What to do in case of exacerbation of cholelithiasis. Help with an attack of gallstone disease. Causes causing an attack

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Sometimes a person susceptible to gallbladder diseases accidentally provokes an attack of gallstone disease by being in a position that is uncomfortable for the gallbladder for a long time, by eating a harmful product, or by drinking alcohol. There are many reasons for exacerbation, the question remains: what to do during an attack of gallstone disease, how to relieve pain and prevent relapse.

The disease develops slowly and imperceptibly: initially, several stones form in the bile ducts, making it difficult to remove bile, and no inflammation, formation of ulcers or other complications are observed. Already at the initial stage, the first obvious sign appears: colic in the liver. Painful sensations are associated with the passage of stones through the bile ducts - the stones try to get into the intestines and then be released with the rest of the waste from the body. However, the size of the stones sometimes does not allow passage through narrow ducts; the flow of bile gets stuck halfway, causing pain.

Symptoms of a late-stage gallstone attack include:

intense and prolonged pain;
the patient experiences rapid breathing with small inhalations and small exhalations;
there is a general change in the skin, the color becomes pale;
sweating develops due to increased metabolism;
Painful shock may occur.

If a person directly experiences the listed symptoms, there is no point in delaying further visits to the doctor.

A little about hepatic colic

Hepatic colic is the first and surest symptom of gallstone disease. Hepatic colic has the following properties:

the pain is localized in the right side and is acute;
at times the pain radiates to the back - shoulder blade, neck, in rare cases, buttock and arm;
the main symptom may be external bloating;
in some cases, the patient’s temperature fluctuates – chills or fever;
often an exacerbation corresponds to a disorder of the gastrointestinal tract, difficulties in digestion;
arrhythmia (heartbeat disturbance) is observed.

Acute pain annoys the patient for half an hour, then smoothly turns into an aching character. If it is impossible to numb the stomach, after a couple of hours the pain completely subsides, sometimes lasting only 10-15 minutes.

Of course, the presence of one of the list of symptoms does not necessarily indicate the formation of gallstones, but such an attack will serve as a good call to change habits and go to the hospital.

How to help yourself

If the attack takes you by surprise, you will need to relieve the attack of cholelithiasis yourself.

First aid is as follows: you need to lie down on a sofa, bed or chair - a place where you can stretch your legs and feel peace. If the patient is alone at home, it doesn’t hurt to call friends and relatives asking for help. Ask your friends to come, there may be a case of vomiting or an intensification of the attack (painkillers do not always help) so much that you will have to call an ambulance.

Painkillers are often:

no-shpa;
drotaverine;
papaverine;
antispasmodics of any order.

The attending physicians prevent the problem in advance - offer the patient a painkiller in case of an attack. If you have not received a proposal from your doctor, discuss the names of the medications at your appointment.

Some doctors recommend taking a bath. The water is at a pleasant, warm temperature (from 37 to 39C), and should not burn the human body. There is no need to lie in the bath for a long time: just relax for 10-15 minutes. Then it is recommended to quickly go to bed so that the warmed body does not cool down again and the body temperature does not change. An alternative option that allows you to “warm” the body and improve the functioning of blood vessels is to apply a heating pad to your legs. It is recommended to wrap the patient as much as possible in blankets and warm clothes; in case of cholelithiasis, warmth will serve a good purpose. If the patient's temperature fluctuates, the patient feels chills, wrap the person in a blanket more tightly.

To avoid dehydration, drink plenty of water. Mineral, filtered water is recommended; tap water and carbonated drinks are strictly prohibited.

As a rule, serious attacks last 20–30 minutes; after the specified time has elapsed, you are allowed to leave the bed or bath and continue doing business. If the attack does not end, then the matter is serious and a doctor’s consultation is urgently needed. You'll have to call the hospital and call an ambulance.

Remember: the sooner it is detected (or several) and the patient complains to the doctor, the higher the likelihood of avoiding surgery.

Complications of cholelithiasis and concurrent diseases

If you do not see a doctor in time for gallstones, you may encounter a number of quite serious complications that greatly affect the condition of your body. At first, the stones are small, painkillers cope with the task of dulling the pain, but gradually the formations become more massive, and passage through the biliary tract becomes more difficult. When stones get stuck, blocking the bile ducts, unpleasant phenomena occur:

biliary cirrhosis of the liver;
jaundice;
cholecystitis();
cholangitis.

Cholecystitis is accompanied by recognizable symptoms:

the pain is localized on both sides of the body, acquiring a girdling character;
yellowed skin;
change in body temperature;
pain radiates to the back, creating a sensation of pulsation;
problems with processing food - vomiting, nausea.

When the stones enlarge and the ducts are blocked, the scary thing is that the pain does not stop and is very intense. In order not to delay treatment until surgery, it is better to worry about preventing consequences in advance.

The following diseases will serve as a prerequisite for the appearance of gallstones:

Crohn's disease;
gout;
diabetes.

The common reason for the transition of diseases into each other is the deterioration of the body’s condition. As a rule, clinics remember this relationship and take preventive measures to reduce the likelihood of gallstones.

Due to complications and parallel diseases that are not treated in time, a person suffers many times: the first time when he tries to cope with a diagnosed disease, the second time when an additional disease appears, and the patient has to fight on several fronts at the same time. The metabolism and life of a person depend on complications of gallstone disease; symptoms indicating the occurrence of complications require an urgent need to call an ambulance. The attending physician will be able to decide whether it is worth hospitalizing the patient or whether it will be possible to get by with a set of basic measures.

During hospitalization, further treatment course is prescribed individually depending on the cause of the attack in addition to the neglected gallbladder.

Prevention

A single gallstone attack is a warning and reminder of the need to take care of your health. To protect yourself from recurrence, it is enough to follow a number of preventive measures. The demands become extremely important after an attack. Eg:

The diet, developed by nutritionists solely to prevent new attacks of gallstone disease, is accompanied by a list of prohibited foods:

pasta (even the highest grade);
sausage;
spinach;
dairy products with high fat content;
dishes subject to heat treatment, in addition to boiling and steaming;
forget about seasonings, pickled and highly salted foods;
coffee;
alcohol.

It is required to adhere to a diet during an attack and after it. The diet helps reduce the load on the gallbladder and the processing system as a whole. Take care of your diet, it is not difficult and does not require much effort.

If you are diagnosed with gallstone disease, you will have to temporarily forget about intensive weight loss methods. Quite often, women mistakenly believe that fitness can improve health; gallstones become an exception. Such diets disrupt metabolism, food processing and the secretion of bile from the bile ducts are impaired. It is better to discuss the need to lose weight with your doctor, finding a way out that suits both parties.

The diet has a list of permitted and prohibited foods, recommendations regarding dosage and frequency of daily meals. The daily intake of nutrients varies from person to person; only a doctor can give clear, individual advice. However, there are known rules that are common to each case.

For example, you will need to plan the menu and the quantitative ratio of dishes on the list in the morning. A large portion of food should be divided into 5-6 meals. The size of the dish should not be massive, so as not to overload the inflamed organs.

By following simple preventive rules, you will be able to forget about it for a long time. It is important to remember that you should not provoke attacks, so that later you do not have the task of relieving unwanted pain.

Gallstones are a condition in which stones form in the liver, gallbladder, or bile ducts. The formation of stones is caused by stagnation of bile or disruption of natural metabolic processes. People most susceptible to this disease are between the ages of 35-60 years.

There are three main types of gallstones: cholesterol, consisting of cholesterol crystals, pigment, consisting of calcium salts and bilirubin, mixed, consisting of cholesterol, bilirubin and calcium salts. The most common are cholesterol stones.

Gallstone disease can develop as a result of disturbances in the metabolism of cholesterol and certain salts, stagnation of bile in the bladder and infection of the biliary tract. The main factor contributing to the development of this disease is a change in the ratio of cholesterol, bilirubin and calcium contained in bile in the state of an unstable colloidal solution.

Cholesterol is kept in a dissolved state due to the action of fatty acids. If their content decreases, cholesterol crystallizes and precipitates. Disruption of the process of formation of fatty acids occurs as a result of the development of functional failure of liver cells.

As a result of infectious inflammation of the gallbladder and bile ducts, the chemical composition of bile is disrupted, as a result of which cholesterol, bilirubin and calcium precipitate with the formation of stones. As a result of the formation of stones, inflammation of the gallbladder develops. In the absence of inflammation, the wall of the gallbladder gradually atrophies and sclerotizes.

Stone pressure

The pressure of the stone leads to the development of bedsores and perforation of the gallbladder wall. Gallstone disease develops as a result of excessive consumption of fatty foods, metabolic disorders, atherosclerosis, biliary tract infection, and damage after Botkin's disease.

Stagnation of bile

Stagnation of bile can be caused by dyskinesia of the biliary tract, adhesions and scars in the gallbladder and bile ducts, and increased intra-abdominal pressure. The latter can be caused by constipation, obesity, and lack of physical activity.

Symptoms of gallstone disease

The most common symptoms of cholelithiasis are biliary colic (pain in the right hypochondrium) and dyspeptic disorders. It should be noted that the occurrence of biliary colic is determined not so much by the number and size of stones as by their location.

For example, there may be no pain if the stones are located at the bottom of the gallbladder. The movement of stones to the neck of the gallbladder or cystic duct, on the contrary, gives severe pain resulting from spasm of the gallbladder or ducts.

