accumulate and form seals - stones in the cavity of the gallbladder or bile ducts. The presence of such inclusions leads to violations of the outflow of bile, inflammatory processes in the membranes of the bladder, infection of the organ and reduces the efficiency of the biliary system of the body.

Why do gallstones form in the gallbladder?

Among the factors provoking the process of formation of stones in the gallbladder, there are leading and additional, concomitant factors:

the leading factor is considered to be an increase in such a characteristic of bile as lithogenicity, which occurs as a result of excessive intake of cholesterol;
, or a decrease in the functional ability of the gallbladder to contract and push bile into the ducts;
hypertension of bile in the organ due to narrowing of the neck of the gallbladder, which also leads to stagnation of bile;
localized or general infectious processes that reduce the efficiency of the activity of the organs of the hepatobiliary system.

There are various risk factors that increase the likelihood of developing cholelithiasis and the formation of gallstones:

belonging to the female sex: women suffer from stones that form in the gallbladder, much more often than men;
elderly and senile age;
the period of pregnancy, since an increase in estrogen levels promotes the secretion of cholesterol into bile;
irrational diets, fasting, weight loss for various reasons;
long courses of parenteral nutrition;
long-term use of drugs containing estrogen, oral contraceptives, sandostatin, ceftriaxone, etc.;
diabetes;
some diseases gastrointestinal tract, hepatobiliary organs, etc.

There are Tirek and Faber formulas that allow, by external signs, to suspect a high probability of a patient having stones in the gallbladder. According to experts, in the group with the highest number of diagnosed bile stones are women with blond hair and skin, with a history of pregnancy, overweight, over the age of 40, with excessive gas formation (flatulence).

Forms of gallstone disease and symptoms of gallstones

Among the clinical forms of gallstone disease, the following are distinguished:

latent form or the so-called stone carrier;
dyspeptic form of the disease;
pain form, accompanied by seizures;
painful torpid form;
cancerous.

A significant number of patients with cholelithiasis (60-80%) in the presence of gallstones have no symptoms and manifestations of the disease. However, this period represents a latent form of the disease rather than a static one. According to observations, up to 50% of patients within 10 years after the discovery of stones in the gallbladder consult a doctor about the onset of symptoms indicating the development of other forms of cholelithiasis and its complications.

The dyspeptic form is clinically expressed in disorders of the functioning of the organs of the gastrointestinal tract. Most often, this is expressed in the appearance after eating a feeling of heaviness in the epigastric region, increased gas formation, bloating, heartburn, bitterness in the mouth. This form is often combined with paroxysmal pain, or manifestations of biliary colic, since palpation can detect pain at characteristic points.

Painful paroxysmal form manifests itself in biliary colic and is the most common variant of the clinical form of cholelithiasis, diagnosed in 75% of patients. The disease manifests itself in the form of sudden, recurring attacks of pain in the right hypochondrium with possible irradiation to the back or to the right shoulder blade. The attack may be accompanied by nausea, reflex vomiting, which does not bring relief. With an attack lasting more than 6 hours, acute cholecystitis is diagnosed.
The torpid form of cholelithiasis is accompanied by constant dull pain in the projection of the gallbladder without periods of remission and the absence of pain.
In about 3% of cases, cholelithiasis is accompanied by the development of tumor formations. According to various sources, from 80 to 100% of cancer patients with cancerous tumors in the gallbladder have stones in the cavity of the organ. Presumably, neoplasms arise as a result of changes in the chemical composition of bile in cholelithiasis, prolonged irritation and traumatization of the inner membranes of the bladder by gallstones, and infection.

Among the general symptoms inherent in most patients with gallstones, we can distinguish the following signs diseases:

pain or discomfort on palpation in the right hypochondrium, a feeling of heaviness in the epigastric region associated with the intake of spicy, fatty, fried foods or alcohol;
change in stool color, discoloration;
the presence of bowel dysfunction: constipation, unstable, irregular stools, flatulence, etc .;
complaints of heartburn, bitter taste in the mouth, etc.

Therapy of cholelithiasis: how to treat stones in the gallbladder?

Complicated forms of cholelithiasis and prevention of their complications are subject to treatment. In the presence of stones without a clinical picture of cholecystitis, therapy consists in following a diet, regimen, maintaining an active lifestyle to reduce the likelihood of bile stasis and related complications, as well as taking drugs that destroy the structure of stones (Chenofalk, Ursosan and others). With single inclusions of calculus stones and no signs of disease in modern medicine use the method of shock wave therapy.

Meals should be frequent, fractional, with small portions of food. Fatty, spicy, fried foods, alcohol are excluded from the menu. It is necessary to monitor the amount of cholesterol in the meals consumed and include foods rich in plant fiber (cereals, greens, vegetables) in the diet.

Conservative treatment during acute attacks can be both a method of therapy and a type of preoperative preparation in patients with a destructive form of cholecystitis. Conservative therapy includes several procedures and techniques, the basis of which is the well-known formula "cold, hunger and peace":

complete hunger with vomiting, if the attack is not accompanied by vomiting, you can drink water;
cold (ice) on the area of the right hypochondrium, the method of local hypothermia to reduce inflammation and hypertension of the gallbladder;
antibacterial drugs in the inflammatory process;
detoxification therapy and forcing the withdrawal of fluid from the body with diuretic drugs;
relief of pain attacks with analgesics (Maxigan, Analgin) and antispasmodic drugs (Papaverine, No-Shpa, Baralgin, Platifillin, etc.) or combined medicines with analgesic and antispasmodic effects.

How to treat gallstones additional ways? In addition to directed actions and drugs, auxiliary therapy is prescribed: drugs that stimulate the release of bile acids, enzymes for digestive system, including destroying fats, medicines to restore balance in the composition of bile, as well as lithotripsy method, both shock wave and drug, and litholysis method for crushing or dissolving calculus stones. Crushed stones are able to go out on their own along with feces.

Surgical treatment as a method of therapy is prescribed for frequent attacks of acute cholecystitis, large stones, destructive course of the disease and the presence of severe complications. The technique of surgical treatment can be based on open or laparoscopic penetration and different options gallbladder manipulation.

The therapy is carried out exclusively under the supervision of doctors, since independent attempts to take drugs for crushing and removing stones can lead to blockage of the bile ducts, obstructive jaundice, acute cholecystitis and other complications of the disease.

