Causes of cholelithiasis. Gallstone disease: symptoms, treatment, signs, causes. Gallstones. Contraindicated for cholelithiasis

A person who is susceptible to gallbladder disease may unintentionally trigger an attack of gallstones, an inflammation that causes the formation of stones in this organ.

There are many reasons for the onset of the disease, but it is important to know how to prevent it, how to stop it and what to do next.

An attack of the disease can begin at any time. The following conditions can cause it:

1. Insufficient number of acids in bile capable of dissolving lipid compounds.
2. Age after 40 years.
3. Large body weight.
4. Metabolic disorders.
5. Unbalanced diet.
6. Bad habits.
7. Lack of physical activity.
8. Continuous change of position, a person’s desire to take a position that is comfortable for him.
9. Excited state.
10. Poor environmental conditions.
11. Biliary tract infection.
12. Pancreatitis.
13. Impaired motility of the bile ducts and gallbladder (dyskinesia).
14. Taking hormonal drugs.
15. Changes in hormonal levels (during pregnancy, menopause).
16. Diabetes.
17. Infectious or toxic liver damage.

Signs of illness

The development of the disease occurs slowly, and at the initial stage it does not manifest itself in any way for a long time. First, several stones up to 0.5 mm in diameter form in the bile ducts, which reduce the lumen of the ducts and impede the exit of bile fluid.

When the stones increase in size and begin to move into the intestines, the first and sure sign of the disease appears - hepatic colic.

As the disease progresses further, symptoms appear:

1. Pain localized in the right side. At the initial stage, it is short-lived and has a paroxysmal character. Over time, its manifestations increase in intensity and duration.
2. Bloating and abdominal tension.
3. Flatulence.
4. Temperature increase.
5. Diarrhea.
6. Digestive problems.
7. Constant feeling of nausea.
8. Vomit.
9. Belching.
10. Development of arrhythmia.
11. Rapid breathing with incomplete inhalations and exhalations.
12. Change in skin color - becomes pale.
13. Sweating increases.
14. Weakness, malaise, fatigue.

The named signs of pathology appear singly or all at the same time, and they cannot be called specific. Using them, it is difficult to diagnose this disease and prescribe adequate treatment. Only a doctor can make an accurate diagnosis by conducting examinations.

Diagnostics

During the initial examination of the patient, the doctor examines his medical history and family history. Be sure to palpate the gallbladder and its ducts: a feeling of discomfort and pain indicates the presence of the disease.

To make a diagnosis, the patient is prescribed the following procedures:

1. Ultrasound examination of internal organs.
2. Urine and blood tests with mandatory indication of bilirubin, duodenal compounds, cholesterol, alpha-amylase, fats.
3. Stool analysis (to identify elements of undigested food in it).
4. Esophagogastroduodenoscopy (examination of the inner layers of the esophagus, surfaces of the stomach and duodenum).
5. Cholangiopancreatography (examination of the bile ducts with a duodenofibroscope).
6. MRI and CT of internal organs.

Such an extensive list of examinations is explained by the difficulty of making an accurate diagnosis due to the specificity of the symptoms of cholelithiasis.

What to do during an attack

Attacks occur with varying frequency and have varying degrees of manifestation. For some people, the pain lasts 3-5 minutes, for others it lasts for hours. But no matter how long it lasts, emergency help is called, and before it arrives, try to improve your well-being on your own.

First aid for an attack of illness:

1. Stopping feeding. You need to fast for the first 12 hours, and then drink rosehip infusion and eat soup made from fresh vegetables.
2. Taking antispasmodics and drugs that dilate blood vessels.
3. Maintain complete peace.
4. Warming your feet with a heating pad.
5. Sitting in a bath with a water temperature of 37-39 degrees (up to 20 minutes) and drinking warm water.

You cannot refuse hospitalization, since the situation may require emergency surgical intervention.

Treatment in hospital

There are several types of medical care for attacks of gallstone disease:

1. Medication.
2. Surgical.
3. Physiotherapeutic.
4. Sanatorium-resort.

The essence of medication is to relieve pain and inflammation, and prevent the development of complications. Therapy is effective for stones less than 1 cm in diameter. For this purpose, 4 groups of drugs are used:

1. Anti-inflammatory non-steroidal drugs: Ibuprofen, Ketoprofen.
2. Antipyretics: Paracetamol.
3. Painkillers: Pethidine, Pentazocine.
4. Antispasmodics: “Papaverine”, “Drotaverine”.

For stones larger than 1 cm, the doctor recommends surgery to remove them. There are 2 types of intervention:

1. Closed cholecystectomy. The operation is performed using a laparoscope, is safe for the patient, and less traumatic. After it, surgical scars are hardly noticeable.
2. Open cholecystectomy . A surgical procedure in which the gallbladder is removed through an incision made in the abdominal cavity.

The type of surgical operation is determined by the surgeon based on the size of the stones and their location.

Physiotherapeutic treatment involves shock wave extracorporeal lithotripsy. Stones are removed using a shock wave if there is no inflammation. After crushing, they are excreted naturally.

Sanatorium-resort assistance consists of:

• moderate physical activity, when patients are recommended to walk at a slow pace;
• drinking mineral waters of low or medium mineralization;
• oxygen-nitrogen baths (daily for up to 15 minutes for a course of 5-7 days).

In the sanatorium, the climate and special dietary food also influence the patient’s recovery.

What is the danger of the condition

As practice shows, an attack is considered a dangerous phenomenon. If a person does not consult a doctor in a timely manner, he is faced with consequences that negatively affect the general condition of the body.

While the stones are small, painkillers can help relieve pain. But when the number of stones increases, they increase in diameter, and moving along the ducts, they clog them.

This condition leads to:

• peritonitis;
• cholangitis;
• acute cholecystitis;
• secondary pancreatitis;
• cirrhosis;
• jaundice;
• choledocholithiasis;
• empyema of the bladder.

The listed diseases are a prerequisite for the development of:

• diabetes mellitus;
• Crohn's disease;
• gout.