Attack of biliary colic

An attack of biliary colic, as a rule, begins after ingestion of fatty foods, hypothermia, physical or neuropsychic stress. Such attacks begin suddenly, most often at night. First, a stabbing or cutting pain is felt in the right hypochondrium with irradiation to the right shoulder blade, neck, jaw, then localized in the gall bladder and epigastric region.

The pain syndrome is so severe that many patients develop pain shock. Often the pain leads to the development of an attack of angina. If the pain caused by prolonged spasm or blockage of the bile duct is prolonged, the patient develops mechanical jaundice.

Attacks may be accompanied by fever, as well as nausea and vomiting. These symptoms disappear immediately after the pain is eliminated.

The duration of attacks of biliary colic can vary from several minutes to several hours, and in severe cases - up to several days. After the pain disappears, the patient’s condition quickly returns to normal.

When examining patients, xanthomatous plaques (cholesterol deposits) are found on the upper eyelid and ears. In addition, patients experience bloating, tension and pain in the abdominal wall, in particular in the right hypochondrium.

Exacerbation of cholelithiasis

Quite often, exacerbation of cholelithiasis is manifested exclusively by dyspeptic syndrome, which is characterized by a feeling of heaviness in the epigastric region, belching and vomiting. Pain in the right hypochondrium may be insignificant and can only be detected by palpation of the abdomen.

The clinical manifestations of cholelithiasis usually change as complications develop (acute cholecystitis or cholangitis), as well as as a result of blockage of the bile duct caused by the movement of stones.

Blockage of the cystic duct is especially dangerous, as it leads to hydrocele of the gallbladder, which is accompanied by acute pain. Hydrocele of the gallbladder is manifested by a feeling of heaviness in the right hypochondrium. If an infection is associated with dropsy, the body temperature rises and the general condition of the patient worsens. Blood tests show leukocytosis and increased ESR.

In case of complete blockage of the bile duct, jaundice develops, the liver enlarges and thickens. As a result of disruption of the outflow of bile, inflammatory processes develop in the gallbladder and bile ducts.

Stones are detected using ultrasound examination of the abdominal cavity, cholongiography, cholecystography. It should be borne in mind that the latter research method is contraindicated in the presence of jaundice.

Treatment

Treatment in most cases is aimed at stopping the inflammatory process, improving the motor function of the gallbladder and the outflow of bile from it. Hospitalization is indicated for patients with biliary colic syndrome. In this case, painkillers are prescribed, including narcotic drugs, as well as antibacterial and sulfonamide drugs. To relieve swelling, cold is applied to the abdomen.

To prevent gallstone disease or its exacerbations, a special diet, therapeutic exercises, and elimination of constipation are recommended. In addition, the drug olimethin is indicated, 2 capsules 3-4 times a day. Low-mineralized alkaline waters promote the outflow of bile and the removal of cholesterol crystals.

If treatment does not produce a positive result, surgery to remove the gallbladder is recommended. Indications for surgery are perforation of the gallbladder with the development of developed or limited bile peritonitis, obstructive jaundice, hydrocele of the gallbladder, bile fistulas. The operation is also indicated in the presence of multiple stones, repeated attacks of biliary colic, as well as in non-functioning gallbladder.

Today, almost every person can detect symptoms of gallstone disease, regardless of age and lifestyle. Moreover, this pathology began to “get younger” and manifest itself much more often than before. If previously it was most often found in people over 40 years of age, now it can be found even in young boys and girls. There can be many reasons for this.

What is the disease?

Before considering the symptoms of gallstone disease, it is necessary to find out the mechanism of its development. The pathology can be chronic or acute. It develops gradually. Characterized by the appearance of small or large stones in the bile ducts and bladder. This process is quite long.

The formation of stones begins when the bile thickens. Granules appear in it, on which molecules of undigested calcium and cholesterol settle. It should be noted that stones can be multiple or single. In addition, they have different sizes. When they begin to move, an acute attack occurs, which is accompanied by very severe pain.

Signs of gallstone disease may not appear immediately, that is, the pathology develops over time. In addition, large elements can “sit” in the ducts for quite a long time and not move anywhere. Although this also causes a lot of problems. It should be noted that this disease is very common, and the number of cases is constantly growing.

It must be said that there are several types of stones:

pigmented;
cholesterol;
calcareous;
pigment-cholesterol;
complex stones consisting of the three above components.

Causes of pathology

Before looking at the symptoms of gallstone disease, it is necessary to understand why it happens in the first place. So, among the reasons contributing to the development of pathology are the following:

age (after 40 years, the body’s nervous and humoral systems begin to act differently on internal organs, less effectively);
heavy weight (especially if a person eats too fatty, spicy foods, rich in cholesterol);
metabolic disorders in the body;
poor nutrition;
unsuitable climate and poor ecology;
infection of the biliary tract (cholesterol precipitates in them, which then accumulates, gets compacted and turns into stones);
insufficient amount of acids that can dissolve lipids;
any other pathologies of internal organs (physiological, infectious or inflammatory).

Signs of pathology

The symptoms of gallstone disease are not specific, so it is quite difficult to recognize it at first. Only a doctor can make an accurate diagnosis. However, the disease manifests itself as follows:

There are other signs of gallstone disease: allergic reactions, increased fatigue, sleep disturbances and lack of appetite, lethargy. It must be said that they can appear individually or simultaneously.

Diagnosis of the disease

Symptoms of gallstone disease in adults cannot provide a complete picture, which is necessary to prescribe adequate treatment. Naturally, you will have to visit an experienced doctor who will carry out the entire range of diagnostic measures. They help determine the size of the stones, the degree of development of the pathology, and its type.

Various tools, both technical and clinical, are used for diagnosis. In the second case, the doctor palpates the gallbladder and ducts, during which the patient may feel discomfort and pain. In addition, colic may be accompanied by the passage of very small stones, which also indicates the presence of the disease.

When making a diagnosis, the symptoms of gallstone disease in adults and children (if there are such cases) are taken into account. In addition, the patient will need to undergo the following procedures:

ultrasound examination of internal organs;
blood and urine analysis (for the content of duodenal elements, cholesterol levels, bilirubin, fat metabolism indicators and alpha-amylase activity);
a thorough analysis of the patient’s medical history and family history;
stool analysis (in it you can often see which elements of food are not digested);
examination of the inner surface of the stomach, duodenum and esophagus (esophagogastroduodenoscopy);
cholangiopancreatography (examination of the bile ducts from the inside using a duodenofibroscope);
computed tomography of internal organs;

It is necessary to take into account the non-specificity of symptoms, so the diagnosis must be made as accurately as possible. Otherwise, the doctor may simply treat the wrong disease, which will lead to unpredictable consequences.

Features of the course of an acute attack and first aid

This pathology can develop gradually, but the time will come when it will make itself felt. Therefore, you must know how to relieve an attack of gallstone disease. It must be said that a person feels worst at the moment when solid particles begin to move through the ducts and clog them. In this case, severe pain and other symptoms appear. In this case, most often the attack occurs at night. It usually lasts up to 6 hours. If you have an attack of gallstone disease, you should definitely know what to do. So, you will have to take the following measures:

A heating pad or warm compress should be applied to the gallbladder. As a last resort, it is necessary to organize a warm bath to reduce pain and alleviate the condition.
Now you need to take any painkiller that can relieve spasms (“Atropine”, “Papaverine”, “No-shpu”).
It is imperative to call an ambulance and hospitalize the victim. Moreover, you need to go to the hospital if the pathology worsens. It is in the hospital that all necessary diagnostics can be carried out and surgical intervention can be performed (if absolutely necessary).
Along with painkillers, it is necessary to take anti-inflammatory and antibacterial medications.

It must be said that timely measures can significantly alleviate the patient’s condition. Now you know how to relieve an attack of gallstone disease. However, this does not mean that the pathology does not need to be treated.

Features of pathology treatment

Now you can figure out how to cope with this problem using traditional, non-traditional and radical methods. Let's start with the first ones. Treatment of gallstone disease should be comprehensive. That is, it is not enough to simply remove stones from the ducts and bladder. It is necessary to carry out drug therapy for a long time, follow a certain diet, and follow doctor’s orders.

Specialists use various drugs for gallstone disease:

To eliminate pain, intramuscular and intravenous analgesics (Talamonal, analgin solution) are used. In extreme cases, narcotic substances can be used: morphine, Promedol.
To eliminate spasms in the ducts, you need to use the drugs “Papaverine” or “No-spa”, and under the skin. To improve bile circulation, you can use special drugs (“Cholenzim”). However, try not to use stronger medications, as this can lead to an acute attack that will end in surgery.
Treatment of cholelithiasis is accompanied by the passage of solid elements. Warm teas and heating pads are usually used for this.
If the pathology has already entered the chronic stage, try to periodically undergo courses of treatment prescribed by your doctor. For example, drugs such as “Liobil” and others are taken.

In any case, you cannot choose medications on your own, as you can only harm yourself. It is better to consult a specialist and undergo a thorough examination.