Most often, the surgical method of therapy is used in patients with acute cholecystitis that is not cured by other types of treatment in a condition that threatens the patient's life. In acute destructive cholecystitis, the operation is performed in the first 24-48 hours after hospitalization. The choice of surgical intervention (cholicisectomy, removal of the gallbladder, or decompression with the removal of infected bile) depends both on the nature of the inflammatory process and the disease, and on the physical condition of the patient.

Gallstone disease (cholelithiasis)- a disease characterized by the formation of stones (another name - calculi) in the gallbladder. Also, stones can be found in the bile ducts, this type of disease is called choledocholithiasis. Typically, stones form in the gallbladder. Those stones that are found in the bile duct most often get there with the flow of bile from the gallbladder, however, the primary formation of stones in the bile duct is also possible.

Currently, gallstones are detected in about one in ten adults. Women suffer from gallstone disease two to three times more often than men. This is due to the influence of the female sex hormone - estrogen on the properties of bile. Under its influence, the content of cholesterol in bile increases, it becomes more lithogenic, that is, capable of stone formation.

Mechanism of stone formation in cholelithiasis

Stones are formed as a result of a violation of the chemical composition of bile. The gallbladder acts as a storage reservoir for bile, where bile "ripens", acquiring the functions necessary for the digestive process, and from where it enters the duodenum. If the chemical balance of the components is disturbed, bile precipitates - small solid particles that settle to the bottom of the gallbladder. If the gallbladder does not work properly and the bile stagnates, these particles become the nuclei of subsequent crystallization; that is, a “speck of dust” (microlite), remaining in the gallbladder, begins to grow and gradually turns into a stone.

Gallbladder stones vary in number, size, and chemical composition. One large stone may form, but more often many (tens or even hundreds) of smaller stones form. The size of the stones varies from millet grain (and smaller) to chicken eggs. In 80% of cases, cholesterol (the so-called cholesterol stones) acts as the main component of the stones, there are also pigment (bilirubin) stones, calcareous stones and stones of a mixed nature.

Causes of gallstone disease

The main reason for the formation of stones in the gallbladder is a combination of two factors - 1) an increased content of certain substances in bile (primarily cholesterol), when their solubility limit is reached and sediment begins to precipitate, and 2) bile stagnation. The emergence and development of gallstone disease can contribute to:

(hormonal restructuring contributes to the release of increased amounts of cholesterol by liver cells);
reception oral contraceptives(substitute hormone therapy);
. Even a slight weight gain due to fat accumulation is accompanied by an increase in cholesterol content in bile;
fast weight loss , for example, due to fasting or following a diet inconsistent with doctors, it can lead to a change in the composition of bile and stimulate the formation of stones;
sedentary lifestyle contributes to the development of dyskinesia of the gallbladder and biliary tract and can lead to stagnation of bile;
genetic predisposition;
various diseases(, Crohn's disease, cirrhosis of the liver, blood diseases, etc.)

With age, the likelihood of developing gallstone disease increases. Persons over 60 years of age are at increased risk of developing this disease.

Stages of development and forms of gallstone disease

Gallstone disease is a chronic disease that develops gradually over a long period of time (years). In its development, the following stages can be distinguished:

change in the composition of bile (physico-chemical stage);
asymptomatic lithiasis(latent, hidden form). While the stones are small, the patient may not notice their presence in the gallbladder. At this stage, the disease is detected most often during an ultrasound of the gallbladder (for example, during a preventive examination);
clinical stage. At this stage, two forms of the disease are distinguished - biliary colic(acute form) and calculous(chronic form).

Stones in the gallbladder injure the mucous membrane and often cause inflammation of the gallbladder (cholecystitis). Cholecystitis in most cases occurs precisely against the background of cholelithiasis.

Symptoms of gallstone disease

Acute calculous cholecystitis (biliary colic) caused by obstruction of the flow of bile from the gallbladder. The stone clogs the entrance to the bile duct or enters the bile duct and irritates the mucous membrane of its walls. Biliary colic (it is also called hepatic colic - according to the localization of pain in the liver) is manifested by symptoms such as:

severe pain in the right hypochondrium. The pain starts suddenly, often at night. The duration of an attack can range from a few minutes to several hours or even days. The nature of the pain is sharp at first, then the pain becomes constant and dull;
strong;
, . An attack of vomiting does not bring relief, a large content of bile is found in the vomit;
temperature increase . With the development of a purulent form of the disease, the temperature can rise to 38-39 ° C;
there may be yellowing of the skin and whites of the eyes, bloating, constipation.

With such symptoms, you need to call an ambulance.

Symptoms chronic calculous cholecystitis appear less acutely. They can occur or intensify after eating a rich and fatty meal. However, it should be borne in mind that similar symptoms are characteristic of a number of other diseases.

The main symptoms of chronic calculous cholecystitis:

Methods for diagnosing gallstone disease

When the first signs of discomfort appear in the right hypochondrium, you should contact. It will be necessary to undergo an examination, including laboratory and instrumental studies.

General blood analysis

In cholelithiasis, attention is drawn primarily to such indicators as the number of neutrophils in the blood and ESR. An increase in the number of neutrophils (neutrophilic leukocytosis) and ESR indicates the development of an inflammatory process (acute cholecystitis).

Blood chemistry

Ultrasound of the abdominal organs

Endoscopic retrograde cholangiopancreatography

In some cases, ultrasound data is not enough (for example, if there is reason to assume the presence of stones in the common bile duct). And then additional instrumental studies are required. To clarify the diagnosis, the method (ERCP) is often used, which involves the introduction of a radiopaque substance into the extrahepatic bile ducts using endoscopic equipment. Next, an X-ray examination is carried out, which reveals stones.

Magnetic resonance imaging (MRI)

Currently, MRI cholangiography is increasingly used, the information content of which is comparable to ERCP.

MRI cholangiography is a non-invasive method. The introduction of a contrast agent is not required. The method allows to obtain a computer reconstruction of a three-dimensional image of the biliary tract.

Methods of treatment of gallstone disease

Treatment of cholelithiasis by conservative methods can be effective only on early stage- before the appearance of stones. Unfortunately, at this stage, rarely anyone goes to the doctor. If the stones have already formed, then treatment is possible, as a rule, only by surgical methods. The search for conservative treatments for gallstone disease is often only an attempt to evade the need to make a decision about surgery. Meanwhile, surgical treatment should not be postponed, as gallstone disease is a serious disease.

