Therefore, it is often detected when education has already penetrated into the ducts or even clog them. A condition characterized by the presence of stones in the gallbladder, is called cholelithiasis. In women, it is diagnosed in two to three times more likely than members of the opposite sex. A similar phenomenon doctors have not found sufficient justification.
Reasons for the formation of gallstones
The main cause of the formation of concretions composition is a disturbance of bile - balance between cholesterol and bile acids. With an excess of bile cholesterol and bile acid deficiency called lithogenic.
Healthy bile has a liquid consistency and does not form stones. Factors provoking their education include:
- Elevated cholesterol levels in the composition of bile, which is why change its properties;
- Violation of the outflow and stagnation of bile;
- Contact with gall bladder infection and the subsequent development of cholecystitis.
The reasons for difficulty of outflow of bile and its stagnation are the following factors:
- The presence of certain diseases: psoriasis (contractility disorders), biliary tract, flatulence (Increased pressure in the gastrointestinal tract complicates bile current), and surgery on the digestive tract in history (vagotomy and so forth).;
- Sedentary lifestyle;
- Pregnancy (uterine pressure on the abdominal organs and prevents the outflow of bile);
- Wrong diet with significant gaps between meals, as well as starvation and dramatic weight loss.
Elevated cholesterol in bile is caused by the following reasons:
- Excessive intake of high cholesterol foods (animal fats);
- Impaired liver function, as reduced production of bile acids;
- The presence of obesity, which occurs in about 2/3 of patients;
- Prolonged use of oral contraceptives containing estrogen (in females);
- Presence of other diseases such as diabetes, hemolytic anemia, cirrhosis, allergy, Crohn's disease and other autoimmune conditions.
the third reason - is infection of the gallbladder, which occurs by ascending from the intestine or through blood and lymph flow and resulting in cholecystitis (inflammation of the mucosa of the bladder wall) and cholangitis (inflammation of the bile ducts). Chronic cholecystitis and cholelithiasis - is interdependent state when one of the diseases maintains, accelerates and complicates for another.
Based on the chemical composition, allocate such varieties of gallstones:
- bilirubin. They are formed when changes in the composition of blood and some congenital anomalies. Stones of this type may be in the gallbladder as well as in liver and excretory ducts. It has a dense structure because their composition contains a calcium salt. This small stones in the gall bladder, the size of which - a centimeter, not more. They are irregular in shape and usually lots of them. Bilirubin calculi may be black and brown color, due to the dominant component. Black stones contain calcium bilirubinate, pigment black, they have no cholesterol. Brown consist of less polymerized bilirubinate calcium and contain negligible amounts of protein and cholesterol. Pigment stones - radiopaque education, making them easy to diagnose.
- cholesterol. This type is the most common and therefore studied in more detail than other types of gallstones. Their main components - microcrystals of cholesterol, however, they have a uniform structure. Cholesterol gallstones reach considerable sizes - to 2 cm. Have a white or yellowish in color, oval or round shape. These concretions are located exactly in the gall bladder, and not in its ducts. Cholesterol stones can not be detected during X-rays.
- Lime (calcification). It is rare, formed of calcium salts and cholesterol crystals. Gallbladder stones with such wall typically has inflamed. Calcareous concretions take the form of rounded formations, single or multiple. This can be a big stone 10 mm or more small (less than 10 mm in diameter). Calcifications can be detected by X-ray.
- hybrid. The complex composition of stones by deterioration in the cholesterol and pigment stones calcifications. As a result of the formation are formed with a layered structure expressed. Often mixed stones have pigmented skin center and cholesterol.
Thus, the appearance of the primary concretions are crucial violations of the structural composition of bile. secondary stone formation is the result of infection with cholestasis and gallbladder. Primary stones are formed primarily in the gallbladder and stagnation due to the thick consistency of bile. Secondary concrements can be formed both in the bladder and in the ducts, and intrahepatic bile.
symptoms
Main symptoms of gallstones depends on the stone localization - a manifestation of gallstone disease is related to the size and shape of the latter. Symptoms experienced by all patients with stones in the gall bladder, the following:
- pain under the right side of the rib (paroxysmal, stitching);
- nausea;
- bitter taste in the mouth;
- flatulence and other intestinal problems;
- burping air;
- the development of jaundice.
Sometimes also note symptoms such as fever and chills - this can happen when the stone begins its movement through the ducts. However, most of the temperature increase indicates the accession of infection and the development of cholecystitis, symptoms of which are peculiar to the inflammatory process.
Predisposing factors causing hepatic colic are stressful conditions and physical stress, eating spicy, fatty and fried foods, excessive drinking alcohol.
The first symptoms of the disease - the deterioration of general health and pain, which, although it is localized under the ribs on the right side, but it gives to other parts of the body. Pain develops due to the fact that the stone in the gall bladder, from going out, annoying and stretches the duct wall. Alternatively, the pain can be caused by overstretching of the bladder due to the accumulation of bile in it.
Note that in the case of occlusion symptoms ducts as follows: the sclera and human skin are yellow, right under the ribs a person feels heavy, there is vomiting of bile, not bringing relief. Such a condition is extremely dangerous, as it can lead to seizures, and the critical temperature increase.
Diagnostics
Often the stones in the ducts of the gallbladder are found by chance during an ultrasound or X-ray. Qualified on the results of studies specialist will determine not only the size of stones and the presence of inflammation, but also determine the approximate composition of stones, will assess the risk of bile colic.
