Gallstone disease: symptoms, treatment, diet

Gallstone disease - disease of the gallbladder and bile duct with stone formation. Although the correct name is the medical term as "gall stones" - code ICD-10: K80. The disease is complicated by inadequate liver function, biliary colic, cholecystitis (inflammation of the gallbladder) and can obstructive jaundice with the need of surgery to remove gall bubble.

Today we look at the causes, symptoms, signs, exacerbation, treatment of gallstones without surgery medical and folk remedies, what to do in a fit of pain, when the operation is necessary. Especially talk about the nutrition of patients (diet), the menu, what can and can not have purged the treatment without surgery and after it.

What it is?

Cholelithiasis - a pathological process in which the stones (calculi) are formed as ducts and gallbladder. Due to the formation of stones in the gall bladder of a patient developing cholecystitis.

How to form gallstones

The gall bladder is a reservoir for bile produced by the liver. of biliary pathways of bile flow is generated by a coordinated activity of the liver, gallbladder, common bile duct, pancreas, duodenum. This ensures the timely flow of bile into the intestine during digestion, and its accumulation in the gallbladder fasting.

The formation of stones in it occurs due to changes in the composition and stagnation of bile (diskholiya), inflammatory processes, motor-tonic disorders biliary excretion (dyskinesia).

Distinguish cholesterol (up to 80-90% of gallstones), pigment and mixed stones.

1. It promotes the formation of cholesterol stones supersaturation of bile with cholesterol, its loss in precipitate formation of cholesterol crystals. When impaired motility of the gallbladder, the crystals do not appear in the intestine but remain and start to grow.
2. Pigment (bilirubin) stones are the result of enhanced decay of erythrocytes in hemolytic anemia.
3. Mixed stones are a combination of both forms. Contain calcium, bilirubin, cholesterol.

It occurs mainly in inflammatory diseases of the gallbladder and bile ducts.

Risk factors

Reasons voziknoveniya cholelithiasis few:

• excess cholesterol in bile secretion
• reduced secretion of phospholipids and bile acids into bile
• bile stasis
• biliary tract infection
• hemolytic disease.

Most gallstones - mixed. It is composed of cholesterol, bilirubin, bile acids, proteins, glycoproteins, various salts, trace elements. Cholesterol stones contain mainly cholesterol, have a circular or oval shape, a layered structure, a diameter of from 4-5 mm to 12-15, localized in the gallbladder.

1. Cholesterol-pigment-lime stones - plural, have the edge, the shape is different. Vary greatly in the number - tens, hundreds or even thousands.
2. Pigment stones - small size, multiple, hard, brittle, very homogeneous, black color with a metallic tint, located in the gallbladder or in the bile ducts.
3. Calcium stones consist of different calcium salts, fanciful shape, have shipoobraznye processes, light or dark brown color.

Epidemiology

According to numerous publications throughout the XX century, especially its second half, going on a rapid increase in the prevalence of gallstone disease, mainly in industrialized countries, including the Russia.

Thus, according to some authors, the incidence of cholelithiasis in the former Soviet Union almost doubled every 10 years, and the stones in the biliary tract were detected at autopsy in every tenth of the deceased regardless of cause of death. At the end of the XX century, more than 5 million have been registered in Germany, and the United States more than 15 million patients with gallstone disease, with the disease affecting approximately 10% of the adult population. According to medical statistics, cholelithiasis occurs in women more often than men (ratio 3: 1 8: 1), and with age, the number of patients increases significantly after 70 years reaches 30% or more population.

Increasing surgical activity against cholelithiasis, which was observed during the second half of the XX century, it has led to the fact that in many countries the frequency of operations on the biliary tract has surpassed the number of other abdominal operations (including appendectomy). For example, in the US in 70 years is held annually more than 250 thousand. cholecystectomies, 80 th - 400 th, and 90 th -. 500 thousand.

Classification

Based on the features of the disease made today the following release its classification in accordance with the relevant steps for him:

1. Stone formation - the stage, which is also defined as latent kamnenositelstvo. In this case, the symptoms of gallstones are not available, but the use of instrumental methods of diagnosis to determine the presence of stones in the gall bladder;
2. Physicochemical (initial) step - or, as it is called, dokamennaya step. It is characterized by changes in the composition of bile. Special clinical manifestations at this stage, no detection of disease at an initial stage possible, which is used for biochemical analysis of bile in particular its composition;
3. Clinical manifestations - stage symptoms that point to the development of acute and chronic forms of calculous cholecystitis.