If multiple stones or stones of a significant size are detected, it is recommended to treat gallstone disease with an operative method, namely, cholecystectomy (removal of the gallbladder). The indication for cholecystectomy is an inflammatory process in the gallbladder (calculous cholecystitis).

Cholelithiasis- symptoms and treatment

What is gallstone disease? We will analyze the causes of occurrence, diagnosis and methods of treatment in the article of Dr. Melentiev A. A., a surgeon with an experience of 13 years.

Definition of disease. Causes of the disease

Cholelithiasis(calculous cholecystitis) - a disease characterized by the presence of calculi (stones) in the gallbladder or its ducts.

Gallstone disease (GSD) is the most common disease in surgical gastroenterology, ranking first among surgical diseases. According to studies in Europe and the USA, cholelithiasis is diagnosed in 10-15% of the adult population. More than 500,000 cholecystectomies (surgeries to remove the gallbladder) are performed worldwide every year.

Most often, the disease affects people aged 40-50 years, but it can manifest itself at a very young and old age.

Gallstone disease is a polyetiological disease and it is not possible to name one cause of its occurrence.

Stones in the lumen of the gallbladder are formed under the influence of a complex of factors. A variety of metabolic disorders contribute to the crystallization of cholesterol, which further leads to the formation of gallstones.

The occurrence of GSD directly depends on the following factors:

gender - according to statistics, cholelithiasis is diagnosed in women three times more often than in men;
age - the older the person, the higher the risk of developing this disease(often it is found in people after 60 years);
heredity and genetic factors;
irrational nutrition - excessive consumption of sweet, too spicy, smoked and fatty foods;
lipid (fat) metabolism disorders;
frequent overeating;
pregnancy or previous multiple births;
prolonged refusal to eat;
smoking, alcohol;
passive lifestyle;
taking certain medications;
infection duodenum or bile ducts by various pathological bacteria or microorganisms;
cirrhosis of the liver.

The resulting stones vary in composition. They are:

pigmented;
cholesterol;
lime;
mixed (consist of various chemical elements).

For cholelithiasis is characterized by its own "face". In this case, the rule of five F works - the most pathognomonic signs:

Female (woman);
Fat (obesity);
Forty (over 40 years old);
Fair (blonde);
Fertile (giving birth).

In obese patients, the concentration of cholesterol in the blood is increased, which is a predisposing factor in the formation of calculi. Women who have given birth over the age of 40 are more susceptible to the occurrence of cholelithiasis, which is associated with hormonal changes in the whole body.

Improper nutrition, excessive intake of cholesterol, fats also affect the risk of gallstone disease. However, even the most strict vegetarians are not immune from it.

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of gallstone disease

Manifestations of gallstone disease are quite obvious. Most often, patients are concerned about dull aching pain or heaviness in the right hypochondrium, which occurs with errors in the diet. Nausea, a feeling of bitterness in the mouth and other dyspeptic disorders may also be disturbing.

Often, cholelithiasis occurs simultaneously with a stomach or duodenal ulcer, diverticulosis (protrusion of the walls) of the colon, which is due to general innervation and the same predisposing factors. In this case clinical picture may not be entirely clear.

Often, gallstone disease is asymptomatic, and stones in the lumen of the gallbladder are found during routine abdominal ultrasound.

In a certain number of cases, the disease manifests (manifests) with acute inflammation or immediately with the development of complications (choledocholithiasis, cholangitis, obstructive jaundice).

With the development of acute cholecystitis against the background of cholelithiasis, the patient is most often worried about acute pain in the right hypochondrium, fever and nausea.

With the development of such a formidable complication of cholelithiasis, such as choledocholithiasis (the presence of stones in the bile ducts) and obstructive jaundice, yellowing occurs skin, sclera, mucous membranes, itching of the skin, darkening of urine and discoloration of feces. The presence of these signs is the reason for emergency hospitalization in a surgical hospital.

The pathogenesis of gallstone disease

Consider the anatomy of the gallbladder and its ducts.

The bile synthesized by the liver cells enters the common hepatic duct through the right and left lobar ducts. Further through the cystic duct, it is deposited (temporarily deposited) in the gallbladder. During a meal, the gallbladder contracts, and bile through the common bile duct through the large duodenal papilla enters the duodenum, where it binds to food. The main role of bile is emulsification (splitting) of fats.

For various reasons, most often from the lumen of the duodenum, pathogenic microorganisms enter the gallbladder, forming the "bacterial core" of the future gallstone. Due to the presence of chronic infectious inflammation in the lumen of the gallbladder, its contractile function. Bile stagnates, contributing to an increase in the number of calculi and their size.

There are several theories of the etiopathogenesis of gallstone disease:

Classification and stages of development of gallstone disease

Calculous cholecystitis involves a chronic and acute course of the disease.

Chronic calculous cholecystitis characterized by periods of exacerbation and remission or asymptomatic course. This type of calculous cholecystitis is distinguished by the clinical picture:

primary chronic cholecystitis- asymptomatic course of the disease;
chronic recurrent cholecystitis- the disease proceeds with periods of exacerbation and remission;
chronic residual cholecystitis- in this case, patients are constantly worried about pain or heaviness in the right hypochondrium.

Acute calculous cholecystitis It is characterized by an acute onset of the disease, an intense pain syndrome, as well as certain changes in the ultrasound picture and blood tests. It is differentiated according to the severity of inflammatory changes in the gallbladder wall:

catarrhal;
phlegmonous;
gangrenous.

In advanced cases, peritonitis occurs, which can be local, widespread and diffuse. Peripesal abscesses may also form.

Complications of gallstone disease

Despite the fact that gallstone disease is well studied, and laparoscopic cholecystectomy (method of choice) surgical treatment) is mastered to perfection by many surgeons, patients often delay treatment "until the last" or are simply afraid of surgery, after which they are admitted to the hospital with such severe complications as choledocholithiasis and obstructive jaundice.

When the calculus migrates from the lumen of the gallbladder into the common bile duct, the stone can get stuck and cause obstructive jaundice. In this case, bile, instead of entering the lumen of the duodenum, is absorbed back into the blood, causing severe intoxication and liver failure.