Features of treatment with folk remedies

Naturally, drug therapy is not a panacea and does not always help. Self-prepared substances can also enhance the effect. For example, treating gallstone disease with folk remedies will significantly increase your chances of getting rid of the pathology, but you should not use them without the consent of your doctor. So, the following recipes may be useful:

Red beet juice. Long-term use of this drink will help you quickly cope with stones. Moreover, they will dissolve completely painlessly. You can use not only juice, but also beet broth. To do this, the vegetable needs to be cooked for a long time. Please note that not all people like this drink.
Treatment of cholelithiasis, folk remedies, in particular, can be done using mixtures of different plants, each of which has its own specific action. For example, the following remedy can relieve pain, cleanse internal organs, and improve their blood supply: the roots of calamus, valerian and buckthorn, wild rosemary herbs, mint, hawthorn, chamomile, lily of the valley and rose hips mixed in equal quantities. Before this, all plants should be chopped. The maximum amount of each herb is 5 grams. Next, pour the mixture with 1.5 liters of water and put on fire. The liquid should boil for no more than five minutes. Also, give the product time to sit (about 6 hours). You need to take it several times a day, 100 ml. It is necessary to drink the remedy until complete recovery.
In order to eliminate stagnation of bile in the ducts, use a decoction of wild strawberry berries and leaves. Take it three times a day, a glass.
Regular dill is also considered useful. To prepare the decoction you will need two large spoons of seeds and 2 cups of boiling water. Next, the mixture must be put on fire. It should boil for no more than 12 minutes. Try to drink half a glass of the product daily. Moreover, the liquid should be warm. It will take you several weeks to heal.
Chicory root infusion will help you effectively dissolve stones and remove them from the body. To prepare the drink, take 60 grams of crushed raw materials and pour 200 ml of boiling water over it. The decoction should sit for at least 20 minutes. Next, take the drink in small portions throughout the day. It is best if the broth is fresh each time.
Black radish juice and honey will help you cleanse your gallbladder and dissolve stones. Try to drink 1 tablespoon of the mixture on an empty stomach in the morning. After this you can eat only after a quarter of an hour. Please note that this procedure is lengthy and takes at least six months.

In addition, try to improve bile secretion. To do this, take carrot and cabbage juice every day.

Indications for surgery and types of operations

There are cases when it is impossible to use medications for gallstone disease or traditional recipes simply do not help. In addition, acute attacks require surgical intervention. In this case, surgical removal of stones is performed. There are certain indications for intervention:

There are also contraindications to surgery: the patient’s serious condition, any oncological diseases of other organs, severe inflammatory processes in the body, as well as individual characteristics.

Gallstones are removed in several ways:

Traditional (laparotomy). To do this, the doctor must open the anterior abdominal wall and remove the bladder along with all its contents. Such an operation is performed if the stones are too large or the organ will no longer perform its assigned function.
Laparoscopic. To do this, you do not need to cut the peritoneum. Specialists simply make small holes in the area of the bubble and remove the stones through them. At the same time, recovery after such an operation occurs much faster, and there are practically no scars left on the skin. That is, this type of intervention is used most often.

If you have gallstone disease, the operation can be performed without a scalpel. For example, now in medicine they use specialized technical means that are capable of crushing the formed elements. This method is called shock wave lithotripsy. This procedure is not possible everywhere. After the procedure, small stones are simply dissolved with the help of medications and removed from the body.

Nutritional Features

For more effective treatment, the patient is prescribed diet No. 5. For gallstone disease, it is considered optimal. So, the calorie content of this diet is about 2800 kcal daily. If the patient is obese, then these indicators can be reduced to 2300 kcal. You need to eat at least 5 times a day in small portions.

You need to drink clean water, and as much as possible (from two liters per day). Try not to drink carbonated water; alcohol is prohibited. Tea, juices and herbal infusions are best. Products for cholelithiasis must be fresh and safe. It is forbidden to eat fatty, fried, smoked, spicy foods, chocolate, canned food, sausages and semi-finished products, fish and meat broths. Also, try to avoid using garlic, pepper, lard, onion, sorrel and excessive amounts of salt while cooking.

Allowed products are: bran bread, vegetables and fruits, low-fat dairy products, lean meat and fish. Moreover, the latter should be baked in the oven or steamed. Eat porridge and boiled eggs (no more than 1 per day). Use olive oil instead of sunflower oil. If you are experiencing a period of exacerbation, then the products should be ground.

You cannot prescribe a diet for yourself. Try to consult with an experienced specialist in this field, as well as your doctor. If you don’t know what you can cook for gallstone disease, the recipes presented in this article will be very useful to you.

So, take 300 g of potatoes, 25 g of carrots, 19 g of butter, 350 g of water, 7 g of parsley and 25 g of onions. All vegetables must be boiled. Gradually add oil and parsley to the “soup”. It is advisable to chop the carrots and potatoes.

Carrot and potato puree is healthy and very tasty during illness. All vegetables must be boiled and crushed (grinded). Next, add a little milk and a little salt to the mixture. Now the puree can be brought to a boil and served.

A very useful vegetable in such a situation is eggplant. It can be stewed in sour cream sauce. To prepare this dish, take 230 g of eggplant, herbs, a little butter and salt. For the sauce you will need 50 g of water, 50 g of sour cream, a little butter and flour. We cook the eggplant last. The sauce is made like this: fry the flour in a heated frying pan, add oil and water. Boil the mixture for about 20 minutes. Lastly, sour cream is added. Now peel and cut the eggplant, salt it and leave for a few minutes to remove the bitterness. Next, place the pieces in a frying pan and simmer a little over low heat. Lastly, add the sauce to the eggplant and leave the dish to simmer for another 5 minutes. Bon appetit!

Prevention of disease

It is necessary to treat the presented pathology, but it is best to prevent it. That is, you are obliged to follow all the necessary preventive measures that will help you avoid the disease. Otherwise, treatment will take a long and painful time.

For example, try to maintain an optimal body weight. Obesity only contributes to the emergence of this pathology and other health problems. Therefore, force yourself to move, do morning exercises, do gymnastics or some active sport. Walk more, hike, run, bike, swim.

A very effective way of prevention is a balanced and proper diet. You should not overload your gastrointestinal tract, so do not overeat, try to give up unhealthy foods, dishes and habits. For example, stop smoking, drinking alcohol, and eating at fast food establishments. Eliminate spicy, fatty, smoked and canned foods from the menu. Limit your consumption of sweets, baked goods, lard, fatty fish and other heavy foods. After all, what is not digested in the stomach turns into harmful sediment, from which stones are subsequently formed. If you don't know how to properly calculate your diet, consult a nutritionist. He will build you a nutritional system that will allow you to get rid of the threat of disease and bring your body into shape.

If you want to lose weight, then you need to do it very carefully so that the functioning of the body's systems is not disrupted. There is no need to lose weight suddenly and quickly. This can only do harm.

However, if the disease does appear, it is urgent to stop its development. That is, try not to delay treatment after detecting the first symptoms and correct diagnosis.

Regarding questions about stone removal, you should consult your doctor. If necessary, you can get advice from other specialists in this field. You should not self-medicate, as the consequences can be very serious. It is better to combine all traditional and non-traditional methods of eliminating the disease under the supervision of a doctor. Be healthy!

An attack of gallstone disease can take anyone by surprise. The result leads to acute and sharp pain in the area of the gallbladder, and subsequently to surgical intervention.

Gallbladder disease progresses unnoticed and rather slowly. The development of the disease leads to the formation of stones in the bile ducts, which prevents the removal of bile. At the initial stage, the first alarming factor arises - the appearance of colic in the liver. Pain occurs when large stones move along the bile ducts, trying to pass into the intestines and leave the body. Causes and factors that can trigger an attack:

use of hormonal drugs;
excess weight (starting from the first stage of obesity);
excessive consumption of spicy, fried, fatty, canned foods;
sedentary lifestyle, lack of physical activity;
disruption of the gallbladder (dyskinesia);
pregnancy (in particular, multiple pregnancy);
malnutrition or overeating;
alcohol consumption;
pancreatitis – inflammation of the pancreas.

To avoid the occurrence of paroxysmal pain, it is enough to monitor your daily diet and devote time to physical training.

Forms of pathology

There are 4 forms of gallstone disease:

Latent or hidden form. Characterized by the absence of symptoms.
Dyspeptic form. It is expressed by the following symptoms: diarrhea, heartburn, heaviness in the right side after eating.
Painful form. It is characterized by long, aching pain under the ribs on the right, malaise and irritability.
Recurrent form. It is expressed by an acute attack of pain on the right side of the hypochondrium and scapula, nausea.

According to statistics, in 70% of patients, cholelithiasis develops without symptoms, and it is detected only on. Only in the remaining 30% of cases does paroxysmal pain occur.

Signs that determine that this is an attack of gallbladder disease:

gagging;
yellow tint of the skin and mucous membranes;
itching all over the body;
temperature increase;
urine becomes darker;
pain in the liver area, that is, in the right hypochondrium.

Pain during an attack is always accompanied by nausea, which feels similar to food poisoning. In case of serious complications, vomiting does not improve the condition of the body. Jaundice is considered an invariable sign of cholelithiasis. It is what gives the skin a yellow tint, contributes to the discoloration of feces and the appearance of a dark tint in the urine.

The temperature can rise to a maximum of 38 ºC. If the attack is accompanied by chills and fever, this indicates the development of a purulent process. In this case, hospitalization is absolutely necessary. In an inpatient setting, the patient is given antispasmodics and sent to hospital.

In extremely serious conditions, antibiotics are prescribed and detoxification therapy is used. If the process progresses, then surgery is prescribed. It follows that the main sign of the development of an attack of cholelithiasis is acute, stabbing pain.