In some instances, also recovered and a fourth step, which is to develop related complications of the disease.

Symptoms of gallstones

In principle, cholelithiasis can occur for a long time without any symptoms or manifestations. This is due to the fact that the stones are in the early stages of small, do not block the bile duct and do not injure the wall. The patient may for a long time did not suspect the existence him to the problem. In these cases, usually talking about kamnenositelstve. When the actual gallstone disease makes itself known, it can manifest itself in different ways.

Among the first symptoms to be noted heaviness in the stomach after eating disorders chair (especially after a fatty meal), nausea and mild jaundice. These symptoms may appear before the expressed pain in the right upper quadrant - the main symptom of gallstones. They explained unexpressed impaired outflow of bile, which is why there is worse digestion process.

The most characterized by the following signs and symptoms for gallstones:

1. Temperature rise. An increase in temperature usually indicates an acute cholecystitis, which often accompanies cholelithiasis. Intense inflammation in the right hypochondrium leads to the release of active substances in the blood, contributing to raising the temperature. Lingering pain after colic accession fever almost always speak of acute cholecystitis or other complications of the disease. Periodic fever (undulating) to rise above 38 degrees may indicate cholangitis. Overall, however, the fever is not required when a symptom of gallstones. The temperature may remain normal even after severe prolonged colic.
2. Pain in the right upper quadrant. The most common manifestation of gallstones is the so-called bile (biliary, hepatic) colic. This attack of acute pain, which in most cases is localized at the intersection of the right costal arch and the right edge of the rectus abdominis muscle. attack time can vary from 10 - 15 minutes to several hours. At this time, the pain can be very strong, to give the right shoulder, back, or other abdominal area. If the attack Bole lasts more than 5 - 6 hours, you should think about the possible complications. The frequency of attacks may be different. Often, the first and second attack takes place about a year. Overall, however, they become more frequent over time.
3. Intolerance to fats. In humans, bile is responsible for emulsification (dissolution) of fat in the intestine, is necessary for normal digestion, absorption and assimilation. When gallstones stones in the neck or biliary bile often block the way to the intestine. As a result, fatty food is not broken down properly and causes disturbances in bowel habits. These disorders may be manifested by diarrhea (diarrhea), gas accumulation in the intestine (flatulence), not expressed abdominal pain. All these symptoms are non-specific and can occur in various diseases of the gastrointestinal tract (GI tract). fatty food intolerance can occur at the stage kamnenositelstva when other symptoms of the disease are not yet available. At the same time, even a large rock located at the bottom of the gallbladder, can not block the flow of bile and fatty foods will be digested properly.
4. Jaundice. Jaundice occurs due to bile stasis. Responsible for its appearance pigment bilirubin, which is normally excreted in the bile into the intestine and then excreted with feces. Bilirubin is a natural metabolic product. If he ceases to be allocated in the bile, then there is its accumulation in the blood. So it spreads through the body and accumulates in the tissues, giving them a characteristic yellowish tint. Most often, patients first yellow sclera eyes, and only then - the skin. In light of people this symptom is noticeable better, and have not expressed swarthy jaundice may miss even an experienced physician. Often simultaneously with the appearance of jaundice and dark urine in patients (dark yellow, but not brown). This is because the pigment begins to stand out from the body through the kidneys. Jaundice is not compulsory symptom in calculous cholecystitis. it also appears not only in this disease. Bilirubin can also accumulate in the blood in hepatitis, liver cirrhosis, certain hematologic diseases or poisoning.

In general, symptoms of gallstones can be quite diverse. There are a variety of violations of the chair, atypical pain, nausea, periodic vomiting. Most doctors are aware of such a variety of symptoms, and in any case prescribe gallbladder ultrasound to rule out gallstones.

Attack of gallstones

Under attack cholelithiasis usually mean biliary colic, which is the most acute and typical manifestation of the disease. Kamnenositelstvo does not cause any symptoms or disorders, digestive disorders and unexpressed patients usually do not give value. Thus, the disease is latent (hidden).

Biliary colic usually appear suddenly. Its cause is a spasm of smooth muscles located in the walls of the gallbladder. Sometimes it damaged and mucosa. This occurs most often when a stone moves and gets stuck in the bladder neck area. Where it blocks the flow of bile, and bile from the liver is not accumulated in the bladder and flows directly into the intestine.