This complication requires immediate endoscopic intervention - ERCP (endoscopic retrograde cholangiopancreatography) and extraction of stones from the common bile duct, followed by laparoscopic cholecystectomy in the near future.

Also, GSD can be complicated by:

Diagnosis of gallstone disease

Diagnosis of cholelithiasis is quite simple and often does not require high-tech instrumental methods of examination.

When collecting an anamnesis, patients often note the appearance of a dull aching pain in the right hypochondrium with errors in the diet, as well as bitterness in the mouth.

Physical examination of a patient with cholelithiasis in the "cold period", that is, without exacerbation, may be inconclusive. Only in acute cholecystitis or in the event of an attack of biliary colic, palpation in the right hypochondrium in the projection of the gallbladder can be painful.

The main instrumental method for diagnosing cholelithiasis is abdominal ultrasound. This routine diagnostic method makes it possible to detect calculi in the gallbladder lumen with an accuracy of 95%, as well as to determine their size and number, to assess the condition of the gallbladder wall, the diameter of the intrahepatic and extrahepatic bile ducts.

Multispiral CT scan It has limited opportunities in the diagnosis of gallstone disease, since stones are often X-ray negative and are not visible in this study.

In case of dubious results of ultrasound examination, as well as in case of a complicated course of cholelithiasis, the patient should undergo magnetic resonance imaging. This method is best method diagnostics of both cholelithiasis and its complications, and any other diseases of the organs of the hepatopancreatoduodenal region.

Treatment of gallstone disease

In the middle of the 20th century, in an animal experiment, the following method of treating cholelithiasis was investigated: the gallbladder was cut, stones were taken out, and sewn back. However, over time, the stones formed again, which is understandable, since gallbladder stones are only a manifestation of the disease, and not the disease itself. chronic inflammation gallbladder did not disappear, which led to a relapse of the disease.

The next attempt to cure cholelithiasis without surgery was shock wave lithotripsy (similar to the treatment urolithiasis). But this type of treatment caused a rupture of the liver tissue or the gallbladder wall with the formation of abscesses, hematomas and peritonitis. Fragments of calculi, if they could be crushed, migrated into the ducts, causing choledocholithiasis and obstructive jaundice. The method had to be abandoned.

Some gastroenterologists recommend that their patients take various choleretic drugs, as well as different types of "dubazh" in order to conservative treatment ZhKB. Under the influence of this therapy, stones can easily migrate from the gallbladder into the extrahepatic bile ducts, causing choledocholithiasis and obstructive jaundice, which in turn will require emergency surgical intervention.

In this way, the only radical cure gallstone disease is its removal - cholecystectomy.

Initially, this operation was performed through a traditional (laparotomic) approach, which led to a large number of complications both in the early and late postoperative period. With the development of new technologies, the operation began to be performed laparoscopically.

Cholecystectomy is performed as follows:

through a centimeter incision above the navel, a tube (trocar) and a laparoscope are inserted into the abdominal cavity, the abdominal cavity is filled with carbon dioxide, thus forming a space for the operation;
one more centimeter and 25 mm trocars are additionally installed;
with the help of special tools, the gallbladder is mobilized, separated from the bed, the cystic duct and artery are clipped with titanium clips;
the gallbladder is removed through the paraumbilical or epigastric access.

The operation is under general anesthesia and lasts an hour on average. Due to the low-traumatic laparoscopic approach, the postoperative pain syndrome is minimal, and on the evening of the day of surgery, the patient can get up and walk without experiencing severe pain.

With a smooth course of the postoperative period, the patient can be discharged the next day after the operation, which is especially important for people of working age. The cosmetic defect of the operation is minimal, already a month after the operation, the scars become almost invisible.

In parallel with laparoscopic cholecystectomy, cholecystectomy arose from minilaparotomy access. However, due to the complexity of visualization of the elements of the hepatoduodenal ligament and the high risk of injury to adjacent organs, this access is practically not used.

Relatively recently, laparoscopic cholecystectomy began to be performed from a single approach. When performing this operation, a single incision 3-4 cm long is made above the navel. This access is especially relevant if the patient has an umbilical hernia, as it allows solving two problems through one incision.

NOTES surgery is gaining more and more popularity - operations through natural openings. For example, laparoscopic cholecystectomy can be performed through an incision in the vagina or rectum, which does not leave scars on the abdomen, but is fraught with infectious and other complications.

Forecast. Prevention

Gallstone disease is an exclusively surgical disease. All attempts at conservative treatment are pointless and often dangerous. The only one possible way defeat the disease - operation.

Laparoscopic cholecystectomy is the "gold standard" for the treatment of gallstones. The intervention is as safe as possible and is accompanied by a low risk of complications. Rehabilitation after surgery is very fast and allows the patient to start work in the next few days after discharge. Average term hospitalization is 1-2 days.

After laparoscopic cholecystectomy, the patient is usually advised to follow a diet (diet No. 5) for a month, avoid physical activity, and also take enzyme preparations (pancreatin, creon, and others).

A month after the operation, the patient can return to their normal diet and lifestyle without any risk of complications. The absence of a gallbladder in no way affects the quality of life in the long term.

It is advisable to perform the operation in the "cold" period, and not during an attack, since the operation in case of acute cholecystitis is accompanied by a higher percentage of complications. Do not postpone the operation "on the back burner". As practice shows, attacks of cholecystitis occur at the most inopportune moment and often far from specialized medical institutions.

You should also not forget that over the years, the heart and lungs work worse, join ischemic disease hearts and Chronical bronchitis, which can adversely affect the course of anesthesia and the postoperative period.

Disease prevention involves an active lifestyle, healthy eating and refusal bad habits. All this to some extent can reduce the risk of gallstone disease, but will not insure against it by 100%.

Thus, when identifying gallstone disease, you should not waste time, but you should contact a professional surgeon to resolve the issue of surgical treatment as soon as possible.

Good day, dear readers!

In today's article, we will consider with you such a disease as cholelithiasis, as well as its signs, causes, diagnosis, treatment, diet and prevention. So…

What is gallstone disease?

Gallstone disease (GSD)- a disease that is characterized by the formation of stones (calculi) in the gallbladder or bile ducts.