Providing first aid to a patient during an attack

If you have a chronic disease, you should know the first aid algorithm. These techniques do not constitute treatment, but only facilitate the course of the attack. Therefore, while waiting for the doctor to arrive, you need to do the following:

put the patient in bed or on a flat surface, but not cold;
provide the patient with peace;
apply a heating pad to the right hypochondrium or help take a warm bath;
take an antispasmodic drug prescribed by your doctor.

But there are also actions that are strictly forbidden to perform during the development of an attack:

consume food and juices;
take medications not prescribed by a doctor;
when using antispasmodics, take the required dosage, but no more;
apply cold water to the sore area.

Rash actions and self-medication in such situations will only worsen the condition. Even if the pain itself disappears, thanks to taking painkillers, the cause of its occurrence will remain. Therefore, at the time of an attack, the intervention of the attending physician is absolutely necessary.

Treatment process for gallbladder disease

Treatment of the inflammatory process has 4 options. The choice of one of them depends on the stage of the disease and the patient’s condition.

Drug therapy

Therapy takes place at the level of prescription by a doctor and taking the necessary medications:

non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation in the gallbladder;
antipyretic and painkillers;
Opioids are prescribed if pain medications do not relieve pain.

Physiotherapeutic

The method is used when the size of the formed stone is no more than 1 cm or when several small stones are detected. Doctors recommend resorting to crushing or dissolving stones. However, with such therapy, in 50% of cases, pain in the gallbladder returns again.

Surgical method of treating the disease

An operation is prescribed if the size of the formed stones exceeds 1 cm. Here, both the classical method of removal and manipulation can be carried out using laparoscopy.

Sanitary resort option

The patient is prescribed a certain regime of physical activity, and treatment with mineral waters and oxygen baths is prescribed. Fresh air and a calm environment promote recovery.

Nutrition after an attack

If you have gallstone disease, you need to adhere to a strict menu so as not to provoke an attack again. The next steps are:

You must fast for 12 hours after the attack;
for the next few days, drink rosehip decoction, eat only vegetable soups;
after two days, return cereals cooked in water to the diet;
after three days, introduce low-fat dairy products, fresh fruits and vegetables that do not have a sour taste, and soups with lean meat;
after a week, carefully add chicken, fish, and turkey meat to the menu.

Nutritionists have developed a long-term diet system that avoids further occurrence of gallbladder attacks and eliminates the inflammatory process. To do this, you need to exclude the following products from your menu:

pasta and sausages;
spinach;
fatty dairy products;
alcohol;
coffee;
spices;
canned foods.

To determine the dosage of nutrition, you need to consult a doctor. It is advisable to prepare a menu for the patient daily or weekly, in which all substances will be combined in quantitative proportions.

It is important to know that there should be 5-6 meals a day, and portions should not be massive. Large portions put an increased load on the inflamed organs and provoke an exacerbation of the disease.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Diagnosis of cholelithiasis

In most cases, diagnosis cholelithiasis in the clinical stage does not present any particular difficulties. Characteristic pain in the right hypochondrium immediately makes doctors suspect this particular pathology. However, a full diagnosis is not limited to just detecting the stones themselves. It is also important to find out what causes and disorders could lead to this disease. Attention is also paid to the timely detection of complications of the disease.

Typically, cholelithiasis is diagnosed by a surgeon or therapist when a patient comes to him with characteristic symptoms. Sometimes the first specialist is also the doctor who performs ultrasound or radiography ( accidental discovery of stone carriers).

During the initial examination of the patient, the doctor usually pays attention to the following symptoms that may have gone unnoticed by the patient himself:

Murphy's sign. Pain occurs if the doctor puts light pressure on the gallbladder area and asks the patient to take a deep breath. Due to the increase in the volume of the abdominal cavity, the gallbladder is pressed against the fingers. The symptom usually indicates the presence of an inflammatory process.
Ortner's sign. Pain in the projection of the gallbladder appears when a finger is gently tapped on the right costal arch.
Shchetkin-Blumberg symptom. This symptom is detected if, after gradually pressing the hand on the abdomen and abruptly releasing the pressure, the patient suddenly experiences pain. This usually indicates an inflammatory process affecting the peritoneum. In case of cholelithiasis, it can be regarded as a sign of cholecystitis or some inflammatory complications of the disease.
Skin hyperesthesia. Hyperesthesia is called increased sensitivity of the skin, which is determined by touching or stroking. Sometimes it is a sharp feeling of discomfort, and sometimes it is moderate pain. Hyperesthesia in cholelithiasis is usually a consequence of the inflammatory process. It is found in the right hypochondrium, shoulder and shoulder blade on the right.
Xanthelasmas. This is the name given to small yellowish spots or bumps that sometimes appear in the upper eyelid area. These formations indicate an increased level of cholesterol in the blood and are actually its deposits in the skin.
Dry coated tongue detected during examination of the oral cavity.
Low blood pressure ( hypotension) sometimes detected during a prolonged attack of cholelithiasis. Hypotension is more often found in elderly patients.

All of the above symptoms and signs are determined, as a rule, already in the symptomatic stage of cholelithiasis. At the stone-carrying stage, when there is no accompanying inflammatory process, they may be absent. Then we have to turn to instrumental and laboratory research methods.

In general, in the process of diagnosing cholelithiasis, the following research methods can be prescribed:

lab tests;
ultrasonography;
radiography;

Blood tests for gallstone disease

A blood test is a routine research method, which, nevertheless, is very informative. The cellular and chemical composition of blood speak eloquently about various pathological processes in the body. As a rule, one or another analysis pattern is more or less characteristic of certain pathologies. In case of cholelithiasis, tests are designed to clarify the possible nature of the formation of stones. Some abnormalities in blood tests may alert a specialist even at the pre-disease stage, when the stones themselves have not yet formed. A good doctor will not ignore such changes, but will try to correct them, and will also warn the patient about the risk of stone formation in the future ( the need for preventive examination).

In case of cholelithiasis in general and biochemical blood tests, you should pay attention to the following indicators:

Leukocyte level. Leukocytes are white blood cells that perform many different functions in the body. One of the main ones is the fight against pathogenic microbes and the development of the inflammatory process. Increased white blood cell count ( 10 – 15 billion per 1 liter) is usually observed with concomitant cholecystitis and a number of complications of the disease.
Erythrocyte sedimentation rate ( ESR). ESR usually increases during inflammatory processes, and its level directly depends on the extent of inflammation. As a rule, ESR above 20 mm/hour occurs with various complications of cholelithiasis. During pregnancy, this indicator is not informative, since the ESR will be high in a healthy woman.
Bilirubin. A high level of bilirubin in the absence of stones can be regarded as a predisposition to their formation in the future. In case of disturbances in the outflow of bile, already during the clinical stage of the disease, the level of associated ( direct) bilirubin. The norm is up to 4.5 µmol/l.
Alkaline phosphatase. This enzyme is present in many human tissues, but its greatest concentration is found in the cells of the liver and bile ducts. When they are damaged, the enzyme enters the blood in large quantities, and its concentration increases during analysis. The norm is 20 – 140 IU/l. In pregnant women, the rate of this enzyme is higher, so it is not as indicative of gallstone disease.
Cholesterol. Determining cholesterol levels can help detect the disease in the early stages, when stones are just forming. Normally, the content of this substance in the blood is 3.6 – 7.8 mmol/l, but it is recommended to maintain its level to 5 mmol/l.
Triglycerides. Triglyceride levels indirectly reflect the risk of stone formation. The norm varies depending on gender and age and averages 0.5 – 3.3 mmol/l in an adult.
Gamma-glutamyl transpeptidase ( GGT). This enzyme is found in high concentrations in the kidneys and liver. An increase in this indicator in combination with other symptoms often indicates a blockage of the bile duct with a stone. The norm is 5 – 61 IU/l and varies depending on the analysis technique ( in various laboratories), as well as the gender and age of the patient.
Liver transaminases. ALT ( alanine aminotransferase) and AST ( aspartate aminotransferase) are found in liver cells and can increase when these cells are destroyed. In the diagnosis of cholelithiasis, this is important for monitoring complications affecting the liver ( reactive hepatitis). The norm is for AST 10 – 38 IU/l, and for ALT – 7 – 41 IU/l. AST levels can also rise in other pathologies that do not affect liver function ( for example, with myocardial infarction).
Alpha amylase. This enzyme is found mainly in pancreatic cells. The norm is 28 – 100 U/l. When diagnosing cholelithiasis, this enzyme is important to monitor some complications ( pancreatitis).

Not all patients have elevated levels of all of the above indicators, and changes in these indicators do not always indicate cholelithiasis. However, a combination of 3 to 5 laboratory signs already indicates the presence of certain problems with the gallbladder.

Blood for general analysis is usually taken from a finger, and for biochemical analysis - from a vein. Before donating blood for analysis, it is advisable not to eat, smoke, or drink alcohol ( in 24 – 48 hours) and do not perform heavy physical activity. All these factors can affect the results of the analysis to varying degrees and somewhat distort the true picture in the conclusion. Deviations in these cases can be up to 10–15%.