There are frequent cases of stones piercing the membrane of a bladder. The consequence of this phenomenon is severe pain shock. Another undesirable complication is dehydration. Conditions that provoke it are diarrhea and vomiting.

How to eat after an attack

Nutrition is of no small importance, because often the disease begins due to a person’s violation of the diet. The diet should be focused on preventing further attacks and include:

• low-fat dairy products;
• porridge cooked in water;
• vegetables;
• low-fat meat broth;
• Rye bread;
• cereals;
• non-sour berries and fruits.

It is important to stick to this diet for the first three days after a seizure. Then you can introduce turkey, chicken and fish.

It is necessary to exclude from the diet foods that provoke the manifestation of symptoms of the disease, these are: fatty, spicy, fried, smoked, pickled, canned, flour, carbohydrate-rich foods, as well as legumes and chocolate.

It is forbidden to drink alcohol, black coffee, carbonated water, or strong tea. Boiled, baked and steamed dishes, salads, will be an excellent replacement for all of the listed products.

The drinking regime also needs to be adjusted. Drink at least 2 liters of still water daily, and mineral water only after consulting a doctor.

Forecast and preventive measures

The earlier the disease is detected, the more favorable its outcome. If the disease is diagnosed early, you can get by with drug treatment in combination with physiotherapy and sanatorium-resort treatment. But in advanced conditions, when stones begin to move through the ducts, it is necessary to resort to surgical intervention.

Ignoring the signs of gallstone disease or treating them yourself is dangerous for the development of complications.

If the attack is isolated in nature, this is a reminder and warning about the need to take measures to prevent its secondary manifestation.

To do this, the following preventive measures must be observed:

1. Set up nutrition.
2. Monitor your body weight.
3. Exercise or play sports moderately, and avoid strength training.
4. Follow the doctor's prescriptions and recommendations.
5. Refuse to garden, since prolonged stay in a bent state provokes a new attack.
6. Try not to travel in public transport due to shaking.
7. Be in a normal psycho-emotional state.
8. Do not smoke or drink alcohol.

A gallbladder attack can be prevented by regular medical examinations to diagnose the disease early.

Medicine today has drugs and technologies that make it possible to cope with the disease in a short time. Doctors never cease to repeat that only constant care for health will help prevent the serious consequences of this pathology. Hide ad

Among the pathologies of internal organs, cholelithiasis occupies one of the leading positions in terms of its prevalence, but not everyone knows the symptoms of the pathology. The difficulty lies in the fact that for a long time the disease occurs in a latent form, without making itself felt.

According to statistics, in developed countries, 15% of the population suffers from this pathology. If we analyze the age groups of the sick, we can find a direct connection between the age, gender of the sick and their number. In particular, it is noted that women get sick twice as often as men.

If we consider women whose age has exceeded 40 years, then every fifth person will become ill. Men of the same age have one case in 10 people. The distribution of the number of cases by age group is as follows:

• 40 – 50 years – 11%;
• 50 – 69 years old – 23%;
• 70 years and older – 50%.

Features of the course of the disease

The following organs are responsible for the function of bile movement: gallbladder, liver, bile duct, duodenum,. Each body on the list has its own “responsibilities”. Together they organize the transport of bile throughout the body.

Part of the bile must enter the intestines to ensure normal digestion. Some of it glows in the bubble itself. If it stagnates, stones begin to form. Motor-tonic disorders of bile secretion, aggravated by inflammatory processes, aggravate the situation. They lead to an acceleration of the process of stone formation. All stones that can form in the gallstones are divided into the following types:

• cholesterol (90% of the total);
• pigmented;
• mixed.

Cholesterol stones form when there is too much cholesterol in the bile. At the same time, stones form in the bile, then they sink to the bottom and are released into sediment. The process is accompanied by the formation of crystals. Since motility is impaired, these crystals cannot enter the intestines and empty the bladder cavity. Therefore, the stones only increase over time. This process becomes irreversible.

Pigment stones have another name - bilirubin stones. The reason for their appearance is the high rate of breakdown of red blood cells. This phenomenon is characteristic of hemolytic anemia.

The mixed type of stones contains features of both described types. They contain bilirubin, cholesterol, calcium, which, after precipitation, are combined and gradually become overgrown with an increasingly significant amount of deposits. The formation of stones in this case provokes an inflammatory process that affects the bile ducts. The development of bile excretion disorders (dyskenesia) becomes an additional factor contributing to the development of pathology.

The main causes of gallstone formation

Determining the cause of gallstone formation is quite difficult. As a rule, this is not one factor, but a whole complex of problems that influenced the development of pathology. There are several main reasons that provoke the formation of stones:

• unhealthy diet, in which little vegetable fats are consumed and too many animals;
• hormonal dysfunction (thyroid dysfunction);
  sedentary standard of living;
• lipid balance disorders (usually accompanied by excess body weight);
• inflammatory phenomena;
• spinal injuries;
• starvation;
• pregnancy;
• diabetes;
• hereditary predisposition;
• problems of the small intestine.

There is another group of factors that sometimes contribute to the formation of stones:

The last factor is considered demographic. It has no specific explanation, but was identified on the basis of many years of observations.

Stages

The disease has several stages. The division of the disease development process into stages is based on the typical manifestation of this pathology in our time. Traditionally, the following stages are distinguished:

1. the initial stage, it is usually called physico-chemical or pre-stone (it is accompanied by a change in bile composition, does not show itself clinically, therefore it can only be detected using laboratory data, namely with the help of a biochemical analysis of bile);
2. the stage of stone formation is considered latent stone-bearing, there are no clinical signs, there are no specific symptoms, but formations in the gallbladder can already be determined instrumentally;
3. stage of clinical manifestations, during this period the formation of calculous cholecystitis of both acute and chronic forms occurs;
4. the fourth stage is the appearance of complications that develop as a result of the destructive effects of the underlying disease

Signs

The manifestation of cholelithiasis will depend on the size of the stones and where they are located. The disease can make itself felt in different ways. This is due to a type of accompanying inflammatory process, as well as functional disorders.