Thus, an attack of gallstones usually manifests characteristic pain in the right upper quadrant. In parallel, the patient may experience nausea and vomiting. Often attack comes after sudden movements or stress or after taking large amounts of fatty foods. Once during the exacerbation may experience discoloration of the chair. This is due to the fact that the intestine does not get pigmented (colored) bile from the gallbladder. It drains bile from the liver only in small amounts and gives an intense coloration. This symptom is called Ahola. In general, the most common manifestation of attack cholelithiasis are characteristic of pain, which will be described hereinafter.

Diagnostics

Identify typical symptoms of biliary colic requires specialist advice. By physical examination, they are held, is meant detection of symptoms characteristic of the presence of gall stones (Murphy, Ortner, Zakharyin). In addition it detected a certain tension and tenderness of the skin in the abdominal wall muscles within the projection of the gallbladder. Also notes the presence of skin xanthomas (yellow spots on the skin formed on the background of disturbances in the body lipid metabolism), there is a yellowness of the skin and sclera.

The results of general blood analysis putting determine signs indicating nonspecific inflammation on the stage of clinical exacerbation, which in particular consist in a moderate increase in ESR and leukocytosis. In biochemical blood study determined hypercholesterolemia and hyperbilirubinemia and increased activity characteristic of alkaline phosphatase.

Cholecystography applied as a method of diagnosing cholelithiasis, determines an increase in the gallbladder, as well as the presence in the wall of lime inclusions. In addition to this well looked through, in this case the stones with lime available inside.

The most informative method, which is also the most common in the study of the region of interest and for the disease in particular, is an abdominal ultrasound. When considering the abdominal cavity in this case is provided in the detection accuracy with respect to the availability of certain entities in ehonepronitsaemyh form stones in conjunction with pathological deformations, which when exposed to disease of the bladder wall, as well as changes in its relevant motility. Clearly visible on ultrasound and signs of a cholecystitis.

The visualization of the gallbladder and the ducts can also be produced using for this purpose MRI and CT techniques in specified areas. As an informative technique, indicating the irregularities in the circulation of bile processes may be used scintigraphy and endoscopic retrograde cholangiopancreatography.

Drug treatment of gallstone disease

Treatment gallstones without operation used in the presence of cholesterol gallstones (Rentgennegativnyh) of up to 15 mm when stored gallbladder contractility and permeability cystic duct.

Contraindications for medical dissolution of gallstones:

• inflammatory diseases of the small and large intestine;
• obesity;
• pregnancy;
• "Disabled" - nonfunctioning gallbladder;
• acute inflammatory diseases of the gall bladder and biliary tract;
• stones with a diameter of more than 2 cm;
• liver disease, diabetes, gastric ulcer and duodenal ulcer, chronic pancreatitis;
• pigment or calcareous stones;
• Cancer of the gallbladder;
• multiple concretions that occupy more than 50% of the gallbladder.

Applied drugs ursodeoxycholic acid, whose action is aimed at only the dissolution of cholesterol stones, take medication for 6 - 24 months. But the likelihood of relapse after the dissolution of stones is 50%. Dose, duration of reception sets only doctor - a physician or a gastroenterologist. Conservative treatment is possible only under medical supervision.

Shock wave holelitotrepsiya - treatment by crushing the large stones into small fragments using shock waves, followed by drug administration bile acid (UDCA acid). The likelihood of recurrence is 30%.

Gallstone disease for a long time may be asymptomatic or malosimptomno that it creates certain difficulties identifying at early stages. This is the cause of late diagnosis, in step already formed gallstones when applying conservative therapies is limited, and the only treatment is surgical.

Treatment of folk remedies gallstones

Here is an example of a few recipes to dissolve the stones. Them, there are many.

1. Green tea. Drink both prevention of gallstones, as green tea prevents lithiasis.
2. lingonberry leaves. The leaves of this plant make it possible to dissolve gallstones. Fill the cup boiling water 1 tablespoon of dried leaves, cranberries, insist 20-30 minutes. Take 2 tablespoons 4-5 times a day.
3. Willow-herb, or willow-herb. Brew a thermos 2 tablespoons dried willow leaf tea, hot water bay (0.5 L). Leave for 30 minutes. Drink 100 ml of tea one hour before meals three times a day for six months. Infuse the same tea leaves can be as long as the tea has a color. Consult a doctor before use, as it is possible to move the stones.