Also, for an in-depth diagnosis of the causes of cholelithiasis, a bile analysis can be performed. Bile is collected using a special procedure - probing. The resulting samples can be sent to a laboratory, where the bile is tested for cholesterol, lecithin and bile acids. As a result, a special lithogenicity index can be calculated. If its indicator is above 1, then the process of stone formation is underway ( even if the stones themselves are not there yet). Thus, it is the biochemical analysis of bile that makes it possible to recognize the disease at the pre-disease stage. Unfortunately, this procedure is rarely performed due to its relatively high cost and relative complexity.

Ultrasonography ( Ultrasound) for cholelithiasis

Abdominal ultrasound is perhaps the gold standard in diagnosing cholelithiasis. This method is inexpensive, informative, has no contraindications and gives results immediately after the procedure. The method is based on the ability of ultrasonic waves to be reflected from dense tissue. The device perceives the reflected waves, processes the data and displays an image on the monitor that is understandable to a specialist.

Typically, an ultrasound is prescribed when dull pain or heaviness appears in the right hypochondrium, as well as after biliary colic to confirm the diagnosis. Ultrasound is often performed for preventive purposes if the patient, according to the doctor, is predisposed to various diseases of the abdominal organs.

Using ultrasound, you can determine the following features of the disease:

the presence of stones even in the absence of symptoms;
number of gallstones;
sizes of stones;
location of stones in the bladder cavity;
the size of the organ itself;
thickness of the walls of the organ;
the presence of stones in the bile ducts or intrahepatic ducts;
helps identify some complications.

X-ray for cholelithiasis
There are a number of studies based on the use of X-rays. They are all united by a common principle of image acquisition. Tiny particles pass through body tissues ( components of the radiation itself). The denser the fabric, the more of these particles are retained in it and the less gets onto the film or detector surface. The result is an image of the body in which the contours of various organs and pathological formations can be distinguished.

The simplest and most common of the methods using x-rays is survey radiography of the abdominal cavity. The patient is in a standing or lying position ( depending on his general condition). The image represents the entire abdominal cavity, in which, depending on the configured radiation characteristics, an image of certain tissues can be obtained. The picture itself is obtained quickly on modern devices. On older models it may take some time.

In case of cholelithiasis, plain radiography of the abdominal cavity can detect an intense inflammatory process in the area of the gallbladder and the stones themselves. In the early stages of the disease, small stones that form may not be detected by x-ray. This is explained by their low density ( X-ray negative stones), which is close to the density of the surrounding tissues. Also, radiography will not detect small stones.

The following X-ray studies can also be used in the diagnosis of cholelithiasis:

Oral cholecystography. This method involves injecting a special contrast agent into the body ( Yodognost, bilitrast, cholevid, etc.). The patient drinks several tablets at night, the contrast is absorbed in the intestines, enters the liver and is excreted in the bile. After about 12 hours, a picture is taken. Due to the presence of contrast in the bile, the contours of the gallbladder and bile ducts become clearly visible on the x-ray. If stones are found, the procedure can be continued. The patient takes medications that stimulate the flow of bile. By emptying the gallbladder, even small stones become more visible. This procedure may not give the expected results if you have liver problems ( Bile is poorly formed) or the duct is blocked by a stone ( then the contrast will not be distributed normally).
Intravenous cholangiocholecystography. Can be performed if oral cholecystography does not give the desired result. Contrast agents are injected into the bloodstream by drip ( 0.5 – 0.9 ml/kg patient’s body weight). After this, after 20 - 30 minutes, the contrast is distributed through the bile ducts, and after 1.5 - 2 hours - through the gallbladder. The stones in the pictures look like “zones of enlightenment”, since they are not filled with contrast.
Retrograde cholangiopancreatography. This research method is more complex, since the contrast is injected directly into the bile ducts. The patient is hospitalized and prepared for the procedure ( Can’t eat, requires sedatives), after which the doctor inserts a special tube through the mouth into the duodenum ( fiberscope). Its end is brought directly to the major papilla, where contrast is injected. After this, an x-ray is taken, which clearly shows the bile ducts. Due to the complexity of retrograde cholangiopancreatography, it is not prescribed to all patients. This method may be needed if choledocholithiasis is suspected ( the presence of stones directly in the bile ducts).

The above methods are much more effective than conventional plain radiography of the abdominal cavity. However, the procedure itself is more complex and expensive. They are sometimes prescribed before surgery or in unclear cases. They are not mandatory for all patients with cholelithiasis.

X-rays using contrast are contraindicated in patients with the following disorders:

severe diseases of the liver and kidneys, accompanied by dysfunction of these organs;
individual iodine intolerance ( since most radiopaque agents contain iodine);
severe heart failure;
some thyroid diseases;
blood protein level is below 65 g/l;
albumin level ( type of blood protein) below 50%;
bilirubin level is more than 40 µmol/l.

Laparoscopy for cholelithiasis

Laparoscopy is used very rarely for diagnostic purposes. In most cases, it is used as a treatment method, since the procedure itself is a full-fledged surgical intervention. The essence of the method is to introduce a special device into the abdominal cavity ( endoscope), equipped with a camera and a light source. To do this, one or more small incisions are made in the anterior abdominal wall. Of course, the procedure takes place in the operating room, under sterile conditions with appropriate anesthesia techniques.

Laparoscopy is the most informative method, since the doctor sees the problem with his own eyes during the procedure. He can assess the condition of tissues, the condition of neighboring organs, and determine the likelihood of various complications. However, due to existing risks ( infection of the abdominal cavity during the procedure, complications of anesthesia, etc.) diagnostic laparoscopy is prescribed only when other research methods have not provided enough information.

Treatment of cholelithiasis

Treatment of cholelithiasis at different stages can occur in different ways. At the stone-carrying stage, when stones in the gall bladder are discovered for the first time, we are not talking about urgent surgery. In many cases, preventative measures in combination with non-surgical treatment methods are effective. However, most patients sooner or later face the question of surgery. In general, removal of the gallbladder along with the stones is the most effective treatment. After it, stones no longer form again, although the patient will have to adhere to some dietary restrictions for the rest of his life.

At the stage of biliary colic, the patient is most often treated by a surgeon. It determines whether immediate surgery makes sense or whether the patient should be observed in a hospital for some time. If there are complications ( especially inflammatory processes in the abdominal cavity) surgery is the best option, as the risk of serious consequences for the patient increases.

In general, all measures for the treatment of cholelithiasis can be divided into the following areas:

Preventive measures. This usually includes a special diet and certain medications. The goal of prophylaxis is to prevent serious complications. For example, with stone-carrying disease, the patient may completely refuse specific therapeutic measures ( nothing bothers him), but will follow preventive measures to prevent inflammation and exacerbations.
Medication ( conservative) treatment. This direction involves treatment with the help of pharmacological drugs - tablets, injections and other means. It is usually aimed at eliminating the symptoms of the disease. Various drugs can be prescribed for infectious complications, biliary colic and other cases. In general, this does not solve the problem, but only eliminates the manifestations of the disease, since the gallstones themselves remain in the gall bladder.
Surgical treatment. In this case, we are talking about removing the gallbladder in one way or another during a surgical operation. This method is the most reliable, as it eliminates the root cause of the disease. However, there are risks of surgical and postoperative complications. In addition, patients may have various contraindications to surgery.
Radical non-surgical treatment. There are a number of methods that can remove stones without surgery involving tissue dissection. In this case, we are talking about chemical dissolution of stones or their crushing using special equipment. These methods are not applicable to all patients with cholelithiasis.

In any case, patients suffering from cholelithiasis or suspecting the presence of gallstones should consult a specialist. Only a doctor can correctly assess the risk at the current moment and recommend this or that treatment. Self-treatment of cholelithiasis in most cases ends in complications that subsequently require surgical treatment.

Hospitalization of the patient is not required in all cases. Most often, the patient is taken to the hospital only to clarify the diagnosis. Even after suffering biliary colic, some patients refuse hospitalization. However, there are a number of conditions in which the patient must be admitted to the hospital for more intensive treatment.

Emergency physicians usually use the following criteria for admitting a patient:

repeated frequent attacks of biliary colic;
acute pancreatitis due to cholelithiasis;
gangrenous and other dangerous forms of cholecystitis;
first attack of cholelithiasis ( to confirm the diagnosis);
pregnancy;
concomitant serious diseases.

The length of hospital treatment depends on many factors. On average, for cholelithiasis it is 5–10 days ( including surgical treatment if necessary). With biliary pancreatitis it will be 2 – 3 weeks.

Which doctor treats cholelithiasis?

In principle, gallbladder diseases belong to the field of gastroenterology - a branch of medicine that deals with pathologies of the gastrointestinal tract. Accordingly, the main specialist who needs to be consulted at all stages of the disease is a gastroenterologist. Other specialists may be involved for consultations in the presence of various complications or for special treatment.

The following doctors may be involved in the treatment of patients with gallstone disease:

Family doctor or therapist– may suspect or independently diagnose a disease and consult the patient for a long time.
Surgeon– carries out surgical treatment if necessary. It may also be used to assess the risk of various complications.
Physiotherapist– sometimes used for preventive measures or non-surgical treatment.
Endoscopist– conducts FEGDS and some other diagnostic studies that require skills in working with an endoscope.
Pediatrician– is necessarily involved when gallstones are detected in children.
Gynecologist– can advise women who have been diagnosed with cholelithiasis during pregnancy.

However, the gastroenterologist always remains the leading specialist. This specialist understands the mechanism of stone formation better than others and can detect concomitant pathologies that led to cholelithiasis. In addition, he will help you choose the optimal diet and explain in detail to the patient all the options for treating and preventing the disease.