Almost always present (biliary colic, hepatic colic). They are determined in the hypochondrium on the right. They most often arise unexpectedly; patients complain that their side “stitches” or “cuts.” Subsequently, the pain is localized specifically at the location of the bladder. The pain can radiate to the shoulder, neck, back, shoulder blade, pain is always felt exclusively on the right. When the pain radiates to the heart, angina develops, which greatly worsens the general condition.

The appearance of pain is associated with eating heavy and junk food. This includes spices, fatty foods, alcohol, and spicy foods. Fried foods are especially difficult to handle. Exacerbation of the disease and pain can be provoked by intense physical activity, exhausting sports, and hard work. Stress is also one of the causes of pain. If your work involves being in an inclined position for a long time, you may also experience pain during illness.

After all, this situation contributes to the appearance of obstacles to the outflow of bile. The source of pain is a spasm of the muscles located in the bile duct area, as well as a spasm of its ducts. Spasms in this case are reflexive in nature; they arise due to the fact that the stones irritate the walls of the gall bladder with their effect.

Also, a spasm appears when the walls of the bladder stretch beyond normal due to the accumulation of excess bile in it.

This happens when the bile ducts become blocked, that is, obstruction occurs. Global cholestasis can be diagnosed by dilated bile ducts in the liver. All this is accompanied by blockage of the bile duct. The liver may also become enlarged. Therefore, in the area of ​​the right hypochondrium, in addition to constant pain, heaviness appears.

Pain is often accompanied by. I feel very sick and almost constantly. This condition may include vomiting. But such vomiting does not provide the relief that should arise. Vomiting also occurs due to irritation; in fact, it is a reflex response of the body. If vomiting has become uncontrollable, most likely the inflammation is spreading and has already affected the pancreas. In this case, bile can be seen in the vomit.

Intoxication gradually develops, which can be expressed in malaise, weakness, and low-grade fever. Sometimes the temperature rises much higher, and a real fever can begin. If a stone blocks the bile duct and the sphincter loses its patency, the stool will become light-colored and jaundice will develop.

Diagnostic methods

Gallstones

If you have hepatic colic, you should definitely consult your doctor. This condition should not be ignored. This is fraught with complications. You should be referred for an examination that will show whether there are different types of stones in the bladder. An external inspection is also carried out.

On the abdominal wall in the area where the bladder is located, you can see tension and soreness of the skin. Yellow spots appear on the skin, they are called xanthomas. They are clearly visible during an external examination. The cause of these spots lies in lipid metabolism disorders. The skin as a whole turns yellow, and the sclera also turns yellow.

General blood tests can determine signs of nonspecific inflammation in the acute stage. These signs include a moderate increase in ESR and increased white blood cells. If a biochemical analysis is carried out, an increase in cholesterol will be detected (hypercholesterolemia), (hyperbilirubinemia), and increased activity will be observed, which occurs with alkaline phosphatase.

Cholecystography is also performed. Its goal is to identify an enlarged gallbladder and the presence of calcareous inclusions in the walls of this organ. This method makes it possible to see stones with lime inside the bubble. This method is considered very effective in making a diagnosis.

Ultrasound is a very informative diagnostic method. This study reveals echo-proof formations (stones), as well as pathological deformations. The diagnostic accuracy in this case is very high. The size and location of stones and their approximate number are determined. You can track changes associated with the motility of this organ. Signs of cholecystitis are also detected on ultrasound.

MRI and CT scans perfectly show the condition of the bile ducts, so their use for examination for the disease in question is very effective. Scintigraphy (introduction of radioactive isotopes into the body in order to obtain an image on a gamma tomograph) shows disturbances in the circulation of bile. To conduct examinations in the same direction, endoscopic retrograde cholangiopancreatography is used.

Treatment

Treatment of the disease is complex

People suffering from cholelithiasis are limited in their workload, and their menu is formed in accordance with the principles of rationality. The hygienic regime corresponds to the general type. Diet No. 5 is prescribed, it is supplemented by the exclusion of fats. The main tactic in treatment is waiting. Specific treatment is rarely prescribed. Often a certain mineral water is recommended.

If calculous cholecystitis begins, then surgical removal is performed. The tactics of the operation depend on the patient’s condition, as well as on the condition of the tissues adjacent to the gallbladder. The size of the stones must also be taken into account.

In this case, surgical intervention cannot be delayed, because this condition can lead to peritonitis, perforation, acute pancreatitis and obstructive jaundice.

If you suspect gallstone disease, you should go for a consultation with a surgeon. It is easier to correct the condition in the initial stages than in advanced cases. After all, following a diet and leading a measured lifestyle is easier than having surgery.

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Gallstones, unfortunately, are a common phenomenon. Many people face this disease. Gallstone disease can cause pancreatitis, cholangitis, cholecystitis and other diseases. Gallstone disease predominantly affects women. As you age, the likelihood of stone formation increases.

Gallstone disease (GSD) is a disease of the gastrointestinal tract, characterized by the formation and growth of hard stones in the gallbladder. The disease occurs in three stages:

1. Physico-chemical. At the first stage, processes occur that predict the formation of stones. Cholesterol levels in bile increase.
2. Latent. Symptoms of the stage do not appear, similar to the first. But the stones are already present in the bladder, irritate the mucous membrane, and scratch. An inflammatory process begins in the gallbladder and ducts.
3. Clinical. At this stage, the symptoms of the disease are fully manifested and taken for attacks.

Stones formed in the organ during the course of the disease enter the bile ducts and can clog them. What happens causes complications in the functioning of the gallbladder. The patient experiences biliary colic, called an attack of cholelithiasis.

Causes of occurrence

The key to the normal functioning of the gastrointestinal tract is proper nutrition. are formed when metabolism is disrupted or an infection enters the body. There are many causes of diseases. Doctors studying disorders that occur in the gastrointestinal tract have identified certain risk factors. The presence of factors often causes the appearance of the disease:

• Sedentary lifestyle.
• Genetic predisposition.
• Poor lifestyle, alcohol consumption.
• Eating disorders, starvation, obesity.
• Diseases of the gastrointestinal tract.

