Gallstone disease - a disease characterized by the formation of stones in the gallbladder or bile ducts. Also known as cholelithiasis, gallstones.
Lithiasis - step process with periods of active growth and remission.
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.
Cholesterol-pigment-lime stones - plural, have the edge, the shape is different. Vary greatly in the number - tens, hundreds or even thousands.
Pigment stones - small size, multiple, hard, brittle, very homogeneous, black color with a metallic tint, located in the gallbladder or in the bile ducts.
Calcium stones consist of different calcium salts, fanciful shape, have shipoobraznye processes, light or dark brown color.
Symptoms of gallstones
Conventionally secrete several forms of the disease.
Latent form gallstones.
It should be regarded as one of the phase currents cholelithiasis. It can last a very long time in the absence of symptoms.
Diarrhea, chronic form of the disease.
Its manifestations:
- uvstvo heaviness in the epigastric and right hypochondrium,
- heartburn,
- flatulence,
- unstable chair.
The appearance of pain provokes eating fatty, fried, spicy food, too large portions of food.
Painful chronic form gallstones.
In this form of expression no pain attacks. The pains are aching in nature, localized in the epigastric and right hypochondrium, distributed in the region of the right scapula. There are weakness, malaise, irritability.
Biliary colic and chronic relapsing form.
This suddenly occurring bout of intense pain in the right upper quadrant and epigastric region. Triggered by the ingestion of fats, spices, negative emotions, physical stress, pregnancy, menstruation.
necessary inspections
- Blood chemistry
- ultrasound
- Doudenalnoe sensing
- X-ray.
Treatment of gallstones
Treatment of gallstones depends on the form of the disease and the degree of operational risk.
1. When individual stones gallbladder diameter greater than 1.2 cm, multiple stones carried gallbladder removal. The gold standard surgical treatment is cholecystectomy - removal of the gallbladder. Radical surgery for gallstones provides 95% of patients with complete recovery. In 10% of patients delaying operation leads to the deterioration of the disease.
2. Dissolution or grinding stones are shown in the cases when small stones (up to 1 cm) and individual stones.
Crushing is carried out using ultrasound or electromagnetic waves. crushing stones in the gallbladder is due to exposure to shock waves stone, which is formed by spark discharge or drive piezoelectric crystals and by using a parabolic reflector focuses on a rock. At the point of focus wave energy reaches a maximum. When this deformation occurs in the stone, which exceeds the strength of the stone. Shock waves at the stone comes not one, but a lot - from 1500 to 3500, depending on the composition of the stone. Such multiple shock waves destroy it into small pieces.
Small fragments, whose size does not exceed the diameter of the cystic duct or emerging from the gallbladder through the cystic duct. Further, through the common bile duct are located in the intestine and excreted.
Larger fragments, which can not pass through the cystic duct, are in the gall bladder. Therefore, to increase the effectiveness of treatment is advisable to add extracorporeal lithotripsy formulations of bile acids.
The main drawback of this method - the high rate of recurrence, ie the re-emergence of gallstones. After 5 years, the recurrence rate is 50%.
3. The dissolution of gallstones is only possible if cholesterol stones.
For this use ursodeoxycholic acid 15 mg / kg per day in 2-3 doses, taking about 2 years. Chenodeoxycholic acid at 15 mg / kg per day (morning doses 1/3 and 2/3 in the evening), during the take a year or more.
The contact dissolution of the stones is carried out using methylbutyl ester: by injection into the lumen of the gall bladder.
4. Diet: Foods containing large amounts of fiber, vitamin C, a reduced amount of protein and fat. Food should be small meals 5-6 times a day.
To read detailed article about nutrition in cholelithiasis.