Another name for the disease is cholelithiasis.

The main symptoms of gallstone disease are colic in the right hypochondrium, heaviness in the abdomen and yellowing of the skin.

The main cause of cholelithiasis is a violation of cholesterol, bilirubin and some other metabolic processes in which bile pigments, "bad" cholesterol, salts, some types of protein and other substances settle in the gallbladder and its ducts. Over time, these substances begin to stick to each other and harden, forming the so-called stones.

One of the most popular consequences of finding stones in the bile organs is development.

The development of gallstone disease

Before understanding the process of formation of stones in the gallbladder and its ducts, we will try to describe in simple language what kind of organs they are and what function they perform in the life of the body.

The gallbladder is an organ, a kind of reservoir for bile, connected to the liver, pancreas and duodenum. In the gallbladder, bile particles are separated from water, i.e. in this organ, bile is concentrated, which, when food, especially heavy food, is ingested, the gallbladder throws it into the initial section of the small intestine (duodenum 12), where this secret contributes to the digestion of food.

The bile ducts are the ducts through which the liver, gallbladder, pancreas, and duodenum are connected.

Bile is a liquid secret produced by the liver, which enters the gallbladder through the hepatic duct, where, as we have already said, it is concentrated (separated from water). Bile is necessary for the normal digestion of food.

Now let's proceed to the consideration of the development of gallstone disease.

Some factors, such as pregnancy, taking certain medications (especially those affecting the metabolism of cholesterol and bilirubin), obesity, fasting, eating junk food, metabolic disorders, diabetes mellitus and other pathologies lead to bile stagnation in the gallbladder. The particles of which bile actually consists begin to “stick together”, forming small seals from themselves, which increase in size over the years. The bile ducts are much larger less bubble, and therefore, at a certain time, for example, when the body is shaken, the stone enters the duct and gets stuck in it, forming a blockage (obturation). Sometimes the stone hardly passes through the lumen of the bile duct, "scratching" its walls. But both cases cause strong feelings in a person. sharp pains in the area where the movement or jamming of the stone occurs. V rare cases stones form in the bile ducts themselves.

Gallstones are seals ranging in size from a few millimeters to several centimeters, formed mainly from cholesterol deposits, calcium salts, various pigments (bilirubin is a bile pigment), proteins and other substances. Stones, or as they are also called in the scientific world - stones, can be of various shapes, sizes, and also based on various particles, with a predominance of one or another substance. The structure of stones can be crystalline, layered, fibrous or amorphous.

The next stage in the development of cholelithiasis depends on the localization of the blockage of the duct. If this occurs before the main bile duct, i.e. immediately behind the gallbladder, bile from the liver enters immediately into small intestine, however, the lack of its concentration leads to poor digestion of food. In addition, bile acids begin to circulate in the body without a controlling organ (bladder), which leads to the fact that an aggressive secret begins to harm the body, because. it is the bladder that regulates when bile is needed in the intestines and when it is not.

If the stone clogs the lumen of the common bile duct, then the bile, only already concentrated, from an overabundance returns back to the liver, and begins to affect it. This leads to toxic hepatitis.

If the stone clogs the lumen of the common duct near the duodenum itself, then the pancreas also enters the affected area.

With all these blockages, you need to understand that bile cannot enter the small intestine in sufficient quantities, or even enter the small intestine at all, while food cannot be digested normally. At the same time, if it is impossible to excrete from the body, bile begins to poison the body, sometimes infectious microorganisms appear in it, which contributes to the development of life-threatening consequences.

Of course, the above process is very superficial, but the overall picture of the state of affairs, I think, is now clear.

Treatment of gallstone disease is aimed at removing stones from the body without damaging the gallbladder and biliary tract. Usually treatment is conservative, but some situations can only be solved surgically.

CVD statistics

Gallstone disease from year to year is becoming more and more common disease of many people around the world. So, some authors point to an increase in the number of cases of cholelithiasis among residents of the CIS countries, every 10 years, almost twice.

The proportion of women who have gallstones compared to men is usually between 2:1 and 8:1. Another factor in which the number of patients with this pathology increases is age, the older the person, the higher the risk of manifestation of the disease.

If we talk about total strength patients with cholelithiasis- 10% of the world's population, over the age of 70 years, the number of patients is up to 30%.

If we talk about the geography of the spread of the disease, the number of cases occurs most of all in developed countries - the USA, Europe, the CIS countries, while where food of plant origin is predominantly eaten - Southeast Asia, India, Japan, cases of gallstone disease are minimal . Of course, in addition to food, movement also plays a big role, because. in underdeveloped countries people are for the most part constantly on the move.

ICD

ICD-10: K80.

Symptoms

The process of development of gallstone disease takes a long time - from the beginning of the formation of stones to the first signs of the disease, it can take from 5 to 10 years. This is due to the fact that the presence of stones in the gallbladder does not disturb a person in any way, and pain appears only when they enter the biliary tract and begin to injure

The first signs of gallstone disease

Yellowing of the skin, sclera of the eyes, mucous membranes oral cavity;
Sharp colic in the right hypochondrium (biliary colic), which appear when the stone moves along the biliary tract;
Feeling of heaviness in the abdomen, frequent belching;
Feeling of bitterness in the mouth.

The main symptoms of gallstone disease

Biliary or hepatic colic (acute sharp pains in the right hypochondrium with a return to the right shoulder blade, forearm, arm, lower back, sternum and even neck), appearing mainly after eating spicy, spicy, fried and fatty foods, drinking alcoholic beverages, stress, severe physical load or shake of the body;
Nausea, (sometimes with bile), after which the feeling of relief usually does not come;
Yellowness of the skin, sclera of the eyes, mucous membranes of the oral cavity ();

Additional symptoms:

Increased body temperature - up to;
increased sweating;
discoloration of feces;
Dull in the area of the liver, which develops as a result of the expansion of the bile ducts of this organ, which leads to an increase in the liver in volume;
Seizures.

Symptoms may vary depending on the location of the blockage of the bile ducts by stones, as well as concomitant diseases.

Complications of gallstone disease

Complications of gallstone disease include:

(inflammation of the gallbladder);
Cholangitis (inflammation of the bile ducts);
Acute biliary pancreatitis;
Fistula formation;
Toxic hepatitis;
Cancer of the pancreas, liver and other organs of the gastrointestinal tract.