The disease often occurs in women during pregnancy. Due to the factors accompanying the expectation of a child, the level of cholesterol, the main component of stones, increases. The process promotes stagnation of bile in the bladder. The likelihood of the disease increases if you take hormonal drugs.

Symptoms of the disease

The first two stages of the disease are asymptomatic. The patient does not know that he is becoming a carrier of gallstones. Symptoms appear when. The first signs of the presence of disorders are considered to be bitterness in the mouth, pain in the right hypochondrium, and heaviness. Nausea, flatulence, and belching develop.

A small stone can pass through the ducts directly into the duodenum. Then the formation leaves the body along with feces. In such cases, the attack goes away on its own, without treatment.

If the stone is large, this is a sure sign of the danger of getting stuck in the ducts. This can lead to serious complications that require treatment. If the ducts are blocked, the pain does not go away, it is recommended to immediately consult a doctor. With exacerbation of cholelithiasis, inflammation of the gallbladder occurs. Without treatment, the patient develops third-party diseases of the gastrointestinal tract:

• Acute pancreatitis.
• Obstructive jaundice.
• Cholecystitis.
• Liver abscess.

To avoid undesirable consequences, you should not ignore the symptoms of the disease. It is important to start treatment on time. In the early stages of the disease, treatment increases the likelihood of a full recovery with the least amount of time and effort for the patient.

Diagnosis of the disease

A gastroenterologist diagnoses and treats a patient with cholelithiasis. The doctor collects anamnesis and visual examination, studies the patient’s predisposition to the disease. Accurate diagnosis is extremely important; early symptoms are similar to other gastrointestinal diseases, for example, gastritis and pancreatitis.

To clarify the diagnosis, a number of additional studies are prescribed, including laboratory and instrumental methods. Ultrasound examination is considered the main instrumental diagnostic method in determining cholelithiasis. The method helps to determine the presence of stones, find out the size and location.

Based on the data obtained, the doctor makes an accurate diagnosis. An important role in diagnosis is played by studying the patient’s lifestyle and genetic predisposition. Observing a detailed picture of the course of the disease, the doctor prescribes appropriate treatment.

Treatment methods

Depending on the degree of progression and severity, treatment methods for gallstone disease are determined. When treating most diseases, doctors try to use conservative methods. Surgical intervention can lead to undesirable consequences for the functioning of the human body. If the disease becomes severe and therapeutic treatment does not bring results, the doctor decides to treat the disease with surgery.

Is it possible to do without surgery?

Many patients question the possibility of effectively treating the disease without surgery - and they are wrong. The opportunity to do without surgery is worth taking advantage of. The correct treatment method can only be prescribed by a doctor after studying the patient’s medical history, taking into account possible factors and risks. Self-medication is dangerous.

Treatment of gallstone disease without surgery is prescribed if the size of the stones is up to three centimeters. Gastroenterologists have sufficiently studied gallbladder disease. Based on research, a number of treatment methods have been developed. Diet, as a means of treatment, is widely used as a component of methods, also acting as a full-fledged method of treating cholelithiasis.

Treatment without surgery

Therapeutic treatments include medications and lithotripsy. Following a strict diet plays an important role. Sanatorium treatment is recognized as a positive way to cure the disease. Not all patients have the opportunity to use this method.

The conditions of sanatorium-resort treatment help to provide the patient with a regimen aimed at normalizing the functioning of the gastrointestinal tract. A similar technique is used for patients with diagnoses: gastritis, stomach ulcers, chronic pancreatitis. Climatic conditions and regular walks prescribed to the patient play an important role. This is aimed at increasing the patient’s activity. The patient takes mineral waters and follows a diet. For people suffering from disorders of the gastrointestinal tract, a special menu is compiled. The patient is prescribed mineral baths and physiotherapy.

The main goal of treatment is to free the gallbladder and ducts from stones; lithotripsy plays an important role. The term denotes a non-contact procedure for the purpose of independent passage of formations through the ducts. The method is used for gallstones up to three centimeters. The danger of the procedure is due to the possibility of clogging the ducts with passing crushed stones. Along with lithotripsy, drugs are prescribed to help dissolve stones. For patients, ursodeoxycholic acid preparations are prescribed.

The doctor controls the treatment method using ultrasound examinations. Additionally, the use of herbal medicine is introduced. The attending physician adjusts nutrition for gallstone disease. Lifestyle changes for cholelithiasis are the main component of effective non-surgical treatment.

Diet for gallstone disease

For a complete recovery, the patient will need to change his lifestyle. Compliance with certain nutritional rules is important for gallstone disease. It doesn’t matter whether surgery was performed or treatment was prescribed without surgery, diet plays a huge role in the recovery process. There is a known list of popular diets for patients with cholelithiasis, the most common and effective from the list is No. 5.

Features of the fifth table

M.I. Pevzner, the founder of Russian diet therapy, developed a method of dietary nutrition in 1929. Based on the methods, a table of treatment tables was created. The scientist's approach to nutrition is widely used in spa treatment. There are fifteen diets in total. For patients with gallbladder dysfunction, diet No. 5 is recommended. The patient’s diet is prescribed by the attending physician, determining the period of compliance. It is also recommended to follow the diet at home, having studied acceptable food products and cooking rules.

The diet is aimed at a normal amount of protein and carbohydrate intake, with a noticeable reduction in fat intake. The energy value of the diet does not exceed 2500 kcal per day. A similar diet is prescribed for patients diagnosed with chronic pancreatitis, gastritis, and liver dysfunction.

The patient is prescribed fractional meals. It is recommended to eat food in small doses, without loading the digestive system. Five to six meals a day. An important element in the diet is food processing. It is recommended to consume food chopped or pureed. This prevents the production of excess bile and reduces the likelihood of colic.

Food should not be fried or smoked. It is advisable to steam and boil dishes. It is acceptable to bake or stew dishes. It is recommended to eat a minimum of salt (10 grams). Daily consumption of simple purified water is increased to two or more liters per day.

