Postcholecystectomical syndrome - a collective term, implying diseases associated directly or indirectly with the operation of removing the gall bubble, as the pathological changes that occur in the body after surgery, varied and not always limited to biliary ways.
Causes
Important role in the development of the syndrome plays a defeat of the extrahepatic biliary tract.
Biliary stones are the most frequent cause resumption of pain after removal of the gallbladder and reoperations.
In rare cases, cause postcholecystectomy syndrome can become a cyst bile duct.
liver disease are, in some cases the cause of the unsatisfactory state of health of patients after gallbladder removal.
Equally important is the development of bile stagnation, which is the reason for the development or growth of liver function after surgery.
Removal of the gallbladder over cholelithiasis It does not relieve the patient of metabolic disorders, tendency to stone formation and preserved postoperatively.
The chaotic flow of bile into the intestine after the removal of the gall bladder violates the digestion and absorption of fat, reduces the bactericidal intestinal contents leads to colonization of the duodenum, weakening growth and function of normal intestinal microflora.
Manifestations postcholecystectomy syndrome
Picture of the syndrome is determined by factors contributing to the disease.
characterized by:
- pain in the right upper quadrant and epigastric region, extending to the back and right shoulder blade,
- may appear jaundicepostcholecystectomy syndromeand and itching of the skin,
- digestive disorders (nausea, feeling of bitterness in the mouth, flatulence, An unstable chair, constipation, Diarrhea).
Diagnostics
Diagnosis postcholecystectomy syndrome - is to identify changes in the liver, the pancreas, which are the cause the suffering of patients, with the whole complex of modern laboratory and instrumental methods of investigation, which include
- Blood definition bilirubin,
- alkaline phosphatase,
- gammaglutamiltransferazy,
- alanine and aspartic transaminase,
- lipase amylaseElastase I.
Laboratory studies were carried out during or within 6 hours after the end of a painful attack, as well as in the dynamics.
"The gold standard" diagnostic believe ERCP and sphincter of Oddi manometry (available so far only a limited number of research centers).
postcholecystectomy Syndrome Treatment
Treatment of patients should be comprehensive and is aimed at eliminating those structural or functional disorders of the liver, biliary ways (channels and sphincters), the gastrointestinal tract and pancreas, which are the basis of suffering and were an occasion to refer to the doctor.
Appointed by frequent small feedings (5-7 times a day), compliance a diet low in fat (40-60g per day vegetable fats) are excluded fried, sharp, acidic foods.
For anesthesia can be used Drotaverinum, mebeverin.
In cases where the medicated tried all embodiments, and no effect of treatment to restore patency of the biliary tract surgery is performed.
To eliminate a relative enzyme deficiency, improve digestion of fats used enzyme preparations containing bile acids (Festalum, panzinorm forte) in average daily doses.
The presence of the hidden and the more blatant violations digestion of fats means long-term use of enzymes as therapeutic and prophylactic purposes. Therefore, the duration of the course of treatment is individual.
Often removal of the gallbladder accompanied by disturbance of intestinal biocenosis.
To restore the intestinal microflora initially appointed antibacterial drugs (doxycycline, furazolidone, metronidazole, intetriks) short 5-7 day courses (1-2 courses).
Then, a treatment with drugs reducing intestinal microbial landscape contributing to the growth of normal microflora (e.g., bifidumbakterin, lineks).
Within 6 months after the removal of the gall bladder patients should be under medical supervision. Spa treatment appropriate to recommend no earlier than 6-12 months after surgery.
prevention
The prevention of the development of the syndrome will postcholecystectomy comprehensive examination of the digestive organs (liver, biliary tract, pancreas, stomach, duodenum) before the operation to detect functional and organic changes.