Causes of gallstone disease

Among the main reasons for the formation of stones in the gallbladder and bile ducts are:

Stagnation of bile in the gallbladder;
Ultra-high concentration of bile;
Violation of metabolic processes in the body, in particular bilirubin, cholesterol, lipids (fats, phospholipids, etc.) and other substances, which often provoke diseases such as fermentopathy, metabolic syndrome, and others;
Dyskinesia of the biliary tract;
, passing into ;
Hypofunction of liver cells;
Diseases of the pancreas and other organs of the gastrointestinal tract;
Hemolytic anemia;
Congenital anomalies in the structure of the organs of the gastrointestinal tract;
The presence in the bile ducts of scars, tumors, adhesions, kinks, inflammatory and other pathological changes, and processes;
The presence of an infection in the body, especially Escherichia coli.

Factors that increase the risk of developing cholelithiasis (cholelithiasis)

Improper nutrition - starvation, overeating or long periods of time between meals;
The use of harmful, spicy, fatty, fried and spicy foods;
Sedentary lifestyle;
Excess weight, ;
Taking certain medications: hormonal contraceptives, estrogens, fibrates, Okreotide, "" and others.
Pregnancy, especially multiple;
Gender - in women, the number of cases with gallstone disease is several times higher than in men;
Age (especially after 70 years) - the older the person, the greater the likelihood of stones;
Heredity.

Types of gallstone disease

JCB is classified as follows:

By localization of cholelithiasis

Cholecystolithiasis- stones form in the gallbladder;
Choledocholithiasis- Stones form in the bile ducts.

According to the composition of stones:

cholesterol stones- consist mainly of cholesterol deposits, and partly of salts, bilirubin (bile pigment), various minerals, protein and other substances. Painted in shades of yellow. Cholesterol stones are found in 80% of all cases of cholelithiasis.

Pigmented (bilirubin) stones- consist mainly of bilirubin, calcium salts and partially cholesterol deposits. Painted in dark brown or black. The formation of pigmented calculi is usually promoted by impaired functioning of the liver, infectious diseases bile ducts and frequent hemolysis.

Lime stones. The main part of the stones consists of impurities of lime salts.

Mixed stones. The most popular type of stones, which consist of all of the above substances.

Stages of gallstone disease:

Stage 1 (initial, physico-chemical or pre-stone stage, primary stones). It is characterized by structural changes in the composition of bile, as well as the absence of clinical manifestations(symptoms) of the disease. Violations can only be detected using biochemical analysis bile.

Stage 2 (formation of stones, latent stone-carrying). It is characterized by the absence of clinical manifestations, only occasionally some discomfort in the abdomen can be felt. You can detect the presence of stones using instrumental diagnostics (ultrasound, x-ray).

Stage 3 (secondary stones). It is characterized by the presence of symptoms of cholelithiasis, may be accompanied by the development of cholecystitis.

4 stage. It is characterized by a number of complications caused by cholelithiasis.

Diagnosis of gallstone disease

Diagnosis of gallstone disease includes the following examination methods:

Anamnesis;
abdominal cavity;
Oral cholecystography;
Retrograde cholangiopancreatography;
Biochemical analysis of bile;
Scintiography of the biliary system.

Treatment of gallstone disease is aimed at removing stones from the body, as well as normalizing the functioning of all organs and their appendages involved in the production, passage and excretion of bile.

Treatment for gallstone disease usually includes the following methods:

1. Removal of gallstones and their removal from the body:
1.1. Medicinal method of removing stones;
1.2. Ultrasonic method;
1.3. laser method;
1.4. External shock wave lithotripsy (ESWLT);
1.5. Surgical method (operation);
1.6. Why you can't remove your gallbladder
2. Diet.

1. Removal of gallstones and their removal from the body

1.1 Medicinal method of stone removal

Removal of gallstones with the help of drugs involves the use of drugs that normalize the composition of bile and metabolism, which leads to the gradual splitting of stones. It is prescribed mainly in the presence of small stones, or after the ultrasonic method of their removal.

The disadvantage of this method of stone removal is the long-term use of drugs, which, firstly, are relatively expensive means, and their use should usually be made for at least 6 months. Secondly, through prolonged use of drugs, it is not uncommon for patients to develop additional unpleasant symptoms that can worsen an already difficult course of cholelithiasis.

Drugs intended for the splitting of stones and their removal from the body are based in most cases on bile acids.

Among the drugs for the treatment of GSD can be identified: ursodeoxycholic acid (Ursonan, Ursodex, Exhol), chenodeoxycholic acid (Chenosan, Henofalk, Henohol), herbal remedies (immortelle sandy extract).

Additionally, drugs are prescribed that stimulate the contraction of the gallbladder, which helps to push the stones out of themselves and their further removal from the body.

Among the drugs that stimulate the gallbladder, we can distinguish: Zixorin, Lyobil, Holosas.

1.2 Ultrasonic stone removal

The ultrasonic method of removing gallstones is performed using special ultrasonic medical equipment, which, using wave action on the gallstone, crushes it into smaller particles.

The disadvantage of this method is the possibility of the formation of pointed fragments, which can damage their mucous membranes when leaving the gallbladder and bile ducts. To prevent such a result, after ultrasound treatment prescribe medications, which we talked about a little higher. The medicine splits sharp corners together with small stones and removes their remains from the body without possible complications.

1.3 Laser stone removal method

The laser method for removing gallstones is performed using special laser medical equipment. The essence of the method lies in the implementation of a small puncture in the human body, through which a special laser is directed directly to the stone itself, which destroys the calculus into smaller particles.

The disadvantage of this method of removing stones is the possible risk of burns on the mucous membranes of the digestive tract, which can later provoke the development of an ulcer. Moreover, as in the case of ultrasonic method, particles of destroyed stones can have sharp edges that can damage the bile ducts when leaving the body. Therefore, after the removal of calculi with a laser, medications are also prescribed.

1.4. External shock wave lithotripsy (ESWLT)

Removal of stones using extracorporeal shock wave lithotripsy (ESWLT) is performed using powerful electrical discharges caused by an electromagnetic generator. The equipment generates pulsed discharges of high and low density, alternating one after another, which, when exposed to a calculus, destroy its structures, after which the stone disintegrates.