Do's and Don'ts

The patient will have to completely adjust the menu. You will need to study the list of foods to exclude from your diet. Alcohol can provoke spasms of the bladder and ducts, causing colic. Remove products that overload the liver and gallbladder, promoting the production of bile and gas formation. Products that irritate the gastrointestinal tract and overload the human digestive system are removed from the menu. Prohibited for use:

• Delicious baked goods.
• Mushrooms.
• Fatty dairy products.
• Cabbage, legumes.
• Smoked, salted, fatty fish.
• Fatty meat, sausages.
• Coffee, strong tea.
• Spices, herbs, onions, garlic.

The list is much longer. It includes products containing an abundance of animal fats, oils, smoked foods, and spicy foods. Strong tea is prohibited for gallstone disease; it is permissible to drink tea with milk or weakly brewed drinks. As an analogue of tea, compotes and rosehip decoction are used. We recommend foods rich in fiber, which improves digestion, pectins, which reduce inflammation, and lipotropic substances, which dissolve fats. A beneficial effect on the body is produced by products containing magnesium, which relieves spasms of the gallbladder.

You need to eat foods:

• Rusks and bran bread.
• Lean meat.
• Dietary vegetable soup.
• Low-fat and lightly salted fish.
• Low-fat fermented milk products.
• Nuts, dried fruits and seeds.
• Vegetables containing pectin.

Fruits allowed include pomegranates and bananas. Baked apples, jelly, and marmalade are allowed. Seafood rich in iodine helps bind cholesterol. Vitamin D prevents salt deposition. Fish oil helps empty the gallbladder. The permitted product is cheese, but in limited use.

Following the rules of the diet can have a beneficial effect on the functioning of the gallbladder and the functioning of the entire body. Eating healthy foods improves the functioning of the gastrointestinal tract, preventing many diseases. Helps strengthen the immune system and improve overall well-being.

Traditional methods of treatment

In folk medicine, selected recipes have been developed, supported by qualified doctors. Many of the descriptions use beets. The vegetable needs to be chopped and cooked until it reaches the consistency of syrup. Drink half a glass of the decoction three times a day. It is allowed to consume beet juice, alone or with radish juice. It is believed that beets help dissolve stones.

There are a huge number of honey-based decoctions. Radish, horseradish, birch sap and other ingredients are added to recipes. Treatment with honey has a choleretic effect, the product helps improve digestion.

Various medicinal herbs are widely used in traditional medicine recipes. A decoction of celandine and mint has a healing effect. Add corn silk, sage, chamomile and other herbs. Often decoctions need to be infused and taken a tablespoon several times a day; with a select few they take baths, others drink them like tea.

Gallstone disease is also called cholelithiasis. The gallbladder or its ducts enter a pathological state in this disease due to the formation of stones in them. These are rocky deposits, popularly called stones. But, of course, it is wrong to compare them with natural stones. They did not come from outside, but formed independently and were deposited inside a person for several reasons. Cholelithiasis is dangerous and carries serious health problems, pain, complications, and gives rise to secondary pathologies. The sooner you pay attention to the symptoms and go to a doctor who diagnoses and begins treatment of the disease, the better it will be possible to avoid surgical intervention to remove stones and the consequences of their formation.

Nature has designed the human body in the wisest way. Everything in it is a single harmonious system, which, if it functions normally, does not cause problems or reasons to think about your health. But when a person feels pain, this is a signal of trouble, some kind of malfunction, which the body sends to the brain so that it takes actions that can get rid of the problem.

Important! Doctors call the main and first symptom of cholelithiasis pain, namely, sudden colic, which is localized in the right side under the ribs. But this is a sign of an emergency operational situation, when the stones have moved and created a pathogenic focus. It all begins, at the stage of small formations, with bitterness in the mouth, heaviness spreading throughout the abdomen, starting from the right, and a transient feeling of nausea.

Bitterness in the mouth is one of the first signs of cholelithiasis

For what reason do stones suddenly appear in a well-functioning, normally functioning body, and why do they accumulate in the gallbladder?

The main reason is a violation of metabolic processes. The metabolism of calcium, protein, bilirubin, cholesterol, and so on is disrupted. Participants in these metabolic processes that do not dissolve in bile accumulate in it. There they, fastened to each other, turn into a monolithic compound, which over time hardens under the pressure of more and more particles arriving and clinging to it.

Important! When microscopic particles form stones, they can reach truly enormous sizes, compared to the size of their container - the gallbladder - five centimeters.

Statistically, the formation of gallstones occurs in every seventh person, and women are twice as susceptible to this pathology as men. Their bodies contain more estrogens, which inhibit the release of bile hormones.

Estrogens are hormones that stimulate stagnation of bile in the gallbladder.

In addition to slow bile outflow, low mobility and a predominantly static lifestyle, in which all metabolic processes are inhibited, can provoke the growth of stones. Also, constant consumption of fatty foods creates cholesterol accumulations, greatly increasing the likelihood of stone formation.

Concretions are divided into four types, depending on the components.

On a note! While the formations are small (and they range from 0.1 mm), they lie quietly at the bottom of the gallbladder, and the owner does not even know about their existence.

If he (or she) is lucky, he will be able to feel bitterness, heaviness and nausea after eating at an early stage of stone formation, before they are overgrown with deposits, reach large sizes and begin to move through narrow ducts, causing unbearable pain.

Signs and diagnosis

So, when a stone or several from the gallbladder decides to come out (under the pressure of bile) out, it is sent along the only available path - the bile duct. The mouth of the duct is narrow, and the paradox is that a small stone that could pass through it without problems will remain at the bottom of the bubble until it grows to a certain size. Only then will its volume and weight begin to interfere with the bile contents, and it will try to “put pressure” on the calculus, expelling it out.

What happens to the duct when a solid object with a volume greater than the width of the passage gets into it? Of course, the duct will become clogged.

Among themselves, doctors call this situation a “rockfall.” If it has begun, the pain may still stop and return, but it will intensify and become more frequent until it becomes incessant.

Important! If the outflow of bile is completely blocked, without providing assistance to the patient, the pancreas will soon become inflamed (it will begin pancreatitis), the gallbladder itself (the name of the pathology is cholecystitis), and also forms obstructive jaundice with all the consequences.