For more information about the disease can be assigned:
- blood tests (general and biochemistry);
- cholecystocholangiography;
- CT, MRI;
- Retrograde holangiorentgenografiya (during the endoscopic procedure, the doctor may remove small concretions).
complications
If you do not take the necessary measures for the treatment of gallstones, a condition sick person may be exacerbated because of the following complications:
- Cholecystitis in an acute form.
- Blockage of the bile duct, which is the basis for the development of infection, chronic cholecystitis and pancreatitis.
- Rupture of the gallbladder and, as a consequence, peritonitis.
- Penetration of large gallstones in the gut with its subsequent blockage.
- The increase in the risk of Cancer of the gallbladder disease.
How to treat gallstones?
If you are in the gall bladder stones, but there are no clinical symptoms and complications of the disease, the need for carrying out a specific treatment there. The specialists take a wait and see tactics. With the development of pronounced calculouse acute or chronic cholecystitis, surgical treatment is recommended, whose main purpose is to remove the gallbladder (cholecystectomy).
Today, there are several treatments for gallstones without surgery, they allow you to maintain the integrity of the gall bladder and ducts:
- This is achieved by dissolving the stones by means of special preparations containing acid (Henofalk, ursosan). However, when such treatment over time zhelchnomzhelchnokamennoy stones can be formed again.
- Excellent destroying concrements in the gall bladder and bile ducts shock wave lithotripsy. This method is most often used to grind a single calculus in patients who have no concomitant inflammation of the gallbladder or ducts.
Conservative treatment holetsistolitiza in remission based on diet and mode active lifestyles, the systematic use of oral medications that contribute to the destruction of stones.
For the treatment of gallstone disease in parallel appointed the following drugs:
- preparations promoting normalization bile formulation (ursofalk, liobil);
- stimulators of secretion of the bile acids (phenobarbital, ziksorin);
- for pain caused by contraction of the gall bladder, the patients are recommended various muscle relaxants (platafillin, drotaverine, no-spa, metacin, pirentsipin).
- enzyme preparations that enhance the digestion process, in particular - the processes of digesting lipids (Creon).
As the size of stones in the gallbladder, for treatment of the patient is recommended lithotripsy (drug, shockwave) or surgical intervention. Indications for lithotripsy are:
- frequent bouts of pain,
- large and multiple calculi,
- comorbidities
Drug lithotripsy performed henohol drugs and Henofalk that can be taken quite a long time - for decades. In such treatment the large calculi in the gallbladder are broken up into smaller sizes, then their remains dissolve by means of oral medicinal products (they are usually given a few weeks before shockwave lithotripsy).
Extracorporeal shock wave lithotripsy
Extracorporeal shock wave lithotripsy (pulverization) - a technique based on the shock wave generation, resulting in crushing stone into a plurality of grains. Currently, this procedure is used as a preparatory phase before litholytic oral therapy.
Indications for ESWL is no violation of biliary patency, single and multiple cholesterol stones diameter of not more than 3 cm.
Contact (local) dissolving the stones
Litholysis contact - is a method comprising administering to the gallbladder or bile ducts of special organic solvent (ether or metiltretbutila propionate). The effectiveness of this method is 90%, but after dissolving concrements patient requires supportive therapy. With contact litholysis approximately 14-16 hours completely dissolve cholesterol stones of various sizes and quantities.
Surgery
During the surgery can be removed the gallbladder with stones within it, or only concretions. Currently, surgical practice in the treatment of cholecystolithiasis uses several types of transactions:
- Classical (open) cholecystectomy (gall bladder removal);
- laparoscopic cholecystectomy;
- Laparoscopic holetsistolitotomiya (conserving operation involving the removal of stones).
Diet and Nutrition rules
diet composition is important in this disease. It is recommended to adhere to a fractional power, eat 5-6 times a day. food reception itself has a choleretic effect, so the flow of the stomach small amounts of food at the same clock stimulates the flow of bile and prevent its stagnation. But a large portion of food gallbladder may instinctively be reduced, and this will cause aggravation.
It is recommended to exclude the following from the menu and dishes:
- Beans, radish, radish, eggplant, cucumbers, artichokes, asparagus, onion, garlic;
- Fried, acidic and savory;
- Rich broth;
- Fatty meats (pork, lamb, beef) and fish as well as fat, liver and by-products;
- Sausage, smoked, canned, pickled vegetables;
- Butter (narrowing is desirable to add porridge);
- Coffee, cocoa and alcohol.
Recommended products:
- Lean meat and fish;
- Fruits and vegetables: pumpkin, carrots, zucchini, cauliflower, apples, watermelon, plums;
- Cheese, cottage cheese, milk with a fat content of not more than 5%;
- Cereals, especially buckwheat and oatmeal;
- Fruit drinks, fruit drinks, mineral water, juices of blueberry, pomegranate, quince.
The diet should be sufficient amount of animal protein, animal fats are not prohibited, but it is usually poorly tolerated, so give preference to vegetable fats. If cholelithiasis is useful to eat foods rich in magnesium.
Prevention of relapse
If a person starts a pathological process of stone formation in the gallbladder, it completely to stop is difficult enough without surgery. Ill after mandatory treatment should undergo regular checkups. Even after surgery, the patient status litholytic prescribed drugs.
The important point is to correct lifestyle, especially diet.
The fight against excess weight often helps to minimize the risk of recurrent stone formation and significantly reduces the frequency of relapses.