The disadvantage of this method is a large number of possible complications, the main of which are biliary colic, the development of acute cholecystitis, pancreatitis, obstructive jaundice, hematoma of the liver and gallbladder.

1.5. Surgical method of stone removal (surgery)

Open cholecystectomy. It is the most popular and cheapest method of removing gallstones. Indications for open surgery are the presence of large stones in the gallbladder and its ducts, frequent severe pain and the development of complications of gallstone disease.

The disadvantage of surgical direct removal of stones is injury (incision) of tissues over a large area - an incision of about 15-30 cm, removal of the gallbladder, the risk of complications - from internal bleeding and infection to lethal outcome(from 1% to 30%, especially the percentage increases with septic shock and other serious complications of cholelithiasis).

Laparoscopic cholecystectomy. Laparoscopic cholecystectomy, unlike open cholecystectomy, involves a gentle method of stone removal, which is performed using a laparoscope. To do this, several small (up to 1 cm) incisions are made, through which, using a laparoscope (a thin tube with a video camera for observation and accuracy of surgical intervention), the gallbladder with stones is taken out of the body. The main advantage is minimal trauma to body tissues. However, the risk of serious complications still remains.

In both the first and second cases, there are contraindications for the surgical method of removing stones, therefore, only the attending physician decides whether to perform the operation or not, and only on the basis of a thorough diagnosis of the body.

1.6. Why you can't remove your gallbladder

As we said at the beginning of the article, the gallbladder plays one of the important roles in the digestive process. This organ accumulates bile, where it is concentrated, after which, when food enters the body, the gallbladder throws bile into the initial section of the small intestine (duodenum), where the food goes through the process of digestion.

If there is no gallbladder, the bile will be more liquid, less concentrated, circulating through all the organs that are part of the so-called "choleretic system" without a controlling organ. These processes ultimately lead to poor digestion of food, the development of a number (, esophagitis, and others). At the same time, patients whose gallbladder has been removed often feel heaviness in the abdomen, pain in the right hypochondrium, a feeling of bitterness in the oral cavity and a metallic taste of food.

But the saddest thing in this picture is that if preventive measures are not followed, the stones may reappear, but already in the biliary tract(choledocholithiasis), because the composition of bile, if you do not change your lifestyle, will not change.

Thus, it can be noted that the treatment of cholelithiasis by removing the gallbladder along with stones is carried out only at least when conservative methods of treatment have not led to the desired result.

A diet for gallstone disease is usually prescribed after the removal of gallstones. This is due to the fact that even without the presence of a gallbladder, calculi can form again, but already in the biliary tract. The diet is aimed at preventing the re-development of cholelithiasis.

After removing the stones, diet No. 5, developed by M.I. Pevzner. Its basis is eating food with a minimum amount of fat and eating in small portions (4-5 times a day).

What can you eat with gallstone disease: low-fat meats and fish, cereals (rice, oatmeal, buckwheat; low-fat dairy products (milk, sour cream, kefir, cottage cheese), eggs (1 per day), bread (better yesterday or the day before yesterday), olive oil, any vegetables and fruits (everything except sour ones), tea, weak coffee with milk, compotes, juices.

What not to eat with gallstone disease: fatty, spicy, spicy, fried and smoked foods, sausages, canned food, fatty meats and fish (pork, domestic duck, catfish, crucian carp, carp, bream), lard, animal fats, pickled vegetables, spinach, legumes, alcohol, strong coffee, soda, grape juice, muffins, chocolate.

Important! Before use folk remedies treatment of gallstone disease, be sure to consult with your doctor!

You also need to understand that the following remedies are aimed at removing stones, so their movement through the bile ducts to exit the body may be accompanied by colic, bouts of nausea and pain.

Birch. 2 tbsp. spoons of birch leaves, collected and dried in the spring, pour a glass of boiling water and put on a slow fire. It is necessary to boil the product until its volume is halved. After that, the product must be cooled, filtered and taken throughout the day for 3 sets, half an hour before meals. The course of treatment is 3 months.

Radish with honey. Squeeze out the juice from the radish, mix it with, in a ratio of 1: 1 and take 1 time per day, starting with 1/3 cup, and over time, the dose should be increased to 1 cup per day.

Rowan red. To remove stones from the gallbladder and its ducts, you can eat 2 cups of fresh fruits of wild red mountain ash daily. To improve the taste properties, berries can be consumed mixed with honey, granulated sugar or bread. The course of treatment is 6 weeks.

Olive oil. Every day, 30 minutes before meals, you need to take olive oil. In the first days - ½ teaspoon, after 2 days - 1 teaspoon, then 2 teaspoons, etc., increasing the dosage to ½ cup. The course of treatment is 1 month.

Gallstone disease is a chronic hereditary disease of the gallbladder with the formation of stones in the organ itself and (or) in the biliary tract. In Russia, it occurs in 15% of the population.

Causes of gallstone disease

Cholelithiasis is a polyetiological pathology. For the formation of stones in the cavity of the gallbladder, the following conditions are necessary:

Oversaturation of bile with cholesterol. Normally, cholesterol is evenly dissolved in the fluid secreted by the liver. With various deviations (obesity, hypercholesterolemia, etc.), cholesterol crystals precipitate and gradually increase their volume.
Nucleation of cholesterol crystals. Glycoprotein-mucin gel is responsible for this process; it is always located on the inner membrane of the gallbladder and captures vesicles (liquid crystals) with cholesterol, which gradually harden under the influence of calcium salts (carbonates, bilirubinates, phosphates).
Decreased contractile activity of the gallbladder. A similar deviation is present in 100% of patients. Against the background of a decrease in the sensitivity of receptors to cholecystokinin or a violation of the nervous regulation, motility decreases.

Expert opinion

Sevastyanov Roman

The most susceptible to cholelithiasis are persons with chronic cholecystitis of bacterial etiology, with damage to the ileum (Crohn's disease), cystic fibrosis, cirrhosis of the liver. In an infected gallbladder, bacteria produce b-glucuronidase, which promotes the transition of bilirubin into an insoluble form and its sedimentation in the form of stones.