Diagnostic methods

Until the patient suffers from pain in the form of colic, it is quite difficult to diagnose cholelithiasis by eye. After all, nausea and heaviness in the stomach are symptoms of many diseases, even those not related to the gastrointestinal tract. Bitterness in the mouth can also be caused by more than just one pathology. Even colic on the right does not indicate one hundred percent of cholelithiasis. How can you find out about the presence of stones? Using ultrasound.

Attention! Primary stones, which are not visible on ultrasound, at the initial stage, can only be detected when bile is taken for biochemical analysis.

Ultrasound or fluoroscopy of the abdominal cavity (in case of early diagnosis, the last procedure is with the introduction of contrast) will give an excellent result and help detect even small stones.

And if for some reason these two types of studies are not available, today there is an alternative - a special study called choledochoscopy. On it, the doctor will see the stones with his own eyes, determine their size and location with an accuracy of a tenth of a millimeter, and also inform the patient how necessary it is to operate in order to remove the stones.

Choledochoscope - a device for conducting choledochoscopy

On a note! The opinion of surgeons regarding stones is clear - remove them in any case. Most doctors of therapeutic specialization believe that it is better not to touch stones in the bile, as long as they behave calmly.

No symptoms - no treatment? It's not quite like that. It is possible and necessary to treat stones. More precisely, stones cannot be treated, but they can be crushed, dissolved, or removed in a less invasive way than surgery.

How to rid a patient of stones

Surgeons believe that it makes no sense to rid the patient of stones using conservative methods. This takes a long time, is not always effective, is fraught with side effects, and most importantly, the stones are likely to grow again.

That is, in principle, two ways are proposed. If stones are found, but their size is small and they do not give symptoms, it is recommended to ignore their presence, while following a diet and monitoring their size in order to notice in time their increase, which threatens the patient’s health. This situation can last for years and even decades.

The second way, if a “rockfall” has begun, is to completely remove the entire gallbladder.

Is there life without a gallbladder? Today medicine answers: “yes,” but its representatives on this issue are divided into two camps. Many people believe that a modern person does not need a gallbladder. And although it is removed, along with the stones and ducts present there, in emergency situations, for example, when acute cholecystitis, which is about to develop into peritonitis, causing inflammation of the entire peritoneum, or with complete blockage and developing rapidly pancreatitis, you can live without a gallbladder.

Moreover, the patient’s life and health will remain full, subject to regular nutrition. No, you won’t need special diets or strict regimes.

Regular nutrition is the key to permanent removal of the gallbladder

On a note! Our primitive ancestors did not have refrigerators and supermarkets. They received food only when they hunted successfully, and this did not happen every day. And if they are full, accordingly, irregularly. But on the day of a successful hunt, they ate “for future use.” This is why the gallbladder was needed - to store bile in a “reservoir” until the moment when it is needed to digest food (fats and proteins).

Since today a person can easily afford not to eat “for future use,” bile can be released directly from the liver in small doses gradually, carrying out a continuous digestive process.

The second “camp” is categorically against removing the bladder without endangering the patient’s life. They believe that the gallbladder plays a vital role in the digestive process. This is true, the organ accumulates bile and throws it in portions into the intestines and stomach to ensure the digestion process. Without a bladder, bile will flow directly, its concentration will be more liquid, food will be digested less efficiently, which will eventually lead to gastrointestinal diseases.

Treatment methods

If we leave aside radical surgical methods, there are still several options to cope with stones.

Table. Non-surgical methods of treating cholelithiasis.

Way	Description
	Firstly, a well-functioning diet. The regime is strict, the diet is specific. No fats, spicy, smoked, fried, minimum protein foods. This is necessary so that the stones, if any, do not acquire new “details” and remain safe, lying at the bottom of the gallbladder.
	Secondly, medications that dissolve stones. Such means exist, and they, albeit slowly, do their job. "Ursofalk", chenodeoxycholic acid and other drugs, with the help of which, with a certain patience and luck, you can completely get rid of stones within a year. Yes, it is expensive and not always effective. The effect depends on many factors, not just the size and number of stones. Moreover, if patients maintain their previous lifestyle, stones will almost certainly form again after just a few years. And possible complications after long-term use of these drugs are damage to liver cells.
	The third way to destroy stones is a shock wave. If the formations are single and small, they can be crushed and removed from the body naturally in small parts. This procedure is the most commonly used today because it is minimally invasive, well tolerated, highly effective, and can even be performed on an outpatient basis.
	The method has a significant drawback - the stones are crushed using an ultrasonic device into fragments with sharp ends. At the exit, they can damage the shells. Therefore, after crushing, the above-mentioned drugs are prescribed to dissolve the corners and smooth out the shapes in order to reduce complications.
	This method can partially be classified as surgical, since in order for the laser beam to crush the stone in a directional manner, a puncture is made in the body. There is also a drawback here - the possibility of burns to the mucous membrane.

In all cases except the first, the stones will almost certainly grow back. And the patient, exhausted from the fight against stones, will sooner or later agree to an operation to excise the gallbladder.

On a note! In case of surgery to remove the gallbladder, it is best to choose laparoscopy. With it, the anterior abdominal wall is punctured (that is, the tissue is not cut), and through these punctures the gallbladder with all its contents is removed. There are practically no marks, healing proceeds quickly.

Prevention and complications

The development of cholelithiasis is fraught with a number of complications.

What's the best thing to do? Do not have stones, or have them, but they are small, and try to prevent them from growing to a size where they will have to be removed along with the blister. To do this, it is necessary to engage in the prevention of cholelithiasis.

Important! If you have small stones, you cannot take choleretic drugs in any form, not even just medications, but also herbal remedies. They will certainly cause migration of stones and complications. You should also not drink mineral water.

Preventive measures include:

In general, there is nothing terrible or difficult in following these preventive measures. This is the norm of life of a healthy person, which he must adhere to if he does not want to have not only gallstones, but also many other diseases. After all, maintaining health is not the highest price to pay in order not to one day be faced with a dilemma: to live with a gallbladder filled with stones or without it.