What to do in case of an attack of cholelithiasis?

With the sudden appearance of acute pain in the right hypochondrium, the most likely diagnosis is an attack of cholelithiasis - biliary colic. First aid must be provided to the patient immediately, even before the ambulance doctors arrive. This will reduce pain, make the work of doctors easier after their arrival and slow down the pathological process.

As first aid for biliary colic, it is recommended to resort to the following measures:

The patient should be placed on his right side with his knees bent. If this position does not bring him relief, then he can take any position in which the pain eases. You just shouldn't move a lot ( some patients become very agitated and begin to suddenly change positions or walk).
You can apply a warm heating pad to your right side. Heat can relieve spasm of smooth muscles, and the pain will gradually ease. If the pain does not subside after 20–30 minutes, you should immediately consult a doctor. It is not recommended to use heat for longer, as this may worsen the patient’s condition. If an attack of pain appears for the first time, and the patient is not sure that it is caused by gallstones, then it is better not to apply heat until the diagnosis is clarified.
The patient's collar is opened, a belt or other items of clothing that may interfere with normal blood circulation are removed.

In general, biliary colic is only a symptom of gallstone disease, but requires separate drug treatment. This is explained by the fact that the patient experiences very severe pain, which simply does not allow doctors to examine him normally. For biliary colic, doctors will first make sure the diagnosis is correct ( characteristic symptoms and signs), after which painkillers will be used.

For biliary colic, the following remedies will be most effective for relieving pain:

Atropine. As first aid, 1 ml of solution with a concentration of 0.1% is administered. If necessary, the dose can be repeated after 15 – 20 minutes. The drug relieves spasm of smooth muscles, and the pain gradually decreases.
Eufillin. The dose is selected individually. It is usually administered intramuscularly as a solution in the absence of atropine. It can also relieve spasm of smooth muscles.
Promedol. It is a narcotic pain reliever, which is often combined with atropine for colic. The usual dose for an adult is 1 ml of a solution with a concentration of 1 - 2%.
Morphine. It can also be administered in severe cases for pain relief in combination with atropine. Typically, 1 ml of a one percent solution is used.
Papaverine. Can be used both in tablets and in injections. This is an antispasmodic that quickly eliminates spasm of smooth muscles. For biliary colic, an intramuscular injection is usually given, 1 - 2 ml of a 2% solution.
Omnopon. It is a combination drug containing a narcotic pain reliever ( morphine), antispasmodic ( papaverine) and a number of other components.

All of the above remedies effectively relieve pain, and the patient can feel healthy within 20 to 30 minutes. However, it is still recommended to hospitalize him for further examination. If the pain does not go away after using the above remedies, or returns after a few hours, an urgent cholecystectomy is usually required - removal of the gallbladder along with the stones.

It should be noted that painkillers and antispasmodics during an attack of cholelithiasis are best administered in the form of injections. Patients may vomit ( sometimes multiple), which will negate the effect of the pills.

Surgery for gallstone disease

Surgical treatment of cholelithiasis, according to many experts, is the most effective and rational. Firstly, removal of the gallbladder along with stones guarantees relief from the main symptom - biliary colic. Secondly, stones will no longer form in the gallbladder. According to statistics, the relapse rate ( re-formation of stones) after drug treatment or crushing is about 50%. Thirdly, a number of dangerous complications that may appear over time are excluded ( fistulas, gallbladder cancer, etc.).

The operation itself for cholelithiasis is called cholecystectomy. It involves dissecting the tissue of the anterior abdominal wall and removing the entire gallbladder along with stones. The bile duct is ligated, and in the future bile will flow directly from the liver into the duodenum. If necessary, the bile ducts can also be operated on ( for example, if a stone is stuck in one of them).

In general, cholecystectomy is considered a routine operation, during which complications are rare. This is explained by the high prevalence of cholelithiasis and the extensive experience of doctors. Currently, there are several ways to remove the gallbladder. Each of them has its own advantages and disadvantages.

Based on the method of removing the gallbladder, surgical methods can be divided as follows:

Endoscopic removal ( minimally invasive). Endoscopic removal of the gallbladder is now considered the optimal method of treating cholelithiasis. It involves making four small holes in the anterior wall of the abdominal cavity, through which special instruments are inserted ( a small camera, a special electric scalpel, etc.). A small amount of carbon dioxide is pumped into the abdomen to inflate the abdomen, giving the doctor room to maneuver. After this, the gallbladder is removed and pulled out through one of the holes. The main advantage of the laparoscopic method is minimal trauma. Patients can lead an almost full life within a few days. There is no risk of suture dehiscence, postoperative complications are quite rare. The main disadvantage of this method is the doctor’s limited field of activity. Laparoscopic removal of the gallbladder is not recommended for various complications ( purulent complications, fistulas, etc.).
Laparotomy. In this case, a dissection of the anterior abdominal wall is performed, which provides the surgeon with wide access to the gallbladder area. The incision is made parallel to the costal arch ( askew), at the edge of the abdominal muscle on the right or along the midline of the abdomen. The type of incision usually depends on the intended extent of the operation. In the presence of various complications, a midline incision will be preferable, which will give the surgeon greater access. Laparotomy for cholelithiasis is currently not used so often. After surgery, incisions take longer to heal, and the risk of postoperative complications is higher. As a rule, laparotomy is necessary in the presence of fistulas, ulcers and other complications of cholelithiasis, which require a more scrupulous approach. For uncomplicated cholelithiasis, they try to use laparoscopic methods, and laparotomy is used only in the absence of the necessary equipment or specialists.

Most patients tolerate cholecystectomy well by any method. In the absence of complications, mortality is extremely low. It is slightly increased among older patients, but is associated more with concomitant diseases than with the operation itself.

The need for surgical removal of stones in asymptomatic stone carriers is highly controversial. In this case, surgery may seem like an unjustified risk. However, most often in patients with stone-carrying stones, sooner or later biliary colic still occurs, and the question of surgery arises. Removal of the gallbladder during an asymptomatic course allows for a planned operation, in which the risk is significantly lower than with an urgent one ( the patient is gradually prepared for surgery).

In general, there are the following indications for surgical treatment of cholelithiasis:

planned removal for stone-carrying cases ( at the request of the patient);
a large number of small stones, as they can cause acute pancreatitis;
patients with diabetes mellitus ( after proper preparation), since in them complications of the disease develop quickly and pose a great danger;
signs of calcification of the gallbladder walls ( the risk of developing cancer is believed to be high over time);
purulent complications ( empyema, peritonitis, etc.);
biliary fistulas and a number of other complications.

If you have stones, it is recommended to pay attention to the patient’s lifestyle. Surgical intervention is recommended for those patients who travel a lot, fly, or do heavy physical work. If they have gallstones, they are at high risk of colic in the most inappropriate place ( on a plane, on a train, in an area far from hospitals). In these cases, medical care will most likely be provided late, and the patient's life will be at risk.

Medicines for cholelithiasis

Drug treatment for gallstone disease mainly fights not the gallstones themselves, but the manifestations of the disease. Of the effective radical methods of drug therapy, there is only drug dissolution of stones, which will be discussed below. In general, patients with cholelithiasis are prescribed painkillers for biliary colic and supportive care for the liver and other organs of the gastrointestinal tract.

In most cases, symptomatic drug treatment can be prescribed by a general practitioner. Symptoms represent certain disturbances in the body's functioning that can be corrected. Drug treatment is prescribed already at the stone-carrying stage in order to improve the patient’s condition and, if possible, prevent the disease from progressing to the next stage.

In general, the following groups of drugs can be used for cholelithiasis:

Painkillers ( analgesics). The need for their use usually arises during severe biliary colic. During this period, patients may be prescribed narcotic painkillers ( usually once). Analgesics are also used at the postoperative stage.
Antispasmodics. This group of medications causes relaxation of smooth muscles. They are usually also prescribed during an exacerbation of the disease.
Pancreatic enzymes. This group of drugs contains enzymes that are responsible for the breakdown of nutrients. The need for them may arise with concomitant pancreatitis or some other digestive disorders.
Antipyretics ( antipyretics). These drugs are usually prescribed for concomitant acute cholecystitis or cholangitis, when the temperature can rise to 38 degrees or more. The most commonly used are non-steroidal anti-inflammatory drugs, which combine anti-inflammatory and analgesic effects.
Sedatives ( sedatives). The need for sedatives may arise when pain occurs, as many patients become restless.
Antiemetics. Often, cholelithiasis causes repeated bouts of vomiting. To improve the patient's condition, vomiting is stopped with medication.
Antidiarrheals or laxatives. Drugs of these groups are taken as needed for corresponding stool disorders.
Hepatoprotectors ( liver protection products). This group of products improves liver function and protects its cells from toxic influences. The formation of bile and its outflow are also normalized. Hepatoprotectors are prescribed for concomitant hepatitis or for its prevention.
Antibiotics. Antibacterial drugs are prescribed to some patients with acute cholecystitis to reduce the likelihood of infectious complications. For preventive purposes, antibiotic therapy can be prescribed in the postoperative period ( usually within 2 – 3 days).

Most often, patients need only a few products from the above groups. It depends on the specific symptoms that appear in the patient. The dosage and duration of administration are determined by the attending physician after examining the patient. Self-medication is prohibited, since the wrong choice of dose or drug can provoke biliary colic or other dangerous complications.