Important in the treatment of folk remedies gallstones - make sure that you present cholesterol stones, which can be dissolved. To do this, go ultrasound (visible stones) and X-ray (cholesterol stones are not visible).

Then visit the doctor fitoterapevta and find the most effective combination of herbs for your case. In parallel with the use of folk remedies, you must adhere to the principles of a balanced diet - sometimes just a change in diet to get rid of small cholesterol stones. It is also necessary to devote time to physical exercise - the pedestrian walks, a small charge in the morning - that is, move more.

Diet for gallstones

You need to limit or exclude from the diet of fatty, high-calorie, cholesterol-rich food, especially when genetic susceptibility to gallstone disease. Meals should be frequent (4-6 times a day), in small portions, which helps to reduce the stagnation of bile in the gallbladder. The diet should contain sufficient dietary fiber, due to vegetables and fruits. food bran (15g of 2-3 times a day) can be added. This reduces lithogenicity (propensity to stone formation) bile.

Lasting therapeutic diet for gallstones from 1 year to 2 years. Dieting - the best prevention of exacerbations of gallstone disease, and if you do not stick to it, you may develop severe complications.

The consequences of non-compliance include: the occurrence of atherosclerosis, the occurrence of constipation, dangerous with stones in the bladder, increasing the burden on the digestive tract and increase the density of the bile. Therapeutic diet to help cope with excess weight, improve the intestinal flora and protects the immune system. As a result, a man improves mood, normal sleep.

In severe cases, non-compliance with the diet leads to ulcers, gastritis, colitis. If you want to recover from the disease without surgery, the diet - the paramount requirement.

Operation

Patients must be subjected to routine operations before the first attack of biliary colic or immediately after it. This is due to the fact that a high risk of developing complications.

After surgical treatment must be personalized dietary regime (frequent split meals with limited or except for individual intolerance of the product, fatty, fried foods), compliance with work and rest, exercises physical exercise. Eliminate the use of alcohol. Perhaps the spa treatment after surgery, provided stable remission.

complications

The appearance of the stones is fraught not only a violation of the functions of organs, but also the occurrence of inflammatory changes in the gallbladder and organs near. So, because of the stones may be injured bladder wall, which in turn, provokes inflammation. Provided that the stones pass through the cystic duct with bile from the gallbladder, bile outflow can be difficult. In the most severe cases, the stones may block the entry and exit of the gallbladder, stuck therein. When such events occur bile stasis, and this - a prerequisite to the development of inflammation. The inflammatory process can develop over several hours, and for a few days.

Under such conditions, the patient may develop acute gallbladder inflammation. Thus as the degree of injury, and speed of development of inflammation could be different. Thus, it is possible as a minor wall edema and its destruction and, as a consequence, gall bladder rupture. Such complications are cholelithiasis life-threatening. If the inflammation spreads to the abdominal organs and peritoneum, the patient developed peritonitis. As a result, complication of these phenomena can become toxic shock and multiorgan failure. Thus there is a disruption of the blood vessels, kidneys, heart, brain. If a strong inflammation and high toxicity of microbes breeding in diseased gallbladder wall, toxic shock may occur immediately.

In this case, even resuscitative measures do not guarantee that the patient will be able to deduce from this state and avoid death.

prevention

For the prevention of diseases is useful to carry out the following activities:

• not practice long fasting;
• for the prevention of gallstone disease is useful to drink enough fluids, not less than 1.5l per day;
• so as not to provoke the movement of stones, to avoid work related to the length of stay in an inclined position;
• diet, normalize body weight;
• increase physical activity, give your body more traffic;
• eat more often, every 3-4 hours to cause regular emptying of the bladder from the accumulated bile;
• women should limit the intake of estrogen, the hormone promotes the formation of stones or their increase.

For the prevention and treatment of gallstones is useful to include in the daily diet of a small amount (1-2ch.l.) Vegetable oil, preferably olive. Sunflower absorbed only 80%, while the olive completely. Furthermore, it is more suitable for frying as forms less of phenolic compounds.

Receipt of vegetable fat stimulates the activity of gall bladder, as a result he is able at least once a day to empty, preventing stagnation and the formation of stones.

To normalize the metabolism and prevent gallstones in the diet should include magnesium. Trace element stimulates bowel movements and the production of bile, removes cholesterol. Furthermore, to produce bile enzyme requires a sufficient intake of zinc.

If cholelithiasis is better to give up drinking coffee. Drink stimulates contraction of the bladder, which may appeal duct blockage and a subsequent attack.