Video - GSD: symptoms

Cholelithiasis is a disease caused by the presence of stones in the gallbladder and bile ducts. The essence of gallstone disease is the formation of stones from cholesterol, bile pigments, calcium salts and other constituent elements of bile in the gallbladder or bile ducts. The incidence of gallstone formation increases with age, reaching 45-50% in women over 80 years of age. In men, gallstones are 3-5 times less common, in children - extremely rare. Only in 20% of cases gallstones exist asymptomatically (“silent” stones).

Causes:

There are two main reasons for the formation of gallstones in the gallbladder - hepatic-metabolic and cystic-inflammatory. The hepatic-metabolic mechanism consists in the formation of gallstones due to factors such as unbalanced nutrition with a predominance of coarse animal fats (pork, lamb, beef) in the diet to the detriment of plant fats; neuroendocrine disorders, in particular those associated with dysfunction of the endocrine system of an age-related nature and hypofunction of the thyroid gland; disturbances of world metabolism with an increase in body weight, damage to the liver parenchyma of toxic and infectious origin; physical inactivity and bile stagnation.
As a result, the liver produces so-called lithogenic bile, i.e., capable of forming cholesterol or mixed stones.

With gallbladder-inflammatory causes, gallstones are formed under the influence of the inflammatory process in the gallbladder, leading to physico-chemical changes in the composition of bile (dyscholia). A change in the pH of bile towards the acidic side, characteristic of any inflammation, leads to a decrease in the protective properties of colloids, in particular the protein fractions of bile, and the transition of bilirubin micelles from a suspended to a crystalline state. In this case, a primary crystallization center is formed, followed by the layering of other ingredients of bile, mucus, epithelium, etc. The causes of the formation of gallstones are obesity, diabetes mellitus, pregnancy, liver disease, insufficiency of thyroid function, hemolytic anemia and other diseases

What are gallstones?

Gallstones (cholelits) are dense formations, the number of which can range from one to several thousand, size - up to several centimeters in diameter, weight - up to 30 g or more.
Round-shaped stones are more common in the gallbladder, ellipsoidal or oblong in the common bile duct, and branched in the intrahepatic ducts. Depending on the composition, cholesterol, pigment-cholesterol, cholesterol-pigment-calcareous, pigment and calcareous stones are distinguished; when cut, they have a pigment core and a layered structure.

Symptoms of gallstone disease:

Signs of the disease are varied. Conventionally, chronic pain, chronic recurrent, dyspeptic, angina pectoris and a number of other clinical forms are distinguished. Symptoms of gallstone disease in a chronic painful form include aching pain in the right hypochondrium and epigastric region, which radiates to the back and right scapula. Pain occurs or intensifies after eating fatty foods, and is generally intermittent. There are usually no severe pain attacks. Weakness, malaise, irritability and dyspeptic symptoms are often observed - flatulence, belching, unstable stool.
Palpation reveals pain points in the epigastric region and right hypochondrium, on the neck.

The chronic relapsing form manifests itself as a sudden severe pain attack. Provoking factors are the consumption of fatty or spicy foods, often negative emotions, severe physical stress, and working in an inclined position. Sometimes a painful attack occurs during menstruation, after childbirth.

Pain often occurs at night, is localized in the right hypochondrium and epigastric region, spreads to the entire upper half of the abdomen and radiates to the right shoulder blade, right shoulder, and neck. The intensity of the pain can be so great that patients groan, rush about in bed, and cannot find a position that alleviates their condition. Often the attack is accompanied by nausea and uncontrollable vomiting.

Icterus of the sclera and slight darkening of the urine are possible. The abdomen is swollen, and upon palpation it is sharply painful in the right hypochondrium. The anterior abdominal wall is tense, especially in the projection of the gallbladder (in elderly people, muscle tension may be absent), symptoms of Ortner, Mussi, Kera, etc. appear.
Sometimes there is a short-term increase in body temperature to 38° and above. In the presence of the so-called valve stone of the common bile duct, intermittent jaundice and skin itching occur. The duration of an acute attack ranges from several minutes or hours to two days.

If the pain syndrome is not accompanied by symptoms of acute cholecystitis and is quickly relieved after the use of antispasmodics and analgesics, they speak of hepatic (or biliary) colic, caused by obstruction of the cystic or common bile duct with a stone and spasm of their smooth muscles. After relief of such colic, patients consider themselves healthy until the next painful attack develops, which can occur after several days, weeks, months or years.

In the dyspeptic form, a feeling of heaviness in the epigastric region, heartburn, flatulence, nausea, and diarrhea are noted. These symptoms occur after eating and are constant or intermittent, often associated with large meals, especially fatty foods or fried foods. On palpation, there may be pain in certain pain points.

The angina form (cholecystocardial syndrome) is characterized by pain of varying intensity in the heart region (in the absence of pain in the right hypochondrium). This pain syndrome is often incorrectly regarded as a manifestation of coronary heart disease - angina pectoris and even myocardial infarction.

Saint's syndrome (or triad) - a combination of cholelithiasis with diaphragmatic hernia and colon diverticulosis - is rare.

Symptoms of an attack of gallstone disease:

The main symptom is an attack of hepatic colic, which occurs suddenly and acutely as a result of diet disorders or stress. Characterized by severe spasmodic pain in the right hypochondrium, radiating to the right half of the abdomen, as well as to the right shoulder blade. The pain is caused by an attempt to move the stone from the gallbladder through its neck into the common bile duct or within it. If the stone cannot overcome the obstacle or is narrow? place, it mechanically irritates the mucous membrane of the gallbladder or duct, and also increases spasm of the bile ducts to increase bile pressure (as if pushing the stone and bile).

Gallstones do not impair the flow of bile through the intrahepatic ducts, but they impede the outflow from the bladder and the flow of bile into the gallbladder. Bile duct stones impede the flow of bile into the duodenum, causing malaise and stagnation of bile in the bile ducts, which is accompanied by the appearance of icteric discoloration of the skin and sclera, the development of inflammatory processes and cirrhosis of the liver. Thus, many small stones more often cause attacks of hepatic colic, since they often obstruct the flow of bile into the duodenum. In cases of a combination of stones and inflammation in the gallbladder and biliary tract, the pain syndrome intensifies and low-grade fever or fever with chills and sweating appears.