The main risk factors are:

age over 40;
female (in men, pathology occurs 3-4 times less often);
burdened family history (increases the risk of development by 5-6 times);
overweight and obesity (BMI over 25);
diabetes;
diseases of the liver and gallbladder (cirrhosis, chronic hepatitis, chronic cholecystitis);
use of drugs that reduce biliary motility (for example, ceftriaxone or prednisolone);
sudden weight loss (more than 20 kg in 3 months);
damage to the distal ileum;
prolonged functional inactivity of the organ (with parenteral nutrition).

Depending on the mechanism of development of gallstone disease, the following types of stones are distinguished:

Cholesterol stones - up to 95% of all cases.
pigment stones. Black ones appear in people of senile age on the background of alcoholism, hemolytic anemia or cirrhosis of the liver. Brown stones are formed during the action of enzymes of bacterial agents on bile pigments.
Lime stones. The main reason is the increased consumption of mineral salts with food or poor-quality drinking water.

Types of stones

Clinical picture

The manifestations of the disease may be different. About 70% of people who have stones in the gallbladder or common excretory duct do not complain at all. The following forms of pathology are distinguished:

latent stone-carrying;
dyspeptic;
painful;
gallbladder cancer.

Dyspeptic form

The main complaints are associated with disorders of the gastrointestinal tract. After eating, there is a feeling of discomfort and heaviness in the epigastric region, as well as early overflow of the stomach. In rare cases, there may be: flatulence, heartburn and a bitter taste in the mouth. The stool can be unstable, with constipation changing to diarrhea every few days.

pain form

This variety can proceed as biliary colic (75% of cases) or torpid pains.

The first variant is characterized by sudden strong periods of acute pain in the right hypochondrium that occurs after errors in the diet (eating fatty, fried foods). There may be irradiation to the right half of the lower back and right shoulder blade. Reflexively, in 70% of cases, bitter vomiting is recorded without subsequent relief. The duration of the attack - no more than 6 hours, if higher - these are signs of acute cholecystitis (frequent repeated attacks, fever, symptoms of local peritonitis).

Expert opinion

Sevastyanov Roman

General practitioner, hepatologist, gastroenterologist, the highest qualification category. Site Expert

In the torpid form, the pain syndrome constantly haunts, however, the pains are not strong and may not cause discomfort to the patient. There are no rest periods.

gallbladder cancer

100% of patients with gallbladder cancer have signs of cholelithiasis. Therefore, oncopathology is singled out as a special form of gallstone disease.

The leading cause of the formation of proliferative diseases is irritation of the bladder wall with accumulated stones, the effect of bile with altered chemical composition, toxic effect of bacteria. benign tumors usually do not occur.

Diagnostics

Diagnosis of the disease is very difficult. In most cases, the clinically pronounced presence of stones in the lumen of the bladder is combined with signs of inflammation. For an accurate diagnosis, the following methods are used:

Ultrasonography. With ultrasound, stones are clearly visualized, their localization is determined. With obstruction of the excretory tract, the volume of the gallbladder is increased, and the walls are thinned (during the inflammatory process, they are thickened and folded)
Plain radiography of the abdominal organs. Allows you to detect only about 30-50% of the available stones.
Cholecystography is an X-ray examination after the introduction of contrast agents. The route can be intravenous or oral (through the mouth). The contractility of the smooth muscles of the organ and the patency of the excretory tract are assessed.
Endoscopic retrograde cholangiography (ERCG) - contrasting the common bile duct by inserting a cannula into the major duodenal papilla. The advantage of the method is that after the discovery of stones, you can begin its destruction and extraction.
MRI is a highly informative method that allows to detect stones with a diameter of more than 2 mm.
Endoscopic ultrasonography– study of the biliary system by introducing a probe into the duodenum.
Radioisotope diagnostics. A radiopharmaceutical is injected into the patient's blood, which accumulates in the cavity of the gallbladder. According to the degree of staining, the shape, volume, and presence of calculi are assessed.

Also appointed general analysis blood and urine and blood biochemistry in order to identify the inflammatory process, establish its etiology, establish the degree of dysfunction of the liver and biliary tract, disorders of the lipid spectrum.

Treatment of gallstone disease without surgery

Non-surgical treatment can be carried out only under the following conditions:

the course of the disease without complications;
the presence of single contrast stones, with a diameter of less than 1 cm;
preserved contractile activity of the bladder;
multiple stones, less than 0.5 cm in diameter;
prevention of cholelithiasis with high lithogenic properties of bile;
refusal of the patient from the operation.

The goal of conservative therapy is to eliminate the manifestations pain syndrome, prevention of attacks of biliary colic and the use of drugs for the indirect dissolution of gallstones. The following groups of funds are assigned:

Antispasmodics. Recommended for use by all patients with pain. They not only quickly eliminate acute pain, but are the only method of preventing recurrent attacks.
Medicines to dissolve gallstones. Ursodeoxycholic acid preparations are prescribed (if therapy is ineffective for 12 months, then it is necessary to apply surgical methods), prokinetics (to activate the motor activity of the bladder wall in order to evacuate stones and destroy them). With pronounced contractile activity, calculi dissolve much faster, especially small ones (up to 4 mm in diameter).

Basic drugs

Name	Pharmacological group	Mechanism of action	Mode of application	average cost
Antispasmodic	It blocks the enzyme phosphodiesterase, leading to muscle relaxation.	Intramuscularly 1 ml of 0.25% solution 2 times a day.	100 rubles
Platifilin	Antispasmodic	It blocks M-cholinergic receptors, which leads to a violation of the efferent innervation of the smooth muscles of the gastrointestinal tract.	0.04 inside 4 times a day.	200-250 rubles
Ursodeoxycholic acid drug	Reduces the synthesis of cholesterol and increases its dissolution in bile, thereby reducing the risk of crystallization.	2 capsules 2 times a day, orally.	1,500-2,000 rubles
Prokinetic	It blocks central and peripheral dopamine receptors, eliminating the inhibitory effect of dopamine on the smooth muscles of the gastrointestinal tract.	Inside, 0.01 4 times a day for 20-30 minutes before meals.	150 rubles

Remote destruction of stones

Shock wave lithotripsy has proven itself well. If the size of gallstones is less than 20 mm, and the activity of the smooth muscles of the gallbladder is preserved, then the influence of the wave can eliminate the cause of the pathology. The impact can be carried out in various ways:

electrohydraulic shock;
ezoelectric shock;
exposure to a magneto-restrictive generator.