Treatment of gallstone disease without surgery

There are two main methods of treating gallstone disease without surgery. Firstly, it is the dissolution of stones with special preparations. In this case we are talking about the chemical effect on the components of stones. A long course of treatment often leads to complete dissolution of gallstones. The second method of non-surgical treatment is stone crushing. Their smaller fragments freely leave the gallbladder naturally. In both cases, treatment is considered radical, since we are talking about eliminating the very substrate of the disease - gallstones. However, each method has its own advantages and disadvantages, indications and contraindications.

Dissolving gallstones is called oral litholytic therapy. It implies a long 1 – 2 years) a course of treatment with special drugs that promote the gradual dissolution of stones. The most effective drugs are those based on ursodeoxycholic and chenodeoxycholic acid. These medications reduce the reabsorption of cholesterol in the intestines ( more bile is excreted in feces), reduce the production of bile, promote the gradual transformation of stones back into bile components. The method is optimal because it does not cause serious side effects and is not associated with serious risks for the patient ( like during surgery). However, oral litholytic therapy is not suitable for all patients. In practice, doctors prescribe such treatment to only 13–15% of patients with cholelithiasis.

Successful conservative treatment is possible only if the following conditions are met:

Treatment is started for patients whose disease is still at an early stage ( stone-carrying);
the chemical composition of the stones should be cholesterol, not pigment;
the patient has no signs of complications of the disease ( Rare colic is acceptable);
the stones must be single and not exceed 1.5 cm in diameter;
the gallbladder should not be atonic or disabled ( his muscles contract normally, bile is secreted);
stones should not contain a lot of calcium ( calcification is determined by the degree of darkness on the x-ray; treatment is prescribed when the attenuation coefficient on CT is less than 70 arbitrary units on the Hounsfield scale).

You should also keep in mind the fairly high cost of such a course of treatment. The drugs should be taken regularly over a long period of time. Regular monitoring by a gastroenterologist, periodic x-rays and ultrasound examinations are required.

The treatment regimen for oral litholytic therapy is as follows ( choose one of the possible options):

Chenodeoxycholic acid- 1 per day ( In the evening) 15 mg per 1 kg of body weight ( that is, the dose for a person weighing 70 kg is 1050 mg, respectively).
Ursodeoxycholic acid– also 1 time per day in the evening, 10 mg per 1 kg of body weight.
A combination of chenodeoxycholic and ursodeoxycholic acids. Taken in the evening before bed in equal doses - 7 - 8 mg per 1 kg of body weight each.

To facilitate dose calculations, it is sometimes believed that for a patient weighing less than 80 kg, 2 capsules of ursodeoxycholic acid are sufficient ( 500 mg), and with a weight of more than 80 kg - 3 capsules ( 750 mg). In any case, take the capsules before bed with a sufficient amount of water or other drinks ( but not alcoholic).

Oral litholytic therapy is not prescribed to patients who have the following contraindications:

women during pregnancy;
excess weight ( obesity);
cirrhosis, acute and chronic hepatitis;
frequent exacerbations of cholelithiasis ( colic);
serious digestive disorders ( prolonged diarrhea);
inflammatory complications of cholelithiasis ( acute cholecystitis);
severe disruption of the gallbladder ( a “disconnected” bladder that does not contract and does not secrete bile well even without blockage of the ducts);
the presence of a stomach or duodenal ulcer ( especially during exacerbations);
some tumors of the gastrointestinal tract;
multiple stones, which in total occupy more than half the volume of the bladder;
large stones with a diameter of more than 15 mm;
pigment stones and stones with high calcium content.

Thus, the patient selection criteria for this treatment method are quite stringent. A significant disadvantage of litholytic therapy is that there is a high probability of re-formation of stones after some time. Within a few years after the stones dissolve, cholelithiasis reappears in almost half of patients. This is explained by a predisposition to this disease or the influence of factors that were not identified the first time. Due to the high relapse rate ( repeated exacerbations) After completion of treatment, patients should undergo a preventive ultrasound every six months, which will detect the formation of new stones at an early stage. In case of relapse, it is possible to re-dissolve the stones according to the above scheme.

Compared to dissolving gallstones, their crushing has more disadvantages and is used less frequently. This method is called shock wave lithotripsy. Stones are crushed using directed ultrasonic waves. The main problem with this is that fragments of crushed stones can clog the bile ducts. Also, this method does not reduce the likelihood of relapse ( for this purpose, after crushing, ursodeoxycholic acid is prescribed) and does not exclude the possibility of some complications ( gallbladder carcinoma, etc.).

Shock wave lithotripsy is used for the following indications:

the presence of one or more stones, provided that the sum of their diameters does not exceed 3 cm;
cholesterol stones;
the gallbladder functions normally, there are no associated complications;
the smooth muscles of the gallbladder ensure its contraction by at least 50% ( important for removing fragments).

Thus, to prescribe shock wave lithotripsy, it is necessary to conduct a number of studies that will determine all of the above criteria. This comes with additional costs.

There is also a third non-surgical treatment option. This is the introduction of special dissolving drugs directly into the gallbladder ( usually through the bile ducts). However, due to the complexity of the procedure and the lack of visible benefits ( there is also a high risk of relapse and contraindications are almost the same) this method of treatment is used extremely rarely. In most cases, doctors absolutely rightly try to convince the patient of the advisability of endoscopic cholecystectomy. Non-surgical treatment methods are often used when there are serious contraindications to surgical treatment.

Treatment of cholelithiasis with folk remedies

Since cholelithiasis is caused by the formation of stones in the cavity of the gallbladder, the effectiveness of folk remedies in treating this disease is very limited. In fact, medicinal plants only increase or decrease the concentration of certain substances in the blood and thus affect certain organs and tissues. However, it is impossible to dissolve stones in this way.

However, traditional medicine can provide significant assistance to patients in combating the manifestations of the disease. For example, some medicinal plants reduce the level of bilirubin in the blood ( reduce jaundice), others relax the smooth muscles in the walls of the organ, reducing pain. There are also plants with moderate anti-inflammatory and antibacterial activity, which reduce the likelihood of complications.

The following folk remedies can be used in the treatment of cholelithiasis:

Cabbage juice. Juice is squeezed out of well-washed white cabbage leaves, which patients take 0.5 cups twice a day. It is recommended to drink the juice warm before meals.
Rowan juice. The juice is obtained from ripe rowan fruits. It is drunk slightly chilled ( about 15 degrees) before meals, 25–50 ml. It is believed that this reduces the inflammatory process in cholecystitis.
Oat infusion. 0.5 kg of washed oats is poured into 1 liter of boiling water. Leave the mixture for about 1 hour, stirring occasionally. After this, filter the infusion and drink half a glass of water three times a day. This remedy normalizes the production and outflow of bile in diseases of the biliary tract and gallbladder.
Beetroot decoction. Ripe medium-sized beets are peeled and cut into thin slices, being careful not to lose the juice. The slices are poured with a small amount of water ( until complete immersion) and cook over low heat. Gradually the broth thickens. The resulting syrup is cooled and drunk 30-40 ml three times a day.
Budra infusion. 5 g of ivy budra is poured into 200 ml of boiling water and left in a dark place for at least 1 hour. Then the infusion is filtered through a bandage or gauze. The resulting liquid is drunk 50 ml before each meal ( 3 – 4 times a day).

In most cases, doctors not only do not prohibit the use of these remedies, but even recommend some of them themselves. For example, plants with hepatoprotective effects ( spotted milk thistle, sandy immortelle, etc.) protect liver cells and normalize their work. This is very important for cholecystitis to reduce the risk of hepatitis and cirrhosis. In addition, in the postoperative period, products based on these plants normalize the production of bile and thus help the body absorb fats. It should, however, be noted that medicinal preparations based on these plants, manufactured by a serious pharmacological company, will have a stronger effect than decoctions or infusions prepared at home. This is due to the higher concentration of active substances. Also in this case, it becomes possible to more accurately calculate the dosage.

There are also some non-herbal remedies that can be used successfully to assist in the treatment of gallstones. For example, after removing stones ( by fragmentation or dissolution when the gallbladder is preserved) Morshyn brine and mineral waters similar in properties can be very useful. Ropa is successfully used for blind probing to enhance the flow of bile. This is useful after prolonged stagnation, and also allows you to take bile samples for biochemical and microbiological research.

Diet for gallstone disease

Diet is a very important component in the treatment of patients with gallstone disease. The main goal of dietary nutrition is a kind of “unloading” of the liver. Different foods are perceived differently by the body. Patients are advised to exclude those foods that require copious amounts of bile to be digested. Their use can provoke biliary colic, various complications, and in case of stone-carrying, accelerates the growth of stones.

For cholelithiasis at all stages, it is recommended to follow dietary table No. 5 according to Pevzner. It is designed to ensure sufficient supply of all necessary nutrients to the body, without putting excess stress on the liver and gallbladder.