If the lumen of the bile duct is completely blocked by a stone, yellowness of the skin of the sclera occurs (the so-called obstructive jaundice), but the stool is not colored, light, the color of clay. An attack of hepatic colic can go away on its own, with spontaneous advancement of the stone and release of the lumen of the biliary tract, or with the help of medications. If improvement does not occur, surgical treatment is indicated.

Complications:

Complications of cholelithiasis are varied. As a result of prolonged pressure from a stone on the mucous membrane of the bladder, ulcers and bedsores may appear in it, diverticulum-like protrusions, internal and external biliary fistulas, perforations with the development of subhepatic or subphrenic abscesses, and biliary peritonitis may form. The movement of gallstones may be accompanied by blockage of the cystic duct, hydrocele of the gallbladder or empyema.

Diagnostics:

The diagnosis is made on the basis of anamnesis, clinical, laboratory, X-ray, ultrasound and other studies. Clinical and biochemical studies reveal leukocytosis, an increase in ESR, an increase in the level of bilirubin and its fractions in the blood, the presence of urobilin in the urine, and the absence of stercobilin in the feces; with duodenal intubation - the absence of portion B, the presence of cholesterol crystals and calcium bilirubinate in the bile.

Survey radiography of the gallbladder area, cholecystography, cholangiography, cholegraphy, as well as echography aimed at identifying gallstones and dysfunction of the gallbladder are of great diagnostic importance. Echography is superior to cholegraphy in its information content, because will make it possible to detect stones measuring 0.5 cm in the gall bladder. Computed X-ray tomography provides greater accuracy in recognizing stones in the gall bladder containing calcium salts.

Gallstone disease must be differentiated from chronic acalculous cholecystitis, dyskinesia of the gallbladder and dyskinesia of the biliary tract, cancer of the gallbladder, peptic ulcer of the stomach and duodenum, hiatal hernia, acute appendicitis with an atypically located appendix, right-sided renal colic, etc.

In the angina pectoris form of cholelithiasis, which should be differentiated from manifestations of coronary heart disease, the results of ECG (absence of pronounced changes) and cholecystography (presence of stones) play an important role. It is necessary to take into account that during an acute attack of cholelithiasis in elderly patients, concomitant diseases of the cardiovascular system may worsen, tachycardia, extrasystole, atrial fibrillation, etc. may appear.

Treatment of cholelithiasis:

In case of an acute attack or exacerbation of cholelithiasis, it is necessary to hospitalize the patient in the surgical department, where the issue of indications for emergency surgery is first decided. In the absence of symptoms of peritonitis, measures are taken to relieve pain and eliminate inflammatory changes in the gallbladder and bile ducts. For this purpose, antispasmodics (papaverine, no-shpu, platifillin, baralgin) and analgesics are administered subcutaneously or intramuscularly: morphine and omnopon are contraindicated, because they cause spasm of the sphincter of Oddi. If a painful attack continues, a perinephric novocaine blockade or blockade of the round ligament of the liver is performed.

Under the influence of the treatment, hepatic colic usually resolves quickly (after a few hours) without any consequences. In a chronic relapsing form with periodically recurring severe attacks or exacerbations, surgical treatment of cholelithiasis should be recommended in a state of complete remission (after 4-5 months), which is the safest for the patient.

If within 2 days the patient’s condition does not improve, despite intensive treatment, or it worsens, surgery should be performed due to the risk of destructive (gangrenous, perforative) cholecystitis and the development of biliary peritonitis. In this case, it is necessary to take into account the patient’s age and the presence of concomitant diseases. In patients under 50 years of age without concomitant somatic pathology, the risk of surgery at the height of an attack is not high (mortality is a fraction of a percent).

In elderly and senile patients, radical surgery - cholecystectomy in combination with removal of stones from the bile ducts (choledocholithotomy) and drainage of the common bile duct is accompanied by a significantly greater operational risk (mortality is 5-10 times higher than in the “cold” period). Therefore, in the treatment of such patients, it is preferable to use recently developed laparoscopic manipulations and operations on the gallbladder: puncture and decompression of the gallbladder with evacuation of purulent contents, washing of its cavity and the introduction of antibiotics into it, microcholecystostomy, laparoscopic cholecystolithotomy.

Thanks to this, it is possible to stop an acute attack and, after appropriate preparation, carry out a radical operation in the most favorable period for the patient. For the same purpose, in case of choledocholithiasis, papillotomy is used - dissection of the papilla of Vater (major duodenal papilla) and removal of stones from the common bile duct using a special fibroduodenoscope. In some cases, palliative operations are possible - cholecystotomy and cholecystolithotomy, cholecystostomy.

For chronic painful forms of cholelithiasis, the basis of treatment is diet therapy: diet No. 5, exclusion of spices, smoked meats, animal fats from the diet, split meals (5-6 times a day) without overeating, mineral waters. For pain, heat (heating pad, warming compress) on the gallbladder area, antispasmodics (atropine drops, no-spa, papaverine, baralgin, etc.) are indicated.

Physiotherapeutic methods (UHF, diathermy, inductothermy), mud therapy and mineral baths, sanatorium treatment (Essentuki, Borjomi, Truskavets, Jermuk, etc.) are used only in the absence of signs of exacerbation of the disease. The prescription of choleretic drugs is undesirable, since the migration of stones caused by them can lead to blockage of the bile ducts and provoke an attack of hepatic colic and the development of other complications.

Methods of general and local dissolution of gallstones, in particular with the help of urso- and chenodeoxycholic acids, cause a decrease in the lithogenicity of bile and the dissolution of cholesterol stones; however, due to a number of conditions and many limitations, as well as the duration of therapy, the use of this method is limited.

Forecast:

The prognosis for uncomplicated cholelithiasis and timely surgical treatment is favorable. Among patients who have undergone cholecystectomy, about 12% suffer from the so-called postcholecystectomy syndrome. Against the background of cholelithiasis, it is possible to develop gallbladder cancer.