Diet No. 5 is based on the following principles:

Food is taken 4 – 5 times during the day. The portions should be approximately equal in volume.
In between meals ( on an empty stomach) It is recommended to drink warm water. A sufficient amount of liquid dilutes the bile somewhat. The total volume should be at least 2 liters per day.
Most dishes must be steamed; boiled meat is allowed. Any fried foods or fatty baked foods should be excluded.
Products that can cause flatulence are not recommended ( bloating).
You should limit your salt intake, both in its pure form and when preparing various dishes ( in total up to 10 g per day).
Maintain approximately equal proportions between liquid and semi-liquid foods.
Food should be warm when consumed ( room temperature or warmer), but not hot. Excessively hot or cold food can provoke spasm of the gallbladder muscles with the appearance of acute pain.

Diet No. 5, provided the patient’s condition is stable, can be used for several years. She allows moderate variety in her diet and maintains normal proportions of proteins ( 70 – 80 g), fats ( up to 80 g, about half – vegetable) and carbohydrates ( up to 350 g) and provides the body with sufficient energy. After an episode of biliary colic, the diet should be followed for at least several days. Long-term adherence to stones will delay the appearance of acute symptoms of the disease.

Examples of permitted and prohibited foods according to diet No. 5 according to Pevzner

Authorized Products	Prohibited Products
Tea ( including sweet or with lemon), herbal decoctions, jelly ( in small quantities).	Coffee or cocoa, carbonated drinks, alcoholic drinks.
Vegetarian soups, green borscht, cabbage soup, legume soups, milk soups.	Rich broths, fatty fish soup, okroshka.
Most cereals and cereals.	Boiled beans or other legumes, corn grits, pearl barley porridge.
Pasta and pasta without seasoning.	Ketchup and other pasta seasonings.
Lean meats ( beef, chicken, rabbit, etc.) boiled or baked. In general, limit your meat consumption a little.	Internal organs ( heart, liver, tongue, etc.)
Dumplings, pilaf or sausages in small quantities.	Fatty meats, fried meat dishes.
Steamed cutlets, meatballs and other low-fat minced meat products.	Most seafood - shrimp, crayfish, mussels, caviar, etc.
Canned vegetables are limited.	Canned meat and fish.
Rusks, rye or bran bread, cookies.	Any fresh baked goods.
Eggs ( in the form of an omelet) and dairy products.	Boiled eggs, salted and fatty cheeses, cream.
Most salads are made from fruits and vegetables.	Seasonings, mushrooms, raw radishes, carrots, radishes, turnips ( root vegetables with tough plant fibers), cabbage.
Jam or jam from permitted fruits, marmalade and most sugar-based products.	Chocolate and cocoa desserts, ice cream, condensed milk.

Following diet No. 5 cannot rid the patient of gallstones. However, it will help fight such symptoms of the disease as nausea, pain and discomfort in the right hypochondrium, and stool disorders. In addition, it involves the prevention of various complications. Patients who have undergone stone removal using non-surgical methods are advised to adhere to this diet for the rest of their lives.

Prevention of gallstone disease

Preventive measures to prevent cholelithiasis are aimed mainly at improving liver function and preventing stagnation of bile in the gallbladder. If we are talking about stone carriers, then the goal is to delay the acute stage of the disease. In most cases, the effectiveness of preventive measures will not be very high. The fact is that if there is a predisposition to gallstone disease or if there are concomitant diseases ( which stimulate the formation of stones) stones will form one way or another. You can only influence the speed of their formation. Also, preventive measures are necessary to reduce the frequency of attacks of the disease and reduce the risk of various complications. A correct lifestyle for this pathology can stop the disease at the stone-carrying stage for life. In other words, the patient will have stones but will not have any serious symptoms, and surgery is often not necessary in these cases.

To prevent cholelithiasis and its complications, it is recommended to observe the following preventive measures:

maintaining normal body weight;
rational use of hormonal drugs ( mostly estrogens);
sufficient physical activity ( playing sports, walking, etc.);
exclusion of fatty foods, alcohol;
diet;
drinking enough liquid;
limiting heavy physical activity and sudden movements at the stone-carrying stage;
periodic consultations with a specialist and ultrasound if necessary ( especially for stone-carrying patients);
removal of the gallbladder at the stone-carrying stage ( to prevent exacerbations and complications in the future);
timely consultation with a doctor in case of visible changes in the patient’s condition;
ursodeoxycholic acid 250 mg/day ( drug prophylaxis for patients diagnosed with lithogenic bile).

Special mention should be made about patients receiving parenteral nutrition. These are patients in serious condition or after operations who cannot receive food naturally for a long time. Nutrients are infused in the form of solutions in droppers. The gastrointestinal tract practically does not work in these cases, and there is a high risk of bile stagnation with the formation of stones. Such patients are given a special drug as prophylaxis – cholecystokinin ( 58 ng per 1 kg of body weight per day). It ensures the dilution of bile and its outflow.

Is it possible to exercise if you have gallstones?

As noted above, physical activity is one of the main contraindications in the prevention of cholelithiasis. Since most sports, one way or another, involve such a load, patients with this disease are advised to refrain from them. However, in reality, much depends on the stage of the disease.

Permitted and prohibited sports at different stages of cholelithiasis are as follows:

At the stone-carrying stage, if the stones are small, you can practice swimming, jogging and other moderate exercise. Active movements will partly prevent the enlargement of stones. However, if the stones are large enough, you should not abuse even moderate loads.
During severe symptoms of the disease, exercise can provoke biliary colic, so it is recommended to exclude almost any kind of sports. The very change in body position in space can cause the displacement of stones and spasm of smooth muscles.
In the postoperative period, the load should also be limited, since the anterior wall of the abdominal cavity was injured. During endoscopic stone removal, trauma is minimal, but there is a risk that internal bleeding may develop. If during the operation the abdominal wall was cut, then the risk of suture divergence is high. After endoscopic surgery, it is recommended to abstain from active sports for at least 6 to 8 weeks. After laparotomy, this period may drag on for several months. In each specific case, the rehabilitation period should be discussed with the attending physician.

In general, after removal of the gallbladder or dissolution of stones, there are no special restrictions in terms of loads. If the seams have healed well, then over time a person can engage in almost any sport.

In general, we can say that in a healthy person, various sports are the prevention of gallstone disease. In the absence of concomitant disorders in the body, movement improves the flow of bile and reduces the likelihood of stone formation. The most suitable for such prevention are swimming, jogging, and cycling. In the presence of stones, the most dangerous sports will be weightlifting, powerlifting, artistic gymnastics, and contact sports. In these cases, there is a high risk of extreme loads, impacts to the gallbladder area, and a rapid change in body position in space is also characteristic. All this can provoke an attack of cholelithiasis.

How much water can you drink if you have gallstones?

In principle, there are no special restrictions on water consumption for cholelithiasis. They exist in kidney stones ( nephrolithiasis) when stones are located in the renal pelvis. Then excess urine production can easily provoke the movement of stones and lead to renal colic. In gallstone disease there is no similar mechanism. A large amount of liquid may dilute the bile slightly, but is not directly related to its quantity. Thus, drinking a large amount of water does not increase the risk of biliary colic or the development of any complications.

Healthy people have normal water intake ( at least 1.5 - 2 liters of liquid) can be regarded as the prevention of cholelithiasis. It has been noted that a lack of fluid can make the bile more concentrated, causing sediment to begin to form. It is especially important to consume sufficient fluids for those people who have been diagnosed with lithogenic bile secretion ( even before the stone formation stage). For them, this is a direct preventive measure that delays the onset of gallstone disease itself.

The average water consumption rate for an adult is ( including those with cholelithiasis) should be about 2 liters. However, various factors should be taken into account. Intense physical activity is associated with additional fluid loss. In summer, in hot weather, the rate of water consumption also increases ( up to approximately 3 l).

There may be any restrictions on fluid intake in the postoperative period. Water passes through the gastrointestinal tract, partly stimulating its contractions. Immediately after surgery, this may create a risk of complications. In each individual case, the amount of fluid allowed after surgery must be clarified with the surgeon. After laparoscopic removal of the gallbladder, there may be no restrictions, but after surgical treatment of some complications, restrictions, on the contrary, can be quite strict.

Is it possible to drink alcohol if you have cholelithiasis?

Drinking alcohol during cholelithiasis is prohibited, as this can cause various complications. This is due to the toxic effect of alcohol on the gastrointestinal tract and liver cells. The most common complication from drinking strong alcoholic beverages is pancreatitis. Difficulties in the outflow of bile caused by stones already create the prerequisites for this. The intake of alcohol ( which can cause pancreatitis in a healthy person) often provokes the onset of an acute inflammatory process.

At the stone-carrying stage, when there are no obvious symptoms of the disease yet, but the patient already knows about his problem, drinking alcohol is also not recommended. The risk of complications in this case is lower, but it still exists. However, we are not just talking about strong alcoholic drinks. Beer, for example, can cause flatulence ( gas accumulations). Increased pressure in the abdominal cavity sometimes causes displacement of stones and biliary colic. In addition, drinking large amounts of beer disrupts the functioning of enzyme systems, can cause bowel problems and increases the risk of infectious complications ( cholecystitis).

Another important factor that excludes alcohol intake is its incompatibility with many medications that patients take. In acute cholecystitis, these are antibiotics, the effect of which is weakened in combination with ethyl alcohol and can even be toxic.

If the patient suffers from cholelithiasis with periodic exacerbations ( chronic cholecystitis), then periodic consumption of alcohol, firstly, will cause increased frequency and intensification of pain. Secondly, such patients develop complications such as carcinoma more quickly ( cancer) gallbladder and cirrhosis of the liver.

Before use, you should consult a specialist.

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